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Home My WebLink AboutKnorr Systems Int'l; 2024-06-03; PR-MPW-24001RTracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 1 City Attorney Approved 2/13/2024 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT MONROE FILTER TANK #3 REPAIR; CONT. NO. PR-MPW-24001R This contract is made on the ______________ day of _________________________, 20__ , by the City of Carlsbad, California, a municipal corporation ("City") and Knorr Systems Int'l, a California corporation whose principal place of business is 2221 S. Standard Ave., Santa Ana, CA 92707 ("Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, as contained in the Standard 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 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 Mike Anderson (City Project Manager). PAYMENT. The City shall withhold retention as required by Public Contract Code Section 9203. 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 Contract California Labor Code Section 1720 et seq., and 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 Sections 1770, 1773 and 1773.1 of the California Labor Code. Consistent with the requirement of Section 1773.2 of the California Labor code, a current copy of applicable wage rates may be obtained via the internet at: www.dir.ca.gov/dlsr/. Contractor shall not pay less than the said specified prevailing rates of wages to all such workers employed DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 3rd June 24 ("Contract") Specifications for Public Works Construction "Greenbook," latest edition and including all errata; Part 1 in the Contractor's proposal. constitute "public works" under Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 2 City Attorney Approved 2/13/2024 by him or her in the execution of the Contract. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Labor Code Section 1776. DIR REGISTRATION. California Labor Code Section 1725.5 requires the Contractor and any subcontractor or subconsultant performing any public work under this Contract to be currently registered with the California Department of Industrial Relations DIR , as specified in Labor Code Section 1725.5. Labor Code Section 1771.1 provides that a contractor or subcontractor/subconsultant shall not be qualified to engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Labor Code section 1725.5. Prior to the performance of public work by any subcontractor or subconsultant under this Contract, Contractor must furnish the City with the subcontractor or subconsultant's current DIR registration number. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATION. 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. CALIFORNIA AIR RESOURCES BOARD (CARB) IN-USE OFF-ROAD DIESEL FUELED FLEETS REGULATION. Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. More information about the requirements and is provided in Exhibit D. FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this Contract and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five (5) years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 (' ') Contractor's Contractor's required certification Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 3 City Attorney Approved 2/13/2024 Signature: ___________________________________ Print Name: ___________________________________ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance 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. 2,000,000 Automobile Liability Insurance in the amount of $2,000,000 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- be limited in any manner. The above policies shall have non-cancellation clauses providing that 30 days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. the California Labor Code. 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. 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, 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 DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 Rich Robert Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation 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"; written on an "occurrence" basis, including personal & Property damage insurance in an amount of not less than ........ $ scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY. Workers' Compensation limits as required by Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 4 City Attorney Approved 2/13/2024 the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and 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 Contract is San Diego County, California. Start Work: Contractor agrees to start within seven (7) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within one (1) working day after receipt of Notice to Proceed. Knorr Systems Int'l 2221 S. Standard Ave (name of Contractor) 562312 (street address) Santa Ana, CA 92707 license number) C-61/D35 4/30/2025 (city/state/zip) 714-754-4044 (license class. and exp. date) 1000878960 6/30/2024 (telephone no.) joef@knorrsystems.com (DIR registration number/exp. date) (e-mail address) AUTHORITY. The individuals executing this Contract 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 Contract. [signatures on following page] DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 expenses including attorneys' fees for litigation, CONTRACTOR'S INFORMATION. {Contractor's Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 5 City Attorney Approved 2/13/2024 CONTRACTOR Knorr Systems Int'l, a California Corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Rich Robert, Vice President/General Manager Parks & Recreation Director (print name/title) By: N/A Single Signer (sign here) (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Contract must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: _____________________________ Deputy / Assistant City Attorney DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 6 City Attorney Approved 2/13/2024 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Type of Work to be Subcontracted Business Name and Address DIR Registration No. & Expiration Date License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than 50% of the work with its own forces. DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 0% Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 7 City Attorney Approved 2/13/2024 EXHIBIT B SCOPE OF WORK AND COST Remove and discard the filter media and laterals from tank #3. Install new laterals and #20 silver silica filter media in tank #3. Perform a backwash to verify proper operation. Total Cost of Project: $7,998.33* *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 • • • Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 8 City Attorney Approved 2/13/2024 EXHIBIT D In-Use Off-Road Diesel-Fueled Fleet Regulation Requirements CARB implemented amendments to the In-Use Off-Road Diesel Fueled Fleets Regulations that apply broadly to all self-propelled off-road diesel vehicles 25 horsepower or greater and other forms of equipment used in California. More information about the requirements can be found at https://ww2.arb.ca.gov/our-work/programs/use-road-diesel-fueled-fleets-regulation Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. The City is a Public Works Awarding Body as that term is defined under Title 13 California Code of Regulations Section 2449(c)(46). Accordingly, the Contractor must submit, with their pre-award contract documents, valid Certificates of Reported Compliance (CRC) for the Contractor any listed subcontractors (including any applicable leased equipment or vehicles). Failure to provide a valid CRC, will to proceed with awarding this Contract. Contractor has an on-going well as all listed subcontractors, most recent CRC issued by CARB. Throughout the Project, and for three (3) years thereafter, Contractor shall make available for inspection including, without limitation, 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 DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 II limit the city's ability II , 's fleet, and for the fleets of obligation for term of this Agreement to provide copies of Contractor's, as and copying any and all documents or information associated with Contractor's and subcontractors' fleet upon two (2) calendar days' notice from the City. Tracking #: MONROE FILTER TANK #3 REPAIR CONT. NO. PR-MPW-24001R Page 9 City Attorney Approved 2/13/2024 EXHIBIT D (CONT.) IN-USE OFF-ROAD DIESEL-FUELED FLEET REGULATION CERTIFICATION Contractor hereby acknowledges that they have reviewed the policies, rules and regulations and are familiar with the requirements of In-Use Off-Road Diesel-Fueled Fleet Regulation. Contractor hereby certifies, subject to the penalty of perjury, that the option checked below relating to the Contractor fleet, and/or that of their The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. The Fleet is exempt from the Regulation under Section 2449.1(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. Contractor and/or their subcontractor is unable to procure R99 or R100 renewable diesel fuel as defined in the Regulation pursuant to Section 2449.1(f)(3). Contractor 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., third party correspondence or vendor bids). The Fleet is exempt from the requirements of the Regulation pursuant to Section 2449(i)(4) Contractor 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). The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached to this certification. Name of Contractor: Knorr Systems Int'l Signature: Name: Rich Robert Title: Vice President/General Manager Date: DocuSign Envelope ID: 9E5C4663-B252-47E9-A95A-E8721 EE807E7 CARB's 's subcontractor(s) ("Fleet") is true and correct: □ □ □ □ because this Project has been deemed an "emergency", as that term is defined in Section 2449(c){18). 5/22/2024 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 8/1/2023 Stephens Insurance, LLC111 Center Street, Suite 100Little Rock, AR 72201 (205) 847-3908 www.stephensinsurance.com Aspen Specialty Insurance Company 10717 Travelers Casualty and Surety Co of Amer 31194 21458 A 1,000,000ERACCC923A8/1/2023 8/1/2024 300,000 3 25,000 3 1,000,000 2,000,000 2,000,0003 B 810-8W994744-23-43-G 8/1/2023 8/1/2024 1,000,000 3 A EXACCCCA23A 8/1/2023 8/1/2024 3,000,0003 3,000,0003 3 0 B UB-9W057283-23-43-G 8/1/2023 8/1/2024 3 1,000,000N 1,000,000 1,000,000 A General Pollution Liability ERACCC923A 8/1/2023 8/1/2024 Each Incident -Contractors Poll (Ded $15K)$1,000,000 -On/Off Site Pollution (Ded $15K)$1,000,000 Michael L. Wilson Jeanie Miller Jeanie.miller@stephens.com Professional (Ded $15K)$1,000,000 Knorr Systems Intl., LLC2221 Standard Avenue Santa Ana CA 92707 75571700 Liability policy. A Waiver of Subrogation is granted in favor of City of Carlsbad in accordance with the policy provisions of the Workers City of Carlsbad Attn: Ms. Tracy Stayton 1635 Faraday Avenue Carlsbad CA 92008 RE: All Projects" with the City. City of Carlsbad is included as Additional Insured in accordance with the policy provisions of the General Compensation policy. 75571700 | Master 23-24 GLALEXWC Poll Knorr Per Project | Jeanie Miller | 8/1/2023 8:37:44 AM (CST) | Page 1 of 3 This certificate cancels and supersedes ALL previously issued certificates. ACORD® I ~ I f--□ □ f-- f-- =7 □ □ - -- -f-- -- -H I I I I I □ I Policy No.: ERACCC923 Effective Date: 03/31/2023 Endorsement No.: 29 ASPENV215 0917 Page 1 of 1 2017 © Aspen Insurance U.S. Services Inc. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT – OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following coverages only: Section 1. COMMERCIAL GENERAL LIABILITY AND EMPLOYEE BENEFITS ADMINISTRATION Section 2 GENERAL POLLUTION LIABILITY Section 3 SITE POLLUTION INCIDENT LIABILITY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s):Location(s) Of Covered Operations: Those required by written contract executed prior to a loss. N/A Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section IV. 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, personal and advertising injury, environmental damage, emergency response cost, or clean-up cost 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. B.With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to your work that is deemed completed in accordance with Section VIII. DEFINITIONS, paragraph OO. (Products-completed operations hazard). C.Notwithstanding Section VII. CONDITIONS, paragraph J. (Other Insurance), with respect to the insurance afforded to the additional insureds added by this Endorsement, this Policy shall be primary to, and non-contributory with, any other insurance available to that person or organization when required by written contract or agreement. All other terms and conditions of this Policy remain unchanged. 75571700 | Master 23-24 GLALEXWC Poll Knorr Per Project | Jeanie Miller | 8/1/2023 8:37:44 AM (CST) | Page 2 of 3 This certificate cancels and supersedes ALL previously issued certificates. ~Aspen - - WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)- POLICY NUMBER: WAIVER 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 DESIGNATED PERSON: DESIGNATED ORGANIZATION: DATE OF ISSUE:ST ASSIGN: UB-9W057283-23-43-G 75571700 | Master 23-24 GLALEXWC Poll Knorr Per Project | Jeanie Miller | 8/1/2023 8:37:44 AM (CST) | Page 3 of 3 This certificate cancels and supersedes ALL previously issued certificates. ~ TRAVELERSJ