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HomeMy WebLinkAboutBSN Sports LLC; 2019-12-16; PKRC719Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS CONT. NO. PKRC719 This agreement is made on the / le"t/1 day of _,_~~---"'"".LLl..i,i:..=.~--· 20.fl, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and BSN Sports, LLC whose principal place of business is 1180 California Avenue, Suite A, Corona, CA 92881 (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: Kevin Granse (City Project Manager) 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. BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS CONT. NO. PKRC719 Page 1 of6 City Attorney Approved 1/25/2019 Tracking#: 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 t debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor s co tractor from participating in contract bidding. Signature: Print Name: 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. 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 BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS CONT. NO. PKRC719 Page 2 of 6 City Attorney Approved 1/25/2019 Tracking#: 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 within 30 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 90 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II II II BSN Sports, LLC (Name of Contractor) 1014517 (Contractor's license number) C-61 / D34, exp. date 5/31/2020 (license class. and exp. date) 1000004433 (DIR registration number) 6/30/2020 (DIR registration exp. date) BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS CONT. NO. PKRC719 Page 3 of6 1180 California Avenue, Suite A (street address) Corona, CA 92881 (city/state/zip) 760-729-0727 (telephone no.) (fax no.) pault@tomark.com (e-mail address) City Attorney Approved 1/25/2019 Tracking#: 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 CITY OF CARLSBAD, a municipal corporation of the State of California A/2EST: \J:imx~ Km~ (sign here) LEE DONOVAN ASST SECRETARY BARBARA ENGLESON ~yClerk (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 Chairman, President, or Vice-President Group B 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: BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS CONT. NO. PKRC719 Page 4 of 6 City Attorney Approved 1/25/2019 Tracking#: 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 Business Name and Address be Subcontracted -.. -l'\1/ A Total % Subcontracted: N/A BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS CONT. NO. PKRC719 Page 5 of 6 DIR Registration No. License No., %of Classification & Total Exoiration Date Contract City Attorney Approved 1/25/2019 EXHIBIT B SCOPE OF WORK Tracking#: BSN Sports, LLC will upgrade gymnasium basketball hoops at Calavera Hills and Stagecoach Community Centers. ITEM DESCRIPTION NO. 1 Calavera Hills Community Center Change six basketball hoop winches to wireless remote control • Install six total receivers on side courts and main court • Provide two remote transmitters • One receiver per basketball structure 2 Stagecoach Community Center Convert two basketball hoop winches to wireless remote control • Install two total receivers on main court • Provide two remote transmitters • Once receiver oer basketball structure TOTAL Agreement amount shall not exceed $6,778.20 BASKETBALL UPGRADES AT CALAVERA HILLS AND STAGECOACH COMMUNITY CENTERS PRICE $4,526.55 $2,251.65 $6,778.20 CONT. NO. PKRC719 Page 6 of 6 City Attorney Approved 1/25/2019 1 180-A California Avenue Corona, CA 92881 Tel: 1-800-959-1844 Fax: 1-S00-986-6275 Visit us at www.bsnsports.com Contact Your Rep Paul Truxaw Email:ptruxaw@bsnsports.com I Phone:1-800-959-1844 Sold to 2030232 CALAVERA COMM CTR Steve Herrera 2997 GLASGOW DR CARLSBAD CA 92010 Item Description Ship To 2030232 CALAVERA COMM CTR 2997 GLASGOW DR CARLSBAD CA 92010 USA SERVICE NOT AX-INSTALL-WIRELESS RECEIVERS Item # -SERVICE_NOTAX PORTER# XELEC12002210 SPORTSONIC II REC Item # -NSPHG PORTER# 12002100 SPORTSONIC II TRANSMI Item # -NSPHG Quote Requested By Name Steve Herrera Tel 760-602-4684 From Paul Truxaw 760-729-0727 pault@tomark.com steve.herrera@carlsbadca.gov LABOR: CHANGE SIX (6) EACH BASKETBALL STRUCTURE WINCHES TO BE CONTROLLED BY WIRELESS REMOTE CONTROL ONE (1) RECEIVER PER BASKETBALL STRUCTURE. NOTE: QUOTE IS A PREVAILING WAGE RATE. Subtotal: Other: Freight: Sales Tax: Quote Quote#: 21146347 Purchase Order#: Cart Name: Quote Date: 10/01/2019 Quote Valid-to: 11/01/2019 Payment Tenns: NT30 Ship Via: Ordered By: STEVE HERRERA Payer 1038216 CITY OF CARLSBAD 1635 FARADAY AVE CARLSBAD CA 92008--7314 USA Qty Unit Price 1 EA $ 2,200.00 SEA $ 290.00 2 EA $ 140.00 Order Total: Payment/Credit Applied: Order Total: Total $ 2,200.00 $ 1,740.00 $ 280.00 $4,220.00 $0.00 $150.00 $156.55 $4,526.55 $0.00 $4,526.55 BSN SPORTS Tenns and Conditions apply to all of your orders with us and our affihates. At any time, these terms and conditions can be found at www bsnsports.comllerms Check your order at www.bsnsports.com/?&Program1D=21146347&zip=9201 O 1180-A California Avenue Corona. CA 92881 Tel: 1-800-959-1844 Fax: 1-800-986-6275 Visit us at www.bsnsports.com Contact Your Rep Paul Truxaw Email:ptruxaw@bsnsports.com I Phone:1-800-959-1844 Sold to 1221907 STAGE COACH COM CTR Steve Herrera 3420 CAMINO DE LOS COCHES CARLSBAD CA 92009-8927 Item Description Ship To 1221907 STAGE COACH COM CTR 3420 CAMINO DE LOS COCHES CARLSBAD CA 92009-8927 USA SERVICE NOT AX-INSTALL-WIRELESS RECEIVERS Item # -SERVICE NOT AX PORTER# XELEC12002210 SPORTSONIC II REC Item # -NSPHG PORTER# 12002100 SPORTSONIC II TRANSMI Item # -NSPHG Quote Requested By Name Steve Herrera Tel 760-602-4684 From Paul Truxaw 760-729--0727 pault@tomark.com steve.herrera@carlsbadca.gov LABOR: CHANGE TWO (2) EACH BASKETBALL STRUCTURE WINCHES TO BE CONTROLLED BY WIRELESS REMOTE CONTROL. ONE (1) RECEIVER PER BASKETBALL STRUCTURE. NOTE: QUOTE IS A PREVAILING WAGE RATE. Subtotal: Other: Freight: Sales Tax: Quote Quote#: 21146569 Purchase Order#: Cart Name: Quote Date: 10/02/2019 Quote Valid-to: 11/02/2019 Payment Terms: NT30 Ship Via: Ordered By: STEVE HERRERA Payer 1038216 CITY OF CARLSBAD 1635 FARADAY AVE CARLSBAD CA 92008-7314 USA Qty Unit Price 1 EA $ 1,250.00 2EA $ 290.00 2EA $ 140.00 Order Total: Payment/Credit Applied: Order Total: Total $ 1,250.00 $ 580.00 $ 280.00 $2,110.00 $0.00 $75.00 $66.65 $2,251.65 $0.00 $2,251.65 BSN SPORTS Terms and Conditions apply to all of your orders with us and our affiliates. At any time, these terms and conditions can be found at www.bsnsports.com\terms Check your order at www.bsnsports.com/?&Program1D=21146569&zip=92009-8927 Page 1 of 1 ACORD• CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) '----' 12/04/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT A FFIRMATIVELY 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 PRO DUCER, 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 WAIV ED, 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 CONTACT NAME: Willis of Texas, Inc. m~>N~ c.t1, 1-877-945-7378 Ir~ Nol: 1-888-467-2378 c/o 26 Centuxy Blvd E-MAIL P.O. Box 305191 •nnoc <:<:, certificates@willis.com Nashville, TN 372305191 USA INSURER(S) AFFORDING COVERAGE NAJC# INSURER A : James River Insurance Company 12203 INSURED INSURER B: Travelers Property Casualty Company of Ame 25674 BSN Sports, LLC 14460 Varsity Brands Way INSURER C: Farmers Branch, TX 75234 INSURERO: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: W14078647 REVISION NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE l ,u~n I=•~ POLICY NUMBER IMM/DO/YYYY\ I fMM/DD/YYYY\ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -n CLAIMS-MADE 0 OCCUR uAMAv~ , v r<c:N , ~v PREMISES (Ea occurrence) s 100,000 A MED EXP (Any one person) $ --y 07/30/2019 07/30/2020 00067824-5 PERSONAL & ADV INJURY s 1,000,000 --GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 fl POLICY □ m~~ □ LDC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ( Ea accidenll -X ANY AUTO BODILY INJURY (Per person) $ B --OWNED ~ SCHEDULED y TJ-CAP-6E004847-TIL-19 07/30/2019 07/30/2020 BODILY INJURY (Per accident) $ --AUTOS ONLY --AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accidenll ---$ UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 1,000,000 A --X EXCESS LIAB CLAIMS-MADE 00063341-5 07/30/2019 07/30/2020 AGGREGATE s 1,000,000 OED I I RETENTION s $ WORKERS COMPENSATION XI ~~fruTE I I OTH- AND EMPLOYERS' LIABILITY ER Y/N B ANYPROPRIETOR/PARTNER/EXECUTIVE E] E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A TC2J-UB-6N324265-19 07/30/2019 07/30/2020 (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 iiitti'p"fio~ ~1;PERATIONS below E.L. DISEASE -POLICY LIMIT s 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 10/14/2019 WITH ID: Wl3367485. RE: Basketball Upgrades at Calavera Bills and Stagecoach Community Centers Cont. No. PKRC719 City Of Carlsbad is included as an Additional Insured as respects to General Liability and Auto Liability. CERT IFICATE 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. City Of Carlsbad AUTHORIZED REPRESENTATIVE Attn: Purchasing 1635 Faraday Ave ~4L¥-. &A)-Carlsbad, CA 92008 © 1988-2016 ACORD CORPORATION. All rights reserved. AC ORD 25 (2016/03) The AC ORD name and logo are registered marks of ACORD SR IO: 18896935 BATCH, 1478700 POLICY NUMBER: 00067824-5 COMMERCIAL GENERAL LIABILITY CG 20100704 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 Name Of Additional Insured Person(s) Or Oraanization(s): Location(s) Of Covered Operations Where required by written contract or written agreement. All operations of the named insureds. 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 2010 0704 © ISO Properties, Inc., 2004 Page 1 of 1 □ POLICY NUMBER: 00067824-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONDITIONAL NOTICE OF CANCELLATION TO PARTIES OTHER THAN THE FIRST NAMED INSURED (Limited to email Notification) This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS In the event we decide to cancel this Policy prior to this Policy's expiration date for reasons other than non-payment of premium: 1. If the first Named Insured is under an existing written contractual obligation to notify the other party if this Policy is cancelled; and 2. If the first Named Insured, either directly or through its broker or agent of record has provided the email address to notify such other party; we will provide notice of cancellation via email to such other party prior to this Policy's cancellation date. Proof of emailing the other party with notice of this Policy being cancelled is sufficient proof of notice. This endorsement does not apply when there are instructions to cancel the policy by a premium finance company, which is a cancellation by the insured. This endorsement does not affect, in any way, coverage under this Policy or the cancellation of this Policy or the effective date of cancellation. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5057US 01-17 Page 1 of 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. I. J. K. L. M. N. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT PERSONAL PROPERTY AIRBAGS NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS BLANKET WAIVER OF SUBROGATION UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in 8.5., Other Insurance, of SECTION IV -BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any cove.red "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO perm1ss1on, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II -COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II -COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph 8.7., Policy Period, Coverage Territory, of SECTION IV -BUSINESS AUTO CONDI- TIONS: (5) Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II -COVERED AUTOS LIABILITY COVERAGE. (v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II -COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c) This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 0215 Includes copyrighted material of Insurance Services Office, Inc. with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE -GLASS The following is added to Paragraph D., Deducti- ble, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION Ill -PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION Ill -PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV -BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV -BUSINESS AUTO CONDITIONS: The unintentional om1ss1on of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 0215 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: TJ-CAP-6E004847-TIL-19 ISSUE DATE: 08 -24 .J.8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY -NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY CANCELLATION: PERSON OR ORGANIZATION: SCHEDULE Number of Days Notice of Cancellation: _3_0 __ Any person or organization to whom you have agreed in a written contract that notice of cancellation of this policy will be given, but only if: 1. You send us a written request to provide such notice, including the name and address of such person or organization, after the first Named Insured receives notice from us of the cancellation of this policy; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this Endorsement. ADDRESS: The address for that person or organization included in such written request from you to us. PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 0311 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 ...... TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) POLICY NUMBER: (TC2J-UB-6N324265-19) NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX-CONDITIONS: Notice Of Cancellation To Designated Persons Or Organizations If we cancel this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organiza- tion before the cancellation is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation. SCHEDULE Name and Address of Designated Persons or Organizations: ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. DATE OF ISSUE: 08-24-18 ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Number of Days Notice 30 Page 1 of 3