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HomeMy WebLinkAboutCosco Fire Protection Inc; 2019-12-30; PWL20-940GSRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: DOC# 2020-0473814 11101 I 1101 IIi 1110 1110 11111111111111111111111111111 Aug 21, 2020 09:46 AM OFFICIAL RECORDS Ernest J. Dronenburg, Jr., SAN DIEGO COUNTY RECORDER FEES: $0.00 (SB2 Atkins: $0.00) PAGES: 1 City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 Space above this line for Recorder's use. PARCEL NO: 209-050-26-00 NOTICE OF COMPLETION Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on February 25, 2020. 6. The name of the contractor for such work or improvement is Cosco Fire Protection, Inc. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Contract No. PWL20-940GS, Fire Alarm Repair at the Safety Training Center. 8. The street address of said property is 5750 Orion Street, in the City of Carlsbad. CITY OF CARLSBAD Geoff Patnoe, Assistant City Manager VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on , 20 Qt., accepted the above described work as completed and ordered that a NoticeN6f Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on , 20, at Carlsbad, California. CITY OF CARLSBAD , arbara Engleson, City CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Cosco Fire Protection, Inc. has completed the contract work required for Contract No. PWL20-940GS - Fire Alarm Repair at the Safety Training Center. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE Fire Alarm Repair at the Safety Training Center $2,368.00 CERTIFICATION OF COMPLETION OF IMPROVEMENTS John hoff, Public Works Mena er Date CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk is hereby authorized to record the Notice of Completion and release the bonds in accordance with State Law and City Ordinances. The City of Carlsbad is hereby directed to commence maintaining the above described improvements. C ( Geoff Patnoe, Assistant City Manager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By: Assistant City Attorney DocuSign Envelope ID: 7C5EC935-E00A-48D3-A502-6CD3FF7BC486 4/6/2020 Project: PWL20-940GS, Fire Alarm Repairs at the Safety Training Center Change Order No. 1 CONTRACT CHANGE ORDER NO. 1 PROJECT: Fire Alarm Repairs at the Safety Training Center CONTRACT NO. ACCOUNT NO. CONTRACTOR: PWL20-940GS 0015320-7801 P.O. NO. P138285 ADDRESS: COSCO Fire Protection, Inc. 4990 Greencraig Lane San Diego, CA 92123 The Contractor is directed to make the following changes as described herein. Changes shall include all labor, materials, equipment, contract time extension, and all other goods and services required to implement this change. Payment stated on this change order includes all charges, direct or indirect, arising out of this additional work including charges for field overhead, extended home office overhead, delays, disruptions, cumulative impacts, loss of efficiency, extended equipment costs and overtime premium costs and is expressly agreed between the City and the Contractor to be the complete and final costs hereof. The requirements of the specifications, where pertinent and not in conflict with this change order, shall apply to these changes. Pursuant to the Standard Specifications for Public Works Construction, perform the following: Additional day of labor approved in contract was not required to complete the work. This change order reflects a deduction to the fees outlined in the project scope and Item 1: fees schedule, Exhibit A Total cost deduction .................................... : ................................. $1008.00 . . J TOTAL DECREASE TO CONTRACT COST .................................................... $1008.00 TIME FOR COMPLETION OF ALL WORK UNDER THIS CONTRACT SHALL BE INCREASED BY ZERO (0) WORKING DAYS AS A RESULT OF THIS CHANGE ORDER. APPROVED AS TO FORM: cW ~ APPROVED BY: d/(~ ~c._"_..,... / CONTRA0 0R 6 ;2't:'> ~ DEPARTMENT HEAD 3 -//-Zo?.£> (DATE) (DATE) PWL20-940GS Fire Alarm Repair at the Safety Training Center - 1 - City Attorney Approved 2/29/2016 CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT FIRE ALARM REPAIR AT THE SAFETY TRAINING CENTER This letter will serve as an agreement between Cosco Fire Protection, Inc., a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to repair fire alarm modules, and to service, inspect and test three (3) fire doors, per Exhibit “A” and “B” and City specifications, for a sum not to exceed three thousand three hundred seventy-six dollars ($3,376). This work is to be completed within fourteen (14) working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees, and volunteers 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 this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney’s fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers’ Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said 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. Insurance is 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. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4 California Labor Code) and the “Immigration Reform and Control Act of 1986” (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. __________ init __________ init 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. _______ init _______ init 7. 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. DocuSign Envelope ID: F29BC99F-5F12-4ADB-8D3A-B5AB5C93DE00 PWL20-940GS Fire Alarm Repair at the Safety Training Center - 2 - City Attorney Approved 2/29/2016 8. 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 the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of 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 the execution of the work covered by this Letter of Agreement. 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. 9. City Contact: Jason Kennedy, 760-931-2236 Contractor Contact: James Grimes, 858-444-2048 CONTRACTOR COSCO FIRE PROTECTION INC., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California 4990 Greencraig Lane San Diego, CA 92123 P: 858-444-2048 F: 858-444-2056 jgrimes@coscofire.com By: By: (sign here) Alex Hernandez / Vice President Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: (sign here) Roger Jump / Secretary & Treasurer (print name/title) (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. 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: F29BC99F-5F12-4ADB-8D3A-B5AB5C93DE00 PWL20-940GS Fire Alarm Repair at the Safety Training Center -3 -City Attorney Approved 2/29/2016 EXHIBIT A FIRE ALARM REPAIR AT THE SAFETY TRAINING CENTER SCOPE OF WORK AND FEES Item No. Description Qty Unit of Measure Unit Price Extended Total 1 Provide tools, labor and materials to correct installation discrepancies with fire alarm modules above the suspended ceiling in the administrative/range building. 1 LS $2,368 $2,368 Inspect, service, and test three (3) Firefly III Plus automated fire doors located on the first and second floors of the administrative/range building. 2 Labor if additional day is required to complete necessary repairs and inspections. 8 HR $126 $1,008 TOTAL $3,376 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: F29BC99F-5F12-4ADB-8D3A-B5AB5C93DE00 Page 1 of 2 Initials Safety Training Center October 2, 2019 5750 Orion Street. Carlsbad, CA 92010 Attention: Jason Kennedy Scope of Work: 1). Provide tools, labor and materials to correct fire alarm modules that were not installed are properly during initial construction of facility. During recent inspection, multiple units were found to be hanging from electrical gang boxes above the suspended ceiling grid. 2). Service, inspect and test three (3) Firefly III Plus fire doors. 3). All work to be performed during regular (7AM – 4PM) hours Monday – Friday, except holidays. A change order will be required if additional materials and labor are required. Exclusions: 1. Working in areas with hazardous material, as defined by Cal/OSHA. 2. Cleaning, patching or paint repairs. 3. Fire watch. 4. Plans, permit, and inspection fees. Base Bid: $2,368.00 If another day is needed to complete the repairs add: $1,008.00 This quote is valid for 30 days. Please sign acceptance line, print name, title, date below and initial Cosco Fire Protection’s Terms and Conditions attached to authorize work order. Please do not hesitate to call me at 858-444-2000 should you have any questions regarding this or other projects Sincerely, James Grimes James Grimes Alarm & Detection Division Accepted by: Print Name: Title: Date: FIRE ALARM REPAIR PROPOSAL 4990 Greencraig Lane San Diego, CA 92123 Tel: 858.444.2000 Fax: 858.444.2056 jgrimes@coscofire.com www.coscofire.com EXHIBIT B PWL20-940GSDocuSign Envelope ID: F29BC99F-5F12-4ADB-8D3A-B5AB5C93DE00 ···••··· COSCO •••••••• • • • •• • • • ···••··· Fire Protection ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YVYY) ~ 01/04/2019 THIS CERTIFICATE JS 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 IHSURER(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 endon;ement(s) . PRODUCER ... uA,K~• NAME· Marsh USA Inc. ~ --- l ~,Nol: 125 Ottawa Avenue NW ..Ext&_ Suite 400 L Grand Rapids, Mf 49503 ADDRl'SS; Attn: grandrapids.certfflQuest@msrsh.com -INSUR!!RlSl AFFORDING COVERAGE NAIC# CN1081591S9-MX-GAW-19-20 ,__ SDiego INSUReR A : HDI Global lnsuranoe Comoanv 41343 INSURED INSURER B : ACE Amerit:al lnSurance Cool"""• 22667 Coste Fire ProlBction, Inc. 4990 Graencraig Lane INSURER C : NIA NIA San Diego, CA 92123 INSURERO : lNSUREftE: INSURERF; COVERAGES CERTIFICATE NUMBER; CHl-009209689--01 REVISION NUMBER· 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWJTHSTANDING 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. 1~,s:1 ~DLlsua POUCYEFF POLJCYEl(P -----TYPE OF INSURANCE POLICY NUMBER . LIMITS A W'-•~=u.,.,n X GLD1447202 01/01/2019 01/0112020 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ~ OCCUR O~OREN,cv 1,000,000 P!3EMISES (E,i !!!!!!![Amtel _Jj__ MEO EXP (""" one pa"°") s 10,000 PERSONAL & ADV INJURY $ 2,000,000 q -~~~""",~es "" GENERAL AGGREGATE $ 2,000,000 POLICY 0 r;rar O LOC I 2,000,000 I P~-COI.IPIOP AGG $ OTHER: $ a AUTOMOBILE LIABI LITV I 11 SAH2527361 8 01/0112019 01/0112020 ~~~J.~if '"'"LE LIMIT 1$ 1,000,000 -X ANY AUTO BODILY INJURY (Per pem>n) $ ,--OWNED ~~~ ·- AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED NON,OWNED r:.~:~di;,;;RAMAGE $ -AUTOS ONLY AUTOS ONLY SIR: $ 250,000 H UMBRELLA LIAB H OCCUR 1 I EACH OCCURRENCE s EXCESS LIAS CLAIMS-MADE I AGGREGATE $ OE0 I I RETENTION s 5 8 I WORKERS COMPENSATION X WLRC65439372 I U 111/l/llll!I 01/U1tL\/iU X :ffrnrE I I ~~ AND EMPLOYERS' LIABILITY YIN WA Stop Gap 1,000,000 ANYPROPRIETOR/PARTNERIEXE.CUTIVE 0 e.L. E:ACH ACCIDENT $ OFFICER/MEMBER EXCLUDE ll? NIA (Mandatory In NH) E.L. DISEASE · EA Et/.PLOYEE $ 1.000,000 N yes, ~eecdbe under E.L. DISEASE • POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS~ $ I j I I I I DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101. Additional Remarks Schadule. may be -clled If more spice is r■qulrtd) Re: All Operallons Ctty of cartsba1 is/are includtd as adoltional insured where required by written conlrad wi1h respect to General llabiily. This Insurance is prima,y and 110n-co111nl>utory OWi! any exJstiog insurance and fmiled '> liability arising ool of !he operations of Ille named insured subject lo policy lerms all<I conditions. Waiver of subrogation is applicable vmere requi111d by written conltact ano subjecl 10 poITcy tenns and conditions. CERTIFICATE HOLDER CANCELLATION City of Ca~sbad/CMWD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE c/o EXIGIS Insurance Compliance Sel'lices THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 4668-ECM#35050 ACCORDANCE Wl'ht TltE POLICY PROVISIONS. New Yorlc, NY 10163--4468 AUTHORIZED REPRESENTATIVE of Ma,.,,h USA Inc. I Scott Pen ~-t::6, ~ ~ © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ENDORSEMENT Policy Number GU>144720 2 HDI Global Insurance Company Ncll'led Insured MX HOLDINGS US, INC. Agent Name MARSH USA INC. or MI (GRAP) Agent No; P02082030 This Endo,-rnent Changes The Palloy. PlesStl Fwd h Catefu/[y, NANED INSURED-ENDORSEMENT THE NAMED INSURED IS AMENDED TO READ AS FOLLOWS: MX HOLDINGS US, INC. MINIMAX FIRE SOLUTIONS, INC. COSCO 'FIRE PROTECTION, INC. FLAMEX INC, CFP, INC. MINIMAX CHINA FIRE PROTECTION SYSTEM CO., LIMITED FIRETROL PROTECTION SYSiEMS, INC. CFP FIRE PROTE:CTION, INC. Bfective Oale o 1 / o 1/2 b 19 12:01 A.M., Standard Time PIEDMONT SOUND & SIGNAL, INC. . FIRETROL PROTECTION SYSTEMS, INC, DBA ARIZONA ~IRe AND SECURITY KLISTER LLC ALL OTHER T~MS AND CONDITIONS REMAIN TH~ SAME. MAN-GL {01 / 02) ENDORSEMENT Poley Number GlD1447202 HDI Global Insurance Company Ncmed Insured MX HOLDINGS US, INC . Agent Name MARSH USA INC. OF MI (GRAP) AgentNn P02082030 This Endor~TJErl Changes The PrJNcy. Please Read Jt Ca,efu/ly. Effective D~e: 0 1-01-19 12:01 A.M., Standard Time BLANKET ADDITIONAL INSURED • OWNERS, LESSEES OR CONTRACTORS· SCHED~LED PERSON OR ORGANIZATION CG 201010 01 VERSlON AS PER THE WRITTEN CONTRACT INCLUDING PROJECT /JOB NUMBER (IF NO ENTRY APPEARS ABOVE, INFORMATION REQUIRED TO COMPLETE THIS ENDORSEME:NT WILL BE SHOWN IN THE DECLARATIONS AS APPLICABLE TO THIS ENDORSEMENT.) . A. SECTION II -WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN INSURED THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF YOUR ONGOING OPERATIONS PERFORMED FOR THAT INSURED. B. WITH RESPECT TO THE INSURANCE AFFORDED TO TH ESE ADDITIONAL INSUREDS, THE FOLLOWING EXCLUSION IS ADDED: 1Hr~~~~8E DOES NOT APPLY TO "BODILY INJURY'' OR "PROPERTY DAMAGE" OCCURRING AFTER: (1) ALL WORK, INCLUDING MATERIALS, PARTS OR EQUIPMENT FURNISHED IN CONNE.CTION WITH SUCH \i\ORK, ON THE PROJECT (OTHER THAN SERVICE, MAINTENA.NCE OR REPAIRS) TO BE PERFORMED BY OR ON BEHALF OF THE ADDITIONAL INSURED(S) AT THE SITE 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 E!Y ANY PERSON OR ORGANIZATION OTHER THAN ANOTHER CONTRACTOR OR SUBCONTRACTOR ENGAGED IN PERFORMING OPERATIONS F'OR A PRINCIPAL AS A PART OF THE SAME PROJECT. MAN-OL (01/02) ENDORSEMENT Policy Number GI.D1447202 HDI Global Insurance Company Named Insured MX HOLD I NGS US, INC . Effectivl3 Date: 0 1 -0 1-19 12:01 A.M., Standard Time Agent Nane Agent No. MARSH US-A INC . OF MI (GRAP) P02082030 This Endor~11Ed ChMgesThe Policy. Please Rt,ad It Ca,efuly. BLANKET ADDITIONAL INSURED • OWNERSs LESSEES, OR CONTRACTORS· COMPLETED OPERATIONS CG 203710 01 AS PER THE \ARITTEN CONTRACT INCLUDING PROJECT/JOB NUMBER (IF NO ENTRY APPEARS ABOVE, INFORMATION REQUIRED TO COMPLETE THIS ENDORSEMENT WILL BE SHOWN IN THE DECLARATIONS AS APPLICABLE TO THIS ENDORSEMENT.) SECTION II -WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN INSURED THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF "YOUR OORK" AT THE LOCATION DESIGNATED AND DESCRIBED IN THE SCHEDULE OF THIS ENDORSEMENT PERFORMED FDR THAT INSURED AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERATIONS HAZ-ARO•. MAN•G.. (01/02) Workers' Compensation and Employers' Liability Policy Named lnwred Endorgement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE PoJlcy Number IRVINE CA 92618 II Svmbo1WLR Number: C65439372 Polfcy Period Effeclive Dale of Endorsement 01-01-2019 TO 01-01-2020 01-01-2019 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY lnnrt the Dowcv m.mbqr. The remainder of the iriformilion i5 to be l:QITIDle!ed only v.hen tlis encl1m;emeot ~ i~sued subie11uent to the preparation cf the p~icy, WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer I~ in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an emplCY)ler in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.SA.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.SA 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Representative WC 00 03 13 (11/05) Copyright 1982-83, National Council on Compensation 'C w arkers ompensal1on an mp ayers I 11ty o icy dE 'L.abT P r Namecl l11su~ Endornmem Number MX HOLDINGS US, INC. 1 53 TECHNOLOGY ORNE Policy Number IAVINE CA 92618 Symbol:WL~ Number: (65439372 -Polley Period Effective Date of Endorsement 01 -01-2019 TQ 01-01 -2020 01-01-2019 lssued By (Name ot Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the POiicy number. The remainder .at the information is to be-c:cmpleted only When this en~orsementis issued s~bsequentto the preparation cf the ·polic~. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only _to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2 . Operations: ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 Authorized Representative we eo 03 75 (05/18) Warker5' Compensation and Employers' Liability Policy Named Insured Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE Polley Number IRVINE CA 92618 GI S:,,nbol. WLR Number: C65439372 Policy Per:lod Effeclive Dale of Endorsemenl 01-01-2019 TO 01-01-2020 01-01-2019 Issued By (Name of lnsuranee Company) ACE AMERICAN INSURANCE COMPANY lnseit ttte pottc:i, n~ ber. The rem·aincter of the iritormaticn i5 to be completed only Ylhen this endorsement is"is!ii1Jed subsli!Quent to the preparation at the p01icy. TEXAS WAIVER OF OUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Tex:as is shown in item 3.A. of the Information Page: 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, but this waiver appliE!s only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the schedule. 1. Schedule Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium: The premium charge for this engorsement shall be 2.0 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: $0 Authorized ft.epresentative WC 42 03 04B (06114) © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Re-served. Workers' ComptnnUoo and lmphlyers' liabiHty Policy Named Inrured 'Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE PolicyNurttbcr IRVINE CA 92818 Svmhol:Wl.R Number: C65439372 Policy Pl'.f'iod Eifcc;tive Dile of'Endorsement 01-01-2019 TO 01-01-2020 01-01-2019 Issued By (Name ofinsunme Companyj ACE AMERICAN INSURANCE COMPANY Int ert lht ooliCY !IIJnlbcr. The remainder of the illfcrrnlllim a to be colllJ)leted oalv v-.he:n lhi1 enda-ument it inmrl sub aequw to the or£1laration of the llolicy. UTAH W AJVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page. 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 perfonn work llllder a written contract: that requires you to obtain this agreement from u s.) This agreement Slall not operate directly or indirectly to benefit anyone not named in the schedule. our waiver of rights does not rdease your employee~• rights against third parties and does not release our authority as trustee of claims against third parties. Schedule ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT 0.F RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. c~-- Authorized A~ WC 43 03 05 (10/00)Ptd. in U.SA.