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HomeMy WebLinkAboutGlobal Power Group Inc; 2018-04-09; PWL18-132GSPWL18-132GS CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT Fire Station No. 3 Differential Pressure Controller This letter will serve as an agreement between Global Power Group, Inc., a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to install a differential pressure controller, per Exhibit "A" and City specifications, for a sum not to exceed one thousand eight hundred twenty-seven dollars thirty-seven cents ($1,827.37). This work is to be completed within thirty (30) working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees, and volunteers from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers' Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Insurance is to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII",; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4 California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code s~c;tiq_ns 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. (1c init ~ c.._ init 6. The Contractor hereby acknowledges that debarment by another jurisdictij1iC:rounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. · init '.::, C init 7. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Fire Station No. 3 Differential Pressure Controller - 1 -City Attorney Approved 2/29/2016 PWL18-132GS 8. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in the execution of the work covered by this Letter of Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 9. City Contact: Brian Bacardi 760-434-2944 Contractor Contact: Mike Luna 619-579-1221 CONTRACTOR Global Power Group, Inc., a California corporation 12060 Woodside Ave. Lakeside, CA 92040 ·/ P: 619-579-1221 F: 619-579-1166 / 1 mluna@gpgpower:com By: (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Dated: Elaine Lukeyipucworfs Director as authorized by the City Manager (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: Deputy City Attorney Fire Station No. 3 Differential Pressure Controller - 2 -City Attorney Approved 2/29/2016 PWL18-132GS EXHIBIT A Fire Station No. 3 Differential Pressure Controller SCOPE OF WORK AND FEE DESCRIPTION Contractor to provide all materials, tools, and labor to install a new Differential Pressure Controller on the existing generator located at Carlsbad Fire Station No. 3, 3465 Trailblazer Way, Carlsbad, CA 92010. Once installed, contractor will run the generator and take readings off the gauge to ensure correct operation. *Includes taxes, fees, expenses and all other costs. Fire Station No. 3 Differential Pressure Controller Page 3 of 3 TOTAL PRICE $1,827.37 $1,827.37 City Attorney Approved 9/27/16 GLOBPOW-01 MANDY ACORD. CERTIFICATE OF LIABILITY INSURANCE I DA TE (MM/DD/YYYY) ~ 03/16/2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Snapp & Associates Insurance Services (11.~g_Nt.ro, Ext): (619) 908-3100 I FAX 438 Camino Del Rio S Ste 112 (A/C, No):(619) 908-3110 San Diego, CA 92108 ~~6'J~ss: Service@snappins.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Valley Forge Insurance Co. 20508 INSURED INSURER B: Continental Casualty Company 20443 Global Power Group, Inc. INSURER c: Continental Insurance Company 35289 Sal Ceballos INSURER D: Hartford Fire Insurance Co. 19682 12060 Woodside Ave Lakeside, CA 92040 INSURER E: Tokio Marine Specialty Ins Co INSURER F: COVERAGES CERTIFICATE NUMBER· 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD 'MID IMM/DD/YYYY\ IMM/DD/YYYY\ A~ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 D CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED 100,000 X 6046226841 03/15/2018 03/15/2019 PREMISES /Ea occurrence) $ MED EXP (Anv one oerson) $ 0 ~ 1,000,000 PERSONAL & ADV INJURY $ ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Fl POLICY 0 ~r8-f DLOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 6045999519 03/15/2018 03/15/2019 BODILY INJURY (Per person) $ ~ OWNED ~ SCHEDULED ~ AUTOS ONLY ~ AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED tP~?~c\'td~t?AMAGE $ ~ AUTOS ONLY ~ AUTOS ONLY I $ CIX UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 10,000,000 i EXCESS LIAB CLAIMS-MADE 6045999522 03/15/2018 03/15/2019 AGGREGATE $ 10,000,000 OED I X I RETENTION$ 0 $ , WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS" LIABILITY STATUTE ER Y/N I ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ D Equipment Floater 72UUMZN8594 03/15/2018 03/15/2019 Rented Eq 1,000,000 E Pollution Liability PPK1791990 03/15/2018 03/15/2019 Pollution 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is requir,}1 Re: Operations of the named insured subject to the terms and conditions of the policy. The City of Carlsbad, its o icials, employees and volunteers are named additional insured per the attached endorsement. 30* days notice of cancellation, 10* days notice of cancellation in the event of nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Services P.O. Box 4668 -ECM #35050 New York, NY 10163 AUTHORIZED REPRESENTATIVE I JtvUvL c~· ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C'NA Policy No.: 6046226841 G-18652-J (Ed. 07-12) CONTRACTORS' GENERAL LIABILITY EXTENSION ENDORSEMENT It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. The changes this endorsement makes do not apply with respect to any coverage that has been excluded or amended by another endorsement attached to this policy. SCHEDULE Coverage is summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding policy provisions in the body of this endorsement 1. Additional Insureds Seven additional insured extensions. 2. Bodily Injury -Expanded Definition 3. Broad Knowledge of Occurrence/ Notice of Occurrence 4. Broad Named Insured 5. Broadened Liability Coverage For Damage To "Your Product'' And "Your Work" Limit: $100,000. 6. Contractual Liability-Railroads Expanded definition of "insured contract" 7. Contractual Liability For Personal And Advertising Injury 8. Electronic Data Liability Loss of Electronic Data Limit: $100,000. 9. Expanded Personal And Advertising Injury -Discrimination Or Humiliation 10. Expected Or Intended Injury Reasonable force -"bodily injury'' or "property damage." 11. General Aggregate Limits Of Insurance -Per Project 12. In Rem Actions 13. Incidental Health Care Malpractice Coverage 14. Joint Ventures/Partnership/Limited Liability Companies Coverage for your interest in such terminated or ended organizations. 15. Legal Liability/Alienated Premises/Borrowed Equipment Coverage Extended perils. Default limit increased to $500,000 for Damage to Premises Rented To You. $25,000 limit for "property damage" to borrowed tools or equipment at a jobsite. 16. Liberalization Clause 17. Liquor Liability Coverage Extension 18. Medical Payments Limits increased to $15,000. Reporting increased to three years from the date of accident 19. Non-owned Aircraft Coverage 20. Non-owned Watercraft Increased to 75 feet 21. Primary And Non-Contributory To other Insurance 22. Property Damage -Elevators 23. Supplementary Payments Cost of bail bonds increased to $5, ODD. Daily loss of earnings increased to $1,000. 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subrogation -Blanket ------_ _ylJaiver of subroga_tion wher~ requir~d _IJyvvri_tt_~n c::c:intract or written c3gr~~me_1"1t_ 26. Wrap-Up Extension G-18652-J (Ed. 07-12) Page 1 of 12 Copyright, CNA All Rights Reserved. --------·-- C'NA 1. ADDITIONAL INSURED SECTION II -WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs A. through G. below whom you are required to add as an additional insured on this policy under a written contract or written agreement, provided the written contract or written agreement: i. Is currently in effect or becomes effective during the term of this policy; and ii. Was executed prior to the "bodily injury," "property damage" or "personal injury and advertising injury" for which the additional insured seeks coverage. However, we will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. The maximum permitted by law; b. Required in the written contract or written agreement; c. Afforded to you under this policy; or d. Described in the applicable paragraphs A. through G. below. A. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of 1. Their financial control of you; or 2. Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co-owned by you and covered under this insurance but only with respect to the co-owner's liability as co-owner of such premises. C. Lessor -Equipment 1. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. G-18652-J (Ed. 07-12) Page 2 of 12 Policy No.: 6046226841 G-18652-J (Ed. 07-12) 2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. D. Lessor -Land An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to lease that land; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. E. Lessor -Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. F. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. G. State or Governmental Agency or Subdivision or Political Subdivisions A state or governmental agency or subdivision or political subdivision subject to the following provisions: 1. This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or Copyright, CNA All Rights Reserved. C'NA political subdivision has issued a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. The construction, erection, or removal of elevators; or c. The ownership, maintenance or use of any elevators covered by this insurance. 2. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. 3. This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products- completed operations hazard." A governmental permit which requires you to add the governmental entity as an additional insured will trigger this Provision 1. as if the permit were a written contract. 2. BODILY INJURY -EXPANDED DEFINITION SECTION V -DEFINITIONS, the definition of "bodily injury" is changed to read: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 3. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Condition 2. Duties in The Event of Occurrence, Offense, Claim or Suit of SECTION IV - COMMERCIAL GENERAL LIABILITY G-18652-J (Ed. 07-12) Page 3 of 12 Policy No.: 6046226841 G-18652-J (Ed. 07-12) CONDITIONS is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE You must give us or our authorized representative notice of an "occurrence," offense, claim, or "suit" only when the "occurrence," offense, claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or (4) A manager, if you are a limited liability company B. NOTICE OF OCCURRENCE Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an "occurrence," offense, claim or "suit" and that failure is solely due to your reasonable belief that the "bodily injury'' or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence," offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence," offense claim or "suit." 4. BROAD NAMED INSURED A. Any subsidiary or affiliate organization, other than a partnership, joint venture or limited liability company, in which a Named Insured specifically shown in the Declarations has management control, directly or through one or more subsidiary organizations, at the time of loss will qualify as a Named Insured but only if there is no other similar insurance available to such organization, nor similar insurance which would be available but for exhaustion of its limits. For the purpose of this provision, similar insurance means general liability or equivalent insurance, no matter whether its coverage is broader or narrower than that provided by this insurance. But if the only other similar insurance is for a "consolidated (wrap-up) program," then a subsidiary that qualifies as a Named Insured on such project-specific insurance can still qualify as a Named Insured on this insurance, but not for projects covered by the "consolidated (wrap-up) program." [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap-up) program."] Copyright, CNA All Rights Reserved. C'NA B. This endorsement does not apply to any organization for which coverage is excluded by another endorsement attached to this policy. C. Only for the purpose of this endorsement: 1. Management control means: a. Ownership interest representing more than 50% of the voting, appointment, or designation power for the subsidiary organization's governing body; or b. Having the right, pursuant to a written contract, or pursuant to the by-laws, charter, operating agreement, or similar document of a specifically shown Named Insured or controlled subsidiary organization to select, appoint, or designate a majority of the subsidiary organization's governing body. Such contract or document must have been created prior to the time of loss; or c. Having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer and sell property held by a trust. 2. Governing body means the Board of Directors of a corporation. 3. Loss means: a. The occurring of the "bodily injury'' or "property damage"; or b. The committing of the offense that caused the "personal and advertising injury." D. The insurance provided by this policy applies to Named Insureds when trading under their own names, or under such trading names or doing- business-as (OBA) names as any should choose to employ. 5. BROADENED LIABILITY COVERAGE FOR DAMAGE TO "YOUR PRODUCT" AND "YOUR WORK" A. Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete exclusions k. and I. and replace them with the following: [This insurance does not apply to ] k. Damage to Your Product "Property damage" to "your product" arising out of it, or any part of it except when caused by or resulting from: 1 Fire; G-18652-J (Ed. 07-12) Page 4 of 12 (2) Smoke; (3) Collapse; or (4) Explosion. Policy No.: 6046226841 G-18652-J (Ed. 07-12) I. Damage to Your Work "Property damage" to "your work'' arising out of it, or any part of it and included in the "products-completed operations hazard." This exclusion does not apply: (1) If the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor; or (2) If the cause of loss to the damaged work arises as a result of: (a) Fire; (b) Smoke; (c) Collapse; or (d) Explosion. B. The following paragraph is added to SECTION Ill -LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most we will pay under Coverage A for the sum of damages arising out of any one "occurrence" because of "property damage" to "your product" and "your work" that is caused by fire, smoke, collapse or explosion and is included within the "product-completed operations hazard." This sublimit does not apply to "property damage" to "your work'' if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. C. This Provision 5. Broadened Liability Coverage For Damage To "Your Product" And "Your Work" does not apply if an endorsement of the same name is attached to this policy. 6. CONTRACTUAL LIABILITY -RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of "insured contract" in SECTION V-DEFINITIONS is replaced by the following: "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by Copyright, CNA All Rights Reserved. C'NA you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 7. CONTRACTUAL LIABILITY FOR PERSONAL AND ADVERTISING INJURY Under SECTION I -COVERAGE B -PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2 Exclusions is amended to delete exclusion e. Contractual Liability. This provision 7. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 8. ELECTRONIC DATA LIABILITY A. Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete G-18652-J (Ed. 07-12) Page 5 of 12 Policy No : 6046226841 G-18652-J (Ed. 07-12) exclusion p. Electronic Data and replace it with the following: [This insurance does not apply to:] p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury." B. The following paragraph is added to SECTION Ill -LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most we will pay under Coverage A for all damages arising out of any one "occurrence" because of "property damage" that results from physical injury to tangible property and arises out of "electronic data." C. The following definition is added to the SECTION V-DEFINITIONS: "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purposes of the coverage provided by this endorsement, the definition of "property damage" in SECTION V -DEFINITIONS is replaced by the following: 17. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data," resulting from physical injury to tangible property. All such loss of "electronic data" shall be Copyright, CNA All Rights Reserved. C'NA deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the $100,000 limit provided by this Provision 8. Electronic Data Liability is part of, and not in addition to, that higher limit. 9. EXPANDED PERSONAL AND ADVERTISING INJURY-DISCRIMINATION OR HUMILIATION A. SECTION V -DEFINITIONS is amended to add the following to the definition of "Personal and advertising injury": h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any insured. B. Under SECTION I -COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to add the following additional exclusions: [This insurance does not apply to:] Discrimination Relating To Room, Dwelling or Premises "Personal or advertising injury" caused by discrimination directly or indirectly related to the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured. Fines Or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. G-18652-J (Ed. 07-12) Page 6 of 12 Policy No.: 6046226841 G-18652-J (Ed. 07-12) This provision 9. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 10. EXPECTED OR INTENDED INJURY Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete exclusion a. Expected or Intended Injury and replace it with the following: [This insurance does not apply to:] a. Expected or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE -PER PROJECT A. For each construction project away from premises you own or rent, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit, is the most we will pay for the sum of: B. All: 1. All damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and 2. All medical expenses under Coverage C, that arise from "occurrences" or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project Aggregate Limit of any other construction project. 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by "occurrences" which cannot be attributed solely to ongoing operations at a single construction project, except damages because of "bodily injury" or "property Copyright, CNA All Rights Reserved. C'NA damage" included in the "products- completed operations hazard"; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, will reduce the General Aggregate Limit shown in the Declarations. C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project Aggregate Limit or the General Aggregate Limit, depending on whether the "occurrence" can be attributed solely to ongoing operations at a particular construction project D. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard," regardless of the number of locations involved will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations. E. If a single construction project away from premises owned by or rented to the insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project F. The provisions of SECTION Ill -LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12. IN REM ACTIONS Any action in rem against any vessel owned or operated by or for you, or chartered by or for you will be treated in the same manner as though the action were in personam against you. In rem is a term used to designate actions instituted against the thing, as distinct from actions against the person, which are said to be in personam. 13. INCIDENTAL HEAL TH CARE MALPRACTICE COVERAGE A. With respect only to "bodily injury'' that arises out of a "health care incident," COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE LIABILITY OF SECTION I -COVERAGES is amended to replace Insuring Agreement G-18652-J (Ed. 07-12) Page 7 of 12 Policy No.: 6046226841 G-18652-J (Ed. 07-12) Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to "bodily injury'' only if you are not in the business of providing professional health care services, and only if: (1) The "bodily injury" is caused by an "occurrence" that takes place in the "coverage territory." For the purpose of this insurance: (a) "Bodily injury'' caused by a "health care incident" will be considered caused by an "occurrence"; and (b) All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a single "occurrence"; (2) The "bodily injury" occurs during the policy period All "bodily injury" arising from an "occurrence" will be deemed to have occurred at the time of the first act, error, or omission that is part of the "occurrence"; and B. With respect only to the insurance provided by this Provision 13., Exclusion 2.e. Employer's Liability of SECTION I -COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE, is amended to append the following: Only for "bodily injury" not covered by other liability insurance (including state-sanctioned self insurance) available to the insured (or which would be available but for exhaustion of its limits), this exclusion does not apply to "bodily injury" that arises out of a "health care incident" C. SECTION V -DEFINITIONS is amended to add the following new definition: "Health care incident" means a negligent act, error or omission by your "employees" or "volunteer workers" working on your behalf in the rendering of or failure to render professional health care services in any of the following capacities, or the related furnishing of food, beverages, medical supplies or appliances: a. Physician; b. Nurse; c. Emergency medical technician; d. Paramedic; e. Chiropractor; Copyright, CNA AJI Rights Reserved. C'NA f. Dentist; g. Athletic trainer; h. Audiologist; i. Physical therapist; j. Psychologist; k. Speech therapist; I. other allied health professional; or m. Provider of first aid or Good Samaritan services rendered in an emergency and for which no payment is demanded or received. D. SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to add the following additional exclusions. These new exclusions apply only to this Incidental Health Care Malpractice Coverage: [This insurance does not apply to ] Dishonesty or Crime Any dishonest, criminal or malicious act, error or omission. Clinical Trials/ Product Testing Acts, errors or omissions that occur in the course of human clinical trials or product testing. Medicare/Medicaid Fraud Medicare or Medicaid fraud or abuse. Services Excluded by Endorsement Any "health care incident" for which coverage is excluded by enrorsement. E. SECTION V -DEFINITIONS is amended to add the following subparagraph to Paragraph f. of the definition of "insured contract": Paragraph f. does not include that part of any contract or agreement: (4) Under which you assume another's tort liability for "bodily injury'' arising out of the rendering of or failure to render professional health care services. F. SECTION II -WHO IS AN INSURED is amended to add the following provisions 1. Your "employees" are insureds with respect to: a. "bodily injury'' to a co-"employee" while in the course of the co-"employee's" employment by you or while performing G-18652-J (Ed. 07-12) Page 8 of 12 Policy No.: 6046226841 G-18652-J (Ed. 07-12) duties related to the conduct of your business; and b. "bodily injury" to a "volunteer worker'' while performing duties related to the conduct of your business; when such "bodily injury" arises out of a "health care incident." 2. Your ''volunteer workers" are insureds with respect to: a. "bodily injury" to a co-"volunteer worker'' while performing duties related to the conduct of your business; and b. "bodily injury'' to an "employee" while in the course of the "employee's" employment by you or while performing duties related to the conduct of your business; when such "bodily injury" arises out of a "health care incident." 3. Paragraphs 2.a. (1 )(a), (b) and (c) of SECTION II -WHO IS AN INSURED do not apply to "bodily injury'' for which insurance is provided this Provision 13. 4. Paragraph 2.a.(1 )(d) of SECTION II - WHO IS AN INSURED is deleted. G. With respect to the insurance provided by this Provision 13., the following is added to Paragraph 4.b.(1) of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS: To the extent this insurance applies, it is excess over any of the other insurance (including qualified self insurance), whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. 14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES A. The following is added to SECTION II -WHO IS AN INSURED: 4. You are an insured when you had an interest in a joint venture, partnership or limited liability company which terminated or ended prior to or during this policy period, but only to the extent of your interest in such joint venture, partnership or limited liability company. This coverage does not apply: a. Prior to the termination date of any joint venture, partnership or limited liability company; Copyright, CNA All Rights Reserved. C'NA b. If there is other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; or c. To a joint venture, partnership or limited liability company which is or was insured under a "consolidated (wrap- up) insurance program." [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap-up) program."] B. The last paragraph of SECTION II -WHO IS AN INSURED is deleted and replaced by the following: Except as provided under the Contractors' General Liability Extension Endorsement or by the attachment of another endorsement (if any), no person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. 15. LEGAL LIABILITY/ALIENATED PREMISES/ BORROWED EQUIPMENT A. Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following: [This insurance does not apply to:] j. Damage to Property "Property damage" to (1) Property you own, rent, or occupy; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. G-18652-J (Ed. 07-12) Page 9 of 12 Policy No : 6046226841 G-18652-J (Ed. 07-12) Paragraph (2) of this exclusion does not apply if the premises are "your work." Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to tools or equipment loaned to you. A separate limit of insurance applies to such tools or equipment that are damaged while being used in your operations. Paragraphs (1 ), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises rented to you or temporarily occupied by you with the permission of the owner, or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in SECTION Ill -LIMITS OF INSURANCE. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products-completed operations hazard " B. Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE the last paragraph of Paragraph 2. Exclusions is deleted and replaced by the following. Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner nor to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in SECTION Ill - LIMITS OF INSURANCE. C. The following paragraph is added to SECTION Ill -LIMITS OF INSURANCE: Subject to 5. above, $25,000 is the most we will pay under Coverage A for damages arising out of any one "occurrence" because of "property damage" to tools or equipment loaned to you by others that occurs while the equipment is being used to perform operations. D. Paragraph 6. Damage To Premises Rented To You Limit of SECTION Ill -LIMITS OF INSURANCE is replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most we will pay under SECTION - I - Copyright, CNA All Rights Reserved. C'NA COVERAGE A for damages because of "property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of: a. $500,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations. E. Paragraph 4.b.(1 )(a)(ii) of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and replaced by the following: (ii) That is property insurance for premises rented to you, for premises temporarily occupied by you with the permission of the owner; or for personal property of others in your care, custody or control; F. This Provision 15. does not apply if Damage To Premises Rented To You Liability under SECTION - I -COVERAGE A is excluded by endorsement. 16. LIBERALIZATION CLAUSE If we adopt a change in our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverage as of the date the revIsIon is effective in your state. 17. LIQUOR LIABILITY Under SECTION I -COVERAGE A-BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion c. Liquor Liability. This provision 17. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part 18. MEDICAL PAYMENTS A. Paragraph 7. Medical Expense Limit, of SECTION Ill -LIMITS OF INSURANCE is deleted and replaced by the following: 7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most we will pay under SECTION - I -COVERAGE C for all medical expenses because of "bodily injury" sustained by any one person. The Medical Expense Limit is the greater of: (1) $15,000; or G-18652-J (Ed. 07-12) Page 10 of 12 Policy No.: 6046226841 G-18652-J (Ed. 07-12) (2) The amount shown in the Declarations for Medical Expense Limit. B. Paragraph 1.a.(3)(b) of SECTION I COVERAGE C MEDICAL PAYMENTS, is replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident; and This paragraph B. does not apply to medical expenses incurred in the state of Missouri. 19. NON-OWNED AIRCRAFT Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE LIABILITY. Paragraph 2. Exclusions is amended such that exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft you do not own, provided that: 1. The pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. The aircraft is rented to you with a trained, paid crew; and 3. The aircraft does not transport persons or cargo for a charge. 20. NON-OWNED WATERCRAFT Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft and replace it with the following. [This exclusion does not apply to:] (2) A watercraft you do not own that is: (a) Less than 75 feet long; and (b) Not being used to carry persons or property for a charge. 21. PRIMARY AND NON-CONTRIBUTORY TO OTHER INSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to Paragraph 4. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this Provision 21., the additional Copyright, CNA All Rights Reserved. C'NA insured's own insurance means insurance on which the additional insured is a Named Insured. This Provision 21. does not apply in situations where the endorsement on this policy affording coverage to the additional insured specifies that this insurance is excess over any other insurance available to that additional insured. 22. PROPERTY DAMAGE-ELEVATORS A. Under SECTION I -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended such that exclusion k. Damage to Your Product, and subparagraph (3), (4) and (6) of exclusion j. Damage to Property do not apply "property damage" that results from the use of elevators. B. With respect only to the coverage provided by this endorsement, Condition 4. Other Insurance in SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following subparagraph b.(1 )(a)(v): 4. Other Insurance b. Excesslnsurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (v) That is Property insurance covering property of others damaged from the use of elevators. 23. SUPPLEMENTARY PAYMENTS A. Under Section I -Supplementary Payments -Coverages A and B, Paragraph 1.b., the limit of $250 shown for the cost of bail bonds is replaced by $5,000: B. In Paragraph 1.d., the limit of $250 shown for daily loss of earnings is replaced by $1,000 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If unintentionally you should fail to disclose all existing hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. 25. WAIVER OF SUBGROGATION -BLANKET Under SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: G-18652-J (Ed. 07-12) Page 11 of 12 Policy No : 6046226841 G-18652-J (Ed. 07-12) We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work'' included in the "products completed operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. 26. WRAP-UP EXTENSION: OWNER CONTROLLED INSURANCE PROGRAM, CONTRACTOR CONTROLLED INSURANCE PROGRAM OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a "consolidated (wrap-up) insurance program" by applicable state statute or regulation: If the endorsement EXCLUSION - CONSTRUCTION WRAP-UP or another exclusionary endorsement pertaining to owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C. C. I. P.) is attached to this policy, then the following changes apply: A. The following wording is added to the endorsement: With respect to a "consolidated (wrap-up) insurance program" project in which you are or were involved, this exclusion does not apply to those sums you become legally obligated to pay as damages because of: 1. "Bodily injury," "property damage," or "personal or advertising injury" that occurs during your ongoing operations at the project, or during such operations of anyone acting on your behalf; nor 2. "Bodily injury" or "property damage" included within the "products-completed operations hazard" that arises out of those portions of the project that are not "residential structures." B. SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add Copyright, CNA All Rights Reserved. C'NA the following subparagraph 4.b.(1 )(c) to Condition 4. Other Insurance: [This insurance is excess over:] (c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to you as a result of your being a participant in a "consolidated (wrap-up) insurance program," but only as respects your involvement in that "consolidated (wrap-up) insurance program." C. SECTION V -DEFINITIONS is amended to add the following definition: "Consolidated (wrap-up) insurance program" means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (O.C. I.P.) or All other terms and conditions of the Policy remain unchanged. Policy No.: 6046226841 G-18652-J (Ed. 07-12) Contractor Controlled Insurance Program (C.C.I.P.). "Residential structure" means any structure where 30% or more of the square foot area is used or is intended to be used for human residency including but not limited to single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments and also includes their common areas and/or appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). When there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities hotels, or motels. Residential structure also does not include hospitals or prisons. This provision 26. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 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. G-18652-J (Ed. 07-12) Page 12 of 12 Material used with permission of ISO Properties, Inc Copyright, CNA All Rights Reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/22/2017 I.... _,/ 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGRATION 15 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 Willis Towers Watson CONTACT NAME: San Diego 12980 Metcalf Ave Suite 500 PHONE (A/C, No Ext): (858) 314-1100 FAX (A/C, NO): (360) 828-0699 Overland Park KS 66213 EMAIL ADDRESS: Elke.Wohlgemuth@bbsihq.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Barrett Business Services, Inc. UC/F INSURERC: GLOBAL POWER GROUP, INC. INSURER D: 12060 WOODSIDE AVE INSURER E: LAKESIDE, CA 92040 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ISSUES 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICYEFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ ,..._ DAMAGE TO RENTED PREMISES (Ea COMMERCIAL GENERAL LIABILITY $ I CLAIMS-MADE D OCCUR occurence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY n ~~~J-n LOG PRODUCTS -COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ----(Ea accident) ANY AUTO ,..._ BODILY INJURY (Per person) $ ALL OWNED AUTOS B SCHEDULED AUTOS ----BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS ,..._ PROPERTY DAMAGE $ ----$ UMBRELLA LIAB ~OCCUR EACH OCCURRENCE $ -EXCESS LIAB OCCUR AGGREGATE $ -OED I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 05/01/17 05/01/2018 ,/ Iwc STATU- I IOTH-LIABILITY Y/N C64382238 TORY LIMITS ER ANY PROPRIETOR/PARTNER/ EXECUTIVE ~ N/A X E.L. EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? Covered states: E.L. DISEASE -EA EMPLOYEE $2,000,000 (Mandatory In NH) If yes, describe under CA DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Services EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4668 -ECM #35050 AUTHORIZED REPRESENTATIVE New York NY 10163-4668 Authorized ~ /It.~ Rep I c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: ____________ _ LOC: #: _____________ _ ~ ACORD® 6... AGENCY ADDITIONAL REMARKS SCHEDULE NAMED INSURED: Barrett Business Services, Inc. L/C/F Arrowhead General Insurance Agency GLOBAL POWER GROUP, INC. POLICY NUMBER 12060 WOODSIDE AVE LAKESIDE, CA 92040 RWC C64382238 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 05/01/17 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services ADDRESS: P.O. Box 4668-ECM #35050 New York NY 10163-4668 30 day notice of cancellation will be provided when possible. Page ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. 2 of 2 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC. L/C/F GLOBAL POWER GROUP, INC. Policy Number 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Svmbol: RWC Number: C64382238 Policy Period Effective Date of Endorsement 05-01-2017 TO 05-01-2018 05-01-2017 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the oolicv number. The remainder of the information is to be comoleted onlv when this endorsement is issued subseauent to the oreoaration of the oolicv. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1 . ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2 . O percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : $0 Authorized Agent WC 99 0322