HomeMy WebLinkAboutNV5 Inc; 2021-11-30; PSA22-1681CA30th
November
(Attachment J)
DocuSign Envelope ID: 450F39D2-6BAC-45E3-BFDF-4720704332DA
PSA22-1681CA
MASTER AGREEMENT FOR COMMUNICATIONS/OUTREACH SERVICES
NVS, INC.
THIS AGREEMENT is made and entered into as of the ______ day of
________ , 2021, by and between the CITY OF CARLSBAD, a municipal
corporation, hereinafter referred to as "City", and NV5, Inc., a California corporation hereinafter
referred to as "Contractor."
RECITALS
A. City requ ires the professional services of a consulting firm that is experienced in
the communications and outreach field.
B. The professional services are required on a non-exclusive, project-by-project
basis.
C. Contractor has the necessary experience in providing professional services and
advice related to communications and outreach.
D. Contractor has submitted a proposal to City under Request for Qualifications
(RFQ) No. 21-1449CA 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 attached Exhibit "A", which is incorporated by this reference in
accordance with this Agreement's terms and conditions.
Contractor's obligations with respect to any project granted to Contractor under this Agreement
will be as specified in the Task Description for the project (see paragraph 5 below).
2. STANDARD OF PERFORMANCE
While performing the Services, Contractor will exercise the reasonable professional care and skill
customarily exercised by reputable members of Contractor's profession practicing in the
Metropolitan Southern California Area, and will use reasonable diligence and best judgment while
exercising its professional skill and expertise.
3. TERM
The term of this Agreement will be effective for a period of three (3) years from December 1, 2021,
through November 30, 2024. The City Manager may amend the Agreement to extend it for one
(1) additional one (1) year periods or parts thereof. Extensions will be based upon a satisfactory
review of Contractor's performance, City needs, and appropriation of funds by the City Council.
The parties will prepare a written amendment indicating the effect'ive date and length of the
extended Agreement.
4. PROGRESS AND COMPLETION
The work for any project granted to Contractor pursuant to this Agreement will begin within ten
(10) days after receipt of notification to proceed by City and be completed within the time specified
in the Task Description for the project (see paragraph 5 below). Extensions of time for a specific
Task Description may be granted if requested by Contractor and agreed to in writing by the City
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Manager or the Division Director as authorized by the City Manager ("Director"). The City
Manager or Director will give allowance for documented and substantiated unforeseeable and
unavoidable delays not caused by a lack of foresight on the part of Contractor, or delays caused
by City inaction or other agencies' lack of timely action. In no event shall a specific Task
Description exceed the term of this Agreement.
5. COMPENSATION
The cumulative total for all projects allowed pursuant to this Agreement will not exceed three
hundred thousand dollars {$300,000) per Agreement term. Fees will be paid on a project-by-
project basis and will be based on Contractor's Schedule of Rates specified in Exhibit "A". Prior
to initiation of any project work by Contractor, City shall prepare a Project Task Description and
Fee Allotment (the "Task Description") which, upon signature by Contractor and for City, the City
Manager or Director, will be considered a part of this Agreement. The Task Description will include
a detailed scope of services for the particular project being considered and a statement of
Contractor's fee to complete the project in accordance with the specified scope of services. The
Task Description will also include a description of the method of payment and will be based upon
an hourly rate, percentage of project complete, completion of specific project tasks or a
combination thereof.
6. STATUS OF CONTRACTOR
Contractor will perform the Services in Contractor's own way as an independent contractor and
in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be
under control of City only as to the result to be accomplished, but will consult with City as
necessary. The persons used by Contractor to provide services under this Agreement will not be
considered employees of City for any purposes.
The payment made to Contractor pursuant to the Agreement will be the full and complete
compensation to which Contractor is entitled. City will not make any federal or state tax
withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be
required to pay any workers' compensation insurance or unemployment contributions on behalf
of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty
(30) days for any tax, retirement contribution, social security, overtime payment, unemployment
payment or workers' compensation payment which City may be required to make on behalf of
Contractor or any agent, employee, or subcontractor of Contractor for work done under this
Agreement. At the City's election, City may deduct the indemnification amount from any balance
owing to Contractor.
7. SUBCONTRACTING
Contractor will not subcontract any portion of the Services without prior written approval of City.
If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the
acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly
employed by the subcontractor, as Contractor is for the acts and omissions of persons directly
employed by Contractor. Nothing contained in this Agreement will create any contractual
relationship between any subcontractor of Contractor and City. Contractor will be responsible for
payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of
a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically
noted to the contrary in the subcontract and approved in writing by City.
8. , OTHER CONTRACTORS
The City reserves the right to employ other Contractors in connection with the Services.
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9. 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 attorneys
fees arising out of the performance of the work described herein caused by any willful misconduct
or negligent act or omission 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'
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.
10. INSURANCE
Contractor will obtain and maintain for the · du ration of the Agreement and any and all
amendments, insurance against claims for injuries to persons or damage to property which may
arise out of or in connection with performance of the services by Contractor or Contractor's
agents, representatives, employees or subcontractors. The insurance will be obtained from an
insurance carrier admitted and authorized to do business in the State of California. The insurance
carrier is required to 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 Associati6n of Insurance Commissioners (NAIC) latest quarterly listings report.
10.1 Coverages and Limits. Contractor will maintain the types of coverages and minimum limits
indicated below, unless Risk Manager or City Manager approves a lower amount. These minimum
amounts of coverage will not constitute any limitations or cap on Contractor's indemnification
obligations under this Agreement. City, its officers, agents and employees make no representation
that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement
are adequate to protect Contractor. If Contractor believes that any required insurance coverage
is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems
adequate, at Contractor's sole expense. The full limits available to the named insured shall also
be available and applicable to the City as an additional insured.
10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an
"occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per
occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply
separately to this project/location or the general aggregate limit shall be twice the required
occurrence limit. The limits for Commercial General Liability can be achieved through a
combination of primary and excess or umbrella liability insurance, provided that such coverage
will result in the same or greater coverage as the coverage required under this Section.
10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's
work for City). $2,000,000 combined single-limit per accident for bodily injury and property
damage.
10.1.3 Workers' Compensation and Employer's Liability. Workers' 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.
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10.1.4 Professional Liability. Errors and omIssIons liability appropriate to
Contractor's profession with limits of not less than $1,000,000 per claim. Coverage must be
maintained for a period of five years following the date of completion of the work .
..
10.2. Additional Provisions. Contractor will ensure that the policies of insurance required under
this Agreement contain, or are endorsed to contain, the following provisions:
10.2.1 The City will be named as an additional insured on Commercial General
Liability which shall provide primary coverage to the City.
10.2.2 Contractor will obtain occurrence coverage, excluding Professional
Liability, which will be written as claims-made coverage.
10.2.3 This insurance will be in force during the life of the Agreement and any
extensions of it and will not be canceled without thirty (30) days prior written notice to City sent
by certified mail pursuant to the Notice provisions of this Agreement.
10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this
Agreement, Contractor will furnish certificates of insurance and endorsements to City.
10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance
coverages, then City will have the option to declare Contractor in breach, or may purchase
replacement insurance or pay the premiums that are due on existing policies in order to maintain
the required coverages. Contractor is responsible for any payments made by City to obtain or
maintain insurance and City may collect these payments from Contractor or deduct the amount
paid from any sums due Contractor under this Agreement.
10.5 Submission of Insurance Policies. City reserves the right to requ ire, at anytime, complete
and certified copies of any or all required insurance policies and endorsements.
11. BUSINESS LICENSE
Contractor will obtain and maintain a City of Carlsbad Business License for the term of the
Agreement, as may be amended from time-to-time .
. 12. ACCOUNTING RECORDS
Contractor will maintain complete and accurate records with respect to costs incurred under this
Agreement. All re.cords will be clearly identifiable. Contractor will allow a representative of City
during normal business hours to examine, audit, and make transcripts or copies of records and
any other documents created pursuant to this Agreement. Contractor will allow inspection of all
work, data, documents, proceedings, and activities related to the Agreement for a period of three
(3) years from the date of final payment under this Agreement.
13. OWNERSHIP OF DOCUMENTS
All work product produced by Contractor or its agents, employees, and subcontractors pursuant
to this Agreement is the property of City. In the event this Agreement is terminated, all work
product produced by Contractor or its agents, employees and subcontractors pursuant to this
Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy
of the work product for Contractor's records.
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14. COPYRIGHTS
Contractor agrees that all copyrights that arise from the services will be vested in City and
Contractor relinquishes all claims to the copyrights in favor of City.
15. 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 are:
For Citt: For Contractor:
Name Eleida Felix Yackel Name Rebecca Cole
Title Senior Contract Administrator Title Project Manager
Dept Public Works Address 15092 Avenue of Science, Suite 200
CITY OF CARLSBAD SAN DIEGO, CA 92128
Address 1635 Faradat Avenue Phone 858-385-2213
Carlsbad, CA 92008 Mobile 619-300-5044
Phone 760-602-2767 Email rebecca.cole@nv5.com
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.
16. 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[xl No D
17. GENERAL COMPLIANCE WITH LAWS
Contractor will keep fully informed of federal, state and local laws and ordinances and regulations
which in any manner affect those employed by Contractor, or in any way affect the performance
of the Services by Contractor. Contractor will at all times observe and comply with these laws,
ordinances, and regulations and will be responsible for the compliance of Contractor's services
with all applicable laws, ordinances and regulations.
Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986
and will comply with those requ irements, including, but not limited to, verifying the eligibility for
employment of all agents, employees, subcontractors and consultants whose services are
required by this Agreement.
18. DISCRIMINATION AND HARASSMENT PROHIBITED
Contractor will comply with all applicable local, state and federal laws and regulations prohibiting
discrimination and harassment.
19. DISPUTE RESOLUTION
If a dispute should arise regard ing the performance of the Services the following procedure will
be used to resolve any questions of fact or interpretation not otherwise settled by agreement
between the parties. Representatives of Contractor or City will reduce such questions, and their
respective views, to writing, A copy of such documented dispute will be forwarded to both parties
involved along with recommended methods of resolution, which would be of benefit to both
parties. The representative receiving the letter will reply to the letter along with a recommended
method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory
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to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The
City Manager will consider the facts and solutions recommended by each party and may then opt
to direct a solution to the problem. In such cases, the action of the City Manager will be binding
upon the parties involved, although nothing in this procedure will prohibit the parties from seeking
remedies available to them at law.
20. TERMINATION
In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may
terminate this Agreement for nonperformance by notifying Contractor by certified mail of the
termination. If City decides to abandon or indefinitely postpone the work or services contemplated
by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon
notification of termination, Contractor has five (5) business days to deliver any documents owned
by City and all work in progress to City at the address contained in this Agreement. City will make
a determination of fact based upon the work product delivered to City and of the percentage of
work that Contractor has performed which is usable and of worth to City in having the Agreement
completed. Based upon that finding City will determine the final payment of the Agreement.
Either party upon tendering thirty (30) days written notice to the other party may terminate this
Agreement. In this event and upon request of City, Contractor will assemble the work product and
put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work
performed to the termination date; however, the total will not exceed the lump sum fee payable
under this Agreement. City will make the final determination as to the portions of tasks completed
and the compensation to be made.
21. COVENANTS AGAINST CONTINGENT FEES
Contractor warrants that Contractor has not employed or retained any company or person, other
than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that
Contractor has not paid or agreed to pay any company or person, other than a bona fide
employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration
contingent upon, or resulting from, the award or making of this Agreement. For breach or violation
of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion,
to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the
fee, commission, percentage, brokerage fees, gift, or contingent fee.
22. CLAIMS AND LAWSUITS
By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must
be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation
of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is
submitted to City, it may be considered fraud and Contractor may be subject to criminal
prosecution. Contractor acknowledges that California Government Code sections 12650 et seq.,
the False Claims Act applies to this Agreement and, 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
information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to
recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a
false claim may subject Contractor to an administrative debarment proceeding as the result of
which Contractor may be prevented to act as a Contractor on any public work or improvement for
a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is
grounds for City to terminate this Agreement.
23. JURISDICTIONS AND VENUE
Any action at law or in equity brought by either of the parties for the purpose of enforcing a right
or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the
County of San Diego, State of California, and the parties waive all provisions of law providing for
a change of venue in these proceedings to any other county.
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24. SUCCESSORS AND ASSIGNS
It is mutually understood and agreed that this Agreement will be binding upon City and Contractor
and their respective successors. Neither this Agreement nor any part of it nor any monies due or
to become due under it may be assigned by Contractor without the prior consent of City, which
shall not be unreasonably withheld.
25. ENTIRE AGREEMENT
This Agreement, together with any other written document referred to or contemplated by it, along
with the purchase order for this Agreement and its provisions, embody the entire Agreement and
understanding between the parties relating to the subject matter of it. In case of conflict, the terms
of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions
may be amended, modified, waived or discharged except in a writing signed by both parties.
26. PUBLIC AGENCY CLAUSE
Contractor agrees that any public agency as defined by Cal. Gov. Code section 6500, if authorized
by its governing body, shall have the option to participate in this contract at the same prices,
terms, and conditions. If another public agency chooses to participate, the term shall be for the
term of this contract, and shall be contingent upon Contractor's acceptance. Participating public
agencies shall be solely responsible for the placing of orders, arranging for delivery and/or
services, and making payments to the Contractor. The City of Carlsbad and Carlsbad Municipal
Water District shall not be liable, or responsible, for any obligations, including but not limited to
financial responsibility, in connection with participation by another public agency.
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EXHIBIT "A"
SCOPE OF SERVICES
Perform a variety of communications and outreach tasks as outlined in individual Project Task
Description & Fee Allotments {PTD&FA) related to the following:
A. Communications
B. Construction Outreach
C. Design / Development Outreach
D. Public Meeting Facilitation
Requests for work not listed above must be contracted under separate agreement.
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Page 2
Staff
Names
1 Rachel Kulis,
Lawrence McGuire,
Wanda Wease
2 Rebecca Cole,
Gabriela Dow
3 Carmen Kasner
4 Amelia Ceccheto
5 Jenna Caprara
6 Wendy Hovland
7 Yolanda Art
8 Teresa Leader
Anderson
9 Hilary Brinegar
10 Felicia Watson, Susan
Duffett
11. Vanessa O'Brien
12 Lizette Palacios
Expenses
Description
1. Mileage
2. Other (reproduction,
subconsultants, direct
costs
Titles
Project Manager
Program Supervisor/ Facilitator
Principal
Community Relations Coordinator
Integrated Marketing Specialist
Strategic Advisor
Community Relations Specialist
Media Relations Specialist
Environmental Outreach Specialist
Graphic Designer
Videographer
Project Administration
Cost
$0.57/mile
Varies
PSA22 -1681CA
Hourly Rate
170
195
265
110
145
195
135
140
140
115
115
90
% Markup
0
15
* Field rates are based on "Prevailing Wage" as determination by the Department of
Industrial Relations (DIR). Rates are effective through December 31, 2021. If contract
assignment extends beyond that date, a new rate schedule will be added to the contract.
Litigation support will be billed at $400.00 per hour.
NIVIS
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CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required)
City of Carlsbad is included as additional insured if required by written contract with respect to General Liability per the
terms and conditions of the policy. A 30-day notice of cancellation is included if required by written contract with respect to
General Liability per the terms and conditions of the policy.
ACORD 25 (2016/03) Certificate Holder ID: 17574922
A_ttachment Code: D587566 Master ID: 1491108, Certificate ID: 17574922 Policy No: 70148561 25
This endorsement modifi es insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
I Name Of Person Or Organization:
Any person or organization against whom you have agreed to waive such right of recovery
in a written contract or agreement.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
I
I
It is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To The
Insurer is amended by the addition of the fo llowing:
Solely with respect to the person or organization shown in the Schedule above, the Insurer waives any ri ght of
recovery the Insurer may have against such person or organization because of payments the Insurer makes for
injury or damage arising out of the Named lnsured's ongoing operations or your work done under a contract
with that person or organization and included in the productsscompleted operations hazard.
All other terms and conditions of the Policy remain unchanged.
This endorsement, wh ich forms a part of and is for attachment to the Policy issued by the designated Insurers,
takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is
shown below, and expi res concurrently with said Policy.
Attachment Code: D587561 Master ID: 1491108, Certificate ID: 17574922
CNA
CNA71526XX
(Ed. 10/12)
ADDITIONAL INSURED ENDORSEMENT -CONTRACTUAL
OBLIGATION
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as
follows:
SCHEDULE
Name of Additional Insured Person Or Organization
AS REQUIRED BY CONTRACT
1. Paragraph A.1. Who Is An Insured of Section II -LIABILITY COVERAGE is amended to include as an
additional insured the person or organization scheduled above, but only if you are required by "written
contract" to make that person or organization an additional insured under this policy.
2. The insurance provided to the additional insured is limited as follows:
a. The person or organization is an additional insured only with respect to "bodily injury" or
"property damage" arising out of a covered "auto" and caused by your negligent acts or
omissions or the negligent acts or omissions of someone, other than the additional insured,
for whom you are legally liable. ·
b. The person or organization is not an additional insured for the person or organization's
own acts or omissions, nor those of anyone, other than you, for whom the person or
organization is legally liable.
c. We will not provide the additional insured any broader coverage or any higher limit of
liability than the least that is:
(1) Required by the "written contract"; or
(2) Afforded to you under this policy.
3. Condition 2. Duties In the Event of Accident, Claim, Suit or Loss of Section IV -BUSINESS AUTO
CONDITIONS
is amended to add the following conditions applicable to the additional insured:
An additional insured under this endorsement will as soon as practicable:
a. Give us written notice of an "accident" which may result in a claim or "suit" under this
insurance, and of any claim or "suit" that does result;
b. Agree to make available any other insurance the additional insured has for a loss we
cover under this policy;
c. Send us copies of all legal papers received, and otherwise cooperate with us in the
investigation, defense, or settlement of the claim or "suit"; and
d. Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer
whose policy or program applies to a loss we cover under this pol icy. But if the "written
contract" requires this insurance to be primary and non-contributory, this provision d. does
not apply to insurance on which the additional insured is a Named Insured.
We have no duty to defend or indemnify an additional insured under this endorsement until we receive
from the additional insured written notice of a "suit."
Attachment Code: D587561 Master ID: 1491108, Certificate ID: 17574922
4. Only for the purpose of the insurance provided by this endorsement, SECTION V -DEFINITIONS is
amended to add the following definition:
"Written contract" means a written contract or written agreement that requires you to make a person or
organization an additional insured under this policy, provided the contract or agreement:
1. Is currently in effect or becomes effective during the term of this policy; and
2. Was executed prior to the accident for which the additional insured seeks coverage under
this policy.
All other terms and conditions of the Policy remain unchanged.
Policy No: 7014842659
Effective Date: 5/1/2021
Insured Name: NV5, Inc.
CNA71526XX (Ed. 10/12)
Attachment Code: D587581 Master ID: 1491108, Certificate ID: 17574922
CNA
POLICY NO: 7014842824
WORKERS COMPENSATION
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.)
This agreement shall not operate directly or indirectly to benefit anyone not named in
the Schedule.
Schedule
Any person or organization against whom you have agreed to waive such right of
recovery in a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by
the designated Insurers, takes effect on the Policy Effective date of said policy at the
hour stated in said policy, unless another effective date (the Endorsement Effective
Date is shown below, and expires concurrently with said policy unless
another expiration date is shown below.
Form No: WC00 03 13 (04-1984)
Endorsement Effective Date: 5/1/2021
Policy: WC657040561
Attachment Code: D587581 Master ID: 1491108, Certificate ID: 17574922
CNA
WORKERS COMPENSATION
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown
in Item 3.A. of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this
policy. We will not enforce our right against the person or organization named in the Schedule,
but this waiver applies only with respect to bodily injury arising out of the operations described in
the Schedule where you are required by a written contract to obtain this waiver from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the
Schedule.
The premium for this endorsement is shown in the Schedule.
Schedule
1 . [ ] Specific Waiver
[X] Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to
furnish this waiver.
2. Operations: Waiver of Subrogation Operations
Premium:
The premium charge for this endorsement shall be
premium developed on payroll in connection with work performed for the above person(s) or
organization(s) arising out of the operations described.
1. Advance Premium: Waiver of Subrogation Advance Premium
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the
designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in
said policy, unless another effective date (the Endorsement Effective Date) is shown below, and
expires concurrently with said policy unless another expiration date is shown below.
Form No:WC.:42 03 04 B (06-2014)
Endorsement Effective Date:05/01/2021
Policy No. 7014842824
Attachment Code: D587581 Master ID: 1491108, Certificate ID: 17574922
CNA
UTAH WAIVER OF SUBROGATION ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Utah is
shown in Item 3.A. of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by
this policy. We will not enforce our right against the person or organization named in the
Schedule. (This agreement applies only to the extent that you perform work under a
written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in
the Schedule. Our waiver of rights does not release your employees' rights against third
parties and does not release our authority as trustee of claims against third parties.
Schedule
Any person or organization against whom you have agreed to waive such right of
recovery in a written contract or agreement
All other terms and conditions of the policy remain unchanged.
:his endorsement, which forms a part of and is for attachment to the policy issued by the
designated Insurers, takes effect on the Policy Effective date of said policy at the hour
stated in said policy, unless another effective date (the Endorsement Effective Date) is
shown below, and expires concurrently with said policy unless another expiration date is
shown below.
Form No: WC 43 03 05 (07-2000)
Endorsement Effective Date: 05/01 /2021
Policy No. 7014842824
Attachment Code: D587584 Master ID: 1491108, Certificate ID: 17574922
CNA
POLICY NUMBER: 7014842810
WORKERS COMPENSATION
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached.
It is agreed that Part One -Workers Compensation Insurance G. Recovery From Others and Part Two -
Employers Liability Insurance H. Recovery From Others are amended by adding the following:
We wi.11 not enforce our right to recover against persons or organizations. (This agreement applies only
to the extent that you perform work under a written contract that requires you to obtain th is agreement
from us.)
PREMIUM CHARGE -Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard
premium for California exposure. The amount is [Blanket Waiver of Subrogation Percentage Charge].
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of an is for attachment to the policy issued by the designated
Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless
another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with
said policy unless another expiration date is shown below.
Form No. G-19160-B (11-1997)
Endorsement Effective Date: 05/01/2021
Policy Number: 7014842810
A ... ~hrnen,Srde: D5,7573 Master ID: 1491 l~, Certificate ID: 17574922 . tserK1ey nsura_nce "'ompany Page 1 of 1
Change Endorsement
Other Insurance
In consideration of the premium paid for this Policy, it is understood and agreed that Section VII. Conditions, I. Other Insurance is
deleted and replaced with the following:
I. Other Insurance
If there is other collectible insurance, including but not limited to other professional liability insurance or project specific insurance,
that applies to a Claim covered by this Policy, the other insurance shall be primary and this Policy shall be excess over the other
insurance, unless the other insurance is written specifically excess of this Policy. This Policy will then apply to the amount of the
Claim that exceeds the available limits of liability and any deductibles or retention amounts of the other insurance, as well as the
Deductible under this Policy. If such other insurance has a duty to defend a Claim or assumes the defense of a Claim, this Policy ·
shall not be obligated to defend that Claim.
Solely as respects Insuring Agreement B -Contractor's Pollution Liability, when required in a signed, written agreement
executed prior to the report date of a Claim, this policy shall be primary to other collectible insurance that applies to those Claims
resulting from the performance of your Contractor Services. Any other collectible insurance that applies to a Claim covered by
Insuring Agreement B shall be excess and non-contributory.
Whenever printed in this Endorsement, the boldface type terms shall have the same meanings as indicated in the Policy Form. All other
provisions of the Policy remain unchanged.
Insured I Policy Number
NV5 Global, Inc. AE C-904411 4-05
Effective Date of This Endorsement Authorized
05/01/2021 Representative
10 -BDP0713106 (07-13) 26882-9036395-87 455 Policy Form: BDP0417001 (04-17)