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Anderson & Howard Electric Inc; 2024-04-18; PWM24-3422UTIL
PWM24-3422UTIL Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 1 General Counsel Approved 8/15/2023 CARLSBAD MUNICIPAL WATER DISTRICT MINOR PUBLIC WORKS CONTRACT DUCT BANK RELOCATION AT MAERKLE CONT. NO. 5009 This agreement is made on the ______________ day of _________________________, 2024, by 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, California, hereinafter referred to as “CMWD”, and Anderson & Howard Electric, Inc., a California corporation, whose principal place of business is 1950 Cordell Court, Suite 109, El Cajon, CA 92020 (hereinafter called "Contractor"). CMWD and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, as contained in the Standard Specifications for Public Works Construction “Greenbook,” latest edition and including all errata; Part 1 General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor’s proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Sean Diaz (CMWD Project Manager). PAYMENT. CMWD shall withhold retention as required by Public Contract Code Section 9203. WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE April 18th PWM24-3422UTIL Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 2 General Counsel Approved 8/15/2023 Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is CMWD’s "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. 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. 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. 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. 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. DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE PWM24-3422UTIL FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to CMWD must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five (5) years and that debarment by another jurisdiction is grounds for CMWD to disqualify the Contractor or subcontractor f~=ipating in contract bidding. Signature: _h-, Print Name: -.,---Z0---G-r-eg_E_lli_o_tt_, -Pr_e_s-id-e-nt ___ _ REQUIRED INSURANCE. The successful contractor shall provide to CMWD, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to CMWD prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than ........ $1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ....... $1,000,000 Property damage insurance in an amount of not less than ........ $1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non-scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that 30 days written notice shall be given to CMWD prior to such cancellation. The policies shall name CMWD as additional insured. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 3 General Counsel Approved 8/15/2023 PWM24-3422UTIL Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 4 General Counsel Approved 8/15/2023 WORKERS COMPENSATION AND EMPLOYER’S LIABILITY. Worker’s Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless CMWD and the City of Carlsbad, and its officers, officials, employees and volunteers, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of CMWD or City of Carlsbad. The expenses of defense include all costs and expenses including attorneys’ fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within thirty (30) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Anderson & Howard Electric, Inc. 1950 Cordell Court, Suite 109 (name of Contractor) 258268 (street address) El Cajon CA 92020 (Contractor’s license number) C10; C-7 4/30/26 (city/state/zip) 619-633-8687 (license class. and exp. date) 1000000070 6/30/25 (telephone no.) mattp@aandh.com (DIR registration number & exp. date) (e-mail address) 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. DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE CONTRACTOR ANDERSON & HOWARD ELECTRIC, INC., a California corporation By:g~ By: (sign here) Greg Elliott, President (print name/title) ~D"'""'"°' by, o;;:~~.~ Deborah Betts, CFO & Secretary (print name/title) PWM24-3422UTIL CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad By: Vicki V. Quiram, General Manager, as authorized by the Executive Manager If required by CMWD, proper notarial acknowledgment of execution by Contractor must be attached. !f.i corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, General Counsel BY: ___ bi_·-~-~-~--°"---- Assistant General Counsel Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 5 General Counsel Approved 8/15/2023 PWM24-3422UTIL Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 6 General Counsel Approved 8/15/2023 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract NONE Total % Subcontracted: 0% The Contractor must perform no less than 50% of the work with its own forces. DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE PWM24-3422UTIL Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 7 General Counsel Approved 8/15/2023 EXHIBIT B Duct Bank Relocation at Maerkle All Contractor’s Work Performed at Prevailing Wage Rates JOB QUOTATION ITEM NO. DESCRIPTION PRICE Contractor responsible for the following: 1 Identify feeders and control wires to be rerouted 2 Lock out tag out and safe off feeders 3 Pull out the existing 3/0 feeders and control wires from the Chlorine Dioxide building to the existing pull box west. Assuming the wires and cables will pull out undamaged and are long enough. 4 Demo and expose the existing concrete encased duct bank. 5 Install (3) new 3” sched. 40 PVC from an existing pull box west to the exposed existing duct bank. Concrete encased red 2000psi. 6 Mandrel the new 3” conduits and the existing 3” conduits to the Chlorine Dioxide building. 7 Pull in the existing 3/0 feeders, megger, and terminate 8 Pull in the existing control wires and terminate. TOTAL NOT TO EXCEED* *$41,370.00 *Includes taxes, fees, expenses and all other costs. • Prior to any work, contact CMWD representative for access to the site: Andrew Wilson, 760- 802-5720, or Ray Martinez, 760-802-8097. • Any additional work not covered by Contractor’s proposal must be authorized in writing by CMWD representative: Sean Diaz, Project Manager, or his designee. • No payments will be made for work not authorized in writing by CMWD representative. • Trenching done by CMWD. DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE EXHIBITC LABOR AND MATERIALS BOND PWM24-3422UTIL Bond No. 57BCSIZ5944 Premium: $266.00 WHEREAS, the Board of Directors of the Carlsbad Municipal Water District has awarded to Anderson & Howard Electric, Inc. (hereinafter designated as the "Principal"), a Contract for: DUCT BANK RELOCATION AT MAERKLE CONTRACT NO. 5009 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of Its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Anderson & Howard Electric, Inc., as Principal, (hereinafter designated as the "Contractor"), and Hartford Fire Insurance Company as Surety, are held firmly bound unto CMWD In the sum of forty-one thousand three hundred seventy dollars *and 00/100 ($41,370), said sum being an amount equal to: 100% of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with california Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Duct Bank Relocation at Maerkle; Cont. No. 5009 Pages General Counsel Approved 8/15/2023 DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE PWM24-3422UTIL This labor and materials bond may be approved as to form by the General Counsel for CMWD in counterpart, and the counterparts shall all constitute a single, original instrument. SIGNED AND SEALED, this __ 1_1t_h __ day of _________ A_p,_r_il __ _, 2024 _A_n_d_e_rs_o_n_&_H_o_w_a_rd_E_l_ec_tr_ic_, _ln_c_. ___ (SEAL) ,, (Pr~~al) By #-~ 7 (Signature) ew~ 6\\\ ott \ Qrt~, cUn ~ (Name/Title) ___ H_a_rt_fo_rd_F_i_re_l_ns_u_ra_n_c_e _c_o_m_pa_n_y_(SEAL) (Surety) By J~ (SY.~';;'&--✓-'~ ~ · •. • ---------...,, --,:... -.·, .... _--.....· .. _ -, Misty R. Hemje, Attorn~-:.ttt:F_:,ct -., __ ---: --_ --:--~ (Name/Tftle) _· ---~..,. ·: ::: ~ __ ,,,._ -. -- (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACTfER.TIFICATE) -_--. :__----:::: ---., . ... .,......, APPROVED AS TO FORM: CINDIE K. McMAHON, General Counsel By: ____ bi_·IA4-__ t\-_~--~---- Assistant General Counsel Duct Bank Relocation at Maerkle; Cont. No. 5009 Page 9 General Counsel Approved 8/15/2023 DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of _____ C_o_n_tr_a_C_o_s_ta ____ _ before me, _____ B_r_itt_a-'ny::...._K_a_va_n_:.,_N_o_ta_ry-<--P_u_b_lic ____ _ (insert name and title of the officer) personally appeared Misty R. Hemje who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. ~IIIIIIIDli~ISlllllllllllllllllllllli~ --: BRITTANY KAVAN : n. f COMM. #2338092 z rJ) ~' NOTARY PUBLIC · CALIFORNIA ~ Z CONTRA COSTA COUNTY -' --: My Commission Expires 12/19/2024 : ,,,.,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,r DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE Direct Inquiries/Claims to: THE HARTFORD POWER OF ATTORNEY Hartf~~;.~:~r~~:i~~t~6155 Bond.Claims@thehartford.com call: 888-266-3488 or fax: 860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: A J GALLAGHER RISK MGMNT SVCS LLC AgencyCode: 57-554532 [D Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut [!=:] Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana ~ Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State ofConnecticut D Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut D Twin City Fire Insurance Company, a corporation duly organized under the laws of the State oflndiana D Hartford Insurance Company of Illinois, a corporation duly organized under the laws ofthe State of Illinois D Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana D Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint, up to the amount of Unlimited : Tina K. Nierenberg, Virginia L. Black, Brian F. Cooper, Susan Hecker, M. Moody, Maureen O'Connell, Kevin Re, Janet c. Rojo, Betty L. Tolentino, Robert P. Wrixon, K. Zerounian, Courtney Chew, Maria De Los Angeles Reynoso, Susan M. Exline, Misty R. Hemje, Brittany Kavan, Thuyduong Le, Julia Ortega of SAN FRANCISCO, California their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by 181. and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. m• ~ Shelby Wiggins, Assistant Secretary STATE OF FLORIDA } ss. Lake Mary COUNTY OF SEMINOLE ~Yd?/2 Joelle L. LaPierre, Assistant Vice President On this 20th day of May, 2021, before me personally came Joelle LaP!erre, to me known, who being by me duly sworn, did depose and say: that (s)he resides in Seminole County, State of Florida; that (s)he Is the Assistant Vice President of the Companies, the corporations described in and which executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority. • o t •,I;,' T ~ -f--A~. -~&:i-. :.: ~-= :i• ~·'!t: -.. •··. . , ... '~OFf\,: ,, '°1 t I I l' h-~ My Commission HH 122280 Expires June 20. 2025 I, the undersigned, Assis~.lltllir:..~_President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney~~i::utr,d::by sald-C9mpanies, which is still in full force effective as of April 11, 2024 . Signed and seal~t:fin Lak~;.r§roi:icra>.. _ --~-~-,-, ~ .. ,;,-.. _~---~.:=. /. _-_ .. ~- ·.__ --~---- ..... ~ .,,. ---... • ~ '. -',,. ..... -._ ___ _ Keith D. Dozois, Assistant Vice President DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange On April 12th, 2 o 2 4 before me, ___ C_ri_st_ia_n_N_u_n_e_z"'-, N_ot_a~ry_P_u_b_li_c __________ _ Date Here Insert Name and Title of the Officer personally appeared ----------~G~r~e=g~E=ll~io~tt~-------------- Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity{ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Seal Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. / Signature---,.~--s-· ,-.g-n_a<..._t-:-r-e-_·:-;-·~-o-t-~-A.---,.-_ -------==--- ----------------oPTIONAL---------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: _____________ Document Date: _______ _ Number of Pages: ___ Signer{s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ Signer's Name: ____________ _ D Corporate Officer -Title(s): ______ _ D Corporate Officer -Title(s): ______ _ D Partner -D Limited D General D Partner -D Limited D General D Individual D Attorney in Fact D Individual D Attorney in Fact D Trustee D Guardian or Conservator D Trustee D Guardian or Conservator 0 Other: ______________ _ 0 Other: ____________ _ Signer Is Representing: _________ _ Signer Is Representing: _________ _ ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 PWM24-3422UTIL City Attorney Approved Version 12/14/2023 EXHIBIT D CALIFORNIA AIR RESOURCES BOARD The California Air Resources Board (“CARB”) implemented amendments to the In-Use Off-Road Diesel- Fueled Fleets Regulations (“Regulation”) which are effective on January 1, 2024, and apply broadly to all self-propelled off-road diesel vehicles 25 horsepower or greater and other forms of equipment used in California. A copy of the Regulation is available at: https://ww2.arb.ca.gov/sites/default/files/barcu/regact/2022/off-roaddiesel/appa-1.pdf. Bidders are required to comply with all CARB and Regulation requirements, including, without limitation, all applicable sections of the Regulation, as codified in Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. Bidders must provide, with their Bid, copies of Bidder’s and all listed subcontractors the most recent, valid Certificate of Reported Compliance (“CRC”) issued by CARB. Failure to provide valid CRCs as required herein may render the Bid non-responsive. The City of Carlsbad is a Public Works Awarding Body, as that term is defined under Title 13 California Code of Regulations section 2449(c)(46). Accordingly, Bidders must submit, with their Bids, valid Certificates of Reported Compliance (“CRC”) for the Bidder’s fleet, and for the fleets of any listed subcontractors (including any applicable leased equipment or vehicles). Bidders must complete and submit the Fleet Compliance Certification, on the form provided. Failure to provide a CRC for the Bidder, and for all listed subcontractors, or failure to complete the Fleet Compliance Certification, may render the Bid non-responsive. COMPLIANCE WITH CALIFORNIA AIR RESOURCES BOARD REGULATIONS. Contractor shall comply, and shall ensure all subcontractors comply, with all applicable requirements of the most current version of the California Air Resources Board (“CARB”) regulations including, without limitation, all applicable terms of Title 13, California Code of Regulations Division 3, Chapter 9 and all pending amendments (“Regulation”). Throughout the Project, and for three (3) years thereafter, Contractor shall make available for inspection and copying any and all documents or information associated with Contractor’s and subcontractors’ fleet including, without limitation, Certificates of Reported Compliance (“CRC”), fuel/refueling records, maintenance records, emissions records, and any other information the Contractor is required to produce, keep or maintain pursuant to the Regulation upon two (2) calendar days’ notice from the City of Carlsbad. Contractor shall be solely liable for any and all costs associated with complying with the Regulation as well as for any and all penalties, fines, damages, or costs associated with any and all violations, or failures to comply with the Regulation. Contractor shall defend, indemnify and hold harmless the City of Carlsbad, its officials (appointed and elected), officers, and employees from any claims, liabilities, costs, penalties or interest arising out of any failure or alleged failure to comply with the Regulation. DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE AHE fleet does not include any off road diesel equipment X DocuSign Envelope ID: E4E7903E-90E3-4034-B42E-EE83E52BBBBE PWM24-3422UTIL FLEET COMPLIANCE CERTIFICATION. Bidder hereby acknowledges that they have reviewed the CARB's policies, rules and regulations and are familiarwith the requirementsofTitle 13, California Code ofRegulations, Division 3, Chapter 9, effective on January 1, 2024 (the "Regulation"). Bidder hereby certifies, subject to the penalty of perjury, that the option checked below relating to the Bidder's fleet, and/or that oftheir subcontractor(s) ("Fleet") is true and correct: D The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. D The Fleet is exempt from the Regulation under Section 2449.l(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. D Bidder and/or their subcontractor is unable to procure R99 or RlOO renewable diesel fuel as defined in the Regulation pursuant to Section 2449.l(f)(3). Bidder shall keep detailed records describing the normal refueling methods, their attempts to procure renewable diesel fuel and proof that shows they were not able to procure renewable diesel (i.e ., t hird party correspondence or vendor bids). D The Fleet is exempt from the requirements of the Regulation pursuant to Section 2449(i)(4) because this Project has been deemed an "emergency", as that term is defined in Section 2449(c)(18). Bidder shall only operate the exempted vehicles in the emergency situation and records of the exempted vehicles must be maintained, pursuant to Section 2449(i)(4). D The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached t o this certification. Name of Bidder: Inc. Signature: Name : Greg Elliott Title: President Date: City Attorney Approved Version 12/14/2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 2/23/2024 Phoenix-Alliant Insurance Services, Inc.2415 E Camelback Rd Ste 950Phoenix AZ 85016 Kenna Fisher 602-707-1928 phxcsgcerts@alliant.com License#: 0C36861 Liberty Mutual Fire Insurance 23035 ANDE&HO-02 Liberty Insurance Corporation 42404Anderson & Howard Electric, Inc.15 ChryslerIrvine, CA 92618 Pacific Insurance Company, Lim 10046 126677137 A X 1,000,000 X 300,000 5,000 X Contractual Liab 1,000,000 2,000,000 X X Y Y TB2-Z91-469556-013 10/1/2023 10/1/2024 2,000,000 Total Agg Limit 15,000,000 A 1,000,000 X X X Y Y AS2-Z91-469556-023 10/1/2023 10/1/2024 B X X 10,000,000YTH7-Z91-469556-043 10/1/2023Y 10/1/2024 10,000,000 X 10,000 A X N Y WC2-Z91-469556-033 10/1/2023 10/1/2024 1,000,000 1,000,000 1,000,000 C Professional Liability &Pollution Liability 59 CPI FN3336 10/1/2023 10/1/2024 Each Claim/AggEach Claim/Agg $2,000,000$2,000,000 COMMERCIAL GENERAL LIABILITY per attached forms, as required by written contract or agreement: Certificate Holder and any other person or organizationare included as Additional Insured; coverage applies on a primary and non-contributory basis; Waiver of Subrogation applies; 30 Day Notice of Cancellation(except 10 Day Notice for non-payment). For OCIP/Wrap-Up projects, coverage afforded is for off-site exposure only. AUTOMOBILE LIABILITY per attached forms, as required by written contract or agreement: Certificate Holder and any other person or organization areincluded as Additional Insured; coverage applies on a primary and non-contributory basis; Waiver of Subrogation applies; 30 Day Notice of Cancellation (except10 Day Notice for non-payment). See Attached... City of Carlsbad/CMWD1635 Faraday Ave.Carlsbad CA 92008 ACORD® I ~ I ~ □ □ ~ ~ Fl □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: ANDE&HO-02 1 1 Phoenix-Alliant Insurance Services, Inc.Anderson & Howard Electric, Inc.15 ChryslerIrvine, CA 92618 25 CERTIFICATE OF LIABILITY INSURANCE WORKERS COMPENSATION per attached forms as required by written contract or agreement: Waiver of Subrogation applies; 30 Day Notice of Cancellation(except 10 Day Notice for non-payment). UMBRELLA/EXCESS LIABILITY follow form of underlying COMMERCIAL GENERAL LIABILITY, AUTOMOBILE LIABILITY and EMPLOYER’S LIABILITYsubject to policy terms and conditions. The policy is excess of the General Liability, Automobile Liability and Employer’s Liability limits. Project #PSA24-2391UTIL - Wastewater System Electrical I CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. TB2-Z91-469556-013 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations All persons or organizations as required by a written contract or agreement entered into prior to an "occurrence" or offense All locations as required by a written contract or agreement entered into prior to an "occurrence" or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations All persons or organizations as required by a written contract or agreement entered into prior to an "occurrence" or offense All locations as required by a written contract or agreement entered into prior to an "occurrence" or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. TB2-Z91-469556-013 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 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 This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named Insured under such other insurance; and (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page of 1 1CG 20 01 04 13 POLICY NUMBER: TB2-Z91-469556-013 TB2-Z91-469556-013POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 240405 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule below. SCHEDULE Name Of Person Or Organization: As required by written contract or agreement entered into prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 240405 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 LIM 99 01 05 11 © 2011 Liberty Mutual Group of Companies. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Policy Number Issued by THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Organization(s): Email Address or mailing address: Number Days Notice: Schedule on file with the Company 30 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. : TB2-Z91-469556-013 : Liberty Mutual Fire Insurance Company AS2-Z91-469556-023 Liberty Mutual Fire Insurance Company Policy Number: Issued by: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULL V. DESIGNATED INSURED -NONCONTRIBUTING This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS 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" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage form. Schedule Name of Person(s) or Organizations(s): All persons or organizations as required by a written contract or agreement entered into prior to an "occurrence" or offense Regarding Designated Contract or Project: Each person or organization shown in the Schedule of this endorsement is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The following is added to the Other Insurance Condition: If you have agreed in a written agreement that this policy will be primary and without right of contribution from any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement was executed prior to the "bodily injury" or "property damage", then this insurance will be primary and we will not seek contribution from such insurance. AC 84 23 0811 © 2010, Liberty Mutual Group of Companies. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 POLICY NUMBER:COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 AGAINST OTHERS TO US (WAIVER OF SUBROGATION) Name(s) Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. With respect to coverage provided by thisendorsement,the provisionsof the Coverage Form applyunless modified by the endorsement. 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. Premium: $ Any person or organization where the Named Insured has agreed, by written contract executed prior to the date of "accident", to waive rights of recovery against such person or organization Included AS2-Z91-469556-023 AS2-Z91-469556-023 Liberty Mutual Fire Insurance Company Policy Number: Issued By: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person(s)/ Email Address or mailing Organization(s): address: Per schedule on file with Company Number Days Notice: 30 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 01 05 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Liberty Mutual Fire Insurance Company 16586 WC2-Z91-469556-033 10/1/2023 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 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$ 250 per policy. Person or Organization Where required by contract or written agreement prior to loss and allowed by law. Issued by For attachment to Policy No Issued to Anderson & Howard Electric, Inc. WC0403 06 Ed : 04/1984 Effective Date Job Description Any Premium$ Page 1 of 1 Liberty Mutual Fire Insurance Company 16586 WC2-Z91-469556-033 10/1/2023 NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. Name of Other Person(s) / Organization(s): Per schedule on file with the Company Schedule Email Address or mailing address: Per schedule on file with the Company Number Days Notice: 30 All other terms and conditions of this policy remain unchanged. Issued by For attachment to Policy No Issued to Anderson & Howard Electric, Inc. WC 99 20 75 Ed . 12/01/2016 Effective Date Premium$ © 2016 Liberty Mutual Insurance Page 1 of 1