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HomeMy WebLinkAboutDownstream Services Inc; 2022-07-28; PWM23-1895UTILPWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 1 of 7 City Attorney Approved 1/20/2020 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT SUNNYHILL DRIVE WETWELL CONVERSION This agreement is made on the ______________ day of _________________________, 2022, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Downstream Services, Inc., a California corporation whose principal place of business is 2855 Progress Place, Escondido, CA 92029 (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor’s proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Jesse Castaneda (City Project Manager). PAYMENT. The City shall withhold retention as required by Public Contract Code Section 9203. WAGE RATES. 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 Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the 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 execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 July 28th PWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 2 of 7 City Attorney Approved 1/20/2020 Wilma G. Roberts 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. FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, 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 the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five (5) years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: ___________________________________ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers’ Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are 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. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than……..$1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ….…$1,000,000 Property damage insurance in an amount of not less than……..$1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for “any auto” and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that 30 days written notice shall be given to the City prior to such cancellation. The 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. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 PWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 3 of 7 City Attorney Approved 1/20/2020 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. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, 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 the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys’ fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. 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. Start Work: Contractor agrees to start within ninety (90) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within two hundred sixty (260) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Downstream Services, Inc. 2855 Progress Place (name of Contractor) 807953 (street address) Escondido, CA 92029 (Contractor’s license number) Class A, C31 and HAZ (city/state/zip) 760-746-2544 (license class. and exp. date) 1000004632; exp 6/30/2023 (telephone no.) LorenR@downstreamservices.com (DIR registration number and exp. date) (e-mail address) /// /// /// /// /// /// /// DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 PWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 4 of 7 City Attorney Approved 1/20/2020 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 DOWNSTREAM SERVICES, INC., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Wilma G. Roberts, President & Secretary Vicki V. Quiram, Utilities Director, as authorized by the City Manager (print name/title) By: (sign here) (print name/title) If required by City, 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, President, or Vice-President Secretary, Assistant Secretary, 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, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 PWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 5 of 7 City Attorney Approved 1/20/2020 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Type of Work to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Sawcutting M. Baker Concrete Cutting PO BOX 848 San Marcos, CA 92079 1000006968 636696 C-61/D06 exp. 3/31/2024 5% Slurry Delivery Superior Ready Mix Concrete 1508 W. Mission Rd Escondido, CA 92029 1000003711 626277 A exp. 8/31/2023 7% Total % Subcontracted: 12% The Contractor must perform no less than 50% of the work with its own forces. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 PWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 6 of 7 City Attorney Approved 1/20/2020 EXHIBIT B SUNNYHILL DRIVE WETWELL CONVERSION JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION UNIT PRICE ITEM TOTAL 1 LS 1 Predl installation inspection, (3) Rausch couplings, and freight $7,300 $7,300 2 LS 1 Offsite project management $500 $500 3 LS 1 Utility markouts, permitting, and traffic control $1,250 $1,250 4 HR 4 Mobilize, deliver, and offload of Predl materials $581 $2,324 5 LS 1 Sawcut Exisitng Pavement $4,524 $4,524 TOTAL* $15,898 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 PWM23-1895UTIL SUNNYHILL DRIVE WETWELL CONVERSION Page 7 of 7 City Attorney Approved 1/20/2020 EXHIBIT B (continued) SCOPE OF SERVICES The scope of the project is as follows: • Delivery and installation of Fiberglass Reinforced Plastic (FRP) lined flat top, access collar, 42” PVC Riser, FRP line base bottom and sleeves, and all necessary liner installation appurtenances as specified in liner installation drawing. • Provide all operated and non-operated equipment required for project demolition and construction. • Apply for Right-of-Way permit (no fee) and provide traffic control. • Provide construction contractor, heavy crew with backhoe, and installation crew. • Deliver, offload, and stage all Predl (equal or equivalent) materials. • Provide and install pipe plugs inside manhole channel inlets to stop live flow or install bypass flow plugs as appropriate. Protect manhole from construction debris during all operations. • Saw cut and remove existing pavement, subgrade and any removal of existing manhole structure as required. • Install FRP base liner bottom and grout into place as required, apply mastic sealant to top joint of base. • Install temporary bracket for securing liner. • Install Rausch (equal or equivalent) couplings into each of the three (3) FRP sleeves and restore flow to the manhole as early as possible in the liner installation process. • Place PVC riser, ensuring riser is plumb and seated on to joint. • Provide and place fill grout. • Place FRP lined precast lid onto PVC riser. Place mastic sealant, apply primer and external joint wrap around riser lid to joint. Install telescopic access collar and collar gaskets as required. • Install city provided frame and cover to grade. • Place backfill and perform compaction per City of Carlsbad standards. • Restore pavement per City of Carlsbad standards. Contractor will provide: • 1 year contractor’s labor warranty City will provide: • Provision of the preferred grade rings, cast iron frame and lid • Cleaning of existing structure prior to install DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 outl e t insid e d r o p NOTES: preliminary ASECTION A:A SCALE: 1:30 TELESCOPIC ACCESS COLLAR DETAIL N.T.S. TELESCOPIC ACCESS COLLAR COLLAR GASKET flat top liner EXTERNAL JOINT WRAP(BEST FIT) PVC PIPE RISER MASTIC SEALANT FRP LID SLAB LINER 42" Ø pvc Riser PREDL PVC MANHOLE SPECIFICATIONS 1.ALL "PIPE TO MANHOLE" CONNECTIONS SHALL HAVE GASKETS AS SHOWN IN THE DRAWINGS UNLESS OTHERWISE NOTED. PREDLSYSTEMS WILL ONLY RECOMMEND WHAT TYPE OF GASKET SHALL BE USED. 2.ALL PIPE GASKETS SHALL BE INSTALLED USING THE MANDREL RECOMMENDED BY THE GASKET MANUFACTURER.3.ONLY PREDL CERTIFIED WELDERS AND FABRICATORS ARE AUTHORIZED TO FABRICATE, REPAIR, WELD, OR TEST THE BASELINER, TELESCOPIC ACCESS COLLAR, AND LID LINERS.4.ALL SECTIONS SHALL BE SEALED TOGETHER AS PER THE MANUFACTURER INSTRUCTIONS UNLESS OTHERWISE NOTED.5.LINER AND PVC RISER IS NOT TO BE COMPROMISED BY DRILLING OR PUNCTURING UNLESS SPECIFIED AND APPROVED BY PREDL LINER MANUFACTURER. PERFORATION OF LINER TO INSTALL LADDER RUNGS IS NOT RECOMMENDED.6.ROUND PRECAST MANHOLES TYPICALLY DESIGNED TO ASTM C478. NON-ROUND MANHOLE STRUCTURES TYPICALLY DESIGNED TO ASTM C913.7.FOR CANADIAN PROJECTS, MMCD PLATINUM (2009) SECTION 33 44 01 MANHOLES AND CATCH BASINS IS THE RECOGNIZED STANDARD IN BRITISH COLUMBIA FOR PRECAST MANHOLES.8.PRECAST CONCRETE STRUCTURE WITH INTEGRAL PREDL CPL TO BE VACUUM TESTED IN ACCORDANCE WITH ASTM C1244 PRIOR TO FINAL INSTALLATION AND SPARK TESTING OF CPL. PREDL PVC MANHOLE INSTALLATION INSTRUCTIONS1.BASE IS TO BE SET PER LOCAL SPECIFICATIONS AND BEST PRACTICES 2.INSERT PIPES INTO PREDL BELL AND GASKET (OR ALTERNATIVE CONNECTION METHOD, AS CALLED FOR ON PROJECT PLANS)3.PLACE ASTM C990 BUTYL RUBBER MH JOINT SEALANT ONTO TOP JOINT OF MANHOLE BASE 4.PLACE PVC RISER, ENSURING RISER IS PLUMB AND SEATED ON TO JOINT5.APPLY PRIMER AND EXTERNAL JOINT WRAP AROUND BASE TO RISER JOINT6.PARTIALLY BACKFILL AS REQUIRED 7.PLACE ASTM C990 BUTYL RUBBER MH JOINT SEALANT ONTO TOP OF PVC RISER8.PLACE FRP LINED PRECAST LID ONTO PVC RISER. 9.APPLY PRIMER AND EXTERNAL JOINT WRAP AROUND RISER TO LID JOINT10.TELESCOPIC ACCESS COLLAR (TAC) MUST BE INSTALLED WITH PREDL TAC GASKET AND IN ACCORDANCE WITH INSTALLATION GUIDE. WWW.PREDLSYSTEMS.COM/WP-CONTENT/UPLOADS/2015/06/PREDL-SYSTEMS-TAC.pdf 11.BRING TO GRADE WITH GRADE RINGS AND CASTING (NOT SUPPLIED BY PREDL)12.INSTALL LADDER IF REQUIRED.13.PREDL TECHNICIAN ONLY ENTERS THE MANHOLE FOR INSPECTION, WELDING AND TESTING.14.**FOR REHABILITATION OF EXISTING STRUCTURE, CONTRACTOR IS RESPONSIBLE FOR: REMOVAL OF EXISTING LADDER RUNGS, WASHING OF EXPOSED STRUCTURE WALLS, PROVIDING INTERNAL SHORING, INSTALLING PREDL CONCRETE PROTECTIVE LINER (CPL) & PVC LINER, GROUTING ANNULAR SPACE BETWEEN CPL/PVCAND EXISTING STRUCTURE, WIRE MESH REBAR INSTALLATION, EXCAVATION AND ANY/ALL ADDITIONAL REQUIRED WORK TO BE PERFORMED BY THE CONTRACTOR. WIRE MESH REBAR TO BE INSTALLED IF EXISTING STRUCTURE IS STRUCTURALLY UNSTABLE.15.PREDL'S ROLE IS LIMITED TO PROVIDE INSTALLATION ADVISE, AND ANY/ALL STEPS REQUIRED TO ASSURE THE LINER'S PERFORMANCE ARE MET. PREDL IS NOT APRIME CONTRACTOR OR SUBCONTRACTOR TO THIS PROJECT, UNLESS OTHERWISE NOTED. 16.DOCUMENTATION OF SUCCESSFUL COMPLETION OF ASTM C1244 REQUIRED. 17.MANHOLE STRUCTURE INTERIOR MUST BE CLEAN, DRY AND MINIMUM 10° C (50° F) PRIOR TO ON-SITE FABRICATION OR REPAIR OF FRP LINER.18.CONTRACTOR IS RESPONSIBLE FOR THE SAFETY OF ALL JOB SITE WORKERS AT ALL TIMES.19.CONTRACTOR IS RESPONSIBLE FOR PROVIDING ALL CONFINED SPACE AND/OR H2S SAFETY EQUIPMENT UNLESS OTHERWISE NOTED. 20.ALL CONFINED SPACE AND/OR H2S EQUIPMENT, PROCEDURES AND PERSONNEL CERTIFICATIONS ARE MANDATORY IN ACCORDANCE TO LOCAL GOVERNING BODYSTANDARDS. 21.GAGE FULL LENGTH (GFL) DUCTILE IRON PIPE IS REQUIRED WHEN CONNECTING DUCTILE IRON PIPE TO PREDL BELL AND GASKET Existing manhole lid must be removed to provide Ø48" clear opening DWG NO: SHEET: REV NO: CLIENTS JOB NUMBER: SPECIFIED FOR: PROJECT DESCRIPTION: DRAWING DESCRIPTION: SCALE: DRAWN BY:DATE DRAWN: systems 7520 Conrad Street Burnaby, B.C. V5A 2H7 Phone : 604 415-9944Fax : 604 415-9954 DWG NO: SHEET: REV NO: CLIENTS JOB NUMBER: SPECIFIED FOR: PROJECT DESCRIPTION: DRAWING DESCRIPTION: SCALE: DRAWN BY:DATE DRAWN: REV NO DATE/DESCRIPTION -- -- -- -- -- -- -- -- -- -- -- -- 1 PVC WETWELL REHABILITATION CARLSBAD CASUNNYHILL DRIVE WETWELL REHAB CPM AS NOTED 32182365-1 MAY 28 2021BY astm c478 fiberglass Lined Flat Top Rated For H-20 Loading detail-a SEE DETAIL B grade rings as required (by others) frame & cover (by others) tac opening size: Ø24" jack hammer/ demolition of existing base by contractor if required PVC PIPE RISER MASTIC SEALANT FRP BASE LINER DETAIL BN.T.S Temporary Bracket For Securing Liner While Grout Is Poured & Set 1.5" angle (size tbd by contractor) existing concrete wall (grind walls if needed) OD 1130 [44.50"] ID 1086 [42.76"] 608 [24"] riser1833 [72.18"] 2681 [105.53"] fast-set, non-shrink field grout, approximately 50 cuft (by others) existing manhole exs. mh 1219 [48.00"] 152 [6.00"] 183 [7.19"] 458 [18.0"] predl - type 300inside drop (REMOVE CAP, BY OTHERS) 92° 75° existing 8"Ø pipe existing 8"Ø pipe existing 8"Ø pipe benching non-skid surface trelleborg internal coupler, or rausch quick coupler, or approved equal (optional) 108 [4.25"] 151 [5.94"] 39 [1.54"] 12"Ø id dead-end channel install internal coupler drill Ø8" hole on site. install temporary foam plug to match with existing pipe id. after grout is cured, install internal coupler existing 8"Ø pipeexisting 8"Ø pipe existing 8"Ø pipe flush with manhole id 762 [30.0"] frp baseliner internal coupler (optional)A1156 [45.5"] 167° ASTM C478 CONCRETE PRECAST FLAT TOP SLAB DETAIL aN.T.S field grout 92° wire mesh 57 [2.24"] 462 [18.17"] pvc riser to exs. wall space44 [1.75"] lid to ex.s wall space32 [1.25"] exs. mh backfill/grout by others EXS. MH ID. 1219 [48.00"] DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS 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 10/26/2021 License # 0C36861 25682 DownStream Services, Inc. 2855 Progress Place Escondido, CA 92029 25674 00000 A 1,000,000 X DT22-CO-8L890612-TCT-21 11/15/2021 10/24/2022 300,000 Owners & Contractor 10,000 EBL, Blkt AI,WOS,Pri 1,000,000 2,000,000 2,000,000 Deductible 5,000 1,000,000B X 810-8L837211-21-26-G 11/15/2021 10/24/2022 Comp/Coll Ded 1,000 10,000,000B CUP-8L903833-21-26 11/15/2021 10/24/2022 10,000,000 10,000 10,000,000 B X UB-3R104531-21-26-G 10/24/2021 10/24/2022 1,000,000 1,000,000 1,000,000 C Professional Liabili 73594I210APL 11/15/2021 10/24/2022 Each Claim/Gen. Agg.1,000,000 Re: Job #PSA19-712, Storm Drain Assessment FY 18-19, All Operations. City of Carlsbad/CMWD is named as Additional Insured on primary and non-contributory basis, waiver of subrogation applies. City of Carlsbad/CMWD 1635 Faraday Ave. Carlsbad, CA 92008 DOWNSER-01 SVULLI San Diego-Alliant Insurance Services, Inc. 701 B St 6th Fl San Diego, CA 92101 Salvador Perez salvador.perez@alliant.com Travelers Indemnity Company of Connecticut Travelers Property Casualty Company of America StarStone Specialty Insurance Company PRO-COM OPE AGG X X X X X X X X X X X X DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 ~ ACORD" ~ f------□ f------ f------ f------ Fl □ f------ ' f------ f------ f------ □ □ ~ f------ f------ H I I I □ DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 POLICY NUMBER: DT22-CO-8L890612-TCT-21 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 11/15/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury'' or "property damage" that occurs, or for "personal injury'' caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section Ill -Limits Of Insurance. b. The insurance provided to such additional insured does not apply to: (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury'' or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. (2) If a claim is made or "suit" is brought against the additional insured: CG D2 46 0419 © 2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV -Commercial General Liability Conditions. Page 2 of 2 © 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 0419 DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 POLICY NUMBER: DT22-CO-8L890612-TCT-21 COMMERCIAL GENERAL LIABILITY ISSUED DATE: 11/15/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured -Unnamed Subsidiaries B. Blanket Additional Insured -Governmental Entities -Permits Or Authorizations Relating To Operations PROVISIONS A. WHO IS AN INSURED UNNAMED SUBSIDIARIES The following is added to SECTION II -WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury'' or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II -Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: C. Incidental Medical Malpractice D. Blanket Waiver Of Subrogation E. Contractual Liability -Railroads F. Damage To Premises Rented To You a. An organization other than a partnership, joint venture or limited liability company; or b. A trust; as indicated in its name or the documents that govern its structure. B. BLANKET ADDITIONAL INSURED GOVERNMENTAL ENTITIES -PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II -WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury'', "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products-completed operations hazard". CG D316 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II -WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury'' arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION Ill -LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I - COVERAGES -COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury'' or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II -Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. E. CONTRACTUAL LIABILITY -RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; Page 2 of 3 © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to: COMMERCIAL GENERAL LIABILITY a. Any premises while rented to you or temporarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. CG D316 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 POLICY NUMBER: 810-8L837211-21-26-G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which USE -INCREASED LIMIT I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS 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. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in 8.5., Other Insurance, of SECTION IV -BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "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 an "employee's" name, with your CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 COMMERCIAL AUTO perm1ss1on, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II -COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II -COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Policy Period, Coverage Territory, of SECTION IV -BUSINESS AUTO CONDI- TIONS: (5) Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II -COVERED AUTOS LIABILITY COVERAGE. (v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II -COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c) This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 0215 Includes copyrighted material of Insurance Services Office, Inc. with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE -GLASS The following is added to Paragraph D., Deducti- ble, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION Ill -PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION Ill -PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV -BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -BUSINESS AUTO CONDI- TIONS: 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 ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV -BUSINESS AUTO CONDITIONS: The unintentional om1ss1on of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved . CA T3 53 0215 Includes copyrighted material of Insurance Services Office, Inc. with its permission. DocuSign Envelope ID: 8A2BC549-165A-41DD-90AE-71DF62416788 ~ TRAVELERSJ WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) - POLICY NUMBER: UB-3R104531-21-26-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be mium. % of the California workers' compensation pre- Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/24/2021 Insured Downstream Services, inc. Policy No. UB-3R104531-21-26-G Endorsement No. Insurance Company ti'i"1/ . Countersigned by ~a:.--. ~ Travelers Property Casualty Company of America DATE OF ISSUE: 10/24/2021 ST ASSIGN: Page 1 of 1