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HomeMy WebLinkAboutGeary Floors Inc; 2020-10-05; PWM21-1268FACPWM21-1268FAC Wood Floor Refinishing Page 1 of 6 City Attorney Approved 1/25/2019 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT WOOD FLOOR REFINISHING This agreement is made on the ______________ day of _________________________, 2020, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Geary Floors, Inc., a California corporation whose principal place of business is 349 South Marshall Ave., El Cajon, CA 92020 (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: Barney Dresman (City Project Manager). PAYMENT. The City shall withhold retention as required by Public Contract Code Section 9203. 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: 126BEF8E-623E-4AD3-97CA-967EC602BDCD 5th October PWM21-1268FAC Wood Floor Refinishing 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: _____Sean Geary____________________ 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. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. DocuSign Envelope ID: 126BEF8E-623E-4AD3-97CA-967EC602BDCD PWM21-1268FAC Wood Floor Refinishing 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 within eighty (80) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within forty (40) working days after commencing work. CONTRACTOR’S INFORMATION. Geary Floors, Inc. 349 S. Marshall Ave. (name of Contractor) 592705 (street address) El Cajon, CA 92020 (Contractor’s license number) C15 - 8/31/2022 (city/state/zip) 619-596-1537 (license class. and exp. date) 1000008149 (telephone no.) N/A (DIR registration number) 6/30/2022 (fax no.) sean@gearyfloors.com (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// /// DocuSign Envelope ID: 126BEF8E-623E-4AD3-97CA-967EC602BDCD PWM21-1268FAC Wood Floor Refinishing 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 GEARY FLOORS, INC., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Sean Francis Geary / President & CFO Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: (sign here) (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: _____________________________ Assistant City Attorney DocuSign Envelope ID: 126BEF8E-623E-4AD3-97CA-967EC602BDCD PWM21-1268FAC Wood Floor Refinishing 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 None Total % Subcontracted: zero The Contractor must perform no less than fifty percent (50%) of the work with its own forces. DocuSign Envelope ID: 126BEF8E-623E-4AD3-97CA-967EC602BDCD PWM21-1268FAC Wood Floor Refinishing Page 6 of 6 City Attorney Approved 1/25/2019 EXHIBIT B Wood Floor Refinishing at Four City Facilities •Contractor will cordon work area with caution tape for the duration of the project. •All objects from the room will be removed from the work area by the Contractor prior to work beginning and all air vents will be covered. The Contractor will place all objects removed in their original location once the floor finish is complete. •All rubber base will be taped before sanding. •All wood base will be removed prior to sanding and replaced when finish work is complete. •Abrade wood floors at all locations with 120 grit diamond discs. •Remove all sanding residue, vacuum and clean post-sanded surfaces. Hand sanders will be used to reach all edge and corner portions of the floor. All walls, doors, frames and windows will be vacuumed and cleaned after the abrade or sanding process. All tape and taped-off protection barriers and screens will be removed upon completion of work. •Apply two (2) coats of Advantage Defense (equal or equivalent) floor finish, allowing sufficient dry time between coats, at three basketball courts. •Apply two (2) coats of Bona Traffic (equal or equivalent) floor finish, allowing sufficient dry time between coats, on three dance room floors. •The Contractor will apply all finishes according to the manufacture’s recommendations and the Contractor will clearly communicate the required drying time to the Contract Administrator. JOB QUOTATION Location Address Project type Approx. Square feet Price Calavera Hills Community Center 2997 Glasgow Dr. Basketball Court 10,000 $4,675 Dance/activity room 1630 $2,050 Stagecoach Community Center 3420 Camino De Los Coaches Basketball Court 10,000 $4,675 Dance/activity room 1630 $2,050 Pine Community Center 3209 Harding St. Basketball Court 8100 $3,120 Senior Center 799 Pine Ave. Dance Room 1080 $1,025 TOTAL* $17,595 *Includes taxes, fees, expenses and all other costs DocuSign Envelope ID: 126BEF8E-623E-4AD3-97CA-967EC602BDCD ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/21/2020 License # 0C32169 (619) 937-0164 (619) 937-0168 44393 Geary Floors, Inc. 349 South Marshall Avenue El Cajon, CA 92020 24066 12177 A 1,000,000 X BKW56483318 5/1/2020 5/1/2021 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000B BAA56483318 5/1/2020 5/1/2021 2,000,000B ESA56483318 5/1/2020 5/1/2021 2,000,000 C X WCV5501938-02 1/1/2020 1/1/2021 1,000,000 1,000,000 1,000,000 RE: OPERATIONS OF THE NAMED INSURED AS CERTIFICATE HOLDERS INTEREST MAY APPEAR SUBJECT TO POLICY TERMS, CONDITIONS, AND EXCLUSIONS. CITY OF CARLSBAD/CMWD IS INCLUDED AS ADDITIONAL INSURED PER FORMS CG2010 0413 AND CG2037 0413 ATTACHED. WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER AND ADDITIONAL INSUREDS APPLIES TO WORKERS COMPENSATION POLICY.(cp) CITY OF CARLSBAD/CMWD C/O EXIGIS INSURANCE COMPLIANCE SERVICES P.O. BOX 947 MURRIETA, CA 92564 GEARFLO-01 CERTT2 Rancho Mesa Insurance Services, Inc. 250 Riverview Parkway Santee, CA 92071 West American Insurance Co American Fire And Casualty Company Comp West Insurance 2 X X X X X X X X X 62214ofBLANKET AS REQUIRED BY WRITTEN CONTRACT, AGREEMENT, OR PERMIT Location(s) Of Covered Operations POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGEPART CG 20 10 04 13 Insurance Services Office, Inc., 2012 Page 1 of 2 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): 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 in- jury", "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 operatons 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 permit- ted by law; and 2.If coverage provided to the additional in- sured is required by a contract or agree- ment, 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 addi- tional exclusions apply: This insurance does not apply to "bodily in- jury" or" property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed 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 or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. BKW56483318 63214of56483318001829280CG 20 10 04 13 66214ofBLANKET AS REQUIRED BY WRITTEN CONTRACT, AGREEMENT, OR PERMIT Work described in writing in the contract, agreement or permit Location(s) at which You performed work described in written contract, agreement or permit." POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGEPART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGEPART CG 20 37 04 13 Insurance Services Office, Inc., 2012 Page 1 of 1 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations 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 in- jury" or "property damage" caused, in whole or in part, by "your work" at the location des- ignated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-com- pleted operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permit- ted by law; and 2.If coverage provided to the additional in- sured is required by a contract or agree- ment, 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 ap- plicable Limits of Insurance shown in the Dec- larations. BKW56483318 107214of56483318001829280AAIS CL 0100 03 99 Page 1 of 1 COMMON POLICY CONDITIONS CL 0100 03 99 Copyright, American Association of Insurance Services, Inc.,1998 1. Assignment --This policy may not be as- signed without "our" written consent. 2. Cancellation --"You" may cancel this policy by returning the policy to "us" or by giving "us" written notice and stating at what future date coverage is to stop. "We" may cancel this policy, or one or more of its parts, by written notice sent to "you" at "your" last mailing address known to "us". If notice of cancellation is mailed, proof of mail- ing will be sufficient proof of notice. If "we" cancel this policy for nonpayment of premium, "we" will give "you" notice at least ten days before the cancellation is effective. If "we" cancel this policy for any other reason, "we" will give "you" notice at least 30 days in advance of cancellation. The notice will state the time that the cancellation is to take effect. "Your" return premium, if any, will be calcu- lated according to "our" rules. It will be re- funded to "you" with the cancellation notice or within a reasonable time. Payment or tender of the unearned premium is not a con- dition of cancellation. 3. Change, Modification, or Waiver of Policy Terms - -A waiver or change of the "terms" of this policy must be issued by "us" in writ- ing to be valid. 4. Inspections --"We" have the right, but are not obligated, to inspect "your" property and operations at any time. This inspection may be made by "us" or may be made on "our" behalf. An inspection or its resulting advice or report does not warrant that "your" property or operations are safe, healthful, or in compli- ance with laws, rules, or regulations. Inspec- tions or reports are for "our" benefit only. 5. Examination of Books and Records --"We" may examine and audit "your" books and records that relate to this policy during the policy period and within three years after the policy has expired. Policy Number: BKW56483318 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT – CALIFORNIA Schedule Person or Organization Job Description WC 99 03 13 C(Ed. 7-09) 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.) Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned by 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 $ Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. 500 01/01/20 WCV5501938-02 Geary Floors, Inc. CompWest Insurance