Loading...
HomeMy WebLinkAboutEnvironmental Logistics Inc; 2021-04-06; PSA21-1424UTILPSA21-1424UTIL General Counsel Approved Version 6/12/18 1 AGREEMENT FOR HAZARDOUS AND NON-HAZARDOUS WASTE DISPOSAL SERVICES ENVIRONMENTAL LOGISTICS, INC. THIS AGREEMENT is made and entered into as of the _____________________ day of _________________________________, 2021, by and between 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, ("CMWD"), and Environmental Logistics, Inc., a California corporation, ("Contractor”). RECITALS CMWD requires the professional services of a consultant that is experienced in hazardous and non-hazardous waste disposal services. Contractor has the necessary experience in providing these professional services, has submitted a proposal to CMWD and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, CMWD and Contractor agree as follows: 1. SCOPE OF WORK CMWD 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 thirty (30) days from the date first above written. 3. COMPENSATION The total fee payable for the Services to be performed will be four thousand five hundred thirty- six dollars and seventy-five cents dollars ($4,536.75). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. CMWD reserves the right to withhold a ten percent (10%) retention until CMWD has accepted the work and/or the Services specified in Exhibit “A.” 4. PREVAILING WAGE RATES Any construction, alteration, demolition, repair, and maintenance work, including work performed during design and preconstruction such as inspection and land surveying work, cumulatively exceeding $1,000 and performed under this Agreement are subject to state prevailing wage laws. 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 such workers employed by him or her in the execution of the 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. DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 6th April PSA21-1424UTIL General Counsel Approved Version 6/12/18 2 5. 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 CMWD. Contractor will be under the control of CMWD only as to the results to be accomplished. 6. INDEMNIFICATION Contractor agrees to indemnify and hold harmless CMWD 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 CMWD incurs or makes to or on behalf of an injured employee under the CMWD’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 7. 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 CMWD by certified mail. CMWD will be named as additional insured on General Liability which shall provide primary coverage to CMWD. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. Contractor will furnish certificates of insurance to CMWD with endorsements to CMWD, prior to CMWD’s execution of this Agreement. 8. NOTICES The name of the persons who are authorized to give written notices or to receive written notice on behalf of CMWD and on behalf of Contractor under this Agreement. For CMWD For Contractor Name Timothy Smith Name Keilah Serrano Title Utilities Maintenance Planner Title Customer Service Carlsbad Municipal Water District Address 140 W. Monte Avenue Address 5950 El Camino Real Rialto, CA 92316 Carlsbad, CA 92008 Phone 909-721-2318 Phone 760-421-6434 E-mail keilah@envlogs.com DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 PSA21-1424UTIL General Counsel Approved Version 6/12/18 3 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. 9. 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 ☐ No ☒ 10. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. 11. TERMINATION CMWD or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. CMWD 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. 12. 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 CMWD to terminate this Agreement. 13. 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. 14. 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 CMWD. 15. AMENDMENTS This Agreement may be amended by mutual consent of CMWD and Contractor. Any amendment will be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. /// /// /// /// /// /// DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 PSA21-1424UTIL General Counsel Approved Version 6/12/18 4 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 CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad ENVIRONMENTAL LOGISTICS, INC., a California corporation By: By: (sign here) Vicki V. Quiram, General Manager, as authorized by the Executive Manager James Goyich, Secretary (print name/title) By: (sign here) Mark Freeman, Vice President (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, 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: CELIA A. BREWER, General Counsel By: _____________________________ Assistant General Counsel DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 PSA21-1424UTIL General Counsel Approved Version 6/12/18 5 EXHIBIT “A” SCOPE OF SERVICES DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 NVIRONMEN LOGISTICS Estimate (888)641-3940 www.envlogs.com Generator Name/Address Estimate By JON Bill To Name/ Address Estimate# Date 513 2/1 8/2021 CITY OF CARLSBAD CITY OF CARLSBAD STORM DRAIN MAINTENANCE 5950 EL CAMINO REAL ATTN: LINDA VOIGTLANDER CARLSBAD, CA 92008 5950 EL CAM1NO REAL CARLSBAD, CA 92 008 Contact Name Phone Email EPAID Terms LINDA VOIGTLANDER LINDA .VOIGTLANDER@CARLS ... Credit Card Description Qty Unit Rate Total DISPOSAL NON-RCRA HAZARDOUS WASTE LIQUID 1 55DM 125.00 125.00 (MOTOR OIL) NON-RCRA HAZARDOUS WASTE LIQUID I 30 DF 150.00 150.00 (LAB PACK) NON-RCRA HAZARDOUS WASTE SOLID I 5DF 75.00 75.00 (LAB PACK) NON-HAZARDOUS WASTE SOLID 1 30 OF 100.00 100.00 (DRAINED USED OIL FILTERS) RCRA HAZARDOUS WASTE I 55DM 425.00 425.00 (FLAMMABLE LIQUID TOXIC LAB PACK) RCRA HAZARDOUS WASTE 1 5 CY 450.00 450.00 (UN1956, COMPRESSED GAS 2.2) Total ASSUMPTIONS -The work schedule will not be affected by inclement or dangerous weather conditions.-Hourly rates are based on portal to portal, during normal weekday operations .-Overtime (after 8 hours) Double Time (after 12 hours and weekend and Holiday Normal rates) apply. -Additional services requested that are not listed in this proposal will be billed according to our standard schedule of rates. -Actual volume of waste materials may vary from estimate and will be billed accordingly.-Disposal charges are subject to approval of the waste profile by the disposal facility. Page 1 Hazardous/Non-Hazardous Pickup & Disposal R60350 DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 ENVIRONMENT� LOGISTICS� Estimate (888)641-3940www.envlogs.com Generator Name/Address Estimate By JON Bill To Name / Address Estimate# Date 513 2/18/2021 CITY OF CARLSBAD CITY OF CARLSBAD STORM J:?RAIN MAINTENANCE 5950 EL CAMINO REAL ATTN: LINDA VOIGTLANDER CARLSBAD, CA 92008 5950 EL CAMINO REAL CARLSBAD, CA 92008 Contact Name Phone Email EPAID Terms LINDA VOIGTLANDER LINDA. VOIGTLANDER@CARLS ... Credit Card Description Qty Unit Rate Total *TRANSPORTATIONSERVICE TRUCK 6 HRS 125.00 750.00 *PERSONNELPROJECT MANAGER 6 HRS 125.00 750.00 TECHNICIAN 6 HRS 110.00 660.00 *SUPPLIES5 GAL OPEN TOP POLY DRUM 2 EA 20.00 40.00 55 GAL DOT OPEN TOP MET AL DRUM 2 EA 55.00 110.00 30 GAL OPEN TOP POLY DRUM 2 EA 65.00 130.00 VERMICULITE 2 EA 30.00 60.00 LEVEL"D"SAFETY 2 EA 35.00 70.00 *SERVICESE-MANIFEST FEE 2 EA 25.00 50.00 INVOICE SUBTOTAL 3,945.00 15% ENVIRONMENTAL ENERGY CHARGE 15.00% 591.75 Total ASSUMPTIONS -The work schedule will not be affected by inclement or dangerous weather conditions.-Hourly rates are based on portal to portal, during normal weekday operations.-Overtime (after 8 hours) Double Time (after 12 hours and weekend and Holiday Normal rates) apply.-Additional services requested that are not listed in this proposal will be billed according to our standard schedule of rates.-Actual volume of waste materials may vary from estimate and will be billed accordingly.-Disposal charges are subject to approval of the waste profile by the disposal facility. Page 2 DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 ENVIRONMEN'I LOGISTICS Estimate (888)641-3940 www.envlogs.com Generator Name/Address Estimate By JON Bill To Name I Address Estimate# Date 513 2/18/2021 CITY OF CARLSBAD CITY OF CARLSBAD STORM DRAIN MAINTENANCE 5950 EL CAMINO REAL ATTN: LINDA VOIGTLANDER CARLSBAD, CA 92008 5950 EL CAMINO REAL CARLSBAD, CA 92008 Contact Name Phone Email EPAID Terms LINDA VOIGTLANDER LINDA.VOIGTLANDER@CARLS ... Credit Card Description Qty Unit Rate Total *PREY AILING WAGE RA TES APPLY Total $4,536.75 ASSUMPTl0NS -The work schedule will not be affected by inclement or dangerous weather conditions.-Hourly rates are based on portal to portal, during normal weekday operations.-Overtime (after 8 hours) Double Time (after 12 hours and weekend and Holiday Normal rates) apply.-Additional services requested that are not listed in this proposal will be billed according to our standard schedule of rates. -Actual volume of waste materials may vary from estimate and will be billed accordingly. -Disposal charges are subject to approval of the waste profile by the disposal facility. Page 3 DocuSign Envelope ID: DE5A3AC8-E8AF-407C-A4A9-42A4E8721E02 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME:FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER: $ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A(Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 2/16/2021 License # 0757776 (951) 779-8549 (951) 742-4679 22322 Environmental Logistics, Inc.P.O. Box 806 Colton, CA 92324 24554 37885 36940 A 1,000,000 X GEC003992908 2/15/2021 2/15/2022 300,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000B AEC003993008 2/15/2021 2/15/2022 8,000,000C UEC003993108 2/15/2021 2/15/2022 8,000,000 10,000 A X WEC300137903 10/28/2020 10/28/2021 1,000,000N1,000,000 1,000,000 D Pollution/Legal Liab PEC003993808 2/15/2021 Occurrence/Aggregate 1,000,000 D Professional Liab PEC003993808 2/15/2021 2/15/2022 Occurrence/Aggregate 5,000,000 City of Carlsbad/CMWD, their officers, officials, employees and volunteers are Additional Insured in regard to General Liability when required by abwritten contract per the attached endorsement CG2033 04/13. Primary & Non-Contributory applies when required by a written contract per the attached endorsementXIL424 06/05. Per Project Aggregate applies when required by a written contract per the attached endorsement CG2503 05/09. Waiver of Subrogation in favor of the City of Carlsbad/CMWD, their officers, officials, employees and volunteers, with regard to the Workers Compensation policy when required by a writtencontract per the attached endorsement form WC040306 (Ed. 04-84). "Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any rights which may be SEE ATTACHED ACORD 101 City of Carlsbad/CMWD Dept. of Public Works 1635 Faraday Avenue Carlsbad, CA 92008 ENVILOG-01 SGONZALEZ HUB International Insurance Services Inc.PO Box 5345Riverside, CA 92517 Chad Hill chad.hill@hubinternational.com Greenwich Insurance Company XL Insurance America, Inc XL Specialty Insurance Company Indian Harbor Insurance Company X 2/15/2022 X X X X X X X X X FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. HUB International Insurance Services Inc. ENVILOG-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance License # 0757776 1 SEE P 1 Environmental Logistics, Inc.P.O. Box 806Colton, CA 92324 SEE PAGE 1 SGONZALEZ 1 Description of Operations/Locations/Vehicles: afforded within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation date." COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 33 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES ORCONTRACTORS – AUTOMATIC STATUS WHENREQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II – Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1.Only applies to the extent permitted by law; and 2.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1."Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. Environmental Logistics. Inc. POLICY NUMBER: GEC0039929 0 Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 04 13 2. "Bodily injury" or "property damage" occurring after: a. 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 b. 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. C.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; 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. 20 GEC0039929 0 GEC0039929 0 Environmental Logistics, Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WC 04 03 06 Page 1 of 1 (Ed. 04-84)Copyright 1984 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA 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 Where required by written agreement signed prior to loss. 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 No. Endorsement Effective Insured Environmental Logistics, Inc. Policy No. WEC3001379 Insurance Company XL Specialty Insurance Company Countersigned By