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HomeMy WebLinkAboutAlliance Environmental Group LLC; 2019-12-17; PWM20-937GSPWM20-937GS Fire Station 2 Asbestos Abatement Page 1 of 6 City Attorney Approved 1/25/2019 CITY OF CARLSBAD RATIFICATION OF MINOR PUBLIC WORKS CONTRACT FIRE STATION NO. 2 ASBESTOS ABATEMENT This agreement is made on the ______________ day of _________________________, 2019, but effective October 23, 2019, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Alliance Environmental Group, LLC., a limited liability company, whose principal place of business is 990 W. 10th Street, Azusa, CA 91702 (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor’s proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by Brian Bacardi, Public Works Superintendent. WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. DocuSign Envelope ID: ECCAB505-630E-45E3-BF5E-1F8B0ECE98D6 17th December PWM20-937GS Fire Station 2 Asbestos Abatement Page 2 of 6 City Attorney Approved 1/25/2019 FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: ____Jeff McLean_____________________ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers’ Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than……..$1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ….…$1,000,000 Property damage insurance in an amount of not less than……..$1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for “any auto” and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY. Workers’ Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. DocuSign Envelope ID: ECCAB505-630E-45E3-BF5E-1F8B0ECE98D6 PWM20-937GS Fire Station 2 Asbestos Abatement Page 3 of 6 City Attorney Approved 1/25/2019 INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys’ fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start work October 23, 2019. Completion: Contractor agrees to complete work by November 11, 2019. CONTRACTOR’S INFORMATION. Alliance Environmental Group, LLC. 990 W. 10th Street (name of Contractor) 716538 (street address) Azusa, CA 91702 (Contractor’s license number) B and C22 exp. 05/31/2020 (city/state/zip) 626-633-3500 (license class. and exp. date) 1000058821 (telephone no.) 626-633-3599 (DIR registration number) 06/30/2022 (fax no.) andrewgrabhorn@alliance-enviro.com licensing@alliance-enviro.com (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// DocuSign Envelope ID: ECCAB505-630E-45E3-BF5E-1F8B0ECE98D6 PWM20-937GS Fire Station 2 Asbestos Abatement Page 4 of 6 City Attorney Approved 1/25/2019 AUTHORITY. The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR: Alliance Environmental Group, LLC., a limited liability company CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Jeff McLean / CEO- Managing Partner Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: (sign here) Joseph McLean / Managing Partner (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: _____________________________ Deputy City Attorney DocuSign Envelope ID: ECCAB505-630E-45E3-BF5E-1F8B0ECE98D6 PWM20-937GS Fire Station 2 Asbestos Abatement Page 5 of 6 City Attorney Approved 1/25/2019 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ DocuSign Envelope ID: ECCAB505-630E-45E3-BF5E-1F8B0ECE98D6 none none none none None noneNonenone none none 0 PWM20-937GS Fire Station 2 Asbestos Abatement Page 6 of 6 City Attorney Approved 1/25/2019 EXHIBIT B FIRE STATION NO. 2 ASBESTOS ABATEMENT SCOPE OF WORK AND FEE Contractor provided all material, tools and labor to remove the flooring and all asbestos containing material adhesive securing the flooring to the underlying concrete slab at Fire Station No. 2 located at 1906 Arenal Road, Carlsbad, CA 92009. All work shall be performed in accordance with all Federal, State and Local laws. The scope of work consisted of: - Isolating the work areas by constructing a containment barrier. - Setting up a decontamination system adjacent to the work area. - Running negative air filtration during the abatement and monitoring the air in the work areas. - Removing and disposing of carpeting and asbestos containing materials beneath the flooring. - Removing and disposing of vinyl flooring and asbestos containing materials beneath kitchen flooring. - Upon successful clearance testing from a third party, removing containment and equipment. DESCRIPTION PRICE Asbestos abatement of the living area of Fire Station No. 2 $19,750 TOTAL* $19,750 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: ECCAB505-630E-45E3-BF5E-1F8B0ECE98D6 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME:PHONE(A/C, No, Ext):FAX(A/C, No): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR TYPE OF INSURANCE ADDLINSD SUBRWVD POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC OTHER: EACH OCCURRENCEDAMAGE TO RENTEDPREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ $ $ AUTOMOBILE LIABILITY ANY AUTO OWNEDAUTOS ONLYHIREDAUTOS ONLY SCHEDULEDAUTOSNON-OWNEDAUTOS ONLY COMBINED SINGLE LIMIT(Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE(Per accident) $ $ $ $ $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE $ $ $ WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?(Mandatory in NH) If yes, describe underDESCRIPTION OF OPERATIONS below N / A PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03)©1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD LOCKTON COMPANIES3657 BRIARPARK DRIVE, SUITE 700Houston TX 77042 Alliance Environmental Group, LLC990 West Tenth StreetAzusa CA 91702 1/29/2020 1444909 X X Comp & Coll 1,000,000 XXXXXXX XXXXXXX XXXXXXX Medical Pay 5,000 XXXXXXX XXXXXXX X X 1,000,000 300,000 50,000 1,000,000 2,000,000 2,000,000 Contractors Pollution Per Occurrence: $1,000,000Aggregate: $2,000,000 N X 1,000,000 1,000,000 1,000,000 Starr Indemnity & Liability Company 38318 Starr Surplus Lines Insurance Company 13604 B SISIPCA08264419 6/10/2019 6/10/2020 A 1000065722191 6/10/2019 6/10/2020 A 1000065722191 6/10/2019 6/10/2020 B 100 0002615 03 1/29/2019 1/29/2020 NOT APPLICABLE See Attachments City of Carlsbad/CMWDc/o EXIGIS Insurance Compliance ServicesP.O. Box 4668 - ECM #35050New York NY 10163-4668 16335159 16335159 10/1/2019 Additional insured in favor of The City of Carlsbad on all policies (except Workers' Compensation/El) where and to the extent required by written contract. X Y Y Y Y Y Y Y Professional Liability Policy No.: 1000065722191 Policy Term: 6/10/2019 - 6/10/2020 Insurer: Starr Surplus Lines Insurance Company Limits: $1,000,000 Each Claim $1,000,000 Aggregate Attachment Code : D544488 Master ID: 1444909, Certificate ID: 16335159 Chicago, IL 1-646-227-6300 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: 1000065722191 Effective Date: 6/10/2019 at 12:01 A.M. Named Insured: Alliance Environmental Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage Form Products/Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE Where Required By Written Contract A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of “your work” for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to “bodily injury” or “property damage” arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured’s shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured’s because of payments we make for injury or damage arising out of “your work” done under a written contract with the additional insured. 3. The term insured is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS LINES INSURANCE COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Counsel SL 023 (06/11)Page 1 of 1 Copyright © C. V. Starr & Company and Starr Surplus Lines Insurance Company. All rights reserved.Includes copyrighted material of ISO Properties, Inc., used with its permission. Attachment Code : D543064 Master ID: 1444909, Certificate ID: 16335159 Name Of Additional Insured Person(s) Or Organization(s):Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 1000065722191 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Attachment Code : D543996 Master ID: 1444909, Certificate ID: 16335159 Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 1000065722191 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Attachment Code : D543997 Master ID: 1444909, Certificate ID: 16335159 Dallas, TX 1-866-519-2522 Additional Insured – Where Required Under Written Contract or Written Agreement Endorsement Policy Number:SISIPCA08264419 Effective Date: 6/10/2019 at 12:01 A.M. Named Insured:Alliance Environmental Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the declarations page. Please read the endorsement and respective policy(ies) carefully. Business Auto Coverage Form THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is hereby agreed that SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, is amended to include the following: d. Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered “auto”. However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said written contract or written agreement. All other terms and conditions of this Policy remain unchanged. Steve Blakey, President and Nehemiah E. Ginsburg, General Counsel Chief Executive Officer SICA 1016 (04/14)Page 1 of 1 Copyright © Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Attachment Code : D543060 Master ID: 1444909, Certificate ID: 16335159 POLICY NUMBER: SISIPCA08264419 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured:Alliance Environmental Holdings, LLC Endorsement Effective Date:6/10/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): Blanket where required by a written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Attachment Code : D544287 Master ID: 1444909, Certificate ID: 16335159 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04-84) agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule not enforce our right against the person or organization named in the Schedule. (This agreement applies Any person or organization to whom you become obligated to waive your rights of recovery against, under We have the right to recover our payments from anyone liable for an injury covered by this policy. We will any contract or agreement you enter into prior to the occurrence of loss. only to the extent that you perform work under a written contract that requires you to obtain this WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Endorsement Effective: 1/29/2019 Policy No.: 100 0002615 03 Endorsement No.: Insured:Premium: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Alliance Environmental Holdings, LLC Insurance Company:Countersigned by: WC 00 03 13 (Ed. 04-84)Page 1 of 1 Attachment Code : D544681 Master ID: 1444909, Certificate ID: 16335159 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be of the California workers' compensation premium2.0% otherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contract Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Endorsement Effective: 1/29/2019 Policy No.:100 0002615 03 Endorsement No.: Insured:Premium: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Alliance Environmental Holdings, LLC Insurance Company:Countersigned by: WC 04 03 06 (Ed. 04-84)Page 1 of 1 Attachment Code : D544681 Master ID: 1444909, Certificate ID: 16335159