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HomeMy WebLinkAboutGlenn A. Rick Engineering Development and Co; 2018-11-28; PSA19-578CAPSA19-578CA City Attorney Approved Version 7/19/17 1 PROJECT TASK DESCRIPTION AND FEE ALLOTMENT NO. 1 PROJECT NO. 6619 This first Project Task Description and Fee Allotment, is entered into on _________________________________________, pursuant to an Agreement between Glenn A. Rick Engineering & Development Co., a California corporation, ("Contractor") and the City of Carlsbad, ("City") dated November 28, 2018, (the “Agreement”), the terms of which are incorporated herein by this reference. 1. CONTRACTOR'S OBLIGATIONS Contractor shall provide civil engineering services in accordance with the City of Carlsbad Engineering Standards, 2016 Edition, the Standard Specifications for Public Works Construction, 2018 Edition and the supplements thereto as published by the “Green Book” Committee of Public Works Standards and the proposal dated July 16, 2019, (“proposal”), attached as Appendix "A" for the Design of the Buena Vista Creek Concrete Channel Maintenance Project, (the “Project"). The Project services shall include providing a drainage analysis of Buena Vista Creek and creating construction bidding documents for the maintenance of the concrete drainage channel section defined by South Vista Way and El Camino Real Bridges. 2.PROGRESS AND COMPLETION Contractor's receipt of this Project Task Description and Fee Allotment, signed by the City Manager or Director and a Purchase Order from the City’s Purchasing Department, constitutes notification to proceed to the Contractor. Contractor shall begin work within Five (5) working days after receiving this fully executed document and a City Purchase Order. Contractor shall complete the work within five hundred twenty (520) working days thereafter. Working days are defined in section 6-7.2 “Working Day” of the Standard Specifications for Public Works Construction (Green Book). Extensions of time for this Task Description may be granted if requested and agreed to in writing by the Director or City Manager. In no event shall Contractor work beyond the term or authorized compensation of the Master Agreement, as amended by this Project Task Description and Fee Allotment. 3.FEES TO BE PAID TO THE CONTRACTOR Contractor’s compensation for the Project is shown in Table 1, "Fee Allotment", herein. Fees shall be paid on the basis of time and materials for each task group shown in Table 1. Progress payments shall be based on work days. Appendix "A", attached, prepared by Contractor and reviewed by City, shows the parties’ intent as to the elements, scope and extent of the task groups. Contractor acknowledges that performance of any and all tasks by the Contractor constitutes acknowledgment by Contractor that such tasks are those defined in Appendix "A". Additional task groups, not shown in Table 1 or Appendix “A”, will be performed by the Contractor only upon authorization of the City through the mechanism of a separate Project Task Description and Fee Allotment and Purchase Order. In the event that City directs Contractor to curtail or eliminate all, or portions of the task groups identified in Table 1 or Appendix “A”, then the Contractor shall only invoice the City for work actually performed. The maximum total cost of Contractor's services for this Project Task Description and Fee Allotment is $67,270. DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 August 14, 2019 PSA19-578CA City Attorney Approved Version 7/19/17 2 TABLE 1 FEE ALLOTMENT DRAINAGE ANALYSIS AND IMPROVEMENT PLAN TASK GROUP TIME & MATERIALS Hydrology and Hydraulic Analysis Report $17,880 Channel Maintenance Plan $30,840 Storm Water Pollution Prevention Plan $6,395 Reports and Plans Processing $6,245 Design Services Through Construction $5,910 TOTAL (Not-to-Exceed) $67,270 CONTRACTOR Glenn A. Rick Engineering & Development Co. Glenn A. Rick Engineering & Development Co. (name of Contractor) (name of Contractor) By: By: (sign here) (sign here) Kevin Gibson, Vice President Donald D. Woolley, Secretary (print name/title) (print name/title) If Contractor is a corporation, this document must be signed by one individual from each column: Column A Chairman, President or Vice-President Column 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. CITY OF CARLSBAD, a municipal corporation of the State of California By: ________________________________ Date: _________________________ for Scott Chadwick, City Manager APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: ____________________________ Deputy City Attorney DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 August 14, 2019 APPENDIX "A" SCOPE OF SERVICES DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 July 16, 2019 Mr. Daniel Zimny City of Carlsbad 1635 Faraday Avenue Carlsbad, California 92008 SUBJECT: HYDROLOGIC AND HYDRUALIC ANALYSES AND IMPROVEMENT PLAN FOR BUENA VISTA CREEK MAINTEANCE Dear Mr. Zimny: Pursuant to your email of June 24, 2019 and our site walk on July 8, 2019, the following is a proposal to provide engineering services for the above-referenced project. Project Understanding The project is located in the City of Carlsbad (City) in the vicinity of the El Camino Real Bridge over Buena Vista Creek. More specifically, the project includes a portion of Buena Vista Creek with concrete lined bottom and side slopes, currently covered with sediment deposition and vegetation, that begins approximately 600 feet west (downstream) of the El Camino Real Bridge and extends upstream of the bridge approximately 230 feet (total distance, including the bridge area is approximately 1,000 feet). An access road is located adjacent to the north side of the channel. The concrete lined portion of the creek as well as upstream and downstream earthen creek reaches have been mapped by the Federal Emergency Management Agency (FEMA) as Zone AE, which means that Base Flood Elevations (BFEs) have been determined for the area. Most likely FEMA has a hydraulic model that was utilized to determine the BFEs. The concrete lined and earthen portions of the creek in the project area are mapped as Zone AE. It is our understanding that this portion of Buena Vista Creek has not maintained since circa 2003, and over the years sediment deposition of unknown depths has occurred along with the growth of vegetation, including riparian woody vegetation. During the 2018-2019 wet season, a storm event resulted in elevated water levels in the creek, which in turn resulted in the adjacent Highway 78 not draining as designed and Caltrans shutting down the east-bound traffic lanes for a period of time. The City of Carlsbad (Client) desires to have the accumulated sediment and vegetation removed from the concrete lined portion of Buena Vista Creek. Additionally, during the site walk performed on July 8, 2019, erosion and slope failure along the maintenance road was observed along the north side of the earthen portion of the creek at a location approximately 550 feet east (upstream) of the upstream limits of the concrete portion of the creek. The project includes proposing improvements to stabilize the slope and reestablish the access road to a reasonable width. The Client is at the beginning of the process to obtain the appropriate environmental permits that will allow the creek to be maintained, including the sediment and vegetation removal and slope repair. This process requires the preparation of hydrology and hydraulic analysis report and improvement plans. The Client has asked Rick Engineering Company (RICK)(Consultant) to prepare a cost proposal to obtain available existing data, perform hydrologic and hydraulic analyses, prepare plan sheets for the maintenance, and provide design services through the maintenance phase. The preparation of environmental permits is not a part of the RICK scope and is being performed by another consulting firm. DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 2 of 8 Scope of Work Task 1 – Hydrology and Hydraulic Analyses Report Task 1A. Request Hydraulic Modeling Data RICK will prepare a request for data to FEMA in an attempt to obtain the effective hydraulic model files associated with the Buena Vista Creek in the project area. As shown on the Flood Insurance Rate Map (FIRM) (Map Number 06073C0762G, dated May 16, 2012) the area is mapped as Zone AE. RICK will prepare the draft request and provide to the Client. It is anticipated that the Client will place the request on City of Carlsbad letterhead and authorize. The data request fee is waived for public agencies that participate in the National Flood Insurance Program (NFIP) requesting data from FEMA. RICK will send the request to FEMA utilizing the online FEMA Library Request process. It is unknown if there is currently a FEMA hydraulic model available. Task 1B. Preparing Existing Condition Hydraulic Model RICK will revise the effective hydraulic model obtained from FEMA based on the data collected as discussed above. If a hydraulic model is not available, RICK will prepare a hydraulic model of the project site, upstream reach (extending approximately 300 feet upstream from the project site), and downstream reach (extending downstream approximately 300 feet). RICK will utilize the Hydrologic Engineering Center’s River Analysis System (HEC-RAS) software, or similar, to perform hydraulic modeling. Data from as-built plans (see Task 2) showing the upstream and downstream reaches, if available, will be incorporated into the hydraulic model if not already in the effective model. The general level of sediment (i.e., bridge bottom elevations) will be incorporated into the model. Flow rate data for the 10-year, 50-year, and 100-year storm events will be obtained from the Flood Insurance Study (FIS) and incorporated into the model. If additional flow rate data is required (e.g., 5-year return frequency), such data will be obtained based on log-probability interpolation from the mentioned three data points. The model results will be analyzed in order to determine the hydraulic capacity of the project site and upstream and downstream reaches. The hydraulic capacity (flow rate) will be correlated to storm event return frequency flow rate (e.g., 100-year event or less). Task 1C. Maintained Condition Hydraulic Analysis RICK will prepare a maintained condition hydraulic modeling analysis with a goal to estimate the improved capacity based on removing sediment to the original line and grade (per as-built), as part of the maintenance activities. The existing condition model will be used as the base model and modified to reflect the proposed maintained condition. The maintained condition model will be utilized to guide the design of riprap revetment at the upstream limits of the concrete lined portion of the channel. The maintained condition model will also be used to guide the design of access repairs located approximately 550 feet upstream of the concrete lined portion of the channel. DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 3 of 8 Task 1D. Riprap Revetment Calculations RICK will analyze the transition area from earthen channel to maintained concrete lined channel in order to determine key hydraulic parameters related to riprap design calculations. RICK will perform riprap calculations to determine the appropriate channel protection within the transition area. The methodology and results of the riprap design calculations will be document in the project Hydrology and Hydraulic Report. The riprap design results, include rock blanket classification, depths, and general geometry, will be coordinated with the RICK civil team for incorporation into the Channel Maintenance Plan. Task 1E. Hydrology and Hydraulic Report RICK will prepare a Hydrology and Hydraulic (H&H) Report in support of regulatory agencies permit applications. The hydrology portion of the document will include a watershed map and general description of the watershed characteristic (i.e., area, land use, and soil type) and will document the source of the existing condition 100-year, peak flow rate as in the FIS hydraulic model. Hydrology analysis will not be performed as part of this scope of work. Peak flow rates for return periods other than the 100-year, 50-year and 10-year may be estimated, as applicable, using the log-probability correlation. The proposed project does not include features that will affect the peak flow rate, and thus the pre-project and post-project peak flow rate will be equivalent, and the report will explain this. The H&H Report will provide the methodology and results of the hydraulic analysis and riprap revetment calculations for the existing and post-maintenance conditions. The results of the hydraulic analysis of the proposed upstream slope repair area will also be presented in the H&H Report. Task 2 – Channel Maintenance Plan Task 2A. Site Survey Coordination Provide survey coordination with the City of Carlsbad to develop a work map that establishes limits of additional survey required to supplement the existing topographic mapping collected during previous site work. This task includes reviewing existing topographic data provided by the City, existing contours obtained from GIS and determining the location of additional channel cross section, spot elevations and limits of channel erosion (adjacent to the existing access road that was discussed during the team site walk on July 8th, 2019). The survey request work map will be provided to the City prior to the start of design work. Task 2B. Right-of-Way Document Review Assist the City of Carlsbad with review of existing rights-of-way and easements documents within the limits of the proposed channel maintenance. It is understood that documents provided by the City and property linework obtained from GIS will be utilized as the basis of design for property boundaries shown in the CAD base files and no survey or mapping work is included in this task. Task 2C. Topographic Mapping Consolidation Compile survey data provided from previous site work, GIS contour data and additional topographic DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 4 of 8 mapping collected in association with Task 2A above. This task includes incorporating as-built channel information and developing an existing topographic terrain model. Task 2D. As-Built Plan Research Obtain and review as-built plans from the public agencies that identify the existing concrete channel, bridge structures and utilities within the limits of channel maintenance. This task includes coordination with the City and specific municipalities and franchise utility agencies (City of Oceanside, Caltrans, SDG&E) to gather the available record documents. Task 2E. Base Map Preparation Prepare one existing conditions base map pursuant to work compiled from the tasks above. This task includes consolidating the topographic terrain model, rights-of-way and easements, existing documented utilities, and channel limits. The existing conditions base map will be developed utilizing AutoCAD Civil 3D 2018 and will be distributed to the design team. Task 2F. Channel Maintenance Plan Development Prepare one channel maintenance plan to restore a portion of the existing channel geometry by removing sediment buildup and vegetated growth within the concrete lined portion of the Buena Vista Creek drainage corridor. This task includes maintaining the section of channel from an area just west (downstream) of S. Vista Way to a point east (upstream) of El Camino Real, the total distance being approximately 1,000 linear feet. In addition, provide an erosion repair plan for a portion of earthen channel upstream of the concrete channel section and adjacent to the Ronald Packard Parkway (CA 78) that has recently experienced slope failure due to sediment and vegetation buildup. The plan set will include the following items:  Title Sheet - vicinity maps, notes and legends  Maintenance Plan - limits of work, typical sections, Best Management Practices (BMPs) designators, staging and access, clear water diversions and riprap placement  Erosion Repair Plan – material placement, sections, over-excavation limits, project details and access  Maintenance Methodology Tables – tables, maintenance requirements and mitigation measures Task 2G. Environmental Consultant Collaboration Assist City staff and environmental consultant with the development of the maintenance methodology tables and mitigation measures required for the channel maintenance. This task includes collaboration with the environmental team through file transfers and conference calls to finalize project requirements noted on the maintenance and erosion repair plans. DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 5 of 8 Task 2H. Quantity Estimate Prepare quantity estimates with measurements of payment for the work required to maintain the channel and restore slope erosion area. This task includes developing the units of measurements and quantities of the sediment removals, vegetation removal, temporary access, riprap placement and slope repair. Backup calculations will be provided for all quantity measurements and provided to the City in Excel format. Task 2I. Opinion of Probable Construction Costs Prepare one opinion of probable construction cost estimate. This task will include developing unit costs for the items identified in the task above; the costs will be based on published unit prices provided by the City, obtained from the County of San Diego and/or recently finalized projects of similar scopes of work. Task 2J. Specification Package Assist the City with the preparation of project specifications required to publish the bid package. The specifications will be based on the Green Book (current edition) and supplemental specifications provided by the City. This task includes the development of Section 9 – Measurements and Payment and providing payment clauses for all bid items listed in the maintenance and erosion repair plans. Task 3 – Storm Water Pollutant Prevention Plan (SWPPP) Prepare a SWPPP based on the requirements of the State Water Resources Control Board (SWRCB) National Pollutant Discharge Elimination System (NPDES) General Permit for Storm Water Discharges Associated with Construction and Land Disturbance Activities Order No. 2009-0009-DWQ NPDES No. CAS000002 (adopted September 2, 2009). The scope and fee for the SWPPP includes two major tasks. The first task will be conducted to determine the Risk Level (either Risk Level 1, 2 or 3) for the project. The next task will be to prepare a SWPPP for the specific Risk Level determined by the Risk Determination Analysis. This task will include the preparation of a Notice of Intent (NOI) on the Storm Water Multi Application Report Tracking System (SMARTS) database. The Legally Responsible Person (LRP) must designate Rick Engineering Company as a Data Entry Person to upload the NOI, SWPPP, and Site Maps. The LRP must electronically certify and submit the NOI, SWPPP and Site Maps to the SWRCB’s SMARTS system along with the other Permit Registration Documents (PRDs) (such as filing fees and certifications that are submitted by the LRP). Rick Engineering Company will act as the initial Qualified SWPPP Developer (QSD) for the preparation of the SWPPP; however, the LRP will assign a QSD/Qualified SWPPP Practitioner (QSP) for implementation of the SWPPP throughout the life of the project. It should be noted that since the adoption of the Construction General Permit 2009-0009-DWQ, interpretations and guidance on specific requirements are still being released. In addition, it is DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 6 of 8 anticipated that a reissued Draft Construction General Permit will be released in 2019. Therefore, amendments to the SWPPP based upon new guidance or regulations may be required and is not included in this scope and fee. Task 4 – Water Resources Reports and Maintenance and Erosion Repair Plan Sheet Processing Process the H&H Report, SWPPP, and plans through the City of Carlsbad review and resource agencies review. It is anticipated that feedback received from the City of Carlsbad and resource agencies on the H&H Report, SWPPP, and plans will be minor; however, because the effort to process a reports and plans varies greatly from agency to agency, any time associated with processing the H&H Report, SWPPP, and plans will be charged on a time and materials basis not to exceed stated fee without prior authorization from the client. This task assumes 16 hours, 6 hours, and 16 hours (total of 38 hours) of an engineer’s time for the H&H Report, SWPPP, and plans, respectively. Task 5 – Design Services Through Construction Task 5A. Bid Assistance Assist City staff with the preparation of bid documents and responding to comments related to maintenance and slope repair plan set. This task includes providing assistance with forms, addendums, and supplemental documents as needed. For budgeting purposes it is estimated that 10 hours of an engineer’s time will be required to perform this task. Task 5B. Support Services During Construction Provide support services to assist the Client through the construction period. The services may include attending a pre-construction meeting, responding to requests for information (RFIs), and attending to other design related issues. Services will be performed on a time and materials basis not to exceed contract amount unless authorized in writing. This task includes approximately 24 hours of an engineer’s time in support of assisting through the construction period. Any additional services can be provided with a contract addendum if requested. DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 7 of 8 Fee Our “Consultant” fee for the above-described work would be on a time and materials basis per our Schedule of Hourly Rates (pursuant to the Master Agreement for Storm Drain Engineering Services, dated November 28, 2018), not to exceed $67,270.00 without your prior authorization. Task 1 – Hydrology and Hydraulic Analyses Report Task 1A. Request Hydraulic Modeling Data ........................................................... $ 840.00 Task 1B. Preparing Existing Condition Hydraulic Model ....................................... $ 2,385.00 Task 1C. Maintained Condition Hydraulic Analysis................................................ $ 6,290.00 Task 1D. Riprap Revetment Calculations ................................................................ $ 2,210.00 Task 1E. Hydrology and Hydraulic Report .............................................................. $ 6,155.00 Task 2 – Channel Maintenance Plan Task 2A. Site Survey Coordination .......................................................................... $ 1,055.00 Task 2B. Right-of-Way Document Review ............................................................. $ 1,345.00 Task 2C. Topographic Mapping Consolidation ....................................................... $ 2,240.00 Task 2D. As-Built Plan Research ............................................................................. $ 2,020.00 Task 2E. Base Map Preparation ............................................................................... $ 3,035.00 Task 2F. Channel Maintenance Plan Development.................................................. $14,120.00 Task 2G. Environmental Consultant Collaboration ................................................. $ 1,570.00 Task 2H. Quantity Estimate ..................................................................................... $ 1,310.00 Task 2I. Opinion of Probable Construction Costs .................................................... $ 1,055.00 Task 2J. Specification Package ................................................................................ $ 3,090.00 Task 3 – Storm Water Pollutant Prevention Plan ..................................................... $ 6,395.00 Task 4 –Reports and Plans Processing ....................................................................... $ 6,245.00 Task 5 – Design Services Through Construction Task 5A. Bid Assistance........................................................................................... $ 1,650.00 Task 5B. Support Services During Construction ..................................................... $ 3,960.00 *Direct Expenses ............................................................................................................ $ 300.00 Total $67,270.00 *Direct expenses include printing and blueprinting (plan sheet plotting) expenses. Exclusions Any title company fees, soils reports, blueprinting and miscellaneous expenses are extra and not a part of this agreement. Also not included are any items not specifically referred to above. The following items may be required, but are not included in the scope of work outlined above. Additional authorization will be required for these services:  Topographic surveying. The collection of topographic data by ground crews and/or aerial equipment may be performed for additional fee through a change order or separate contract.  Data entry of non-digital hydraulic modeling files (e.g., HEC-2 hard copy).  Hydrology analysis to revise the 1% (100-year) flow rate through the project site.  FEMA analysis, forms, and process are excluded from this scope.  Environmental survey or study of any kind.  Water quality calculations DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 Mr. Daniel Zimny July 16, 2019 Page 8 of 8  Storm Water Quality Management Plan (SWQMP)  SWPPP specifications  Soil sampling or analysis  Geotechnical Engineering  Landscape Architecture  Structural engineering services.  Title report review  Boundary, lot line or easement plotting  Base map preparation Fees and expenses will be billed monthly as the work progresses and the net amount shall be due within thirty (30) days from the date of receipt of the invoice in the Client's office. Work will performed in accordance to the provisions set forth in our Master Agreement for Storm Drain Engineering Services, dated November 28, 2018. If notice is delayed for any reason beyond thirty (30) days, it is understood by the parties that the terms and conditions contained herein are subject to revision. If you would like us to proceed on this work as outlined above, we ask that you please sign and return this agreement as our written authorization. Upon signature by Client, this proposal and the attached terms become the agreement for services and the notice to proceed. If you have any questions regarding this agreement, please contact Anthony Cotts at 619-688-1444 or Jayne Janda-Timba at 619-688-1448. Thank you for requesting Rick Engineering Company to provide these services. Sincerely, RICK ENGINEERING COMPANY Jayne Janda-Timba, QSD/QSP, ToR, QISP R.C.E. 70649, Exp. 6/21 Associate Principal JJT:AMC:es:k/files/proposal/Zimny.002 APPROVED: BY: _________________________________________ DATE: _____________________________ PRINT NAME: DocuSign Envelope ID: 2868E640-3246-47FA-BB87-13A63F454A71 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? 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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 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: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12/31/2018 Cavignac &Associates450BStreet,Suite 1800SanDiegoCA92101 Certificate Department 619-744-0574 619-234-8601 certificates@cavignac.com XL Specialty Company 37885 RICKENG-01 Valley Forge Insurance Company 20508GlennARickEngineeringandDevelopmentCompany5620FriarsRoadSanDiego,CA 92110 Continental Casualty Co.20443 Continental Insurance Company 35289 Amer Cas.Co of Reading,PA 1679178157 B X 1,000,000 X 1,000,000 X Contractual Liab 10,000 X Separation of In 1,000,000 2,000,000 X X X Y 6076046485 1/1/2019 1/1/2020 2,000,000 Deductible 0 C 1,000,000 X 6076046499 1/1/2019 1/1/2020 D X X 10,000,000 0 6076046504 X 10,000,000 1/1/2019 1/1/2020 E Y 6076046521 1/1/2019 1/1/2020 X 1,000,000 1,000,000 1,000,000 A ProfessionalLiability DPR9930428 8/15/2018 8/15/2019 Each ClaimAggregate $3,000,000$8,000,000 Re:Agreement Number :TRAN1166,Agreement Name :Engineering Services.Additional Insured coverage applies to General Liability for City ofCarlsbad/CMWD per policy form.Waiver of subrogation applies to Workers Compensation per policy form.Excess/Umbrella policy follows form over underlyingpolicies:General Liability,Auto Liability &Employers Liability (additional insured and waiver of subrogation apply).Professional Liability -Claims made form,defense costs included within limit.If the insurance company elects to cancel or non-renew coverage for any reason other than nonpayment of premium theywillprovide30daysnoticeofsuchcancellationornonrenewal. City of Carlsbad/CMWDc/o EXIGIS Insurance Compliance ServicesP.O.Box 4668 -ECM #35050NewYorkNY10163-4668 Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A.in the performance of your ongoing operations subject to such written contract; or B.in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products-completed operations hazard, and only if: 1.the written contract requires you to provide the additional insured such coverage; and 2.this coverage part provides such coverage. II.But if the written contract requires: A.additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10-01 edition of CG2037; or B.additional insured coverage with “arising out of” language; or C.additional insured coverage to the greatest extent permissible by law; then paragraph I.above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III.Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A.coverage broader than required by the written contract; or B.a higher limit of insurance than required by the written contract. IV.The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A.the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1.the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2.supervisory, inspection, architectural or engineering activities; or B.any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V.Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: Primary and Noncontributory Insurance Policy No: 6076046485 Effective Date: 01/01/2019 CNA75079XX (10-16) Page 1 of 2 Insured Name: Rick Engineering Company Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1.primary and non-contributing with other insurance available to the additional insured; or 2.primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI.Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1.give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2.send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3.make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self-insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII.Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A.is currently in effect or becomes effective during the term of this policy; and B.was executed prior to: 1.the bodily injury or property damage; or 2.the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Policy No: 6076046485 Effective Date: 01/01/2019 CNA75079XX (10-16) Page 2 of 2 Insured Name: Rick Engineering Company Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement CNA75008XX (10-16) Policy No: 6076046485 Effective Date:  Insured Name: Rick Engineering Company Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured’s ongoing operations or your work included in the products-completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. AS REQUIRED BY CONTRACT Policy No:Form No: CC68021A (02-2013) Endorsement Effective Date: 01/01/2019 © CNA All Rights Reserved. It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS 6076046499,6076046485, 6076137871,6076046521 Named Insured: Rick Engineering Company 3ROLF\1R6076046521 6076046521 Effective Date: 01/01/2019 Named Insured: Rick Engineering Company PSA 19-578CA MASTER AGREEMENT FOR STORM DRAIN ENGINEERING SERVICES GLENN A. RICK ENGINEERING DEVELOPMENT & CO. THIS AGREEMENT is made and entered into as of the 2 ~ hJ Qr--8\/V\'t;;:leL , 2018, by and between the City of Carlsbad, a corporation, ("City"), and Glenn A. Rick Engineering Development & Co., a California corporation, hereinafter referred to as "Contractor." RECITALS day of municipal A. The City requires the professional services of a consulting firm that is experienced in storm drain engineering services. B. The professional services are required on a non-exclusive, project-by-project basis. C. Contractor has the necessary experience in providing professional services and advice related to storm drain engineering services. D. Contractor has submitted a proposal to the City under Request for Qualifications (RFQ) No. 18-05, and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, the City and Contractor agree as follows: 1. SCOPE OF WORK The City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", which is incorporated by this reference in accordance with this Agreement's terms and conditions. Contractor's obligations with respect to any project granted to Contractor under this Agreement will be as specified in the Task Description for the project (see paragraph 5 below). 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. IEB.M The term of this Agreement will be effective for a period of three (3) years from December 1, 2018, through November 30, 2021. The City Manager may amend the Agreement to extend it for one (1) additional one (1) year period or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, the City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. PROGRESS AND COMPLETION The work for any project granted to Contractor pursuant to this Agreement will begin within ten (10) days after receipt of notification to proceed by the City and be completed within the time specified in the Task Description for the project (see paragraph 5 below). Extensions of time for a specific Task Description may be granted if requested by Contractor and agreed to in writing by the City Manager or the Division Director as authorized by the City Manager ("Director"). The City Manager or Director will give allowance for documented and substantiated unforeseeable and unavoidable delays not caused by a lack of foresight on the part of Contractor, or delays caused by the City inaction or other agencies' lack of timely action. City Attorney Approved Version 6/12/18 PSA 19-578CA 5. COMPENSATION The cumulative total for all projects allowed pursuant to this Agreement will not exceed two hundred fifty thousand dollars ($250,000) per Agreement term. Fees will be paid on a project-by- project basis and will be based on Contractor's Schedule of Rates specified in Exhibit "A". Prior to initiation of any project work by Contractor, City shall prepare a Project Task Description and Fee Allotment (the "Task Description") which, upon signature by Contractor and for City, the City Manager or Director, will be considered a part of this Agreement. The Task Description will include a detailed scope of services for the particular project being considered and a statement of Contractor's fee to complete the project in accordance with the specified scope of services. The Task Description will also include a description of the method of payment and will be based upon an hourly rate, percentage of project complete, completion of specific project tasks or a combination thereof. 6. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City's election, City may deduct the indemnification amount from any balance owing to Contractor. 7. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 8. OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. City Attorney Approved Version 6/12/18 2 PSA 19-578CA The parties expressly agree that any payment, attorney's fee, costs or expense the City incurs or makes to or on behalf of an injured employee under the City's self-administered workers' compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 1 o. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor's agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to 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. 10.1 Coverage and Limits. Contractor will maintain the types of coverage and minimum limits indicated below, unless the Risk Manager or the City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. The City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this projecUlocation or the general aggregate limit shall be twice the required occurrence limit. 10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for the City). $2,000,000 combined single-limit per accident for bodily injury and property damage.using primary and/or excess/umbrella policies. 10.1.3 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 the City's satisfaction, a declaration stating this. 10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor's profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. City Attorney Approved Version 6/12/18 3 PSA 19-578CA 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to the City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to the City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to the City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then the City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by the City to obtain or maintain insurance and the City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 10.5 Submission of Insurance Policies. The City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS UCENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of the City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13. OWNERSHIP Of DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of the City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to the City. Contractor will have the right to make one (1) copy of the work product for Contractor's records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in the City and Contractor relinquishes all claims to the copyrights in favor of the City. Ill Ill Ill City Attorney Approved Version 6/12/18 4 PSA 19-578CA 15. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of the City and on behalf of the Contractor under this Agreement. For City Name Eleida Felix Yackel Title Senior Contract Administrator Department Public Works City of Carlsbad Address 1635 Faraday Avenue Carlsbad, CA 92008 Phone No. 760-602-2767 For Contractor Name Jayne Janda-Timba Title Contract Manager Address 5620 friars Road San Diego, CA 92110 Phone No. 619-291-0707 Email jjanda-timba@rickengineering.com Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. 16. CONfUCT Of INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. Yes~ No D 17. GENERAL COMPLIANCE WIJH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 18. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or the City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained City Attorney Approved Version 6/12/18 5 PSA 19-578CA is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 20. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, the City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If the City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, the City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by the City and all work in progress to the City address contained in this Agreement. The City will make a determination of fact based upon the work product delivered to the City and of the percentage of work that Contractor has performed which is usable and of worth to the City in having the Agreement completed. Based upon that finding the City will determine the final payment of the Agreement. Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and upon request of the City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to the City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. The City will make the final determination as to the portions of tasks completed and the compensation to be made. 21. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, the City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22. CLAIMS AND LAWSUIJS By signing this Agreement, Contractor agrees that any Agreement claim submitted to the City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to the City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, 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 information. If the City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for the City to terminate this Agreement. City Attorney Approved Version 6/12/18 6 PSA 19-578CA 23. JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 24. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon the City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of the City, which shall not be unreasonably withheld. 25. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. 26. eusuc AGENCY CLAUSE Contractor agrees that any public agency as defined by Cal. Gov. Code section 6500, if authorized by its governing body, shall have the option to participate in this contract at the same prices, terms, and conditions. If another public agency chooses to participate, the term shall be for the term of this contract, and shall be contingent upon Contractor's acceptance. Participating public agencies shall be solely responsible for the placing of orders, arranging for delivery and/or services, and making payments to the Contractor. The City of Carlsbad and Carlsbad Municipal Water District shall not be liable, or responsible, for any obligations, including but not limited to financial responsibility, in connection with participation by another public agency. Ill Ill Ill Ill Ill Ill Ill City Attorney Approved Version 6/12/18 7 PSA 19-578CA 27. 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. Executed by Contractor this _____ day of ___________ , 2018. CONTRACTOR GLENN A RICK ENGINEERING DEVELOPMENT & CO., a Calif rnia corpor~ By. ' CITY OF CARLSBAD, a municipal corporation of the State of California By: (sign here) lie Vi/I 6-it.s~ _, Pr l4tJ~ 1)11;, e fl.~J:J- ~ (print name/title) ATTEST: By: If required by the 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. Groyp A Chairman, President, or Vice-President Groyp 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: CELIA A. BREWER, City Attorney BY D2.l C}lp Deputy City Attorney'\ City Attorney Approved Version 6/12/18 8 PSA 19-578CA EXHIBIT "A" SCOPE Of SERVICES Perform a variety of storm drain engineering services related tasks as outlined in individual Project Task Description & Fee Allotments (PTD&FA) related to the following: A. Hydro Modification.Retention and Low Impact Design B. Hydrology and Hydraulics Studies C. NPDES Compliance Training and Program Monitoring D. Plan Review and Compliance E. Storm Drain Design F. Storm Water Management Plans (SWMP) G. Storm Water Pollution Prevention Plans (SWPPP) Requests for work not listed above must be contracted under separate agreement. City Attorney Approved Version 6/12/18 9 PSA 19-578CA , .... RICK ENGINEERING COMPANY Hourly Rates -California Offices February 24, 2018 -August 31, 2018 Principal Consultant (Special Projects) ................................. $ 275.00 Principal Water Resources Designer ....................................... $140.00 Principal .................................................................................... 245.00 Associate Water Resources Designer ........................................ 130.00 Associate Principal .................................................................... 230.00 Assistant Water Resources Designer ......................................... l l 5.00 Associate/Manager .................................................................... 215.00 Expert Witness .......................................................................... 400.00 GIS Manager ........................................................................... $185.00 Court Appearance per half day or part. ................................... 1,600.00 Principal GIS Project Manager .................................................. 170.00 Associate GIS Project Manager ................................................. 155.00 Principal Project Engineer/Manager .......................................... 190.00 Assistant GIS Project Manager .................................................. 135.00 Associate Project Engineer/Manager ......................................... 175.00 Principal GIS Analyst ................................................................ 125.00 Assistant Project Engineer/Manager .......................................... 160.00 Associate GIS Analyst.. ............................................................. 115 .00 Principal Engineering Designer. ................................................ 140.00 Assistant GIS Analyst ................................................................ 105.00 Associate Engineering Designer ................................................ 130.00 Principal Graphics Designer ...................................................... 115.00 Assistant Engineering Designer ................................................. 115.00 Associate Graphics Designer ..................................................... 110.00 Principal Engineering Drafter...................... . ................. 110.00 Assistant Graphics Designer ........................................................ 95.00 Associate Engineering Drafter ................................................... 100.00 CAD Manager ........................................................................... 175.00 Assistant Engineering Drafter ..................................................... 90.00 Field Supervisor. ...................................................................... $190.00 Principal Construction Engineer/Manager. ............................. $190.00 One-person Survey Party ........................................................... 140.00 Associate Construction Engineer/Manager ............................... 175.00 One-person Survey Party with Robotics .................................... 190.00 Assistant Construction Engineer/Manager ................................ 160.00 Two-person Survey Party .......................................................... 220.00 Principal Construction Technician ............................................ 140.00 Three-person Survey Party............ .. ................................. 285.00 Associate Construction Technician ........................................... 130.00 Assistant Construction Technician ............................................ 115.00 3D Laser Scanning Crew (One-Person) .................................. $220.00 3D Laser Scanning Crew (Two Person) ................................... 260.00 Senior Transportation/Traffic Engineer. .................................. $200.00 Principal Transportation/Traffic Engineer ................................. 190.00 Principal 3D Laser Scanning Project Manager ....................... $180.00 Associate Trnnsportation/Traffic Engineer. ............................... 175.00 Associate 3D Laser Scanning Project Manager ......................... 165.00 Assistant Transportation/Traffic Engineer ................................. 160.00 Assistant 3D Laser Scanning Project Manager.. ........................ 150.00 Principal Transportation/Traffic Designer ................................. 140.00 Principal 3D Laser Scanning Specialist.. ................................... 130.00 Associate Transportation/Traffic Designer. ............................... 130.00 Associate 3D Laser Scanning Specialist .................................... 120.00 Assistant Transportation/Traffic Designer ................................. 115.00 Assistant 3D Laser Scanning Specialist ..................................... l 10.00 Principal 3D Laser Scanning Technician ................................... I 10.00 Principal Community Planner ................................................ $210.00 Associate 3D Laser Scanning Technician .................................... 95.00 Principal Project Planner/Manager ........................................... 190.00 Assistant 3D Laser Scanning Technician ..................................... 85.00 Associate Project Planner/Manager .......................................... 175.00 Senior Planner ........................................................................... 165.00 Photogramrnetry Supervisor .................................................... $180.00 Associate Planner ...................................................................... 130.00 Principal Photogrammetrist ....................................................... 125.00 Assistant Planner ....................................................................... 110.00 Associate Photogrammetrist ...................................................... 110.00 Planning Technician .................................................................... 85.00 Assistant Photogrammetrist .................................................... l 00.00 Principal Landscape Architect ................................................. $210.00 Computing & Mapping Director .............................................. $190.00 Principal Project Landscape Architect/Manager ....................... 180.00 Principal Survey Analyst ........................................................... J 75.00 Associate Project Landscape Architect/Manager ..................... 155.00 Associate Survey Analyst .......................................................... 135.00 Assistant Project Landscape Architect/Manager ....................... 120.00 Assistant Survey Analyst.. ......................................................... 115.00 Principal Landscape/Urban Designer ........................................ 110.00 Associate Landscape/Urban Designer...................... .. ........ I 05.00 Assistant Landscape/Urban Designer .......................................... 95.00 Associate Project Administrator ................................................ $75.00 Assistant Project Administrator ................................................... 65.00 Administrative Assistant... ........................................................... 70.00 Principal Environmental Project Manager.. ............................. $ I 75.00 Associate Environmental Project Manager ................................ 155.00 Assistant Environmental Project Manager ................................ 135.00 Principal Environmental Specialist... ......................................... 120.00 Associate Environmental Specialist .......................................... 115.00 Assistant Environmental Specialist ........................................... 110.00 Environmental Technician ........................................................... 90.00 Rates subject to change for prevailing wage contracts. When authorized, overtime shall be charged at the listed rates times 1.3. Unless otherwise agreed upon, we shall charge for printing, reproduction, deliveries, transportation, and other expenses. A ten ( I 0) percent fee for administration, coordination and handling will be added to all subcontracted services. 10 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego On <nc }e~ °l, ZQle\ before me, ;J/~k t ?ulJe- (insert name and title o e cifficer) personally appeared ~Al:{ lJ..)00 fft:,/ ______ , who proved to me on the basis of satisfactory eviden7E! to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ,.~~ WITNESS /~and official seal. L...,,,~;~~1~ Signatu~_ ::S---(Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego personally appeared \\-tu1V\ G;k)~o""'y\ who proved to me on the basis of satisfactory evidence to be the personks] whose name~ is/eye subscribed to the within instrument and acknowledged to me that he/~/tl).ey executed the same in his/1),ef/tlJ,e'(r authorized capacity(i.f,SJ, and that by his/h,eti~ir signature(.sf on the instrument the person~, or the entity upon behalf of which the person{g) acted, executed the instrument. (Seal) ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 10/10/2018 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~f~i~cT Certificate Deoartment Cavignac & Associates rA~~N,t =~", 619-744-o574 I FAX 450 B Street, Suite 1800 IA/C Nol: 619-234-8601 San Diego CA 92101 ioMlJ~ss: certificates@cavignac.com INSURER/SI AFFORDING COVERAGE NAIC# INSURER A : XL Specialty Company 37885 INSURED RICKENG-01 INSURER B: Travelers Prooerty & Casualty Company of America 25674 Glenn A Rick Engineering and Development Company INSURERC: 5620 Friars Road San Diego, CA 92110 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 581252036 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 POLICYEFF POLICY EXP LTR TYPE OF INSURANCE ..,.,n un,n POLICY NUMBER IMM/DD/YYYY\ IMM/DD/YYYY\ LIMITS B X COMMERCIAL GENERAL LIABILITY y 6806H046886 1/1/2018 1/1/2019 EACH OCCURRENCE $1,000,000 I CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence\ $1,000.000 X f--Contractual Liab MED EXP (Any one person) $10,000 X Separation of In f--PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Fl 0PRO-[8]Loc PRODUCTS -COMP/OP AGG $2,000,000 POLICY JECT OTHER: Deductible $0 B AUTOMOBILE LIABILITY BA7276L522 1/1/2018 1/1/2019 COMBINED SINGLE LIMIT $1 ooo noo /Ea accident\ f-- X ANY AUTO BODILY INJURY (Per person) $ f--ALL OWNED ~ SCHEDULED BODILY INJURY (Per accident) $ f--AUTOS f--AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS /Per accident\ f--f--$ B X UMBRELLA LIAB M OCCUR CUP4187T939 1/1/2018 1/1/2019 EACH OCCURRENCE $ 10,000,000 f-- EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 / OED I X I RETENTION $ n $ B WORKERS COMPENSATION y UB6H924546 1/1/2018 1/1/2019 X I ~ffTUTE I I OTH- AND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE • N/A E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A Professional Liability DPR9930428 8/15/2018 8/15/2019 Each Claim $3,000,000 ./ Aggregate $8,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Agreement Number: TRAN1166, Agreement Name: Engineering Services. Additional Insured coverage applies to General Liability for City of Carlsbad/CMWD per policy form. Waiver of subrogation applies to Workers Compensation per policy form. Excess/Umbrella policy follows form over underlying policies: General Liability, Auto Liability & Employers Liability (additional insured and waiver of subrogation apply). Professional Liability -Claims made form, defense costs included within limit. If the insurance company elects to cancel or non-renew coverage for any reason other than nonpayment of premium they will provide 30 days notice of such cancellation or nonrenewal. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad/CMWD ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services P.O. Box 4668 -ECM #35050 AUTHORIZED REPRESENTATIVE New York NY 10163-4668 -7 ~ I l_,, © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Policy Number: 6806H046886 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED {ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section Ill - Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed operations hazard" unless the "written contract requ1nng insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG DJ 81 09 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission Policy Number: 6806H046886 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: 6806H046886 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY-NOTICE OF CANCELLATION/NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: NONRENEWAL: Number of Days Notice of Cancellation: 30 Number of Days Notice of Nonrenewal: PERSON OR ORGANIZATION: 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 RECEIVED SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: A. If we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancel- lation 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 can- cellation. B. If we decide to not renew this policy for any statu- torily permitted reason, and a number of days is shown for nonrenewal in the schedule above, we will mail notice of the nonrenewal 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 nonrenewal in the schedule above be- fore the expiration date. IL T40012 09 © 2009 The Travelers I ndemnrty Company Page 1 of 1 COMMERCIAL AUTO POLICY ENDORSEMENT -CA T8 04 01 16 POLICY NUMEER BA7276L522 ** THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ** NOTICE OF CANCELLATION IT IS AGREED THAT: 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 SCHEDULE CANCELLATION: NUMBER OF DAYS NOTICE OF CANCELLATION: 30 PERSON OR ORGANIZATION: 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 SHOWN IN THE DECLARATIONS 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 SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN ~TTr'H W1.!TTT'RN' RRQTTR~T li'ROM VOIT TO TT~. PROVISIONS: A. IF WE CANCEL THIS POLICY FOR ANY STATUTORILY PERMITTED REASON OTHER THAN NONPAYMENT OF PREMIUM 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 CANCRLLATION IN' TRR SCHEDOLR llOVE BRli'OP.li! TRR EFFECTIVE DATE OF CANCELLATION. ~ TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT O 6183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) Policy Number: UB6H924546 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 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 RECEIVED SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Number of Days Notice 30 Page 1 of 3 .... TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) Policy Number: UB6H924546 Name and Address of Designated Persons or Organizations: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Number of Days Notice 30 Page 2 of 3 ~ TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) Poliq· Number: UB6H924546 Name and Address of Designated Persons or Organizations: All other terms and conditions of this policy remain unchanged. Number of Days Notice 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 Insured Policy No. Endorsement No. Insurance Company ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Premium$ Countersigned by _______________ _ Page 3 of 3 WORKERS COMPE'.'ISATIO'.\f A'.\fD EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (00) POLICY NUMBER: UB6H924546 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) 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. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WEICE TEE NAMED INSURED F.AS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Job Description ,1.1.1:. t.nc .. rnrn-..:s p,.n,. 1 n of 10