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HomeMy WebLinkAboutCosco Fire Protection Inc; 2022-12-19; PSA23-2025FACPSA23-2025FAC City Attorney Approved Version 8/2/2022 1 AGREEMENT FOR CITYWIDE FIRE PROTECTION SYSTEM INSPECTION SERVICES COSCO FIRE PROTECTION, INC. THIS AGREEMENT is made and entered into as of the ______________ day of _________________________, 2022, by and between the City of Carlsbad, a municipal corporation ("City"), and Cosco Fire Protection, Inc., a California corporation ("Contractor"). RECITALS A. City requires the professional services of a consultant that is experienced in fire protection system inspection services. B. Contractor has the necessary experience in providing professional services and advice related to fire protection system inspection services. C. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A," which is incorporated by this reference in accordance with this Agreement’s terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective for a period of two (2) years from the date first above written. The City Manager may amend the Agreement to extend it for two (2) additional two (2) year periods or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term shall not exceed thirty-nine thousand nine hundred ninety-five dollars ($39,995) per year. No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. If the City elects to extend the Agreement, the amount shall not exceed thirty-nine thousand nine hundred ninety-five dollars ($39,995) per Agreement year. The City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or Services specified in Exhibit "A." Incremental payments, if applicable, should be made as outlined in attached Exhibit "A." DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 December 19th PSA23-2025FAC City Attorney Approved Version 8/2/2022 2 6. 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. 7. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City’s election, City may deduct the indemnification amount from any balance owing to Contractor. 8. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 9. OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 10. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorney’s fees arising out of the performance of the work described herein caused by any negligence, DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC City Attorney Approved Version 8/2/2022 3 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 City incurs or makes to or on behalf of an injured employee under the City’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 11. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor’s agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. 11.1 Coverage and Limits. Contractor will maintain the types of coverage and minimum limits indicated below, unless the Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 11.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an “occurrence” basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 11.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $2,000,000 combined single-limit per accident for bodily injury and property damage. 11.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. 11.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor’s profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 11.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 11.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC City Attorney Approved Version 8/2/2022 4 11.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 11.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 11.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 11.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 11.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 12. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 13. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 14. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy of the work product for Contractor’s records. 15. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City. 16. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. /// /// /// DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC City Attorney Approved Version 8/2/2022 5 For City For Contractor Name Charles Balteria Name Casey Pritchett Title Program Manager Title Account Manager Department Public Works Address 4990 Greencraig Lane City of Carlsbad San Diego, CA 92123 Address 405 Oak Avenue Phone No. 858-444-2016 Carlsbad, CA 92008 Email cpritchett@coscofire.com Phone No. 760-802-7530 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. 17. 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 four categories. Yes No 18. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 19. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 20. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 □ PSA23-2025FAC City Attorney Approved Version 8/2/2022 6 21. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement. City may terminate this Agreement by tendering thirty (30) days written notice to Contractor. Contractor may terminate this Agreement by tendering thirty (30) days written notice to City. In the event of termination of this Agreement by either party and upon request of City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. 22. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 23. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement. 24. JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC City Attorney Approved Version 8/2/2022 7 25. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld. 26. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC City Attorney Approved Version 8/2/2022 8 27. 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 CITY OF CARLSBAD, a municipal corporation of the State of California COSCO FIRE PROTECTION, INC., a California corporation By: By: (sign here) Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager Alexander Hernandez, Vice President (print name/title) By: (sign here) Roger Jump, Treasurer & Secretary (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, 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 BY: _____________________________ City Attorney DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC City Attorney Approved Version 8/2/2022 9 EXHIBIT “A” SCOPE OF SERVICES Contractor to provide all tools, materials and labor to perform fire protection system inspection and testing services at the City of Carlsbad locations identified on the Vendor Proposed Cost of Service Chart “Exhibit B.” Inspections A visual examination of a system or portion thereof, intended to establish within a reasonable certainty the operational condition of the system[s]. This is done by observing that the system[s] has not been tampered with and there is no obvious physical damage, or any condition that will prevent its complete operation. The value of an inspection lies in the frequency, and thoroughness with which it was conducted. All systems shall be inspected at mandated intervals or at intervals that are more frequent when circumstances require and shall be in accordance with NFPA. Testing The labor, tools and/or specialized equipment needed to verify that all system[s] and ancillary components will function as intended. The frequency of such tests shall be in accordance with NFPA. Maintenance The necessary or required repair work and adjustments performed outside of inspections and testing to keep fire protection systems and ancillary components at full operational condition and “automatic” in its function. Such maintenance and/or repair work will be bid separately and independently from this agreement. Reports Inspection reports listing all items that were inspected and tested will be returned to the customer after each inspection as a record of inspection compliance. Any deficiency listed on the inspection reports will be bid separately and will only be performed upon customer approval. Deficiencies must be repaired to maintain systems’ operational readiness. Task 1. Annual Test & Inspection of the Automatic Fire Sprinkler Systems Annual Inspection of water-based fire protection system as required by NFPA 25 [2013 California Edition] to include: • 100 % visual inspection of all exposed and accessible fire sprinkler heads • System gauges • Hydraulic nameplates • System pipe hangers and seismic bracing • System pipe and fittings • Water-flow alarm devices • Valve supervisory alarm devices DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC Exhibit “A” (Cont.) City Attorney Approved Version 8/2/2022 10 • Spare sprinklers and head wrench • Fire department connections • Pressure regulating devices • Control valve position • Alarm valves [exterior only] • Post indicator valves and backflow prevention assemblies • Listing all deficiencies that must be corrected to certify the system as fully operational • Submit inspection report [AES 1 thru 9] as record of inspection and compliance Annual Testing of water-based fire protection system as required by NFPA 25 [2013 California Edition] to include: • Testing of control valves, backflow and PIV control valves supervisory [tamper] devices • Main drain water-flow test [record of test pressures in inspection report] • Verification of alarm bell by activation of water-flow switch • Verification of supervisory alarm devices and tamper signals to fire alarm control panel and monitoring company • Exercise control valves thru full range of motion • Submit inspection report [AES 1 thru 9] as record of inspection and compliance Task 2. Annual Test & Inspection of the Fire Alarm and Detection Systems Annual Inspection and Testing of fire alarm control panel and ancillary alarm components per NFPA 72, to include the inspection and testing of: • Pull stations • Smoke detectors • Duct smoke detectors • Heat detectors • Fire alarm control panel • Battery load test • Supervisory devices • Water flow devices • Alarm bells • All horns and strobes • FACP and off-site monitoring interface [if installed] • Complete inspection report and inventory as record of inspection compliance and system status Task 3. Semi-Annual Test & Inspections of the Gas Fire Suppression Systems Semi-Annual inspection and testing of engineered fixed extinguishing systems as required by the state of California, Title 19, Chapter 5, and in accordance with the manufacturer's written instructions, to include: • Cylinders o Check all cylinder bracketing o Check cylinder discharge hoses for structural damage, weather checking, and abrasions o Determine cylinder pressure is within the operational range by cylinder fixed gauge (if present) DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC Exhibit “A” (Cont.) City Attorney Approved Version 8/2/2022 11 o Check hoses - must be hydro tested every 5 years [done at additional cost when due] o Check for corrosion, damage or missing components o Cylinders are undamaged, corrosion free and no signs of tamper o Check cylinders for last hydro test date o Check each cylinder agent volume o FM200, Halon, CO2, etc. By cylinder weight (compare to weight stamp) o Inergen, Argonite by cylinder pressure (compare to manufacturer's pressure /temperature chart) o Install cylinder tag on each cylinder with date, inspector name, cylinder status and agent volume • Actuators o Manual actuators must operate freely o Electrical actuators must be wired correctly and properly connected • Switches o Piping is firmly and properly attached o Check for signs of damage or corrosion o Verify all pressure switches in place and in non-operated position o Test pressure switch operation and alarm panel response o Check all switches on the system to assure proper operation o Include maintenance switches, abort switches, main /reserve switches, etc. • Control Panel o Check condition of panel for tampering, corrosion, or damage o Visually verify that control panel and releasing devices are functioning properly o Test alarm panel for detector, manual pull stations, alarm devices reporting to control panel with alarm activation and main panel interface o Test control panel response and cylinder activation o Return panel to normal operational status • Detectors and Pull Stations o In place and connected o Not physically damaged o Free of contaminating substance or paint o Have not been tampered with o Are accessible and not obstructed from use o Operate each device to make certain it operates the alarm panel when energized o Test detectors and pull stations for panel response and cylinder activation • Hazard Area o Verification that hazard area has not changed o New equipment and/or different fuel loads o All penetrations to agent flood area have been properly sealed o Blocked open doors or dampers • Alarm Devices o Free from damage, dirt, and corrosion o Test pre-release alarm response o Test release alarm response o Test abort button response • System Piping o Piping is secure o Nozzles are clean and unobstructed o Check all components for damage, disconnected or loose parts, and corrosion DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC Exhibit “A” (Cont.) City Attorney Approved Version 8/2/2022 12 Exclusions • Working in areas with hazardous material, as defined by OSHA • Release of test water only to atmosphere for common area collection [no hoses to sanitary collection] • 12-year hydrostatic test and/or service of Ansul tanks, replacements and/or parts [done at additional cost] • 5-year hydrostatic test and/or service of gas suppression system discharge hoses • Stand-by time waiting for system or system component access • Modifications to the system(s) for needed corrections found during the inspection • Repair or replacement of components of system that fail or break during inspection • Firewatch for system impairment during time of inspection [if needed] • 5-Year Certification of the fire sprinkler systems (done at additional cost when due) • Annual backflow preventer certification as may be required by the local water authority • Submittal of inspection reports to the compliance engine, if City Fire Dept. decides to adopt process • Monitoring service of the fire alarm panels (performed by others) • Elevator recall testing and associated fire alarm devices [elevator contractor assistance on a T&M basis] DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC Exhibit “B” (Cont.) City Attorney Approved Version 8/2/2022 13 EXHIBIT “B” Vendor Proposed Cost of Service Chart Location Task 1. Annual Fire Sprinkler Task 2. Annual Fire Alarm Task 3. Gas Fire Suppression Systems Annual Totals Alga Norte Community Park 6565 Alicante Road $1,995.00 $ 1,995.00 Aviara Park Maintenance Shop 6435 Ambrosia Lane $495.00 $ 495.00 Calavera Community Park 2997 Glasgow Drive $895.00 $ 895.00 City Hall Complex 1200 Carlsbad Village Drive n/a $1,795.00 $ 1,795.00 CMWD Building 5950 El Camino Real $1,495.00 $ 1,495.00 Cole Library 1250 Carlsbad Village Drive $2,895.00 $595 x (2) $ 4,085.00 Dove Library 1775 Dove Lane $3,195.00 $795 x (2) $ 4,785.00 Faraday Building 1635 Faraday Ave $1,895.00 $495 x (2) $ 2,885.00 Farmers Insurance Building 5815 El Camino Real $2,395.00 $ 2,395.00 Fire Station No. 2 1906 Arenal Rd $995.00 $ 995.00 Fire Station No. 3 3465 Trailblazer Way $995.00 $ 995.00 Fire Station No. 4 6885 Batiquitos Lane $495.00 n/a $ 495.00 Fire Station No. 5 2540 Orion Street $995.00 $ 995.00 Fire Station No. 6 7201 Rancho Santa Fe Rd $695.00 $ 695.00 Fire Station No. 7 4600 Carlsbad BLVD $495.00 n/a $ 495.00 Harding Community Center 3096 Harding Street $595.00 $ 595.00 Las Palmas Building 2075 Las Palmas $1,360.00 $ 1,360.00 Leo Carrillo Historic Park 6200 Flying L.C. Lane $995.00 $ 995.00 DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 PSA23-2025FAC Exhibit “B” (Cont.) City Attorney Approved Version 8/2/2022 14 Location Task 1. Annual Fire Sprinkler Task 2. Annual Fire Alarm Task 3. Gas Fire Suppression Systems Annual Totals Library Learning Center 3368 Eureka Place $1,095.00 $ 1,095.00 Magee House 258 Beach Street n/a $495.00 $ 495.00 Pine Community Center 3209 Harding Street $1,595.00 $ 1,595.00 Poinsettia Community Park 6600 Hidden Valley Lane $395.00 n/a $ 395.00 Police & Fire HQ 2560 Orion Street $2,095.00 $495 x (2) $ 3,085.00 Safety Training Center 5750 Orion Street $2,795.00 $ 2,795.00 Senior Center 799 Pine Ave $1,295.00 $ 1,295.00 Stagecoach Community Park 3420 Camino de los Coches $795.00 $ 795.00 Total fees not to exceed $39,995 per agreement year. Notes: Inspections to be conducted during normal business hours; Monday - Friday 7 a.m. – 4 p.m. The annual fire sprinkler and annual fire alarm must be scheduled and performed in conjunction with one another, per location. DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 A 2,000,000 GLD1447205 X CHI-009209689-10 1,000,000 8,000,000 Includes Stop Gap X 22667 8,000,000 Grand Rapids, MI 49503 N X01/01/2022 9 01/01/2023 01/01/2023 GrandRapids.CertRequest@marsh.com ISA H25549880 B 2,000,000 2,000,000 X N/A ACE American Insurance Company 1,000,000 X 11/21/2022 SDiego 01/01/2022 Re: All Operations City of Carlsbad is/are included as additional insured where required by written contract with respect to General Liability. This insurance is primary and non-contributory over any existing insurance and limited to X PO Box 4668-ECM#35050 New York, NY 10163-4468 City of Carlsbad/CMWD liability arising out of the operations of the named insured subject to policy terms and conditions. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. A N/A CN108159189-MX-GAW-22-23 10,000 01/01/2023 2,000,000 CUD1447305 2,000,000 41343 1,000,000 1,000,000 WLR C68917396 125 Ottawa Avenue NW Marsh USA Inc. X Suite 400 X 4990 Greencraig Lane Cosco Fire Protection, Inc. San Diego, CA 92123 X 01/01/2022 c/o EXIGIS Insurance Compliance Services X 01/01/2022 X B Marsh | U.S. Operations 01/01/2023 (866) 966-4664 HDI Global Insurance Company DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 ~ ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) ~ 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 CONTACT NAME: wgN:o Extl: I FAX IA/C Nol: E•MAIL ADDRESS: INSURERISl AFFORDING COVERAGE NAIC# INSURER A : INSURED INSURERB: INSURERC: INSURERD: INSURERE : INSURERF : 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 ADDL SUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE '""'D WVD POLICY NUMBER IMMIDD/YYYYI IMMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ~ □ CLAIMS-MADE □ OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence) $ ~ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl □PRO-D Loc PRODUCTS • COMP/OP AGG $ POLICY JECT OTHER: $ AUTOMOBILE LIABILITY fE~~~~d~~tf lNGLE LIMIT $ ~ 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) ~ ~ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ ~ EXCESSLIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION $ $ WORKERS COMPENSATION I PER I I OTH• AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE □ N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE • EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ~USA~~- © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 Policy #GLD1447205 Effective: 1/1 /2022-1/1 /2023 HDI GLOBAL INSURANCE COMPANY IL Al 4001 (06 11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED INSURED ENDORSEMENT The Named Insured is amended to read as follows: MX HOLDINGS, US INC. MINIMAX FIRE SOLUTIONS, INC . COSCO FIRE PROTECTION , INC. FLAMEX, INC. CFP, INC. MINIMAX CHINA FIRE PROTECTION SYSTEM, INC. LIMITED FIRETROL PROTECTION SYSTEMS CO., CFP FIRE PROTECTION SYSTEMS, INC. OBA ARIZONA FIRE AND SECURITY KLISTER, LLC. FIRE CALL, INC. FIRETROL PROTECTION SYSTEMS, INC. FIRETROL PROTECTION SYSTEMS, INC D/B/A ARIZONA FIRE & SECURITY PREDOMONT SOUND & SIGNAL, INC . CFP FIRE PROTECTION, INC . All other terms and conditions remain the same. THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN. Page 1 of 1 IL Al 4001 (06 11) DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 ENDORSEMENT Policy Number GLD1447205 HDI Global Insurance Company Named Insured MX HOLD I NGS US, I NC. Agent Name Agent No. MARSH USA INC. OF MI (GRAP) P02082030 This Endorsement Changes The Policy. Please Read It Carefully. Effective Date: 0 1 -0 1 -2 2 12:01 A.M., Stan dard Time BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION CG 201010 01 VERSION AS PER THE WRITTEN CONTRACT (IF NO ENTRY APPEARS ABOVE, INFORMATION REQUIRED TO COMPLETE TH IS ENDORSEMENT WILL BE SHOWN IN THE DECLARATIONS AS APPLICABLE TO THIS ENDORSEMENT.) A. SECTION II -WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN INSURED THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF YOUR ONGOING OPERATIONS PERFORMED FOR THAT INSURED. B. WITH RESPECT TO THE INSURANCE AFFORDED TO THESE ADDITIONAL INSUREDS, THE FOLLOWING EXCLUSION IS ADDED: 2. EXCLUSIONS TH IS 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 SITE 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. MAN-GL (01 /02) DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 ENDORSEMENT Policy Number GLD1447205 HDI Global Insurance Company Named Insured MX HOLD INGS US, I NC. Agent Name Agent No. MARSH USA INC. OF MI (GRAP) P02082030 This Endorsement Changes The Policy. Please Read It Carefully. Effective Date: 0 1 -0 1 -2 2 12:01 A.M., Stan dard Time BLANKET ADDITIONAL INSURED -OWNERS, LESSEES, OR CONTRACTORS -COMPLETED OPERATIONS CG 203710 01 AS PER THE WRITTEN CONTRACT (IF NO ENTRY APPEARS ABOVE, INFORMATION REQUIRED TO COMPLETE THIS ENDORSEMENT WILL BE SHOWN IN THE DECLARATIONS AS APPLICABLE TO THIS ENDORSEMENT.) SECTION II -WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN INSURED THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF "YOUR WORK" AT THE LOCATION DESIGNATED AND DESCRIBED IN THE SCHEDULE OF THIS ENDORSEMENT PERFORMED FOR THAT INSURED AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERATIONS HAZ-ARD". MAN-GL (01 /02) DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE SUITE 200 Policy Number IRVINE CA 92618 Symbol: WLR Number: C68917396 Policy Period Effective Date of Endorsement 01-01-2022 TO 01-01 -2023 01-01-2022 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. Th e remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. WA IVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us . This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PE RSON OR ORGANIZATION AGAI NST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY I N A WRITTEN CONTRACT , PROVI DED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS . For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287 .150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas , use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K .S.A .. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Agent WC 00 03 13 (11/05) © Copyright 1983-2017 National Council on Compensation Insurance, Inc. All Rights Reserved. DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE SUITE 200 Policy Number IRVINE CA 92618 Symbol: WLR Number: C68917396 Policy Period Effective Date of Endorsement 01-01-2022 TO 01-01 -2023 01-01-2022 Issued By (N ame of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsemen t changes the policy to which it is attached and is effective on the date issued unless otherwise stated. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this wa iver from us . You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described . 4. Minimum Premium: $0 Authorized Representative WC 90 03 75 (05/18) DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE SUITE 200 Policy Number IRVINE CA 92618 Symbol: WLR Number: C68917396 Policy Period Effective Date of Endorsement 01-01-2022 TO 01-01 -2023 01-01-2022 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the schedule. 1. Schedule Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2 . O percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: $ 5 , 4 3 6 Authorized Representative WC 42 03 04B (06114) © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved . DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE SUITE 200 Policy Number IRVINE CA 92618 Symbol: WLR Number: C68917396 Policy Period Effective Date of Endorsement 01-01-2022 TO 01 -01-2023 01-01-2022 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsemen t changes the policy to which it is attached and is effective on the date issued unless otherwise stated. UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from u s.) This agreement shall not operate directly or indirectly to benefit anyone not named in the schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties. Schedule ANY PERSON OR ORGAN IZATION AGAI NST WHOM YOU HAVE AGRE ED TO WAIVE YOUR RIGHT OF RECOVERY I N A WRITTEN CONTRACT, PROVI DED SUCH CONTRACT WAS EXECUTED PR IOR TO THE DATE OF LOSS . Authorized Representative WC 43 03 05 (10/00) Ptd. in U.S.A. DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 CA I cN~IUN uf INFORMATION PAGE Named Insured Endorsement Number MX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE SUITE 200 Policy Number IRVINE CA 92618 Symbol: WLRNumber: C68917396 Policy Period Effective Date of Endorsement 01-01-2022 TO 01-01-2023 01-01-2022 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. SCHEDULE OF NAMED INSURED ITEM 1., NAMED INSURED, OF THE INFORMATION PAGE IS EXTENDED AS FOLLOWS: NAMED INSURED MX HO LDINGS US, INC . CFP FIRE PROTECTION , INC . COSCO FIRE PROTECTION , INC . FIRETROL PROTECTION SYSTEMS , INC . FLAMEX , INC . MINIMAX FIRE SOL UTIONS, INC . For the state of CA refer to state specific endorsement. WC 99 99 99 A (10/06) FEIN 202356604 562302 92 9 954208955 870405034 561814722 263288050 ~ Authorized Repres entative Page 1 of 1 DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 C: H LI B B ISSUING COMPANY POLICY NUMBER Symbol: WLR Number: PREVIOUS POLICY NO. ACEAMER~ANINSURANCECOMPANY NCCI CARRIER CODE 12165 □ New [81 Renewal C6 89 17 39 6 □ Individual D Partnership Workers' Compensation and Employers Liability Insurance Policy D Rewrite Information Page D Association Symbol: WLR Number: C67810089 [81 Corporation D Joint Venture D Other Legal Entity Item 1. Named Insured Mailing Address jMX HOLDINGS US, INC. 153 TECHNOLOGY DRIVE SUITE 200 IRVINE CA 92618 L Inter/Intrastate ID No.: 911306794 Federal Employer ID No.: 202356604 Employer's ID No.: PIIC CODE: 1711 For other named insured see Extension of Information Page -Schedule of Named Insured, WC 99 99 99 A For other workplaces see Extension of Information Page -Schedule of Other Workplaces, WC 99 99 99 B Item 2. Policy period: From 01-01-2022 To 01-01-2023 12:01 A.M., standard time at the named insured's mailing address. Item 3A. Workers' Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here: AL,AZ,CA,CO,FL,ID,LA,MA,NC,NV,OK,OR,TX,UT Item 38. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 Bodily Injury by Disease $ 1,000,000 Bodily Injury by Disease $ 1,000,000 Item 3C. Other States Insurance: Part Three of the policy app lies to the states, if any, listed here: ALL ST A TES EXCEPT ND,OH,WA,WY, AND STATES DESIGNATED IN ITEM 3.A Item 3D. This Policy includes these endorsements and schedules: See schedule of Forms and Endorsements WC999999D each accident policy limit each employee Item 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE -CLASSIFICATIONS If indi£ated here, interim agiustments of premium will be made: LJ Semi-Annually LJ Quarterly LJ Monthly PRODUCER NAME AND MAILING ADDRESS MARSH USA INC 125 OTTAWA AVE NW SUITE 400 GRAND RAPIDS Ml 49503 PRODUCER CODE : 221539 36-1436000 CGU COMMISSION : Percent: .00 Amount: 0 .00 MARKETING OFF ICE: CHICAGO BRANCH ISSUE DATE : 12/29/2021 Minimum Premium collected in AL $ Total Estimated Premium $ Deposit Premium $ Target Risk No: S800066620 Fae. Reins. D Yes (8]No ~ Authorized Represen tative WC 00 00 01 A {05/88) Copyright 1987 National Council on Compensation Insurance COMPANY COPY DocuSign Envelope ID: 0B174DD7-6155-4221-8EDB-FCFE90104C32 Policy #GLD1447205 Effective: 1/1 /2022-1/1 /2023 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance (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. 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 CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1