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Home My WebLink AboutDudek; 2024-03-14; PSA24-2383TRANPSA24-2383TRAN City Attorney Approved Version 12/22/2023 Page 1 AGREEMENT FOR GABBIANO LANE STORM DRAIN OUTFALL INSPECTION AND MAINTENANCE ASSESSMENT SERVICES DUDEK THIS AGREEMENT is made and entered into as of the ______________ day of ___________________, 2024, by and between the City of Carlsbad, California, a municipal corporation ("City") and Dudek, a California corporation ("Contractor”). RECITALS City requires the professional services of an environmental consulting consultant that is experienced in environmental consulting. Contractor has the necessary experience in providing these professional services, 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 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 ninety (90) day(s) from the date first above written. 3. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term shall not exceed five thousand dollars ($5,000). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or the Services specified in Exhibit “A”. 4. CONSTRUCTION MANAGEMENT SOFTWARE Procore Project Management and Collaboration System. This project may utilize the Owner’s Procore (www.procore.com) online project management and document control platform. The intent of utilizing Procore is to reduce cost and schedule risk, improve quality and safety, and maintain a healthy team dynamic by improving information flow, reducing non-productive activities, reducing rework and decreasing turnaround times. The Contractor is required to create a free web-based Procore user account(s) and utilize web-based training / tutorials (as needed) to become familiar with the system. Unless the Engineer approves otherwise, the Contractor shall process all project documents through Procore because this platform will be used to submit, track, distribute and collaborate on project. If unfamiliar or not otherwise trained with Procore, Contractor and applicable team members shall complete a free training certification course located at http://learn.procore.com/procore-certification- subcontractor. The Contractor is responsible for attaining their own Procore support, as needed, either through the online training or reaching out to the Procore support team. It will be the responsibility of the Contractor to regularly check Procore and review updated documents as they are added. There will be no cost to the Contractor for use of Procore. DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 14th March PSA24-2383TRAN City Attorney Approved Version 12/22/2023 Page 2 It is recommended that the Contractor provide mobile access for Windows, iOS located at https://apps.apple.com/us/app/procore-construction-management/id374930542 or Android devices located at https://play.google.com/store/apps/details?id=com.procore.activities with the Procore App installed to at least one on-site individual to provide real-time access to current posted drawings, specifications, RFIs, submittals, schedules, change orders, project documents, as well as any deficient observations or punch list items. Providing mobile access will improve communication, efficiency, and productivity for all parties. The use of Procore for project management does not relieve the contractor of any other requirements as may be specified in the contract documents. 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 City. Contractor will be under the control of City only as to the results to be accomplished. 6.INDEMNIFICATION Contractor agrees to defend (with counsel approved by the City), indemnify, and hold harmless the City and its officers, elected and appointed officials, employees and volunteers from and against all claims, damages, losses and expenses including reasonable attorney’s fees arising out of the performance of the work described herein caused by any willful misconduct or negligent act or omission 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. 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 the City by certified mail. City will be named as an additional insured on General Liability which shall provide primary coverage to the City. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Contractor will furnish certificates of insurance to the Contract Department, with endorsements to City prior to City’s execution of this Agreement. 8.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: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 PSA24-2383TRAN City Attorney Approved Version 12/22/2023 Page 3 For City For Contractor Name David Edwards Name Nicole Rieger Title Senior Engineer Title Project Manager Department Public Works Address 605 Third Street City of Carlsbad Encinitas, CA 92024 Address 1635 Faraday Ave Phone No. 760-479-4148 Carlsbad, CA 92008 Email nrieger@dudek.com Phone No. 442-339-5286 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 as required in the City of Carlsbad Conflict of Interest Code. Yes ☐ No ☒ If yes, list the contact information below for all individuals required to file: Name Email Phone Number 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.CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATIONS Contractor’s vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 PSA24-2383TRAN City Attorney Approved Version 12/22/2023 Page 4 12.TERMINATION City or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. City 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. 13.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 the City of Carlsbad to terminate this Agreement. 14.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. 15.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 City. 16.AMENDMENTS This Agreement may be amended by mutual consent of City and Contractor. Any amendment will be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. 17.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. This Agreement may be executed in counterparts. 18.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. [signatures on following page] DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 PSA24-2383TRAN City Attorney Approved Version 12/22/2023 Page 5 CONTRACTOR DUDEK, a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager Joseph Monaco, President (print name/title) By: (sign here) Amy M. Paul, 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, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 PSA24-2383TRAN City Attorney Approved Version 12/22/2023 Page 6 EXHIBIT A SCOPE OF SERVICES AND FEE DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 January 19, 2024 Jason Evans City of Carlsbad 1635 Faraday Ave. Carlsbad, CA 92008 Subject: Gabbiano Lane Storm Drain Outfall Inspection and Maintenance Assessment Greetings Mr. Jason Evans: Thank you for the opportunity to discuss the development of technical and permitting activities to support the city of Carlsbad (city) for the Gabbiano Lane Storm Drain Outfall Inspection and Maintenance Assessment. This activity will require an initial assessment to determine regulatory agency jurisdictional information in order to inform future maintenance activities to address standing water and develop a maintenance activity plan of action for the Gabbiano Lane storm drain system. Dudek is pleased to submit this proposal and fee estimate for professional services. Scope of Services TASK 1 JURISDICTIONAL ASSESSMENT AND SUMMARY Dudek will conduct a jurisdictional assessment of the outfall/headwall at the Gabbiano project site and a 100- foot buffer around the outfall/headwall. The assessment will be conducted by a qualified biologist. Hydrology, vegetation, and soils will be examined. A predominance of hydrophytic vegetation, where associated with a stream channel, will be used to estimate CDFW-regulated and City wetland habitat. Dudek will provide a preliminary assessment of water pumping options for the existing configuration based on indicators observed on the site. The preliminary assessment will be in email summary format. Cost for Task 1 ......................................................................................................................................................... $2,200 TASK 2 PERMITTING REQUIREMENTS Dudek will review and summarize permitting requirements for dewatering activities onsite needed to perform maintenance of storm drain infrastructure. Dudek will prepare a summary memorandum in email format of the required waters permits for the proposed work at the Gabbiano project site. Cost for Task 2 ......................................................................................................................................................... $2,800 PSA24-2383TRAN Exhibit "A"DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 TO: JASON EVANS SUBJECT: GABBIANO LANE STORM DRAIN OUTFALL INSPECTION AND MAINTENANCE ASSESSMENT DECEMBER 2023 2 TOTAL COST.............................................................................................................................................................. $5,000 We sincerely appreciate the opportunity to provide a proposal for this work and we are looking forward to working with the city. If there are any questions or comments, please call or email me at (760) 479-4148 or nrieger@dudek.com. Sincerely, ____________________ Nicole Rieger Senior Project Manager PSA24-2383TRAN Exhibit "A" (Cont.) PSA24-2383TRAN Exhibit "A" (Cont.)DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 ~ ACORD® CERTIFICATE OF LIABILITY INSURANCE 8/28/2024 I DATE (MM/DDNYYY) ~ 8/23/2023 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 Lockton Companies CONTACT NAME: 444 W. 47th Street, Suite 900 PHONE I FAX IA/C No Extl: IA/C Nol: Kansas City MO 64112-1906 E-MAIL (816) 960-9000 ADDRESS: kcasu@lockton.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Zurich American Insurance Company 16535 INSURED DUDEK INSURER B : American Guarantee and Liab. Ins. Co. 26247 1475335 605 THIRD STREET 1NsuRER c : Continental Casualtv Comnanv 20443 ENCINITAS CA 92024 INSURERD: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 16768908 REVISION NUMBER: xxxxxxx 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER /MM/DD/YYYY\ IMM/DD/YYYY\ LIMITS A X COMMERCIAL GENERAL LIABILITY y y GLO0146311 8/28/2023 8/28/2024 EACH OCCURRENCE $ 1,000 000 ~ □ CLAIMS-MADE [x] OCCUR DAMA(.jE TO RENTED PREMISES /Ea occurrence\ $ 100 000 f--MED EXP (Any one person) $ 10.000 PERSONAL & ADV INJURY ~ $ 1.000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000 000 Fl [x] PRO-[x] LOG PRODUCTS -COMP/OP AGG $ 2.000 000 POLICY JECT OTHER: $ A AUTOMOBILE LIABILITY y y ~ BAP0146329 8/28/2023 8/28/2024 fE~~~b~d~~llNGLE LIMIT $ 1.000 000 ~ ANY AUTO BODILY INJURY (Per person) $ xxxxxxx OWNED ~ SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ xxxxxxx ~ HIRED ~ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY /Per accidentl $ xxxxxxx f--f-- $ xxxxxxx B ~ UMBRELLA LIAB ~ OCCUR N y AUC0146407 8/28/2023 8/28/2024 EACH OCCURRENCE $ 3.000 000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 3,000 000 DED I I RETENTION $ $ xxxxxxx WORKERS COMPENSATION y I PER I I OTH- A WC0146330 8/28/2023 8/28/2024 X STATUTE ER AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE Cm E.L. EACH ACCIDENT $ 1.000 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1.000 000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1.000 000 DESCRIPTION OF OPERATIONS below C PROFESSIONAL N N EEH591932835 INCL POLL 8/28/2023 8/28/2024 PER CLAJM $1,000,000 LIABILITY AGGREGATE $2,000,000 INCLUDES POLLUTION DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PROJECT: ALL PROFESSIONAL SERVICES AS CONTRACTED. THE CITY OF CARLSBAD, WATER DISTRICT, ITS OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY COVERAGE, ON A PRIMARY, NON-CONTRIBUTORY BASIS, IF REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED APPLIES ON WORK COMP, GENERAL, AUTO, AND UMBRELLA LIABILITY COVERAGE, IF REQUIRED BY WRITTEN CONTRACT AND WHERE ALLOWED BY LAW. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. CERTIFICATE HOLDER 16768908 CITY OF CARLSBAD I CMWD c/o EXIGIS Insurance Compliance Services P.O. Box947 Murrieta CA 92564 CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Doa.iSlgn Envelope ID: 02DBDB72-70CB-4D85-B9FB-C7D00285D3FO Attachment Code: D574649 Certificate ID: 16768908 Additional Insured -Owners, Lessees Or Contractors -Scheduled Person Or Organization ill ZURICH THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLO0146311 Effective Date: 8/28/2023 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Addltlonal Insured Parson(s) Or Organization(s): Location(•) Of Covered Operations ANY PERSON OR ORGANIZATION ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT. ALL LOCATIONS Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-2169-A CW (02/19) Page 1 of2 DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 Attachment Code: D574649 Certificate ID: 16768908 A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule of this endorsement, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated in such Schedule. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. All other terms, conditions, provisions and exclusions of this policy remain the same. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-2169-A CW (02/19) Page 2 of2 Waiver Of Subrogation (Blanket) Endorsement INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Commercial General Liability Coverage Part Transfer Of Rights Of Recovery Against Others To Us Condition DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 Attachment Code: D574648 Certificate ID: 16768908 Policy No. Eff. Date of Pol. Exp. Date of Pol. GL00146311 8/28/2023 8/28/2024 This endorsement modifies insurance provided under the: The following is added to the Eff. Date of End. Producer Add'lPrem. Return Prem. 8/28/2024 37385000 $ $ If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights ofrecovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B CW (12/01) Page 1 ofl DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 Attachment Code: D574651 Certificate ID: 16768908 POLICY NUMBER: BAP0146329 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DUDEK Endorsement Effective Date: 8/28/2023 SCHEDULE Name Of Person{s) Or Organization{s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA20481013 © Insurance Services Office, Inc., 2011 Page 1 of 2 DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 Attachment Code: D574651 Certificate ID: 16768908 Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. CA20 4810 13 © Insurance Services Office, Inc., 2011 Page 2 of 2 DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9F8-C7D00285D3F0 Attachment Code: D574651 Certificate ID: 16768908 POLICY NUMBER: BAP0146329 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DUDEK Endorsement Effective Date: 8/28/2023 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED INSURED. ! Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA04441013 © Insurance Services Office, Inc., 2011 Page 1 of 1 ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OFRECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMEDINSURED. DocuSign Envelope ID: 02DBDB72-70C8-4D85-B9FB-C7D00285D3F0 Attachment Code: D574650 Certificate ID: 16768908 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC0146330 Dudek 8/28/20238/28/2024 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 00 0313 (Ed. 4-84) 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 anyone not named in the Schedule. WC000313 (Ed. 4-84) ~ 1983 National Council on Compensation Insurance. Schedule