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American Marine Corporation - 2022-05-01
SERVICE AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND AMERICAN MARINE CORPORATION FOR DIVING SERVICES AT HUNTINGTON BEACH PIER THIS AGREEMENT(`Agreement') is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of Califomia, hereinafter called "City," and American Marine Corporation, a California Limited Liability Company, hereinafter referred to as "Contractor." Recitals A. The City desires to retain a Contractor having special skill and knowledge in the field of diving services. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. Contractor entered into a Consultant Agreement with the City of Los Angeles on or about August 6, 2021, referred to as the "Agreement Between the City of Los Angeles and American Marine Corporation' City desires to "piggyback" on the City of Los Angeles Contract pursuant to HBMC Section 3.02.190(C)(2), and unless otherwise noted, contained in this Agreement, or in conflict with this Agreement, the Parties wish to be bound by the same terms and conditions as the City of Los Angeles. D. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a comparable company or firm in the field. Contractor has been selected to perform these services pursuant to Huntington Beach Municipal Code Chapter 3.02. NOW, THEREFORE, it is agreed by City and Contractor as follows: 1. Scope of Services Contractor shall provide all services as described in Exhibit"A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes hereinafter be referred to as the"Project." Contractor hereby designates Michael O. Dunn, who shall represent it and be its sole contact and agent in all consultations with City during the performance of this Agreement. 22-109683/276841 I 2. City Staff Assistance City shall assign a staff coordinator to work directly with Contractor in the performance of this Agreement. 3. Compensation a. City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in Exhibit"B." The total sum to be expended under this Agreement, shall not exceed Two Hundred Fifty Thousand ($250,000)per year for any one year during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. C. Contractor shall be paid pursuant to the terms of Exhibit"B." 4. Term Time is of the essence of this Agreement. The services of Contractor are to commence or as soon as practicable after the execution of this Agreement by City (the "C mmencement Date") and terminate three (3) years from commencement, unless terminated earlier in accordance with the provisions of this Agreement. Contract may be extended for 2 additional one-year periods if mutually agreed to in writing by both parties. The time for performance of the tasks identified in Exhibit"A"are generally to be shown in Exhibit "A." This schedule and Tenn may be amended to benefit the Project if mutually agreed to in writing by City and Contractor. In the event the Commencement Date precedes the Effective Date, Contractor shall be bound by all terms and conditions as provided herein. 5. Extra Work In the event City requires additional services not included in Exhibit"A"or changes in the scope of services described in Exhibit "A," Contractor will undertake such work only after receiving written authorization from City. Additional compensation for such extra work shall be allowed only if the prior written approval of City is obtained. 6. Disposition of Plans Estimates and Other Documents Contractor agrees that title to all materials prepared hereunder, including, without limitation, all original drawings, designs, reports, both field and office notices, calculations,computer code, language, date or programs, maps, memoranda, letters and 22-109683276841 2 other documents, shall belong to City. and Contractor shall turn these materials over to City upon expiration or termination of this Agreement or upon Project completion, whichever shall occur first. These materials may be used by City as it sees fit. 7. Hold Harmless Contractor hereby agrees to protect, defend, indemnify and hold harmless City. its officers. elected or appointed officials. employees, agents. and volunteers from and against any and all claims. damages, losses, expenses,judgments. demands and defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Contractor's employees and damage to Contractor's property, arising directly or indirecth• out of the obligations or operations herein undertaken by Contractor, caused in whole or in part by any negligent act or omission of the Contractor, any subcontractors. an one directly or indirectly employed by ari of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Contractor will conduct all defense at its sole cost and expense and City shall approve selection of Contractors counsel. This indemnity shall apply to all claims and liability regardless of whether an} insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Contractor. S. Workers Compensation Insurance Pursuant to California Labor Code Section 1861. Contractor acknowledges awareness of Section 3700 et seq. of this Code. which requires every employer to be insured against liability for workers' compensation: Contractor covenants that it will comply with such provisions prior to commencing performance of the work hereunder. Contractor shall obtain and furnish to City workers' compensation and employers liability insurance in an amount of not less than the State statutory limits. Contractor shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. Contractor shall furnish to City a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and Contractor shall similarly require all subcontractors to waive subrogation. 9. General Liability Insurance In addition to the workers' compensation and employer's liability insurance and Contractor's covenant to defend, hold harmless and indemnify City. Contractor shall obtain and furnish to City, a policy of general public liability insurance. including motor vehicle coverage covering the Project/Service. This policy shall indemnify Contractor, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out of or in connection with the Project/Service, and shall 22-109683/276841 3 provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability. of One Million Dollars (S1.000,000) per occurrence. If coverage is provided tinder a form which includes a designated general aggregate limit. the aggregate limit must be no less than One Million Dollars (S1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars (S1,000,000) for this Project/Service. This policy shall name City. its officers, elected or appointed officials, employees, agents, and Volunteers as Additional insureds, and shall specifically provide that any other insurance coverage which may be applicable to the Project/Service shall be deemed excess coverage and that Contractor's insurance shall be primary. Under no circumstances shall said above-mentioned insurance contain a self- insured retention. or a "deductible' or any other similar form of limitation on the required coverage. 10. Automobile Liabilitv Insurance Contractor shall obtain and furnish to City an automotive liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for Contractor's automotive liability in an amount not less than One Million Dollars (S1.000.000.00) per occurrence and a separate "Additional Insured Endorsement' page listing both the policy number and naming the "City of/hiaiinguon Beach. its officers. elected or appointed officials, employees. agents and volunteers" as additional insured on the endorsement. The above-mentioned insurance shall not contain a self-insured retention. "deductible' or any similar form of limitation on the required coverage except With the express written consent of City. 11. Certificate of Insurance Prior to commencing performance of the work hereunder. Contractor shall furnish to City a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall: a. provide the name and policy number of each carrier and policy; b. state that the policy is currently in force: and C. promise that such policy shall not be suspended, voided or canceled by either party. reduced in coverage or in limits except after thirty (30) days' prior written notice; however, ten (10) days' prior written notice in the event of cancellation for nonpayment of premium. Contractor shall maintain the foregoing insurance coverage in force until the work under this Agreement is filly completed and accepted by City. 22-109683/276841 4 This requirement for carrying the foregoing insurance coverage shall not derogate from Contractor's defense. hold harmless and indemnification obligations as set forth in this Agreement. City or its representative shall at all times have the right to demand the original or a copy of the policy of insurance. Contractor shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 12. Independent Contractor Contractor is, and shall be, acting at all times in the performmance of this Agreement as an independent contractor herein and not as an employee of City. Contractor shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security. state disability insurance compensation, unemployment compensation and other payroll deductions for Contractor and its officers, agents and employees and all business licenses, if any, in connection with the Project and/or the services to be performed hereunder. 13. Conflict of Interest Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 14. Termination This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event. Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. Asa condition of such payment, the Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents the CitV'S use thereof for such purposes as the City deenms appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreemment. 15. Gxclusivih, and Amendment This Agreement represents the complete and exclusive statement between the Citv and Contractor. and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terns of this Agreement and any attachments hereto, tilen terns of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of anv purchase order or other instrument that are inconsistent with, or in addition to, the terms 22-109683/276841 5 and conditions hereof. shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements. oral Iv or otherwise. have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 16. Assignment Inasmuch as to this Agreement is intended to secure the specialized services of Contractor. Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment. transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 17. City Employees and Officials Contractor shall employ no City official nor any regular City employee in the work performed pursuant to this Agreement. No officer or employee of City shall have anv financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 18. Notices Any notices. certificates. or other communications hereunder shall be given either by personal delivery to Contractor's agent (as designated in Section I hereinabove) or to City as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States postal Service, to the addresses below. City and Contractor may designate different addresses to which subsequent notices. certificates or other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U.S. certified U.S. certified mail-return receipt requested: To City: Contractor: Citv of Huntington Beach American N4arine Corporation Attn: Denny Bacon Attn: Nlichael O. Dunn 2000 Ngain Street 1500 S. Barracuda Street Huntington Beach, CA 92648 Terminal Island. CA 90731 19. Consent When City's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transactions or event. 22-109683/276841 6 20. Modification No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 21. Section Headings The titles, captions, section, paragraph and subject headings; and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 22. Interpretation of this Agreement The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. 11' ,my provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement.. the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to lacy, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements ofthe law. 23. Duplicate Original The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 24. Immigration Contractor shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification. 22-109683/276841 7 25. Legal Services Subcontracting Prohibited Contractor and City agree that City is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. Contractor understands that pursuant to Huntington Beach City Charter Section 3K the City Attorney is the exclusive legal counsel for City: and Citv shall not be liable for payment of any legal services expenses incurred by Contractor. 26. Confidentiality Contractor recognizes that in the performance of its duties under this Agreement, it must conduct its activities in a manner designed to protect information of a sensitive nature from improper use or disclosure. Contractor warrants that it will use reasonable efforts consistent with practices customary in the facilities management industry in recruiting, training and supervising employees and in otherwise performing its duties hereunder in order to achieve this result. In the furtherance of this, Contractor agrees, at the request of the City, to require its employees to execute written undertakings to comply with the foregoing confidentiality provision. 27. Discrimination Contractor shall not discriminate because of race, color, creed, religion, sex, marital status. sexual orientation. age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection. training, utilization, promotion. termination or other employment related activities. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal. state and local laws and regulations. 28. Jurisdiction — Venue This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be government and construed in accordance with the laws of the State of California. This Agreement has been executed and delivered in the State of'California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County. California, shall be the venue for any action or proceeding that may be brought or arise out of'. in connection with or by reason of this Agreement. 29. Professional Licenses Contractor shall, through the term of this Agreement, maintain all necessary licenses. permits, approvals, waivers. and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Huntington Beach and all other governmental agencies. 22-109683/276841 8 Contractor shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers; and exemptions. Said inability shall be cause for termination of this Agreement. 34). Attornev's Fees In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorneys fees, such that the prevailing party shall not be entitled to recover its attorneys fees from the non-prevailing party. 31. Sun ival Terms and conditions of this Agreement, which by their sense and contest survive the expiration or termination of this Agreement, shall so survive. 32. Governing Law This Acreement shall be governed and construed in accordance with the laws of' the State of California. 33. Signatories Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully for any injuries or damages to City in the event that such authority or power is not, in fact. held by the signatory or is withdrawn. 34. Entirety (a) The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties. oral or otherwise. have been made by that party or anyone acting on that part\'s behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, promise, agreement warranty, fact or circumstance not expressly set forth in this Acreement. (b) All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 22-109683/276841 9 35. Effective Date IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. This Agreement shall be effective on the date of its approval by the Mayor. This Agreement shall expire when terminated as provided herein. CONTRACTOR CITY OF HUNTING a AMERICAN MARINE CORPORATION municipal corpora ' n of the State f Califo a or s Stephen Shdhnazanall ew�o,u.,.cowm By: h ect or of I' Stephen Shahnazarian Print name APPROVED AS FORM: ITS: circle one) Chairman/President/ Vice President AND Megan Keane City Attorney By: ��.� Pri EVIEWED AND APPROVED: ITS: (circle one Secretary/ hief Financial Officer/Asst. Secre a asurer Ta 5City Manager RECEIVE AND FILE ewri4n' 9'4�4n� City Clerk `f 2JIZ2- 22-109683276941 10 EXIIII31T "A" A. STATEMENT OF WORK: (Narrative of work to be performed) Pier inspection and repair. . B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: Level 11 inspection and as needed repairs 85-90 piles; working 30 days onsite with a four man dive crew consisting of one non diving supervisor, two wet divers and one tender. Working Monday- Friday straight time hours only 22-109683/276841 11 EXHIBIT B A ER�CAN MARS N E C O R P O R A r 1 0 N 1500 S. Barracuda St., "Terminal Island, CA 90731 (310) 547-0919 Fax (310) 547-0031 01/14/2021 Quotation: Dieing Services— Huntington Beach Pier Proiect: Huntington Beach Pier— Inspection and Cleaning Thank you for considering American Marine Corporation to provide a quote for diving services for this project. American Marine to provide dive crew labor, equipment including dive support vehicle with shallow water dive spread hydraulic cleaning equipment, underwater video, rental crane truck and basic consumables. S250 000.00 Not to Exceed We estimate this Will include level 11 inspection and as needed repairs 85-90 piles, working 30 days onsite with a four man dive crew consisting of one non divine supervisor. two \vet divers and one tender. Working Monday- Friday straight time hours only. Included is offsite mobilization and demobilization crew labor. AMC equipment listed below, consumables, rental truck crane and final report writing. LABOR RATES Crew Labor and Equipment Rates if Diving from Dock/Pier Navigable Dive Crew- ST OT DT Supervisor $216,16 $306.92 $397.69 Diver $213.41 $302.81 $392.20 Stand By Diver $123.40 $167.78 $212.17 Tender $121.57 $165.04 $208.52 Pile Driver(assistant tender) $116.09 $156.82 $197.55 Marine Travel $115.41 Paid at Straight Time Meetings/Report writing 1 $110.00 1 If required (4 hr. minimum) Recommended Dive Crew (1 Non Diving Supervisor, 2 Diver wet, 1 St-By Diver) 56,131.04 per 8 hour ST day. Diving from Dock/Shore/Pier Navigable;Labor only;Diving Equipment additional Mobilization/Demobilization: $1,000.00/per event EQUIPMENT RATES Shallow water dive spread (Includes: compressor,v-tank, hoses, radio,filter and interconnects) $500/day Hydraulic Equipment(For topside or underwater work) Hydraulic Power Pac(15gpm, 150 ft hose bundle) $250/day U/W hydraulic hand tools:(chainsaw, drill,impactor,grinder,jack hammer,etc.) $100/day U/W Video Photography $350/day Underwater video system vehicles/Trailers Cube Truck $250/day Equipment Discount: due to extended project duration - 580.00 Total daily American Marine Owned equipment cost $870.00 Rental Crane Truck Cost+ 15% Consumables All consumables will be charged at: Cost+ 15% General Conditions: 1) Quotes are based on unfettered access to work site, 2) Pricing includes dieing services labor and equipment. 3) Work will be conducted during straight time hours only. J) Work will be invoiced at above rates within a not to exceed. 5) The number of piles to be inspected/cleaned is estimated,and depends on extent of repairs required 6) work will be sequential to limit loss time and unnecessary mobilization and demobilization events. 7) Labor rates and equipment rates apply for any project delay outside of ANIC's control. 8) 8 hour minimum applies to all divine operations. Minimum dive crew shall consist of I Diver and 1 Standby Diver I Tenders (per OSFIA reg's). 9) Straight Time (ST) rates apply to the first 8 hours of work per day Nlonday through Friday regular starting tines. 10) There will be a 3% per yearly escalation for the above line items for additional costs of labor and material per year effective July I"of each year. 1 I) Overtime(OT) rates apply to all hours worked in excess of the ST hours Monday through Friday and all day Saturday. 12) Double Time (DT) rates apply to all hours worked beyond 12 hours �b1on-Fri, and beyond 8 hours on Saturdays,on Sundays and Union I lolidays. American Marine Corp. is a signatory marine and diving contractor associated with the Pile Drivers Union Local 2375. All pay scales are current prevailing rates. American Marine Corp. is it member of the ADCI (Association of Diving Contractors International)and abides by all the safety and procedural guidelines set forth by that association. Also, all diving operations will be conducted in accordance with the American Marine Corp. Safe Practices Manual and the OSHA regulations regarding diving mandates. American Marine Corp. is fully insured for marine operations, equipment and third parties. Proof of insurances can be provided when appropriate. Additionally. American Marine Corp. maintains a facility at POLA Berth 270-271. American Marine Corp. provides vessel services and topside work includingbut not limited to:moorage.tugboat/crew,boat services. yard. welding and fabrication for staging marine and construction equipment. For information regarding any of these services, please contact our Harbor Operations Manage at (3I0) 547-0919. Thank you again for your consideration in using.American Marine Corp. as the diving subcontractor on this interesting project. we look forward to serving you. If you require clarification or additional details. please contact us at any time. Sincerely. lfllc%ad t, Daaa Michael O. Dunn Diving Operations Manager American Marine Corporation Diving Division 2 UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA APPLICATION FOR ADMISSION TO THE BAR OF THE CENTRAL DISTRICT OF CALIFORNIA: INSTRUCTIONS Except as provided in Local Rules 83-2.1.3, 83-2.1.4, 83-2.1.5, and 83-4.5, an appearance before the Court on behalf of another person, an organization, or a class may only be made by members of the Bar of this Court. Active members in good standing of the State Bar of California may apply for admission to the Bar of this Court by completing this Application for Admission to the Bar of the Central District of California (Form G-60) and submitting it, together with the required fee by credit or debit card, online. Applicants for State Bar membership who have passed the California Bar Examination, completed all other prerequisites for membership in the State Bar, and been sworn in to the State Bar, but who have not vet received a State Bar Number, may submit an Application for Admission to the Bar of the Central District of California, but be advised that such applications will not be processed until the Court determines that a State Bar Number has been issued to the applicant. (if you receive your State Bar Number after submitting your application, send an e-mail to cacti attyadm r cacd.uscourts.gov to update Your application with this information and expedite your admission.) Applicants must certify that they are familiar with this Courts Local Civil and Criminal Rules, and with the Federal Rules of Civil Procedure, Criminal procedure, and Evidence. The focal Rules of the Central District are available on the Court's website at %%,%%,iv.cacd.uscoLirts.gov/coLirt-procc(iures/local-rLileS. Upon completion of the Application for Admission to the Bar of the Central District of California, print it, and sign and date both the application itself and the Oath of Attorney. Electronic signatures are not accepted. Scan the signed application to a Portable Document Format (PDF) file, and then visit www. cacd.IISCOLirts.gov/attoriieys/adinissioiis and click the "Apply Online" button to upload your form, pav the fee, and complete the application process. SWEARING-IN CEREMONIES Submission of the completed and signed Application for Admission to the Bar of the Central District of California, with the required fee, online, is all that is required. It is not necessary to be sworn in by a judge of this Court in order to be admitted to the Bar of this Court. Note that if you participate in a group swearing-in ceremony organized by a law school or other organization in which applicants are sworn in to both the State Bar of California and the Bar of this Court, you must nonetheless submit a completed Application for Admission to the Bar of the Central District of California, with the required fee, online, or your admission will not be processed. ADMISSION Your admission to the Bar of this Court will not be effective until we have received your completed application and payment and have reviewed your application to ensure you are qualified for admission. Once ,your eligibility has been confirmed, you should receive confirmation of your admission by email within a few days. Your admission certificate should be mailed to you within approximately four to five weeks. if you do not receive your certificate, you may send an e-mail to cacti attyadrn2cacd uscourts. S1V G-60(02/20) APPLICATION FOR ADNI ISSIONTOTH E BAR OFTH E CENTRA L DI STRICT OF CALI PORN IA-INSTRUCTION$ Page 10I1 INSURANCE AND INDEMNIFICATION WAIVER MODIFICATION REQUEST I I 1. Requested by: Public Works 2. Date: March 16, 2022 3. Name of contractor/permittee: American Marine Services Group 4. Description of work to be performed: Perform underwater inspections and maintenance for the Huntington Beach Pier 5. Value and length of contract: 3 Vears, $250,000 per year 6. Waiver/modification request: $50 000 deductible for General Liability, $10,000 for Auto Liability 7. Reason for request and why it should be granted: The City only allows up to a $5,000 General Liability deductible and $1,000 for Auto Liability. American Marine Services has provided a financial statement to prove they are in good financial standing. 8. Identify the risks to the City in p oving is waiver/modification: Low 7MJr Departmen a ignat ate: APPROVALS Approvals must be obtained in the order listed on this form. Two approvals are required for a request to be granted. Approval from the City Manager's Office is only required if Risk Management and the City Attorney's Office disagree. 1. Risk Management Ll Approved ElDenied 164 ',22 Sig ature Date 2. City tforney's Office Approved ❑ Denied Signatbre Date 3. City Manager's Office ❑ Approved ❑ Denied Signature Date If approved, the completed waiver/modification request is to be submitted to the City Attorney's Office along with the contract for approval. Once the contract has been approved, this form is to be filed with the Risk Management Division of Human Resources i i Waiver Form 3/16/2022 10:54:00 AM �C-�® DATE(1.u.UUOnYYY) �i CERTIFICATE OF MARINE I ENERGY INSURANCE 31: 20z2 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 collilicate holder Is an ADDITIONAL INSURED,the policy(los)Iiiusl 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 slatornonl on this certificate does not confer rights to the conllicate holder In Ilou of such endorsoment(s). PRODUCER CONTACT Arthur J. Gallagher Risk Management Services, Inc. PHONE FAx 2825 Eastlake Avenue East,Suite 110 INc.,,g.U' 206-270-3400 wF•Hyg 206-270-3409 EMAIL Seattle WA 98102-3084 APPSrgg PRODUCER c 1 0 INSURER(S)AFFORDING COVERAGE NAICI INSURED INSURER A:Aspen American Insurance Company 43460 i American Marine Services Group Nsllanel Casualty Company 11991 65 N.Nimitz Hwy,, Pler 14 INSURER O; P y 1500 S. Harracuda Street, Berth 2701271 L.A. INSURERC: Signal MUIURI Iridemnitt,�Lwj Ljd _ 6331 _ Terminal Island CA 90731 INSURER D, INSURER E: i INSURER F: COVERAGES CERTIFICATE NUMBER:1179399880 REVISION NUMBER: j THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 [HE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON131TION OF ANY CONTRACT OR OUTER DOCUMENT Willi RESPECT TO WHICH]HIS CER'f IFICATF-MAY HE ISSUED OR MAY PERTAIN. 1HE INSURANCE.AFFORM'D BY ITI] POLICIES ULSCRIBED HERLIN IS SUBJECT TO ALL ITE 1E4MS, EXCLUSIONS AND CONDI LIONS OF SUCH POLICIES.LIMBS SHOWN NAY HAVE BEEN REDUCED 13Y PAID CLAIMS. INSR I. N POLICY EFF PDLICY CXP ILIMBS TR TYPEOFINSURANCF. S POLICY NUMBER NI UI MM! UA'YW HULL AHD MACHINERY PER SQIEMLE On!FB E INSUIEUVALUE S COLLISION LIABa1TY COLUSION(E.uavlsnca) S TICI IIARM IIY TOWERS(E.ottuI..) S PROTECTION AND o1DEMNIIY PER CLUB RULES CREWI WIC try 1:1"ESACT FAOCCURRENCE S _ PER VESSEL CSC_ COL I ISIO4 t 1ABR.UY COLLISION(Es xe).OSL $ TOWERS IIA➢IUTY TOWERS(En acc),CA S REIAUVALCr"WRECK HEMOYFL 01 WRECK S IN ITEM S 5 POLLUTION UABILRY EAOCCURRF-NCE S OPA e0 S CF..RQA S NON OPA I NON CERCLA s s MARIT[PAC EMPLOY[Re UAOI LI I Y R(A ANY ONE PERSON S AI.TERNATF.EMPLOYER ANY ONE.ACGDENT S INCLUDES u CREW u EMPS s JONES Act $ OFATH ON TIIE HIGH SEAS S IN REM ENDORSEME.W S S s S i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Huntington Besch Attention: Denny Bacon 2000 Main Street AU mORIZEO REPFl IATIVE i Huntington Beach CA 92648 — _. —• Pagel of 2 02012-2015 ACORD CORPORATION. All rights reserved. ACORD 31 (2016103) The ACORD name and logo are registered marks of ACORD I I i COVERAGES CERTIFICATE NUMBER: 1179199RBO INSN TYPE OF INSURANCE POLICY NUIJOER POLICY EFF POLICY FXP]RID WVTI LIMITS A COMMERCIALOENERALLJARILITY ONIODHNY21 763112021 7/31/2022 EACH OCCURRENCE 51,00Q000 X AWiINF.GF.NENALLWIILI IY -DA.TIOETC-RrRTE _ E'A, ISEEUEaacurrmceL S 1,000,000 CLAIMS.MADE I—X IOCCLRR MCC EYP(". om N.1 510.000 PERSONAL A ADV INJURY 51,000,OCA GENERUILAGGRiEGATE $2,WO,000 AD GENTLAGGRECATE LIMIT APPLIES PER. PRODUCTSCOMPI DPAOG S2,000,000 X POLICY n JEC n lOC $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SMILE LIMIT $ _ .(�iLLI{yiEentl A4Y AUTO SCIIEDLREO WOLY INJURY(Por pare ) S _ AUTOS OWNED NONUWNEU AUTOSONLY AUTOS ONLY BODILY INJURY(1'er e[tldenl) $ AIRED PROPERTYDAMAGE leflyWItall $ a WORKERS COMPENSATION NIA VJCSI035021403 10/1/2021 10f112022 ty1 7AI�E ❑OEiy. AND EMPLOYERS LIABILITY YIN ANYPPOPPIETORJPARTNERJEXECUUVr: �l E L(Each euYlenl) S 1 600,000 OFF(CERRAEMBEREXCLUDED2 ` lM..datory In NH) E.L.DISEASE E.emdlA'eal $1,000,C00 1y, ,deecdee under DESCRIPTION Or OPERATIONS b[. EL.UISEASH.POLICY LIMIT $1,000,000 _ ALTERNATE EMPLEWER S V$ISH ENDORSEMENT $ MARITIME EMPLOYERS I Wilt ITY $ QCSL AC T $ C Y,LO 09 A DOR OA RS iR- PENBATIONAONAGi NIA 5070008 fON J2021 1011f2022 Ix�PER VIE U ER At.I IIRNAT E EM RDYER E L.(Earlr accloedQ $ !ANVIT IeIE EMPLUYEa5l1ABNIY EL.OISE E(Ea emdoYea) $ OCSL ACT E.L.DISEASE-ANN AGO $ S AIRC RAFT LIAOILI TY EACH OCCURRENCE S OWNED AIRCNAFT AGCNEGAIE 5 NON-WJNF.D ARE.T PASSENGER LAORITY $ $ UMORELIA I EXCESS LIAOJBIIMOCRSIROOT FACHOCCURRENCE $ UM.ONELLA u BUDMERSHOOT AGGREGATE ($ EXCESS S CWMBMAre 0OCCUR S BED RETENTIONS I S ENERGY C%,ANY ONE CUNT HOL OF'WELL I OPERAT ORS OCCURRENCE $ EXTRA EXPENSE (100%;Mmeat) JCARE,CUSTODY AND CONTROL ICCC) 00Y 4E�OCCURRENCE S OFFSHORE OIL AND GAS PROPERTY PLATroawis VALUES AS SCHEDULED S PIPELINES VALUES AS SCH1,=ED S _ S ONSHORE 01,AND GAS PROPERTY OIL A GAS PROPERTY VALUES AS SGREGOLED S CONTRACTCR9FOUIPMENT VHLIES AS BCHEWLEO S $ NAMED VA.4DSTORM CCC OFF- OM RE AGGREGATE $ VESSEL(S): AS PER ATTACHED SCHEDULE AS DETAILED IN THE DESCRIPTION OF OPERATIONS DESCRIPTION OF OPERATIONS/LOCATIONS (ACORD 101,Addlllonal Remarb lcMdule,may be tlbcAsd,If more space Is reRvlrsd) Re: Huntington Beach Pier-Inspection and Cleaning 'The City of Huntington Beach is named as additional insured as their interests may appear but Only to the extent set forth In the policy provisions. Marine General Liability Deductibles: $50,000 Each Occurrence $50,000 Each Occurrence-Pollution Exclusion Buy Back Coverage $100,000 Each occurrence - 3rd Party Action Over Indemnity $0 Medical Expense Limit — any one person ACORD 31 (2016103) Page 2 of 2 A�Om oA 0310312022 310 312 0 2 2 l CERTIFICATE OF LIABILITY INSURANCE o310312022 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(es) muut be endorsed. If SUBROGATION IS WAIVED, subject to file farms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does riot confer rights to the certificate holder In lieu of such ondorsoment(s). PRODUCER IIAITC King 8 Neoi,Li-C. P11ONE 808521-8311 FAX Ne1.808-526-3893 i aem.xaFXlr Ho lulu,p Al9681,Suite 7.910 EJMR Honolulu, l 00013 ADDRESS' INSURERSIAFFOROINGCOVERACE NAICP INSURER A: Zurich American Insurance CO. 16535 INSURED American MnMarineINSURER B:Corporation l 1500 SO Barracuda St INSURER C: Be:lh 270r271 INSURER U: TornTnol Island,CA 90731 INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F:OR 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. IHSR A POLCY EFF POLICY E%P 11WTS LIR IYPE OF NSURANCE POLICYNUMUER 1 DO MMIC GENERALLIAMLITY EACH OCCURRENCE S D A 1'S i/—E111 _ CCYLMERCWL GENERAL LIABILITY ,PREMISES(En Ecwvance)_ 5 CLAIMS MADE u OCCUR MET)F.%P(MY me Pdleonl S PERSONAL A ADV INJURY S GENERN.AOCIRFOATE $ GENI.AGGRF.OAlETIMITAPPLIM PER: PRUOUCTS-COMPIOP AGO 5 POLICY PRO. LU(: 5 A AUTOMOBILE LIAWWY BAP386488119 07/0112021 07/01/2022 L0.NUxe1Ean �LWI $ 1,000,000 X ANY AUTO X BOOR.Y INJURY(P.Pala.) 5 K ALLOWNEO K SCIIGDULCO DOOILY WJURY(Pr accbenq $ AUTOS AUTOS NON OWN EO PROPERTY IIAMACfi 5 X HUirri AIDOS 1C AUTOS UAtBRELLALIAB OCCUR EACH OCCURRENCE $ -_ EXCESS UAB CTAIMS-MADE AWREGATE 5 OEO RETENTION S WO"ER9COMPENSATION Y/N 1YC 9TATU- OTH- ANDEMP IMIXUALDa ANY PROPRIETORWARTNER•E%ECUTNE❑ NIA E.L EACH ACCIDENT S OFFICEIUTAEMUER EXCLUDED) IALnCabry In NIT) E.L.NSENSE m EA EMPLOYE 5 u4.%deacdEe MMW OE SCRIPUONOFOPERATIONSMbw EI_DISEASE-POLICY LIMIT $ DESCRVIIONOFOPERATIONSILOCATIONSIVEIRCLES IAtM:h ACORD I01.AddRIMAIROM4,10 Seaedule,If MOM OPa<a la Mc Wmd) Giving SeMces-Huntington Beach Pier Auto Llabillty DeducrlWo:$10,000... (Soo Attached Description) CERTIFICATE HOLDER CANCELLATION S40ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VATH THE POLICY PROVISIONS. The(;try of Huntington Beach 2000 Main Street AUTHORIZED REPRESEN W IVE Huntington Beach,CA 92648 /, ! �J uNM11 ©1988-2010 ACORD CORPORATION. All rights rosorved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD 1 of 4 (BLh100) DESCRIPTIONS (Continued from Page 1 ) Notice of cancellation for the automobile policy per Iho allached form. I 2 of 4 (LYK00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: MARINE GENERAL LIABILITY COVERAGE FORM In consideration of the Premium charged, it is agreed that: SCHEDULE ! I Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations The City of Huntington Beach, its officers, elected or project: appointed officials, employees, agents and volunteers Huntington Beach Pier- Inspection and Cleaning 2000 Main Street Huntington Beach CA 92648 i I i i 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 organizaticn(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: I 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and j i 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. ASPMGLO19 1018 20180Aspen Insurance U.S. Services Inc.All rights reserved. Page 1 of 2 Includes copyrighted material of ISO Properties, Inc. used with permission ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED Effective Date: 03/03/2022 Policy Number: OMOOHNY21 j Named Insured: AMERICAN MARINE CORPORATION i I i ASPMGL019 1018 2018©Aspen Insurance U.S. Services Inc. All rights reserved. Page 2 of 2 Includes copyrighted material of ISO Properties, Inc. used with permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET PRIMARY AND NON-CONTRIBUTORY (WHEN REQUIRED BY CONTRACT) I This endorsement modifies Insurance provided under the following: MARINE COMMERCIAL GENERAL LIABILITY COVERAGE PART When required by written contract of agreement, Section IV, COMMERICAL GENERAL LIABILITY CONDITIONS, Paragraph 3.4, Other Insurance, Is deleted In Its entirety and replaced by the fallowing condition: 4. Other Insurance: (a) With respect to the Third Party set forth below, the Insurance provided by this Policy shall be primary and non-contributing Insurance. Any and all other valid and collectable insurance available to such Third Party with respect to work performed by you under written contractual agreements with such Third Party for loss covered by this Policy, shall in no Instance be considered as primary, co-Insurance, or contributing Insurance. Any such other insurance shall be considered excess over and above the insurance provided by this Policy. THIRD PARTY SCHEDULE The Third Party to whom this Endorsement applies: Absence of a specifically named Third Party above means that the provisions of this Endorsement apply ..as required by written contract of agreement with any Third Party for whom you are performing work." ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. Named Insured:American Marine Corporation Corporation Policy Number:OMOOHNY21 Effective Date: 07/31/2021-07/31/2022 ASPCM 5048 0513 ASPEN AMERICAN INSURANCE COMPANY Page 1 of 1 i I I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT TO COVERAGE GENERAL CHANGE ENDORSEMENT NO. 3 NAMED INSURED; AMERICAN MARINE CORPORATION EFFECTIVE DATE OF ENDORSEMENT: 03/03/2022 i WRITING COMPANY: Aspen American Insurance Company CHANGES: In consideration of the premium charged, it is agreed that the following two forms are added to the policy for The City of Huntinglon Beach: Specific Additional Insured - Designated Person or Organization - Completed Operations Blanket Additional Insured -Ongoing Operations-Required in Written Contract It is agreed that the Company, in the event of policy cancellation, shall provide thirty (30)days written notice of cancellation, except ten (10) days notice shall be given in the event of non-payment of premium, to the specific additional insured stated and addressed above. Premium Adjustment: New Annual Premium Additional Premium Return Premium 1 Authorized Representative Signature I ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. Issued Date: 03/08/2022 Policy Number: 0MOOHNY21 Named Insured: AMERICAN MARINE CORPORATION I ASPMGL025 1018 2018©Aspen Insurance U.S. Services Inc.All rights reserved. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGRATION (When Required by Contract) THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION IV, COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 8, Transfer Of Rights Of Recovery Against Others To Us, Is deleted and replaced by the following: 8.Transfer of Rights of Recovery Against Others To Us In the event of any payment under this policy, then we shall be subrogated to all the Insured's rights of recovery therefore against any person or organization and the insured shall execute and deliver Instruments and papers and do whatever else Is necessary to secure such rights. The Insured shall do nothing after loss to prejudice such rights. Notwithstanding the forgoing,we hereby waive our rights of subrogation against Clients of the Named Insured(s)where required by written contract executed prior to any loss. t I Named Insured:American Marine Corporation Corporation Policy Number:OM00HNY21 Effective Date: 07/31/2021-07/31/2022 ASPCM 5017 1012 ASPEN AMERICAN INSURANCE COMPANY Page 1 of 1 I i WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you per- form 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 1 . 000 % of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization I Blanket Waiver. of: Subrogation as required by written i Job Description contract I i I I I I I I Phis endorsement changes the pollcy to which it is attached and is effective on the date Issued unless otherwise slated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective Daln:10/01/2021 Policy No. WCSIG35021.403 Endorsement No. Policy Effective Date: 10/01/2021 to 10/01/2022 Premium $ i Insured: American Marine Corp-HI i DBA: AMC-Hawaii. Carrier Name/Code: National Casualty Company / I Countersigned by C WC 04 03 06 (Ed.4-84) Page 1 of 1 t POLICY NUMBER: 13AP 3864881-1.9 COMMERCIAL AUTO CA20480299 'THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I DESIGNATED INSURED j This endorsement modifies Insurance provided under the fallowing: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM i Wth 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"insurods"under the Who Is An Insured Provision of the Coverago 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. Endorsement Effective: 7/12021 Countersigned By: j i Named Insured: Amcrlcau Marine Corpornllou Authorized Representative) � SCHEDULE Nacre of Person(s) or Organlzation(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE j REQUIRED TO PROVIDE; ADDITIONAL INSURED STATUS OR j ADDITIONAL INSURED STATUS ON A PRIMARY, NONCONTRIBUTORY i BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. 1 i (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) I Each person or organization shown in the Schedule 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 Farm. CA20480299 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 O 3 of (1.YK00) � Blanket Notification to Others of Cancellation ZURICH' or Non-Renewal Polley No. FIf. Date of Pot I Fxp. Dale of Pol. I Fir.Dale of End. I Producer No. Add.Pram Rolurn Prem. 9AP3864881 7/01/2021 7/01/2022 7/01/2021 1 63184000 1 ------- ------- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies Insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has boon cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured If you are required by written contract or written agreement to provide such notification. However, such notification will not be mailed or delivered if a condilional notice of renewal has been sent to the first Named Insured. Such list: 1. Must be provided to us prior to cancellation or non-renewal; 2. Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed; and 3. Must be in an electronic formal that Is acceptable to us. B. Our notification as described In Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mall or deliver such notification to each person or organization shown In the list: 1. Within seven days of the effective date of the notice of cancellation, If we cancel for non-payment of premium; or 2. At least 30 days prior to the effective dale of: a. Cancellation, if cancelled for any reason other than nonpayment of premium; or b. Non-renewal, but not including conditional notice of renewal. C. Our mailing or delivery of notification described In Paragraphs A.and B. of this endorsement Is Intended as a courtesy only. Our failure to provlde such mailing or delivery will not: 1. Extend the Coverage Part cancellation or non-renewal date; 2. Negate the cancellation or non-renewal; or 3. Provide any additional insurance that would not have been provided In the absence of this endorsement. D. We are not responsible for the accuracy, Integrity, timeliness and valldity of information contained In the list provided to us as described In Paragraphs A.and B. of Oils endorsement. All other terms and conditions of this policy remain unchanged. U-CA-832-A CW(01113) Page 1 of 1 Includes copyrighted malarial of Insurance Services Office,Inc.,with Its permission. 4 of 4 (LYKea)