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HomeMy WebLinkAboutWest Coast Arborists Inc; 2021-07-16; PKRC21-0706Tracking #: TREE/LIMB REMOVAL AT FIRE STATION 2: CONTRACT PKRC21-0706 -- 1 -- City Attorney Approved 2/29/2016 CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT TREE/LIMB REMOVAL AT FIRE STATION 2: CONTRACT PKRC21-0706 This letter will serve as an agreement between West Coast Arborists, Inc., a corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to remove one tree and one large limb, per the Contractor’s proposal dated July 2, 2021 and City specifications, for a sum not to exceed three thousand four hundred ninety-eight dollars ($3,498). This work is to be completed within 3 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 sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. ________ init ________ init 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. ______ init ______ 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. DocuSign Envelope ID: 4A70DDB1-1303-435B-94CE-0CF7C0ED54C1 Tracking #: TREE/LIMB REMOVAL AT FIRE STATION 2: CONTRACT PKRC21-0706 -- 2 -- City Attorney Approved 2/29/2016 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: Morgan Rockdale, 760-434-2985 Contractor Contact: Isaac Ontiveros, 858-566-4204 CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California 8163 Commercial Street La Mesa, CA, 91942 Phone: 858-566-4204 Fax: 858-566-4098 Email: Iontiverow@wcainc.com By: By: (sign here) Patrick Mahoney, President Parks & Recreation Director (print name/title) By: Dated: (sign here) Richard Mahoney, Secretary (print name/title) (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 DocuSign Envelope ID: 4A70DDB1-1303-435B-94CE-0CF7C0ED54C1 July 16, 2021 JOB LOCATION 1900X El Camino Real and Arenal, Fire Station 2 SCOPE OF WORK Tree only removal service of 1 Allepo Pine tree and large limb removal on 1 additional Aleppo Pine tree along El Camino Real adjacent to Fire Station 2. Price includes required traffic control. CUSTOMER INFORMATION Main Contact Billing ContactMORGAN ROCKDALE MORGAN ROCKDALECITY OF CARLSBAD 1166 CARLSBAD VILLAGE DRIVE CARLSBAD, CA 92008 760.434.2820 morgan.rockdale@carlsbadca.gov CITY OF CARLSBAD 1166 CARLSBAD VILLAGE DRIVE CARLSBAD, CA 92008 760.434.2820 morgan.rockdale@carlsbadca.gov Inventory Needed Link Funds to Job #Purchase Order #DIR Project ID # Yes DESCRIPTIONQTY U/M UNIT PRICE TOTAL 53.00 Crew Rental (3 men @ $198/hr)Man Hour $66.00 $3,498.00 Prune Backup - Crew Each $0.00 $0.00 Tree Only Removal Backup - Crew Each $0.00 $0.00 $3,498.00GRAND TOTAL: COMMENTS Prices reflect City of Carlsbad contract rates. Work to be performed by LiUNA Local 89 tree maintenance laborers. DISCLAIMER: West Coast Arborists, Inc. ensures the quality of work performed, however, we do not ensure the customer's/city's entire tree population from failure. Conditions are often hidden within trees and below ground. Arborists cannot guarantee that a tree will be healthy or safe under all circumstances. The controlling authority must manage trees and accept some degree of risk. Only work identified in the scope of the proposal and in the contract line item is included in our quote or invoice. All work will be completed in accordance with ANSI A300 standards. Price reflects payment under prevailing wage rates under the wage determination: Tree Maintenance Laborer and report of certified payroll to the Department of Industrial Relations as applicable in accordance with state labor laws. CA Contractors License 366764 Federal Tax ID: 95-3250682 CA DIR Registration 1000000956 ISAAC ONTIVEROS 07/02/21 ESTIMATED BY TITLE DATE DATETITLEACCEPTED BY AREA MANAGER WEST COAST ARBORISTS, INC. 8163 Commercial Street La Mesa, CA 91942  858.566.4204 Phone 858.566.4098 Fax WCAINC.COM Proforma # 69953 PROFORMA FOR TREE MAINTENANCE SERVICESPROFORMA FOR TREE MAINTENANCE SERVICES Printed on: 7/2/2021 4:03:06 PM Page 1 of 1 DocuSign Envelope ID: 4A70DDB1-1303-435B-94CE-0CF7C0ED54C1 ABOHHolder Identifier : 7777777707070700077763616065553330773617556304557607453136772406310073650566157330020762404113076110207526015772234556071622375320763300772641513205231207744015352274570077727252025773110777777707000707007 6666666606060600062606466204446200622220424024002206002224260262222060020062622402200622202426206220006222206240260022060002240422622020620002606226020006222206042000422066646062240664440666666606000606006Certificate No :570088275252CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/01/2021 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). 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. PRODUCER Aon Risk Insurance Services West, Inc. Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 Los Angeles CA 90017-0460 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 38318Starr Indemnity & Liability CompanyINSURER A: 16109Starr Specialty Insurance CompanyINSURER B: 36056Navigators Specialty Insurance CompanyINSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: West Coast Arborists, Inc. 2200 E Via BurtonAnaheim CA 92806 USA COVERAGES CERTIFICATE NUMBER:570088275252 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 $1,000,000 $5,000 $2,000,000 $4,000,000 $4,000,000 A 07/01/2021 07/01/20221000100141211 PRO-JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE(Per accident) X BODILY INJURY (Per accident) $2,000,000A07/01/2021 07/01/2022 COMBINED SINGLE LIMIT(Ea accident)1000198198211 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 07/01/2021UMBRELLA LIABC 07/01/2022SE21EXCZ059NKIC RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH-ERPER STATUTEA07/01/2021 07/01/2022 Workers Comp AZ 1000004228B 07/01/2021 07/01/2022 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN Workers Comp CA WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 1000004229 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carlsbad is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. A Waiver of Subrogation is granted in favor of the City of Carlsbad in accordance with the policy provisions of the Workers Compensation policy. Excess Liability follows form over the General Liability, Automobile Liability and Employer's Liability policies. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Carlsbad 799 Pine Avenue, Suite 200 Carlsbad CA 92008 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 07/14/2021 Huggins Dreckman Insurance License No. 0212199 5152 Katella Ave, Suite 206 Los Alamitos CA 90720 Theresa Roque (562) 594-6541 (562) 594-0376 theresa@hdinsure.com West Coast Arborists, Inc 2200 East Via Burton Anaheim CA 92806 Ironshore Specialty 25445 2021/2022 A Professional LiabilityRetroactive Date: July 1, 2010 PEO905384-01 07/01/2021 07/01/2022 Each Occurrence 5,000,000 Aggregate 5,000,000 Retention 50,000 City of Carlsbad 799 Pine Avenue Suite 200 Carlsbad CA 92008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY COMMERCIAL GENERAL LIABILITYPOLICY NUMBER: 1000100141211 CG 20 10 04 13Effective: 07/01/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to 1. All work,including materials,parts or include as an additional insured the person(s) or equipment furnished in connection with suchorganization(s) shown in the Schedule, but only work,on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by ordamage"or "personal and advertising injury"on behalf of the additional insured(s) at the caused, in whole or in part, by:location of the covered operations has beencompleted; or1. Your acts or omissions; or 2. That portion of "your work" out of which the2. The acts or omissions of those acting on your injury or damage arises has been put to itsbehalf;intended use by any person or organizationin the performance of your ongoing operations for other than another contractor or subcontractortheadditionalinsured(s)at the location(s)engaged in performing operations for adesignated above.principal as a part of the same project.However:C. With respect to the insurance afforded to these1. The insurance afforded to such additional additional insureds, the following is added toinsured only applies to the extent permitted by Section III – Limits Of Insurance:law; and If coverage provided to the additional insured is2. If coverage provided to the additional insured is required by a contract or agreement, the most werequiredbyacontractoragreement,the will pay on behalf of the additional insured is theinsurance afforded to such additional insured amount of insurance:will not be broader than that which you arerequiredbythecontractoragreementto 1. Required by the contract or agreement; orprovide for such additional insured.2. Available under the applicable Limits ofInsurance shown in the Declarations;B. With respect to the insurance afforded to theseadditionalinsureds,the following additional whichever is less.exclusions apply:This endorsement shall not increase theThis insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the"property damage" occurring after:Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Name Of Additional Insured Person(s) OrOrganization(s):Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COMMERCIAL GENERAL LIABILITYPOLICY NUMBER: 1000100141211 CG 20 37 04 13Effective: 07/01/2021 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 PARTPRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to required by the contract or agreement toprovide for such additional insured.include as an additional insured the person(s) ororganization(s) shown in the Schedule, but only B. With respect to the insurance afforded to thesewithrespecttoliabilityfor"bodily injury"or additional insureds, the following is added to"property damage" caused, in whole or in part, by Section III – Limits Of Insurance:"your work"at the location designated anddescribed in the Schedule of this endorsement If coverage provided to the additional insured isperformed for that additional insured and included required by a contract or agreement, the most wein the "products-completed operations hazard".will pay on behalf of the additional insured is the amount of insurance:However: 1. Required by the contract or agreement; or1. The insurance afforded to such additionalinsured only applies to the extent permitted by 2. Available under the applicable Limits oflaw; and Insurance shown in the Declarations;2. If coverage provided to the additional insured is whichever is less.required by a contract or agreement,the This endorsement shall not increase the applicableinsurance afforded to such additional insured Limits of Insurance shown in the Declarations.will not be broader than that which you are CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Name Of Additional Insured Person(s) OrOrganization(s):Location And Description Of CompletedOperations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. y: 07/01/2021 100 0004228 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 enforceour right against the person or organization named in the Schedule. (This agreement applies only to the extent thatyou 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 thework described in the Schedule. 2.0% of the California workers' compensation premiumThe additional premium for this endorsement shall beotherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contractAny person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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: Policy No.: Endorsement No.: Insured: W e s t C o a s t A r b o ri s ts , In c. Premium: Insurance Company: S t ar r S p e ci a lt y & L ia bili ty C o m p a n y Countersigned by WC 04 03 06 Page 1 of 1(Ed. 04-84) POLICY NUMBER: 1000198198211 COMMERCIAL AUTOCA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FORCOVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORMBUSINESS AUTO COVERAGE FORMMOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unlessmodified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverageunder the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverageprovided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicatedbelow. Named Insured: Endorsement Effective Date: 07/01/2021 SCHEDULE Each person or organization shown in the Schedule isan "insured" for Covered Autos Liability Coverage, butonly to the extent that person or organization qualifiesas an "insured" under the Who Is An Insuredprovision contained in Paragraph A.1. of Section II –Covered Autos Liability Coverage in the BusinessAuto and Motor Carrier Coverage Forms andParagraph D.2. of Section I – Covered AutosCoverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Name Of Person(s) Or Organization(s): Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. West Coast Arborists, Inc.