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HomeMy WebLinkAboutWoodard & Curran Inc; 2022-04-14; PSA22-1798UTILPSA22-1798UTIL General Counsel Approved Version 6/12/18 1 AGREEMENT FOR ANNUAL WATER SUPPLY AND DEMAND ASSESSMENT SERVICES WOODARD & CURRAN INC. THIS AGREEMENT is made and entered into as of the _____________________ day of _________________________________, 2022 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 Woodard & Curran Inc., a Maine corporation, ("Contractor”). RECITALS CMWD requires the professional services of a consultant that is experienced in water supply and demand assessment 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 one (1) year from the date first above written. 3. COMPENSATION The total fee payable for the Services to be performed shall not exceed nine thousand nine hundred ninety-three dollars ($9,993). 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 10% retention until CMWD 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 CMWD. Contractor will be under the control of CMWD only as to the results to be accomplished. 5. 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 attorneys’ 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’ DocuSign Envelope ID: 894EBC58-F938-4CE7-89D9-CDD398CCE520 14th April PSA22-1798UTIL General Counsel Approved Version 6/12/18 2 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 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. 7. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of CMWD and on behalf of Contractor under this Agreement. For CMWD: For Contractor: Name Shoshana Aguilar Name Rosalyn Prickett, AICP Title Senior Management Analyst Title Project Manager Dept Utilities Department Address 10509 Vista Sorrento Pkwy, Ste 205 Carlsbad Municipal Water District San Diego, CA 92121 Address 5950 El Camino Real Phone 858-875-7427 Carlsbad, CA 92008 Email rprickett@woodardcurran.com Phone 760-814-0241 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 ☐ No ☒ 9. 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. DocuSign Envelope ID: 894EBC58-F938-4CE7-89D9-CDD398CCE520 PSA22-1798UTIL General Counsel Approved Version 6/12/18 3 10. 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. 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 CMWD 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 CMWD. 14. 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: 894EBC58-F938-4CE7-89D9-CDD398CCE520 PSA22-1798UTIL General Counsel Approved Version 6/12/18 4 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 CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad WOODARD & CURRAN INC., a Maine corporation By: By: (sign here) Vicki Q. Quiram, General Manager David W. Remick, Executive Vice-President & CFO (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: 894EBC58-F938-4CE7-89D9-CDD398CCE520 PSA22-1798UTIL General Counsel Approved Version 6/12/18 5 EXHIBIT “A” SCOPE OF SERVICES DocuSign Envelope ID: 894EBC58-F938-4CE7-89D9-CDD398CCE520 9655 Chesapeake Drive Suite 320 San Diego, California 92123 www.woodardcurran.com T 800.426.4262 T 858.875.7400 Via Electronic Mail March 3, 2022 Shoshana Aguilar Carlsbad Municipal Water District 5950 El Camino Real Carlsbad, CA 92008 Re: Proposal for Annual Water Supply and Demand Assessment Dear Ms. Aguilar: Thank you for the opportunity to submit this proposal for Carlsbad Municipal Water District’s 2022 Annual Water Supply and Demand Assessment. To be eligible for state funding, urban water suppliers need to have a compliant Urban Water Management Plan (UWMP). Under a separate contract, Woodard & Curran prepared and submitted an UWMP for the District in June 2021, which was deemed compliant by the Department of Water Resources (DWR) in December 2021. Related to the 2020 UWMP, DWR now requires an Annual Water Supply and Demand Assessment (Annual Assessment), due July 1 of each year. The Annual Assessment evaluates projected demands in the coming year assuming dry year conditions, and compares to projected supplies, also assuming dry year conditions. Woodard & Curran has been closely tracking development of the State requirements for the Annual Assessment, and is ready to assist the District with preparing their Annual Assessment for the 2022 deadline. SCOPE OF SERVICES This scope of work to complete the Annual Water Supply and Demand Assessment consists of the following work: •Coordination with the District to review water use and supply data from the past year,on a monthly basis. •Project water demands using dry year demand assumptions in the 2020 UWMP orbased on demand projections from the San Diego County Water Authority, asappropriate. •Project water supplies using dry year supply assumptions from the 2020 UWMP, or asprovided by the San Diego County Water Authority, adjusted for current conditions asneeded. •Prepare required tables, consistent with DWR guidance. Assumed to be Dry YearDemands, Projected Supplies, Supply and Demand Assessment, and Planned Actionsto Mitigate Potential Shortages. •Draft short narrative to accompany tables, including explanation of process, datasources, and to explain outcomes. •Prepare a short presentation for District staff to present to the Board of Directors. EXHIBIT A DocuSign Envelope ID: 894EBC58-F938-4CE7-89D9-CDD398CCE520 Carlsbad Municipal Water District 2 Woodard & Curran, Inc. 2022 Annual Water Supply and Demand Assessment March 3, 2022 •Coordinate with DWR on submittal and responding to potential comments from theState. SCHEDULE Work would begin with a Notice to Proceed by the District, assumed to be March 2022, and complete with submittal of the Annual Assessment to the State on July 1, 2022. BUDGET This scope of work can be completed for a total cost of $8,683. A contingency budget has been added for an additional $1,310, for a total fee for $9,993. This contingency would be available should DWR’s final guidelines include additional requirements or changes to the draft guidance. Final guidelines are expected March 31, 2022. Attachment A includes a fee estimate with hours and staff identified for the tasks included in this proposal, using Woodard & Curran’s standard hourly rates for 2022. All work would be completed on a time and materials basis. TERMS AND CONDITIONS The Scope of Services will be completed in accordance with the terms of the Consultant/Professional Services Agreement between Woodard & Curran, Inc. and the District. ASSUMPTIONS AND UNDERSTANDINGS This scope of work assumes District staff will provide all requested data and will present Annual Assessment to the Board of Directors for approval. CLOSING We greatly appreciate this opportunity to offer our services for the Annual Assessment. If you accept this proposal and wish to proceed with the Scope of Services, please sign in the space indicated below and return a copy for our files. Please feel free to call me at 858-875-7421 or our Project Manager, Haley Johnson at 858-875-7407 if you have any questions regarding this amendment request or require any further information. Sincerely, WOODARD & CURRAN, INC. Rosalyn Prickett, AICP Senior Water Resources Planner, Principal in Charge. cc: Haley Johnson DocuSign Envelope ID: 894EBC58-F938-4CE7-89D9-CDD398CCE520 Attachment A: Proposed Fee EstimateCarlsbad Municipal Water DistrictMarch 2, 20222022 Water Supply and Demand Assessment Annual ReportingTasksTotalRosalyn PrickettSally JohnsonHaley JohnsonMelissa StineJen SindermannPrincipal QA/QCProject ManagerProject PlannerAdmin$315 $260 $245 $205 $120Task 1: Annual Assessment1.1 Information Collection and Review and Kickoff224 $900$0$9001.2 Draft Supply and Demand Assessment261422 $4,860$0 $4,8601.3 Final Supply and Demand Assessment and Submittal1269 $2,035$0 $2,0351.4 Coordination with State and Project Management0.5224.5 $888$0$888Subtotal Task 1:1.5212222 39.5 $8,683 $0 $0 $8,683TOTAL 1.5212222 39.5 $8,683 $0 $0 $8,683Contingency246 $1,310$0 $1,310TOTAL with CONTINGENCY 1.5214262 45.5 $9,993 $0 $0 $9,9931. The individual hourly rates include salary, overhead and profit.2. Other direct costs (ODCs) such as reproduction, delivery, mileage (rates will be those allowed by current IRS guidelines), and travel expenses, will be billed at actual cost plus 10%.3. Woodard & Curran reserves the right to adjust its hourly rate structure and ODC markup at the beginning of the calendar year for all ongoing contracts.ODCsTotal ODCs (2)Total Fee (3)LaborODCs Total HoursTotal Labor CostsDocuSign Envelope ID: 894EBC58-F938-4CE7-89D9-CDD398CCE520 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD 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 COMPENSATION AND 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 IN ACCORDANCE 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. 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). 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 2/18/2022 (617) 328-6555 (617) 328-6888 20443 Woodard & Curran, Inc. 2175 N. California Blvd., Suite 315 Walnut Creek, CA 94596 35289 20427 A 1,000,000 X X 6014561812 2/23/2022 2/23/2023 500,000 15,000 1,000,000 2,000,000 2,000,000 1,000,000B 6014561843 2/23/2022 2/23/2023 2,000,000B 6014561826 2/23/2022 2/23/2023 2,000,000 0 C X WC712160450 2/23/2022 2/23/2023 1,000,000 N 1,000,000 1,000,000 A Professional Liab 114135520 2/23/2022 Per Clm 1000000 Agg 1,000,000 A Pollution Liab 114135520 2/23/2022 2/23/2023 Per Clm 1000000 Agg 1,000,000 If AI box is checked, GL Endorsement Form# CNA75079XX, Auto Endt Form# SCA23500D to the extent provided therein applies and all coverages are in accordance with the policy terms and conditions. The City of Carlsbad shall be listed as additional insured with respect to General Liability where required by written contract. A Waiver of Subrogation and 30 Day Notice of Cancellation is provided in accordance with the policy terms and conditions. Professional Liability Retro-Active Date: Full Prior Acts City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 WOOD&CU-01 CMURPHY Ames & Gough 859 Willard Street Suite 320 Quincy, MA 02169 boston@amesgough.com Continental Casualty Company (CNA) A, XV Continental Insurance Company A(XV) American Casualty Co of Reading, PA A(XV) X 2/23/2023 X X X X X X X X Blanket Additional Insured - Owners, Lessees or Contractors -with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I.WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are requiredby written contract to add as an additional insured on this coverage part, 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: A.in the performance of your ongoing operations subject to such written contract; or B.in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products-completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2.this coverage part provides such coverage. II.But if the written contract requires: A.additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the10-01 edition of CG2037; or B.additional insured coverage with "arising out of' language; or C.additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part. but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. Ill. Subject always to the terms and conditions of this policy, including the limits of insurance. the Insurer will not provide such additional insured with: A.coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV.The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1.the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2.supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on anotherendorsement attached to this coverage part. V.Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in thiscoverage part: Primary and Noncontributory Insurance CNA75079XX (10-16) Policy No: Insurance Carrier Writing Company Insured Name: Page 1 of2 Effective Date: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its pem,ission. Blanket Additional Insured -Owners, Lessees or Contractors -with Products-Completed Operations Coverage Endorsement With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1.primary and non-contributing with other insurance available to the additional insured; or 2.primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI.Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERALLIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1.give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2.send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in theinvestigation, defense, or settlement of the claim; and 3.make available any other insurance, and tender the defense and indemnity of any claim to any other insureror self-insurer, whose policy or program applles to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3.does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII.Solely with respect to the insurance granted by this endorsement, the section entitled 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 on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B.was executed prior to: 1.the bodily injury or property damage; or 2.the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. 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 effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and exoires concurrentlv with said Policv. CNA75079:XX (10-16) Policy No: Insurance Carrier Writing Company Insured Name: Page 2 of2 Effective Date: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Workers Compensation And Employers Liability Insurance Policy Endorsement 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 will 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 this 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 2%. 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. Policy No: WC712160450 Policy Effective Date: 02/23/22 Policy Page: 35 of 55 Form No: G-19160-B (11-1997) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 4; Page: 1 of 1 Underwriting Company: American Casualty Company of Reading, PA © Copyright CNA All Rights Reserved. CA WC