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HomeMy WebLinkAboutWest Coast Arborists Inc; 2022-11-21; PSA23-2018UTILPSA23-2018UTIL General Counsel Approved Version 8/2/2022 1 AGREEMENT FOR SKYLINE RESERVOIR TREE TRIMMING, VINE CUTTING AND DEBRIS REMOVAL SERVICES WEST COAST ARBORISTS, 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 West Coast Arborists, Inc., a California corporation, ("Contractor”). RECITALS CMWD requires the professional services of a consultant that is experienced in tree trimming and landscape maintenance. 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 thirty (30) days from the date first above written. 3. COMPENSATION The total fee payable for the Services to be performed will be three thousand five hundred sixty dollars ($3,560). 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 ten percent (10%) retention until CMWD has accepted the work and/or the Services specified in Exhibit “A.” 4. PREVAILING WAGE RATES Any construction, alteration, demolition, repair, and maintenance work, including work performed during design and preconstruction such as inspection and land surveying work, cumulatively exceeding $1,000 and performed under this Agreement are subject to state prevailing wage laws. 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 such workers employed by him or her in the execution of the 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: DCA9344B-E9DC-4517-AE09-6799C9B05768 November 21st PSA23-2018UTIL General Counsel Approved Version 8/2/2022 2 5. 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. 6. 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’ 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. 7. 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 thirty (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. 8. NOTICES The name of the persons who are authorized to give written notices or to receive written notice on behalf of CMWD and on behalf of Contractor under this Agreement. For CMWD For Contractor Name Andrew Wilson Name Dillon Mccarver Title Utilities Superintendent Title Project Manager Carlsbad Municipal Water District Address 1359 Montiel Road Address 5950 El Camino Real Escondido, CA 92026 Carlsbad, CA 92008 Phone 760-871-2171 Phone 760-802-5720 E-mail dmccarver@wcainc.com DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 PSA23-2018UTIL General Counsel Approved Version 8/2/2022 3 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. 9. 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 ☒ 10. 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. 11. 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. 12. 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. 13. 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. 14. 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. 15. 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: DCA9344B-E9DC-4517-AE09-6799C9B05768 PSA23-2018UTIL General Counsel Approved Version 8/2/2022 4 16. 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 WEST COAST ARBORISTS, INC., a California corporation By: By: (sign here) Vicki V. Quiram, General Manager as authorized by the Executive Manager Patrick Omalley Mahoney, President (print name/title) By: (sign here) Richard Robert Mahoney, Secretary (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: CINDIE K. McMAHON, General Counsel By: _____________________________ General Counsel DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 PSA23-2018UTIL General Counsel Approved Version 8/2/2022 5 EXHIBIT “A” SCOPE OF SERVICES Skyline Reservoir Tree Trimming, Vine Cutting and Debris Removal Services DESCRIPTION Price Contractor to provide all equipment, tools, and staff necessary to prune select eucalyptus trees along fence line. Contractor to cut vines and remove all dead material on the ground adjacent to the chain link fence. Contractor to remove from this site and properly dispose of all debris generated from these services. TOTAL AMOUNT NOT TO EXCEED *$3,560 *Includes taxes, fee’s, expenses and all other costs. NOTE: Contractor to contact CMWD project manager to arrange for access to Skyline Reservoir as it is a limited admittance site. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 ABDEHJOHolder Identifier : 7777777707070700077763616065553330773617556304557607453136772406310073650566157330020762404113076110207166015776274512075626735760367740772641557205671207744015352274570077727252025773110777777707000707007 6666666606060600062606466204446200622000424004220206200024042260002062220240422422000622220624006020006222024060040002062200240422400020622000424226002206222206042000422066646062240664440666666606000606006Certificate No :570094282116CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/30/2022 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PRODUCER Aon Risk Insurance Services West, Inc. Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 Los Angeles CA 90017-0460 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 36056Navigators Specialty Insurance CompanyINSURER A: 38318Starr Indemnity & Liability CompanyINSURER B: 16109Starr Specialty Insurance CompanyINSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: West Coast Arborists, Inc. 2200 E Via BurtonAnaheim CA 92806 USA COVERAGES CERTIFICATE NUMBER:570094282116 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 $1,000,000 $5,000 $2,000,000 $4,000,000 $4,000,000 B 07/01/2022 07/01/20231000100141221 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $2,000,000B07/01/2022 07/01/2023 COMBINED SINGLE LIMIT (Ea accident) 1000198198221 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 07/01/2022UMBRELLA LIABA 07/01/2023SE22EXCZ059NKIC RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH-ERPER STATUTEC07/01/2022 07/01/2023 Workers Comp CA SIR applies per policy terms & conditions $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 1000004228 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Carlsbad (CMWD), its officials, employees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of the City of Carlsbad (CMWD), its officials, employees and volunteers in accordance with the policy provisions of the General Liability, Automobile Liability and Workers Compensation policies. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Carlsbad 5950 El Camino Real Carlsbad CA 92008 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 _____, I ACC>RC,® ~ I -D □ - - - ~ □ □ - -~ -~ -~ -H I I I I I □ AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570094282116 570094282116 Aon Risk Insurance Services West, Inc. 570000083713 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # West Coast Arborists, Inc. TYPE OF INSURANCE POLICY NUMBER LIMITS WORKERS COMPENSATION B 1000004229 07/01/2022 07/01/2023 Workers Comp AZ N/A ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) SIR applies per policy terms & conditions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 I I COMMERCIAL GENERAL LIABILITYCG 20 10 04 13POLICY NUMBER: 1000100141221 Effective: 07/01/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to 1.All work,including materials,parts or include as an additional insured the person(s) or equipment furnished in connection with suchorganization(s) shown in the Schedule, but only work,on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by ordamage"or "personal and advertising injury"on behalf of the additional insured(s) at the caused, in whole or in part, by:location of the covered operations has beencompleted; or1.Your acts or omissions; or 2.That portion of "your work" out of which the2.The acts or omissions of those acting on your injury or damage arises has been put to itsbehalf;intended use by any person or organizationin the performance of your ongoing operations for other than another contractor or subcontractortheadditionalinsured(s)at the location(s)engaged in performing operations for adesignated above.principal as a part of the same project.However:C.With respect to the insurance afforded to these1.The insurance afforded to such additional additional insureds, the following is added toinsured only applies to the extent permitted by Section III – Limits Of Insurance:law; and If coverage provided to the additional insured is2.If coverage provided to the additional insured is required by a contract or agreement, the most werequiredbyacontractoragreement,the will pay on behalf of the additional insured is theinsurance afforded to such additional insured amount of insurance:will not be broader than that which you arerequiredbythecontractoragreementto 1.Required by the contract or agreement; orprovide for such additional insured.2.Available under the applicable Limits ofInsurance shown in the Declarations;B.With respect to the insurance afforded to theseadditionalinsureds,the following additional whichever is less.exclusions apply:This endorsement shall not increase theThis insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the"property damage" occurring after:Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Name Of Additional Insured Person(s) OrOrganization(s):Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 COMMERCIAL GENERAL LIABILITYCG 20 37 04 13POLICY NUMBER: 1000100141221 Effective: 07/01/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PARTPRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to required by the contract or agreement toprovide for such additional insured.include as an additional insured the person(s) ororganization(s) shown in the Schedule, but only B.With respect to the insurance afforded to thesewithrespecttoliabilityfor"bodily injury"or additional insureds, the following is added to"property damage" caused, in whole or in part, by Section III – Limits Of Insurance:"your work"at the location designated anddescribed in the Schedule of this endorsement If coverage provided to the additional insured isperformed for that additional insured and included required by a contract or agreement, the most wein the "products-completed operations hazard".will pay on behalf of the additional insured is the amount of insurance:However: 1.Required by the contract or agreement; or1.The insurance afforded to such additionalinsured only applies to the extent permitted by 2.Available under the applicable Limits oflaw; and Insurance shown in the Declarations;2.If coverage provided to the additional insured is whichever is less.required by a contract or agreement,the This endorsement shall not increase the applicableinsurance afforded to such additional insured Limits of Insurance shown in the Declarations.will not be broader than that which you are CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Name Of Additional Insured Person(s) OrOrganization(s):Location And Description Of CompletedOperations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 Dallas, TX 1-866-519-2522 Primary and Non-Contributory Condition Effective Date: July 1, 2022 at 12:01 A.M.Policy Number: 1000100141221 Named Insured: West Coast Arborists, Inc. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV – CONDITIONS, condition 4. Other Insurance is amended as follows: 1.The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the writtencontract or written agreement requires that this insurance be primary and non-contributory. In thatevent, we will not seek contribution from any other insurance policy available to the additional insuredon which the additional insured is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Counsel OG 107 (04/11) Page 1 of 1Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved.Includes copyrighted material of ISO Properties, Inc., used with its permission. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 -Starr Indemnity & Liability Company COMMERCIAL GENERAL LIABILITYCG 20 12 04 13POLICY NUMBER: 1000100141221 Effective: 07/01/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICALSUBDIVISION – PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE a."Bodily injury","property damage"orA. Section II – Who Is An Insured is amended to "personal and advertising injury" arising outinclude as an additional insured any state or of operations performed for the federalgovernmental agency or subdivision or political government, state or municipality; orsubdivision shown in the Schedule, subject to thefollowing provisions:b."Bodily injury"or "property damage"included within the "products-completed1.This insurance applies only with respect to operations hazard".operations performed by you or on your behalffor which the state or governmental agency or B.With respect to the insurance afforded to thesesubdivision or political subdivision has issued a additional insureds, the following is added topermit or authorization.Section III – Limits Of Insurance: However:If coverage provided to the additional insured isrequired by a contract or agreement, the most wea.The insurance afforded to such additional will pay on behalf of the additional insured is theinsured only applies to the extent permitted amount of insurance:by law; and 1.Required by the contract or agreement; orb.If coverage provided to the additionalinsuredisrequiredbyacontractor 2.Available under the applicable Limits ofagreement, the insurance afforded to such Insurance shown in the Declarations;additional insured will not be broader than whichever is less.that which you are required by the contract This endorsement shall not increase theor agreement to provide for such additional applicable Limits of Insurance shown in theinsured.Declarations.2.This insurance does not apply to: CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 State Or Governmental Agency Or Subdivision Or Political Subdivision: Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 POLICY NUMBER: 1000198198221 COMMERCIAL AUTOCA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FORCOVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORMBUSINESS AUTO COVERAGE FORMMOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unlessmodified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverageunder the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverageprovided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicatedbelow. Named Insured: Endorsement Effective Date: 07/01/2022 SCHEDULE Each person or organization shown in the Schedule isan "insured" for Covered Autos Liability Coverage, butonly to the extent that person or organization qualifiesas an "insured" under the Who Is An Insuredprovision contained in Paragraph A.1.of Section II –Covered Autos Liability Coverage in the BusinessAuto and Motor Carrier Coverage Forms andParagraph D.2. of Section I – Covered AutosCoverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Name Of Person(s) Or Organization(s): Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. West Coast Arborists, Inc. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 Dallas, TX 1-866-519-2522 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Effective Date: 07/01/2022 at 12:01 A.M.Policy Number: 1000198198221 Named Insured: West Coast Arborists, Inc. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights ofRecovery Against Others to Us, is amended to add: However, we will waive any right of recovery we have against any person or organization withwhom you have entered into a contract or agreement because of payments we make under thisCoverage Form arising out of an "accident" or "loss" if: (1)The "accident" or "loss" is due to operations undertaken in accordance with thecontract existing between you and such person or organization; and(2)The contract or agreement was entered into prior to any "accident" or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees oremployees of the person or organization, and we reserve our rights or lien to be reimbursed fromany recovered funds obtained by any injured employee. All other terms, conditions and exclusions of the policy shall remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Counsel SICA 1020 (03/12) Page 1 of 1Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved.Includes copyrighted material of ISO Properties, Inc., used with its permission. DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 • Starr Indemnity & Liability Company ~ €. ~ V y: 07/01/2022 100 0004228 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforceour right against the person or organization named in the Schedule. (This agreement applies only to the extent thatyou perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in thework described in the Schedule. 2.0% of the California workers' compensation premiumThe additional premium for this endorsement shall beotherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contractAny person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: Policy No.: Endorsement No.: Insured: W e s t C o a s t A r b o ri s ts , In c.Premium: Insurance Company: S t ar r S p e ci a lt y & L ia bili ty C o m p a n y Countersigned by WC 04 03 06 Page 1 of 1(Ed. 04-84) DocuSign Envelope ID: DCA9344B-E9DC-4517-AE09-6799C9B05768 l vJ