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HomeMy WebLinkAboutXylem Water Solutions USA Inc; 2020-07-21;AGREEMENT FOR PARTS AND OVERSIGHT OF VARIABLE FREQUENCY DRIVE REPAIR AND REPLACEMENT PUMP IMPELLER SERVICES XYLEM WATER SOLUTIONS USA, INC. THIS AGREEMENT is made and entered into as of the /1 I day of , 20< by and between the CITY OF CARLSBAD, a municipal corporation, ("City'), and Xylem Water Solutions USA, Inc., a corporation, ("Contractor"). RECITALS City requires the professional services of a company that is experienced in providing the parts and labor for the installation of variable frequency drive repair and replacement of two pump impellers. Contractor has the necessary experience in providing these professional services, has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in Exhibit "A", attached and incorporated by this reference in accordance with the terms and conditions set forth in this Agreement. 2. TERM This Agreement will be effective for a period of six months from the date first above written. 3. COMPENSATION The total fee payable for the Services to be performed will be nine thousand forty-six dollars and seventy-five cents ($9,046.75). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or the Services specified in Exhibit "A." 4. STATUS OF CONTRACTOR Contractor will perform the Services as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under the control of City only as to the results to be accomplished. 5. 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 attorney's 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. The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City's self-administered workers' City Attorney Approved Version 6/12/18 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. 6. INSURANCE Contractor will obtain and maintain policies of commercial general liability insurance, automobile liability insurance, a combined policy of workers' compensation, employers liability insurance, and professional liability insurance from an insurance company authorized to transact the business of insurance in the State of California which has 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, in an amount of not less than one million dollars ($1,000,000) each, unless otherwise authorized and approved by the Risk Manager or the City Manager. Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. The insurance will be in force during the life of this Agreement and will not be canceled without thirty (30) days prior written notice to the City by certified mail. City will be named as an additional insured on General Liability which shall provide primary coverage to the City. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Contractor will furnish certificates of insurance to the Contract Department, with endorsements to City prior to City's execution of this Agreement. 7. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City For Contractor Name Morgan Rockdale Name Alan Dahlqvist Title Parks/Trees Supervisor Title District Sales Representative Department Parks & Recreation Address 11161 Harrel Street City of Carlsbad Mira Loma, CA 91752 Address 799 Pine Street, Suite 200 Phone No. 951-332-3669 Carlsbad, CA 92010 Email Alan.Dahlqvist@Xyleminc.com Phone No. 760-434-2985 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. 8. CONFLICT 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 fl No 9. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting City Attorney Approved Version 6/12/18 discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. 10. TERMINATION City or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. City will pay Contractor's costs for services delivered up to the time of termination, if the services have been delivered in accordance with the Agreement. 11. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees it may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. Contractor further acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to terminate this Agreement. 12. JURISDICTIONS AND VENUE Contractor agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Agreement is the State Superior Court, San Diego County, California. 13. ASSIGNMENT Contractor may assign neither this Agreement nor any part of it, nor any monies due or to become due under it, without the prior written consent of City. 14. AMENDMENTS This Agreement may be amended by mutual consent of City and Contractor. Any amendment will be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. /// /// /// 1/1 /// /// /// /// City Attorney Approved Version 6/12/18 3 (sign ere) Icy P A/P (print namettle) By: By: (el ager or Mayor or Director _ By: (sign here) CSO<CV ((t jcCwUStk1i'•)7) (print name/title) CELIA A. BREWER, Ci A rney By: AssisanjICity Attorney 15. 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 CITY OF CARLSBAD, a municipal corporation of the State of California ATTEST: CAcyr pARBARA ENGLESON City Clerk If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A. Group B. Chairman, Secretary, President, or Assistant Secretary, Vice-President 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: City Attorney Approved Version 6/12/18 4 This Unanimous Written Consent of the Board of Directors effective n Jun , 20 XYLEM WATER SOLUTIONS U.S.A,, INC, UNANIMOUS CONSENT OF THE BOARD OF DIRECTORS WHEREAS, the undersigned, constituting all of tho members of the Board of Directors of Xylem Water Solutions U.S.A., Ilse., a Delaware corporation formed pursuant to the laws of the State of Delaware (the "Corporation"), do hereby consent, pursuant to Section 141(0 of the General Corporation Law of the State of Delaware, to the adoption of the resolutions set forth below, with the sumo effect as if said actions were taken by unanhnous approving vote at a meeting at which all of the directors were present in person: RESOLVED: That the 'mild (1011011S taken by the current and former officers of the Corporation, in the name of and on behalf of the Corporation are hereby adopted, ratified, and approved, RESOLVED FURTHER: That the following named persons are appointed as officers of the Corporation in the capacities indicated opposite their respective names, to serve as officers Rom this date forward until their resignation, removal, termination of employment with the Corporation or its affiliates, or death or until their successors are duly appointed. Xmil Mira is JO .3taim Office (s) Ron-Askin Jo5•C " kr , President Peter 131 tolls Vice President, General Counsel & Secretary Matthew Fisher Vice President & Treasurer Theresa Oladstein Vice President & Assistant Treasurer Robert Lyons Vic President & Assistant Treasurer Kyle Foushee Vice President Michael Work Vice President Joseph McCausland Vice President Kenneth Napolitano Vice President James D. Peterson Vice President Michael MeGeover Vice President Patrick Monks Vice President Steve Scheldier Vice President Christine Valencia Vice President Peter Van Winkle Vice President RESOLVED: That any previous appointments of officers for the Corporation arc hereby revoked. RESOLVED FURTHER: That this Unanimous Written Consent may be executed In any number of counterparts, each of which WWI so executed shall be deemed to be an original and all of which when taken together shall constitute one and the same document, and that the different directors of the Corporation need not be signatories to the same counterpart. EXHIBIT "A" SCOPE OF SERVICES 1. Provide parts and installation oversight for the variable frequency drive repair at Pine Avenue Restroom. 2. Replace impellers and insert rings on 2 pump motors, contractor will provide parts and labor. JOB QUOTATION PART NO. QTY DESCRIPTION PRICE 766 79 63 1 KIT,SMARTRUN SRC311 10/230/3+ OR 5/230/1 $3,534.75 14-69 00 00A 4 LABOR,MOBILE SVC FLYGT,NO TAX $588.00 798 25 14 2 IMPELLER,N SH CODE 255/455 HC $3,090.00 798 17 00 2 RING,INSERT HC $708.00 14-69 00 00A 6 LABOR,SVC FLYGT,NO TAX ZI -TP MODELS: $882.00 Freight Charge $244.00 TOTAL NOT TO EXCEED* $9,046.75 *Includes taxes, fee's, expenses and all other costs. City Attorney Approved Version 6/12/18 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Carlsbad/CMWD 1635 Faraday Avenue Carlsbad, CA 92008 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Lauren Giagrande (7> Nr, t.,J,Jarsis-SK•sa—nna—c, -- 1 ® A CCPR CO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 CN108453421-STND-GAWUe-19-20 CONTACT NAME: PHONE FAX (A/C, No. Extl: (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: See Acord 101 INSURED Xylem Water Solutions USA, INC 14125 South Bridge Circle Charlotte, NC 28273 INSURER B: National Union Fire Ins. Co. 19445 INSURER C: Allianz Global Risks US Insurance Company 35300 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-010338181-12 REVISION NUMBER: 18 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 LTR TYPE OF INSURANCE ADDL INSD SUBR VVVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY GL 6862456 . 10/31/2019 10/31/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JEC PRO- T PER: LOC GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 SR. $1,000,000 $ B B B X _ — AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY CA 5320316 (ADS) CA 5320317 (VA) CA 5320318 (MA) 10/31/2019 10/31/2019 10/31/2019 10/31/2020 10/31/2020 10/31/2020 COMBINEent)D SINGLE LIMIT (Ea accid $ 3,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS-MADE USL00109919 10/31/2019 10/31/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below y / N N N/A SEE ACORD 101 10/31/2019 10/31/2020 x PER STATUTE 0TH-ER E.L. EACH ACCIDENT 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 EL. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carlsbad and its officials and employees are included as Additional Insured (except Workers' Compensation) where required by written contract. This insurance is primary over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of Subrogation is applicable where required by written contract and as permissible by law. CERTIFICATE HOLDER CANCELLATION © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN108453421 LOC #: New York ACCoRD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA, Inc. NAMED INSURED Xylem Water Solutions USA, INC 14125 South Bridge Circle Charlotte, NC 28273 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE. Certificate of Liability Insurance WORKERS COMPENSATION: CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608516 (AOS) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608517 (IL, KY, NC, NH, UT, VT) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608518 (NJ, PA) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608519 (MA, OH, WA, WI, WY) CARRIER: AMERICAN HOME ASSURANCE COMPANY! NAIC CODE: 19380 POLICY: WC 020608520 (CA) CARRIER: ILLINOIS NATIONAL INSURANCE COMPANY/ NAIC CODE: 23817 POLICY: WC 020608521 (FL) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608522 (AZ, VA) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY GL 686-24-56 CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 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", "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: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following " attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 10/31/2019 forms a part of Policy No. WC 020608520 Issued to Xylem Inc. By American Home Assurance Company Premium We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. WC 04 03 06 Countersigned by (Ed. 04/84) Authorized Representative ENDORSEMENT This endorsement, effective 12:01 A.M. farms a part of policy No. 532-03-16 issued to Xylem Inc. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: Any person or organization for whom you are contractually bound to provide Additional Insured status. But only to the extent of such person's or organization's liability arising out of use of a covered "auto". SECTION II - LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. 87950 (10/05) Authorized Representative or Countersignature (in States Where Applicable-) Page 1 of 1 ---- 7 ® Accmc• CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 05/28/2020 THIS CERTIFICATE 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 CN108453421-STND-GAWUe-19-20 CONTACT NAME: PHONE FAX (A/C No. Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : See Acord 101 INSURED Xylem Water Solutions USA, Inc. 4828 Parkway Plaza Blvd, Suite 200 Charlotte, NC 28217 INSURER B : National Union Fire Ins. Co. 19445 INSURER c : Allianz Global Risks US Insurance Company 35300 INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-010900489-01 REVISION NUMBER: 4 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 LTR TYPE OF INSURANCE ADDL INSD SUBR MD POLICY NUMBER POLICY EFF (MM/DDNYYY) POLICY EXP (MM/DD/YYYY) LIMITS B x COMMERCIAL GENERAL LIABILITY GL 6862456 10/31/2019 10/31/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JEC PRO- T PER: LOC GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 SIR: $1,000,000 $ CO CO al X AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY CA 5320316 (ADS) CA 5320317 (VA) CA 5320318 (MA) 10/31/2019 10/31/2019 10/31/2019 10/31/2020 10/31/2020 10/31/2020 COMBINEent)D SINGLE LIMIT (Ea accid $ 3,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ $ C v A — UMBRELLA LIAB EXCESS LIAB X _ OCCUR CLAIMS-MADE U5L00109919 10/31/2019 10/31/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPR1ETOR/PARTNER/EXECUTIVE oFFicER/mEmBERExcLuDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N/A SEE ACORD 101 10/31/2019 10/31/2020 x PER STATUTE 0TH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as additional insured (excep Workers Compensation) as required by written contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of Subrogation is applicable where required by written contract and as permissible by law. CERTIFICATE HOLDER CANCELLATION City of Carlsbad/ Parks & Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Administration THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 799 Pine Avenue, Suite 200 ACCORDANCE WITH THE POLICY PROVISIONS. Carlsbad, CA 92008 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Lauren Giagrande © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN108453421 LOC #: New York ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA, Inc. NAMED INSURED Xylem Water Solutions USA, Inc. 4828 Parkway Plaza Blvd, Suite 200 Charlotte, NC 28217 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE. Certificate of Liability Insurance WORKERS COMPENSATION: CARRIER: NEW HAMPSHIRE INSURANCE COMPANY] NAIC CODE: 23841 POLICY: WC 020608516 (AOS) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608517 (IL, KY, NC, NH, UT, VT) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608518 (NJ, PA) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608519 (MA, OH, WA, WI, WY) CARRIER: AMERICAN HOME ASSURANCE COMPANY! NAIC CODE: 19380 POLICY: WC 020608520 (CA) CARRIER: ILLINOIS NATIONAL INSURANCE COMPANY/ NAIC CODE: 23817 POLICY: WC 020608521 (FL) CARRIER: NEW HAMPSHIRE INSURANCE COMPANY! NAIC CODE: 23841 POLICY: WC 020608522 (AZ, VA) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT This endorsement, effective 12:01 A.M. forms a part of policy No. 532-03-16 issued to Xylem Inc. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES TFIE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: Any person or organization for whom you are contractually bound to provide Additional Insured status. But only to the extent of such person's or organization's liability arising out of use of a covered "auto". L SECTION II - LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. 87950 (10/05) Authorized Representative or Countersignature (in States Where Applicable-) Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY GL 686-24-56 CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Per the contract or Agreement. 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 agree- ment, the insurance afforded to such addi- tional 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 Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of Insurance shown in the Decla- rations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 0 ENDORSEMENT This endorsement, effective 12:01 A.M. forms a part of policy No. GL 686-24-56 issued to Xylem Inc. By National Union Fire Insurance Company of Pittsburgh, Pa. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY COVERAGE FOR SPECIFIED PERSONS OR ORGANIZATIONS NAMED AS ADDITIONAL INSUREDS - ONGOING OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following paragraph is added to SECTION II - WHO IS AN INSURED and applies only to persons or organizations we have added to your policy as additional insureds by endorsement to comply with insurance requirements of written contracts relative to the performance of your ongoing operations for the additional insureds: This insurance is primary over any similar insurance available to any individual or entity we have added to this policy as an additional insured. However, this insurance is primary over the other similar insurance only if the additional insured is designated as a named insured in the Declarations of the other similar insurance. We will not require contribution of limits from the other similar insurance if the insurance afforded by this endorsement is primary. This insurance is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, if it is not primary as defined in the paragraph above. All other terms and conditions of the policy are the same. 90534 (3/06) Authorized Representative or Countersignature (in States Where Applicable) Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following ' attaching clause' need be completed only when this endorsement is issued subsequent to preparation of the policy), This endorsement, effective 12:01 AM 10/31/2019 forms a part of Policy No. WC 020608520 Issued to Xylem Inc. By American Home Assurance Company Premium We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. WC 04 03 06 Countersigned by (Ed. 04/84) Authorized Representative