Loading...
NV5, Inc. - 2014 Agreement - Amendment No. 5AMENDMENT TO THE AGREEMENT FOR SERVICES BETWEEN CITY OF GILROY AND NV5, INC FOR SWANSTON AND CASEY WATER MAIN REPLACEMENT PROJECT NO. PO NO. 140828 DATED JUNE 10TH, 2014 AMENDMENT NO.4S This Amendment shall become effective when it has been signed by the City Administrator, Project Manager, and Consultant. All copies forwarded to Consultant for signature shall be returned to the City of Gilroy properly filled out. Upon acceptance by the City, the Consultant's copy will be returned to him as his authori to proceed with the work. As per the attached proposal, this amendment is for additional design services for Swanston and Casey Water System Improvements, in an amount not to exceed $17,000. Additional civil engineering design services were requested to address unforeseen field conditions such as: potholing to verify existing utilities in the street and increasing size of pipe. This extra work required NVS, Inc. to expend additional man hours in the performance of its civil engineering design duties. All requirements of the original Agreement Documents shall apply to the above work except as specifically modified by this Amendment. The contract time shall not extend unless expressly provided for in this Amendment. NVS, Inc. hereby agrees to perform the above work subject to the terms of this Amendment for additional design services as stated in scope of services. Consultant: NVS, Inc. By X� Dave Richard, PE, Principle Date 2. i. . :Z. ACCEPTED: A' i/ // Ci N V 5 February 5, 2016 SJB038000 Christine Salmo City of Gilroy 613 Old Gilroy Road Gilroy, CA 95020 SUBJECT: PROPOSAL FOR ADDITIONAL SERVICES SWANSTON AND CASEY WATER SYSTEM IMPROVEMENTS Dear Christine, As requested, we have prepared this proposal describing additional tasks to be added to our current scope of services for the Swanston and Casey water system improvements project. Our proposal includes a scope of services and fee estimate summarized below. SCOPE OF SERVICES The original project scope of work (dated March 2014) included design milestones of 35 %, 95% and 100% and excluded potholing investigation. Based on feedback from the City, we propose the addition of a potholing investigation. Task 3A — Potholing Potholing will take place to augment available utility as -built information and verify potential conflicts with existing utilities. Exaro Technologies will perform potholing activities for up to 5 locations (identified by engineer) or up to one day. Potholing includes vacuum excavation at the identified locations, followed by backfill with Class II aggregate and asphalt repair with hot mix asphalt paving. This task includes coordination with the potholing contractor. The potholing contractor will notify USA in advance of potholing activities, and provide traffic control as required. The results of the potholing activities will be incorporated into the construction plans. Task 3B — Additional Services in Support of Design Development Following the 35% design submittal in October 2014, the project design was put on hold due to higher priority City capital projects. Comments on the 35% design were received in December 2015. Since the 35% submittal, some project elements have changed including the diameter of the proposed water main (due to recent hydraulic modeling analysis completed by another consultant) resulting in changes to the design documents that were not previously anticipated. In addition, some City standards have changed resulting in additional work to ensure the project meets current standards. 2025 GATEWAY PLACE. SUITE 156 j SAN JOSE. CA 95 1 10 1 WWW.P4V5.COM I OFFICE 408.392.7200 1 F A X 408.392.01 O 1 nAsjb038000 \project work plan\a05- scope - contract- subagreements\swanston -addI services letter- 20160204.doc Christine Salmo February 5, 2016 Page 2 of 2 ESTIMATED FEE Our estimated fee to furnish the additional services is summarized below. Task 3A — Potholing $9,000 Task 3B — Additional Services in Support of Design Development $8,000 TOTAL $17,000 Thank you for this opportunity to provide engineering services for City of Gilroy. If you have any questions or comments, please contact Jill Sylvester at (408) 392.7232. Sincerely, NVS, Inc. Jill Sylvester, PE Project Manager Ll� Dave Richard, PE Principal n: \sjb038000 \project work plan \a05 - scope- contract- subagreements\swanston -addl services letter- 20160204.doc �AACC)R ®® ��.v CERTIFICATE OF LIABILITY INSURANCE DATE (MAiIIDDIYY 6 2i17i2o16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Cavignac & Associates 450 B Street, Suite 1800 San Diego, CA 92101 -8005 License No. OA99520 CONTACT Certificate Department NAME: ME: P PHONE FAX •619 -234 -6848 A/C No:619- 234 -8601 EMAIL :certificates@cavi nac.:com INSURE NS) AFFORDING COVERAGE NAIC# INSURER A LIMITS INSURED NV5 Holdings, Inc.; NV5, Inc. 2525 Natomas Park, Ste 300 Sacramento, CA 95833 United States INSURER B: L OF CT 25682 INSURER C:: TRAVELERS PROP CAS CO OF AMER 25674 INSURERD: HUDSON INS CO 25054 INSURER E: $ 1,006,000 .INSURER F: : $_ 1,000,000 COVERAGES CERTIFICATE.NUMBER: 361504 REVISION NUMBER: 361587 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE. FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR - - -- TYPE OF INSURANCE ADDL wqli SUBR WVn POLICY. NUMBER POLICY EFF MMIDD/YYYY) POLICY EXP (MMIDD/YYYYI LIMITS B GENERAL LIABILITY 6806B97547A 5/1/2015 5/1/2016 EACH OCCURRENCE $ 1,006,000 DAGE TO RENT PPREM SES a ocou D nce - : $_ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-] OCCUR MED EXP (Any one person)- - $ _ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X 'iCross Liab /Sev of Int X X GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - .COMP /OPAGG_ $ 2,000,000 Deductible $ 0 POLICY X PRO LOC A AUTOMOBILE LIABILITY 810927X6534 5/1/2015 5/1/2016 COMBINED SINGLE LIMIT - Ea accident) - 1,000,000. BODILY INJURY (Per person) $ X ANY AUTO BODILY,INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X X PROPERTY DAMAGE r id n $ _ NON -OWNED HIRED AUTOS AUTOS C X UMBRELLA LIAB X OCCUR CUP4E359282 5/1/2015 5/1/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE UB3893T615 5/1/2015 5/1/2016 X WCSTATU: OR LIMITS E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA X (Man&togInNH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $ 11000,000 D Professional Liability AEE7246005 /1/2015 5/1/2016 Ea.Claim $5,000,000 Aggreg $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: Service Agreement: Water Main Upgrades for Casey and Swanston Lanes covers the City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement. Additional Insured coverage applies to General and Automobile Liability for City of Gilroy, its officers, officials and employees, 7351 Rosanna Street, Gilroy, CA 95020 per policy form. Primary coverage applies to General.and Automobile Liability per policy form. Waiver of subrogation applies to General and Automobile Liability and workers Compensation per policy form. Prof. Liab. — Claims made, defense costs included within limit; Pollution Liability is included in policy form City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 United States ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE effrey W. Cavignac The ACORD name and logo are registered marks of ACORD . EXIGIS - CAVIGNAC & ASSOCIATES 361587 CORPORATION. All rights reserved. Page 2 of 9 Certificate# 361587, replaces #361586 A 0 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED NV5 Holdings, Inc.; Inc. Cavignac & Associates (619) 234 -6848 phone 252 2525 Park, Ste 300 to 450 S Street, Suite 1800 (619) 234 -1239 fax Sacramento, CA 95833 United States Sacramento, San Diego, CA 92101 -800'5 certificates ®cavignac.com EFFECTIVE DATE: 2/17/2016 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORMNUMBER: 25 FORMTITLE: Certificate of Liability Insurance #ADI0510002. Cavignac & Associates will provide 30 days notice of cancellation to the Certificate Holder in the event of policy cancellation. ACORD 101 12008/011 © 2008 ACORD CORPORATION. All riahts reserved. The ACORD name and logo are registered marks of ACORD Page 3 of 9 Policy No. 810927K6534 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover - age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered_ A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABILITY COV- ERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in that "em- ployee's" name, with your permission, while EQUIPMENT— INCREASED LIMIT I. WAIVER OF DEDUCTIBLE —GLASS J. PERSONAL EFFECTS K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing duties related to the conduct of your business. However, any "auto" that is Teased, hired, rented or borrowed with a driver is not a covered "auto ". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABILITY COV- ERAGE: CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services office, Inc. with its permission. Page 4 of 9 Policy No. 810927K6534 COMMERCIAL AUTO Any "employee of yours is an "insured" while us- ing a covered "auto you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION 11— LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident' we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION li — LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto ", then the Physical Damage Coverage is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for 'loss" in any one "accident" to a hired, rented or borrowed "auto" is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss "; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss ". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto ". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver, or (b) Any "auto" that is hired, rented or bor- rowed from your "employee ". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III —PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT Paragraph C.2.. Limit Of Insurance, of SEC- TION III — PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a_ covered "auto' will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL EFFECTS The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Effects Coverage We will pay up to $400 for 'loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured "; and (2) In or on your covered "auto ". This coverage only applies in the event of a total theft of your covered "auto ". No deductibles apply to Personal Effects cover- age. Page 2 of 3 © 2010 The Travelers Indemnity Company. All rights reserved. CA T4 20 07 10 Includes copyrighted material of Insurance Services Office, Inc. with 'its permission. Page 5 of 9 Policy No. 810927K6534 K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war - ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss ". L. AUTO LOAN LEASE GAP The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto'; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss'; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Cary -over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss ", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 6 of 9 POLICY NUMBER: 6906a97547A COMMERCIAL GENERAL LIABILITY DATE ISSUED: 5/1/2015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Gilroy its officers, officials and employees, 7351 Rosanna Street, Gilroy, CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: Service Agreement: Water Main Upgrades for Casey and Swanston Lanes covers the City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement. PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but only with respect to liability for "bodily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products - completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage ", or "personal injury" for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the rendering of or failure to render any "professional services ". e. The limits of insurance afforded to the additional insured shall be the limits which you agreed in that "contract or agreement requiring insurance" to provide for that additional insured, or the limits shown in the Declarations for this coverage part, whichever are less. This endorsement does not increase the limits of insurance stated in the CG D3 82 09 07 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission Page 7 of 9 , . P LIMITS OF INSURANCE (Section III) for this coverage part. B. The following is added to paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the additional insured shown in the Schedule, the insurance provided to that additional insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such additional to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed. a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 2007 The Travelers Companies, Inc. Page 2 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission Page 8 of 9 . . WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (00) POLICY NUMBER UB3 a 93 T61 s WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. . 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 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Page 9 of 9