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HomeMy WebLinkAboutVaughn's Industrial Repair Inc; 2018-11-26; PWM19-614UTIL.· RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2018-0529919 111111111111 lllll 111111111111111 lllll lllll lllll lllll 111111111111111111 Dec 27, 2018 03:11 PM OFFICIAL RECORDS Ernest J. Dronenburg, Jr, SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins $0.00) PAGES 2 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full name of the undersigned is Carlsbad Municipal Water District (CMWD), a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on October 81 2018. 6. The name of the contractor for such work or improvement is Vaughan's Industrial Repair Co., Inc. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Agreement No. PWM19-614UTIL. 8. The street address of said property is 6216 Avenida Encinas, in the City of Carlsbad. CARLSBA~ MU~ICIPAL WATER DISTRICT fo1~ -o/ Executive ~er VERIFICATION OF SECRETARY I, the undersigned, say: I am the Secretary of the City Carlsbad Municipal Water Dis~ 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the Executive Manager of said Board on c Q,,,.. IJ , 20 /"? , accepted the above described work as completed and ordered that a Notice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on f)~ • / 9 , 2o_[i_, at Carlsbad, California. CARLSBAD MUNICIPAL WATER DISTRICT UtAYJUAD-Rrr1~~ h,j;ARBARA ENGLESON (JV ~ecretary Q:\Public Works\Utilities\ADMINISTRATIONIAGREEMENTS & CONTRACTSIAGREEMENTS & CONTRACTS\Vaughan's Industrial Repair Co\Pump #2 Removal & Repair Assesment\NOC Docs\NOC (Public and Private) -revised 2018-11-14.doc AND CARLSBAD MUNICIPAL WATER DISTRICT ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Vaughan's Industrial Repair Co., Inc. has completed the contract work required for (PWM19- 614UTIL) Carlsbad Water Recycling Facility (CWRF) Pump No. 2 Assessment. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS (Specify if City or CMWD) Carlsbad Water Recycling Facility (CWRF) Pump No. 2 Assessment (CMWD) VALUE $5,998 CERTIFICATION OF COMPLETION OF IMPROVEMENTS iesManager / Date 7 EXECUTIVE MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The Secretary to the Board of Directors is hereby authorized to record the Notice of Completion and release the bonds in accordance with State Law and City Ordinances. The Carlsbad Municipal Water District is hereby directed to commence maintaining the above described improvements. J&~ P·/l•!U ytf Scott Chaa-, Executive Manager Date \ APPROVED AS TO FORM: CELIA BREWER, City Attorney By[1Ql 94= Defpy CityA.lforney Q:\Public Works\Utilities\ADMINISTRATIONIAGREEMENTS & CONTRACTSIAGREEMENTS & CONTRACTS\Vaughan's Industrial Repair Co\Pump #2 Removal & Repair Assesment\NOC Docs\API (Public Works) -revised 2018-08-01.doc PWM19-614UTIL CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT Page 1 of 6 General Counsel Approved 9/27/16 CARLSBAD MUNICIPAL WATER DISTRICT MINOR PUBLIC WORKS CONTRACT CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT This agreement is made on the ______________ day of _________________________, 2018, by the CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, hereinafter referred to as “CMWD”, and VAUGHAN'S INDUSTRIAL REPAIR, INC., a California corporation, whose principal place of business is 16224 Garfield Ave., Paramount, CA 90723 (hereinafter called "Contractor"). CMWD and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor’s proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Eric Sanders (CMWD Project Manager) WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is CMWD’s "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. DocuSign Envelope ID: F0BA1284-2452-447D-AC9C-E797E07B3217 November 26th PWM19-614UTIL CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT Page 2 of 6 General Counsel Approved 9/27/16 FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to CMWD must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for CMWD to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: ___________________________________ REQUIRED INSURANCE. The successful contractor shall provide to CMWD, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers’ Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to CMWD prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than……..$1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ….…$1,000,000 Property damage insurance in an amount of not less than……..$1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for “any auto” and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to CMWD prior to such cancellation. The policies shall name CMWD as additional insured. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. WORKERS COMPENSATION AND EMPLOYER’S LIABILITY. Worker’s Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. DocuSign Envelope ID: F0BA1284-2452-447D-AC9C-E797E07B3217 Keven T. Vaughan PWM19-614UTIL CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT Page 3 of 6 General Counsel Approved 9/27/16 BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless CMWD and the City of Carlsbad, and its 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 the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of CMWD or City of Carlsbad. The expenses of defense include all costs and expenses including attorneys’ fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor started work on September 5, 2018. Completion: Contractor completed work on October 3, 2018. CONTRACTOR’S INFORMATION. Vaughan's Industrial Repair Co., Inc. 16224 Garfield Ave. (name of Contractor) 535078 (street address) Paramount, CA 90723 (Contractor’s license number) C-61/D21-Machinery and Pumps 7/31/20 (city/state/zip) 562-633-2660 x16 (license class. and exp. date) 1000013667 (telephone no.) 562-633-1604 (DIR registration number) 6/30/19 (fax no.) jack@virc1.com (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: F0BA1284-2452-447D-AC9C-E797E07B3217 PWM19-614UTIL CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT Page 4 of 6 General Counsel Approved 9/27/16 AUTHORITY. The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR VAUGHAN'S INDUSTRIAL REPAIR CO., INC., a California corporation CARLSBAD MUNICIPAL WATER DISTRICT By: By: (sign here) Keven T. Vaughan, Vice President Vicki V. Quiram, General Manager as authorized by the Executive Manager (print name/title) By: (sign here) David Newton, Treasurer (print name/title) If required by CMWD, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, General Counsel BY: _____________________________ Assistant General Counsel DocuSign Envelope ID: F0BA1284-2452-447D-AC9C-E797E07B3217 PWM19-614UTIL CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT Page 5 of 6 General Counsel Approved 9/27/16 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. DocuSign Envelope ID: F0BA1284-2452-447D-AC9C-E797E07B3217 0 0 0 0 0 0 0 0 0 none 0 0 0 0 0 0 0 0 0 0 00 0none0 0 00 0 0 0 0 0 0 0 0 PWM19-614UTIL CARLSBAD WATER RECYCLING FACILITY (CWRF) PUMP NO. 2 ASSESSMENT Page 6 of 6 General Counsel Approved 9/27/16 EXHIBIT B CARLSBAD WATER RECYCLING FACILITY (CWRF) NO. 2 PUMP AND MOTOR REMOVAL FOR INSPECTION AND ASSESSMENT JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 Job EA CONTRACTOR will perform/provide the following: Personnel will arrive on site and verify proper isolation of equipment. Uncouple motor from pump, unbolt pump discharge connection and remove base bolts. Remove vertical pump and 500 HP electric motor, load onto common carrier truck. CONTRACTOR will provide crane and transportation services as required. Transport equipment to CONTRACTOR’S repair center. Disassemble pump/motor, inspect and provide assessment. TOTAL* $5,998 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: F0BA1284-2452-447D-AC9C-E797E07B3217 10/31/2018 Milestone Risk Management & Insurance Services License No. 0B72766 8 Corporate Park, Suite 130 Irvine CA 92606 Teresa Shen (949)852-0909 (949)852-1131 tshen@milestonepromise.com V.S.S. Sales dba Vaughan's Industrial Repair Co. 16224 Garfield Avenue Paramount CA 90723-0000 Admiral Insurance Company 24856 American Fire & Casualty Insurance 24066 Insurance Company of the West 27847 Liberty Mutual Insurance Company 23043 18/19 Master Incl WC A X X X CA00001643507 2/23/2018 2/23/2019 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 Per Occurrence Deductible 5,000 B X X X X BAA(19)56755498 2/23/2018 2/23/2019 1,000,000 Comp. / Coll. Deductibles 1,000 A X X X 0 BEX09601304-03 2/23/2018 2/23/2019 5,000,000 5,000,000 C WSA504410800 11/1/2018 11/1/2019 X 1,000,000 1,000,000 1,000,000 D Rented/Leased Equipment BKO(19)56755498 2/23/2018 2/23/2019 Limit / Deductible $50K / $1K RE: Agreement No. PWM18-13UTIL - Repair 500 HP US Electrick Motor for Encina Vertical Pump and Rebuild Three Valmatic Valve Dampener Controls. The City of Carlsbad is named as an additional insured per the attached endorsements. WC waiver of subrogation applies per the attached endorsement. *30 days written notice of cancellation to the certificate holder/10 days notice for nonpayment of premium. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services PO Box 4668 - ECM #35050 New York, NY 10163-4668 Catherine Montoya/CAM The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$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 Ifyes,describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). 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. INS025 (201401) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. However: in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations When required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT· BLANKET WC990634 (Ed. 8-00) We have the right to re cover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be 3 % of the total California Workers' Compensation premium otherwise due. Person or Organization ANY PERSON/ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT Schedule Job Description ALL CALIFORNIA OPERATIONS 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 11/01/2018 Policy No. WSA 5044108 00 Insured V S S Sales Insurance Company INSURANCE COMPANY OF THE WEST Endorsement No. Premium $ INCL. Countersigned By _____________ _ WC 990634 (Ed. S-00) INSURED