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HomeMy WebLinkAboutBonsall Petroleum Construction Inc; 2022-06-22; PWL22-1874FLTPWL22-1874FLT Fuel Vapor Bucket Replacement -1 -City Attorney Approved 2/29/2016 CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT Fuel Vapor Bucket Replacement This letter will serve as an agreement between Bonsall Petroleum Construction, Inc., a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary for a vapor tank spill bucket replacement, per Exhibit A, B and City specifications, for a sum not to exceed three thousand three hundred forty-two dollars & eighty cents ($3,342.80). This work is to be completed within three (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. DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C PWL22-1874FLT Fuel Vapor Bucket Replacement - 2 - City Attorney Approved 2/29/2016 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. 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. /// /// /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C PWL22-1874FLT Fuel Vapor Bucket Replacement - 3 - City Attorney Approved 2/29/2016 9. City Contact: Bradley Northup, 760-473-1267 Contractor Contact: Laurie Perrault, 760-631-0342 CONTRACTOR Bonsall Petroleum Construction, Inc., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California P.O. Box 969 Bonsall, CA 92003 P: 760-631-0342 F: 760-631-0526 laurie@bonsallpetroleum.com By: By: (sign here) Laurie Perrault, President & Treasurer Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: Dated: (sign here) (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: Assistant City Attorney DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C June 22, 2022(J.~ t PWL22-1874FLT Fuel Vapor Bucket Replacement -4 -City Attorney Approved 2/29/2016 EXHIBIT A Fuel Vapor Bucket Replacement SCOPE OF WORK AND FEE DESCRIPTION PRICE Remove and replace one vapor spill bucket on Tank #1 (East Bucket) - Unleaded Fuel located at 2480 Impala Dr. - Fleet Services $3,342.80 TOTAL* $3,342.80 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C PO Box 969 Bonsall, CA 92003 (760) 631-0342 info@bonsallpetroleum.com Estimate ESTIMATE#77440775 DATE 05/05/2022 PO# CUSTOMER CITY OF CARLSBAD ATTN: ACCOUNTS PAYABLE CARLSBAD CA 92008-7314 (760) 931-2192 SERVICE LOCATION CITY OF CARLSBAD ATTN: ACCOUNTS PAYABLE CARLSBAD CA 92008-7314 (760) 931-2192 DESCRIPTION Spill bucket replacement. Estimate Description Qty Rate Total Skidsteer Tractor Per Day 300.00 Breaker Hammer for Skidsteer Per day 50.00 5 Gal Fill Spill Bucket, Direct Bury, Cast Iron Base 1.00 692.80 692.80 Concrete 1.00 300.00 300.00 Estimated Prevailing Wage Labor, 2 Guys 1 Day 16.00 125.00 2,000.00 CUSTOMER MESSAGE Additional parts may be required. Estimate Total:$3,342.80 PWL22-1874FLT Exhibit "B" -5- DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C ------------~ DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C,,,.--, BONSA-2 nD 1n, Vil ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 04/01/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 619-291-7777 ~2=i~cT Robyn Kettering Kettering-Rose Insurance wg_N:o, Ext): 619-291-7777 I Fffc, No):619-291-7776 9320 Fuerte Road, #101 La Mesa, CA 91941 ii>"!i'M~ss: robynk@krinsure.net Robyn Kettering INSURERISI AFFORDING COVERAGE NAIC# 1NSURERA:Capitol Specialty Ins. Co. 10328 INSURED Bonsall Petroleum INSURER B, California Auto Ins Co 38342 Construction, Inc. INSURER c , State Compensation Ins. Fund 35076 Dba: Moodys INSURER D, Ohio Security Insurance Co 24082 P.O. Box969 Bonsall, CA 92003 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER· 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICYEFF _ _POLJCY !,XP LIMITS ITI> ,.,.,n •••un A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS-MADE [K] OCCUR y y EV2018364204 10/08/2021 10/08/2022 DAMAGE TO RENTED PREMISES !Ea occurrence I $ 50,000 X Owner/Cont Prot. EV2018364204 10/08/2021 10/08/2022 MED EXP IAnv one oersonl $ 5,000 - X Pollution/Prof EV2018364204 10/08/2021 10/08/2022 PERSONAL & ADV INJURY $ 1,000,000 -2,000,000 ~'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [K] ~rc?r □ LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EA ACCidentl $ 1,000,000 - ANY AUTO y y BA040000072817 10/08/2021 10/08/2022 BODILY INJURY !Per oersonl $ -OWNED X SCHEDULED -AUTOS ONLY _ AUTOS BODILY INJURY !Per accident\ $ X HIRED X NON-OWNED ip~?~tc~di;,~t~AMAGE $ -AUTOS ONLY -AUTOS ONLY $ A UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 2,000,000 -EX2018364304 10/08/2021 10/08/2022 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ 'I: C WORKERS COMPENSATION X I ~ifTUTE I I OTH-AND EMPLOYERS' LIABILITY ER Y/N y 9094748 04/01/2022 04/01/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE [Y] E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under 'I: 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT D Equipment Floater BKS57368222 10/08/2021 10/08/2022 Lsd/RntEq 250,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All Pro~ects City of Car sbad /CMWD is included as an Additional Insured as resgects to General Liability & Auto Liability.Coverage is Primary and Non-Con ributory. Waiver of Subrogation applies. CERTIFICATE HOLDER CANCELLATION CITYCA4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad /CMWD ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services AUTHORIZED REPRESENTATIVE P.O.Box947 ~-0¼"1 ~~ 1Murri .. t" CA 92'-R4 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C NOTEPAD: HOLDER CODE INSURED'$ NAME CITYCA4 Bonsall Petroleum *10 Days notice for non-payment of premium **30 Days notice for all other reasons BONSA-2 OPID:VA Date PAGE 2 04/01/2022 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C Capitol Specialty Insurance Corporation THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured -Owners, Lessees or Contractors -Scheduled Person or Organization This endorsement modifies insurance provided under the Environmental Policy for the following: Commercial General Liability Coverage Section Contractors Pollution Liability Coverage Section Environmental Impairment Liability Coverage Section It is hereby understood and agreed that the following changes are incorporated into the Coverage Form(s) / Coverage Section(s) listed above. If the Commercial General Liability Coverage Form is listed above, defined terms shown in bold may appear in quotations in such coverage form. Schedule Name of Additional Insured Person(s) Location(s) of Covered Operations or Organization(s) Any person or organization for whom you are performing All locations where "your work" is performed as specified "your work" when you and such person or organization have in the contract or written agreement between you and the agreed in writing in a contract or agreement that such person Additional lnsured(s). or organization be added as an Additional Insured on your policy. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for Bodily Injury, Property Damage or Personal and Advertising Injury caused, in whole or in part, by: 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(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to Bodily Injury or Property Damage occurring after: 1. 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 2. 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. The Section entitled TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of the Coverage Form or Coverage Section listed above is amended by the adding the following: We waive any right of recovery We may have against the person or organization specified in the above Schedule because of payments We make for injury or damage arising out of Your Work done under a written contract with that person or organization. This waiver applies only to the person or organization specified in this Schedule. D. This insurance shall be considered primary with respect to other valid and collectible insurance available to the Additional Insured for damages or Loss We cover under the Coverage Form(s) / Coverage Section(s) specified above for the Additional Insured. It is also agreed that any such other insurance available to the Additional Insured shall be non-contributory, and We shall not seek contribution from such other insurance. ENV 167 (05-16) © 2016 CapSpecialty, Inc. All rights reserved. Page 1 of 2 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C Capitol Specialty Insurance Corporation Additional Insured -Owners, Lessees or Contractors -Scheduled Person or Organization Continued If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations. All other terms and conditions of this Policy remain unchanged. Authorized Representative ENV 167 (05-16) © 2016 CapSpecialty, Inc. All rights reserved. Page 2 of 2 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C Capitol Specialty Insurance Corporation THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured -Owners, Lessees or Contractors -Completed Operations This endorsement modifies insurance provided under the Environmental Policy for the following: Commercial General Liability Coverage Section Contractors Pollution Liability Coverage Section It is hereby understood and agreed that the following changes are incorporated into the Coverage Form(s) / Coverage Section(s) listed above. If the Commercial General Liability Coverage Form is listed above, defined terms shown in bold may appear in quotations in such coverage form. Schedule Name of Additional Insured Person(s) Location(s) and Description(s) of Covered Operations or Organization(s) Any person or organization for whom you are performing All locations where "your work" is performed as specified "your work", when you and such person or organization have in the contract or written agreement between you and the agreed in writing in a contract or agreement that such person Additional lnsured(s). or organization be added as an Additional Insured for Completed Operations Coverage on your policy. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for Bodily Injury or Property Damage caused, in whole or in part, by Your Work at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the Products-Completed Operations Hazard. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. C. The Section entitled TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of the Coverage Form or Coverage Section listed above is amended by the adding the following: We waive any right of recovery We may have against the person or organization specified in the above Schedule because of payments We make for injury or damage arising out of Your Work done under a written contract with that person or organization. This waiver applies only to the person or organization specified in this Schedule. D. This insurance shall be considered primary with respect to other valid and collectible insurance available to the Additional Insured for damages or Loss We cover under the Coverage Form(s) / Coverage Section(s) specified above for the Additional Insured. It is also agreed that any such other insurance available to the Additional Insured shall be non-contributory, and We shall not seek contribution from such other insurance. ENV 168 (05-16) © 2016 CapSpecialty, Inc. All rights reserved. Page 1 of 2 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C Capitol Specialty Insurance Corporation Additional Insured -Owners, Lessees or Contractors -Completed Operations Continued If this endorsement is issued after the Policy has been issued, it is deemed to have been added to the list of forms and endorsements on the Declarations. All other terms and conditions of this Policy remain unchanged. Authorized Representative ENV 168 (05-16) © 2016 CapSpecialty, Inc. All rights reserved. Page 2 of 2 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C POLICY NUMBER: BA040000062466 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Business Auto Broadening Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED) II. EMPLOYEES AS INSUREDS Ill. AUTOMATIC ADDITIONAL INSURED IV. EMPLOYEE HIRED AUTO LIABILITY V. SUPPLEMENTARY PAYMENTS VI. FELLOW EMPLOYEE COVERAGE VII. ADDITIONAL TRANSPORTATION EXPENSE VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE X. LOAN/LEASE GAP COVERAGE XI. GLASS REPAIR -DEDUCTIBLE WAIVER XII. TWO OR MORE DEDUCTIBLES XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS XIV. WAIVER OF SUBROGATION XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT XVIII. HIRED AUTO -COVERAGE TERRITORY XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 1 of 6 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (Broad Form Named Insured) SECTION II -LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: d. Any business entity newly acquired or formed by you during the policy period provided you own 50% or more of the business entity and the business entity is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisition or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Coverage does not apply to an "accident'' which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS SECTION II -LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: e. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. Ill. AUTOMATIC ADDITIONAL INSURED SECTION II -LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: f. Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. IV. EMPLOYEE HIRED AUTO LIABILITY SECTION II -LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: g. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. V. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments, Subparagraphs (2) and (4) are replaced by the following: MCA85100817-CA (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We are not obligated to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 2 of 6 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C VI. FELLOW EMPLOYEE COVERAGE: SECTION II -LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee This exclusion does not apply if you have workers' compensation insurance in-force covering all of your "employees". Coverage is excess over any other collectible insurance. VII. ADDITIONAL TRANSPORTATION EXPENSE SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation Expenses, is replaced with the following: We will pay up to $50 per day to a maximum of $1000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". If your business shown in the Declarations is other than an auto dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen covered auto from the place where it is recovered to its usual garaging location. VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, the following is added: c. If Liability Coverage is provided in this policy on a Symbol 1 or a Symbol 8 basis and Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this coverage form for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire, subject to the following limit: (1) The most we will pay for "loss" to any hired "auto" is $50,000 or Actual Cash Value or Cost of Repair, whichever is less (2) $500 deductible will apply to any loss under this coverage extension, except that no deductible shall apply to "loss" caused by fire or lightning Subject to the above limit and deductible we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own of similar size and type. This coverage extension is excess coverage over any other collectible insurance. IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following: This exclusion does not apply to the accidental discharge of an airbag. Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 3 of 6 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C X. LOAN/LEASE GAP COVERAGE SECTION Ill -PHYSICAL DAMAGE COVERAGE C. Limit of Insurance, the following is added: 4. In the event of a "total loss" to a covered "auto" shown in the schedule or declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto," less: a. The amount paid under the Physical Damage Coverage Section of the b. policy; and Any: (1) (2) (3) (4) Overdue lease/loan payments at the time of the "loss"; Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. Security deposits not returned by the lessor; Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (5) Carry-over balances from previous loans or leases. The most we will pay under Auto Loan/Lease Gap Coverage for an insured auto is 25% of the actual cash value of that insured auto at the time of the loss. XI. GLASS REPAIR -DEDUCTIBLE WAIVER SECTION Ill -PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. XII. TWO OR MORE DEDUCTIBLES SECTION Ill -PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: If two or more "company" policies or coverage forms apply to the same accident: 1. If the applicable Business Auto deductible is the smallest, it will be waived; or 2. If the applicable Business Auto deductible is not the smallest, it will be reduced by the amount of the smallest deductible; or 3. If the loss involves two or more Business Auto coverage forms or policies the smallest deductible will be waived. For the purpose of this endorsement "company" means the company providing this insurance and any of the affiliated members of the Mercury Insurance Group of companies. XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The requirement in SECTION IV, BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit, Or Loss, a., In the event of "accident", you must notify us of an "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 4 of 6 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C XIV. WAIVER OF SUBROGATION SECTION IV -BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, section is replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS SECTION IV -BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation, or Fraud, the following is added: Any unintentional omission of or error in information given by you, or unintentional failure to disclose all exposures or hazards existing as of the effective date or at any time during the policy period shall not invalidate or adversely affect the coverage for such exposure or hazard or prejudice your rights under this insurance. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, b. For Hired Auto Physical Damage Coverage, is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: 1. Any covered "auto" you lease, hire, rent or borrow; and 2. Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, the following is added and supersedes any provision to the contrary: MCA85100817-CA e. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 5 of 6 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C XVIII. HIRED AUTO -COVERAGE TERRITORY SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, e. Anywhere in the world if:, is replaced by the following: e. Anywhere in the world if: (1) A covered "auto" is leased, hired, rented or borrowed without a driver for a period of 30 days or less; and (2) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico, or Canada or in a settlement we agree to. XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH SECTION V-DEFINITIONS, C. "Bodily Injury" is amended by adding the following: MCA85100817-CA "Bodily injury" also includes mental anguish but only when the mental anguish arises from other bodily injury, sickness, or disease. Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 6 of 6 DocuSign Envelope ID: 8E1169FF-E85E-4B63-B76F-6BBCFA65066C STATE ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS BROKER COPY COMF'ENSATION INSURANCE FUNC HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EFFECTIVE APRIL 1, 2022 AT 12.01 A.M. AND EXPIRING APRIL 1, 2023 AT 12.01 A.M. BONSALL PETROLEUM CONSTRUCTION, PO BOX 969 BONSALL, CA 92003 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9094748-22 RENEWAL SD 3-07-58-95 PAGE 1 OF NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2572 ~:£~ APRIL 4, 2022 Ii~,~~ .dl-e~~ PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 21 7 1