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HomeMy Public PortalAboutC-19-018 PA ARCA AMENDMENT NO. 5 2023 JUNE 15AMENDMENT NO. 5 TO AGREEMENT FOR CONTRACT SERVICES THIS AMENDMENT TO THE AGREEMENT FOR CONTRACT SERVICES ("Amendment No. 5") by and between the City of Carson, a California municipal corporation ("City") and P.A. Arca Engineering, a California corporation ("Consultant"), is effective as of the 16th day of May, 2023. RECITALS A. City and Consultant entered into that certain Agreement for Contractual Services dated April 2, 2019 ("Agreement") whereby Consultant agreed to provide On -Call Engineering Services. B. City and Consultant amended the Agreement on April 26, 2019 ("Amendment No. 1") to decrease the Contract Sum from Five Hundred Thousand Dollars ($500,000.00) to Two Hundred Fifty Thousand Dollars ($250,000.00). C. City and Consultant amended the Agreement on October 6, 2020 (Amendment No. 2) to increase the Contract Sum from Two Hundred Fifty Thousand Dollars ($250,000.00) to Five Hundred Thousand Dollars (500,000.00), and to extend the term by one (1) additional year until June 30, 2022. D. City and Consultant amended the Agreement on June 21, 2022 (Amendment No. 3) to extend the term by six (6) additional months until December 30, 2022. E. City and Consultant amended the Agreement on November 15, 2022 (Amendment No. 4) to extend the term by six (6) additional months until June 30, 2023. F. City and Consultant now desire to again amend the Agreement to extend the term by six (6) additional months until December 30, 2023. TERMS 1. Contract Changes. The Agreement is amended as provided herein (new text in bold italics and deleted text in str-ikethr-e gh) A. Section I, Exhibit "D," "Schedule of Performance," of the Agreement is hereby amended to read in its entirety as follows: "From September 3, 2019 through june 3002823 December 30, 2023, Consultant shall provide Services on an on-call basis as set forth in Exhibit A." 2. Continuing Effect of Agreement. Except as amended by this Amendment No. 5, all provisions of the Agreement, Amendment No. 1, Amendment No. 2, Amendment No. 3, and Amendment No. 4 shal I remain unchanged and in full force and effect. From and after the date of 01007.0006/889244.1 this Amendment No. 5, whenever the term "Agreement" appears in the Agreement, it shall mean the Agreement, as amended by this Amendment No. 5, Amendment No. 4, Amendment No. 3, Amendment No. 2, and Amendment No. 1. 3. Affirmation of Agreement; Warranty Re Absence of Defaults. City and Consultant each ratify and reaffirm each and every one of the respective rights and obligations arising under the Agreement, Amendment No. 1, Amendment No. 2, Amendment No. 3, and Amendment No. 4. Each party represents and warrants to the other that there have been no written or oral modifications to the Agreement other than as provided herein and Amendment No. 1, Amendment No. 2, Amendment No. 3, and Amendment No. 4. Each party represents and warrants to the other that the Agreement, as amended by Amendment No. 1, Amendment No. 2, Amendment No. 3, Amendment No. 4, and this Amendment No. 5, is currently an effective, valid, and binding obligation. Consultant represents and warrants to City that, as of the date of this Amendment No. 5, City is not in default of any material term of the Agreement and that there have been no events that, with the passing of time or the giving of notice, or both, would constitute a material default under the Agreement. City represents and warrants to Consultant that, as of the date of this Amendment No. 5, Consultant is not in default of any material term of the Agreement and that there have been no events that, with the passing of time or the giving of notice, or both, would constitute a material default under the Agreement. 4. Adequate Consideration. The parties hereto irrevocably stipulate and agree that they have each received adequate and independent consideration for the performance of the obligations they have undertaken pursuant to this Amendment No. 5. 5. Authority. The persons executing this Amendment No. 5 on behalf of the parties hereto warrant that (i) such party is duly organized and existing, (ii) they are duly authorized to execute and deliver this Amendment No. 5 on behalf of said party, (iii) by so executing this Amendment No. 5, such party is formally bound to the provisions of this Amendment No. 5, and (iv) the entering into this Amendment No. 5 does not violate any provision of any other agreement to which said party is bound. [SIGNATURES ON FOLLOWING PAGE] -2- 01007.0006/889244.1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 5 on the date and year first -above written. ATTEST: 1 �aurir�� Gul Gi f --j - 04- Dr. Khaleah K. Bradshaw, City Clerk APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP 441.Sunny K. Soltani, City Attorney [rill CITY: CITY O CARSON, a municipal corporation H Luavis-Holmes, Mayor jo oN UNL1M CONSULTANT: P.A. ARCA ENG Nathe:,Perfecto A. Arca, PE Title: President By:�C� Name: Dina Arca Title: Corporate Treasurer Address: 500 E. Carson Plaza Dr, Suite 201 Carson, CA 90746 Two corporate officer signatures required when Consultant is a corporation, with one signature required from each of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. CONSULTANT'S SIGNATURES SHALL BF, D1JLY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED RY THF. BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO CONSULTANT'S BUSINESS ENTITY. -3- 01007.0006/889244.1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 5 on the date and year first -above written. ATTEST: Dr. Khaleah K. Bradshaw, City Clerk APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP Sunny K. Soltani, City Attorney [rill CITY: CITY OF CARSON, a municipal corporation Lula Davis -Holmes, Mayor CONSULTANT: P.A. ARCA ENG Nadneerfecto A. Arca, PE Title: f resident By: Name: Dina Arca Title: Corporate Treasurer Address: 500 E. Carson Plaza Dr, Suite 201 Carson, CA 90746 Two corporate officer signatures required when Consultant is a corporation, with one signature required from each of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. CONSULTANT'S SIGNATURES SHALL BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO CONSULTANT'S BUSINESS ENTITY. -3- 01007.0006/889244.1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. STATE OF CALIFORNIA COUNTY OF LOS ANGELES AP....s R. S r r -r7 G.t-w! A. e ,J � ai,R IF t3 G On Aky , 2023 before me, ���Y (]�4i,a personally appeared T/✓k n�'t- , proved tome on the basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and acknowledged to me that he/she% executeTthe same in Fisher tMeir authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entityupon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. *my AMORSITO CANAON SAPIDA Notary Public - California Signature: Los Angeles County Commission # 2436165 Comm. Expires Jan 27, 2027 OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL CORPORATE OFFICERG Pt ! Gol2.d7o/&-rd TV' ate WL t i -T ff+sa SuS drr-41 S TITLE(S) TITLE OR TYPE OF DOCUMENT ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ ATTORNEY-IN-FACT 3 ❑ TRUSTEE(S) NUMBER OF PAGES ❑ GUARDIAN/CONSERVATOR ❑ OTHER A-Ahy 9. X23 SIGNER IS REPRESENTING: DATE OF DOCUMENT (NAME OF PERSON(S) OR ENTITY(IES)) SIGNERS OTHER THAN NAMED ABOVE H1000Y1i 1IG :AE:f MM1 A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 9i26i2022 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The Certificate Team Assured Partner Design Professionals Insurance Services, LLC PHONE FAX 3697 Mt. Diablo Blvd Suite 230 c No Ext): ac No: E-MLafayette ADDRESS: CertsDesignPro@AssuredPartners.com CA 94549 INSURERS AFFORDING COVERAGE NAIC # INSURER A: XL Specialty Insurance Co. 37885 License* 6003745 INSURED PAARCAE-01 INSURER B : PA Arca Engineering, Inc. 310) 768-3828 INSURER C : INSURER D: 500 E Carson Plaza Dr Ste 201 Carson CA 90749 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1853064673 REVISION NUMBER: 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 SUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS -MADE 7 OCCUR S(RENTED PREMISES Ea occurrence)$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1-1PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE I JER ANYPROPRIETOR/PARTNER/EXECU I — E.L. EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability& DPS9985043 10/19/2021 10/19/2023 Per Claim $1,000,000 Aggregate Limit $2,000,000 Contr. Pollution Liab Included DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations as pertains to named insured. GtK I ItIUA I t HVLUtK L;ANGtLLA I WN 3U UaV NOUCe OT uancellatlon City of Carson 701 E. Carson St. Carson CA 90745 INSURANCE APPROVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN !�T ACCORDANCE WITH THE POLICY PROVISIONS. 6/1/2023 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/31/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Matthew Cowan Julian Summers Insurance TRUIRE--FAX AIC, No, Ext): (310) 361-5630 (AIC, No): ADDRESS: randa@juliansummers.com 5155 W Rosecrans Avenue suite 205 INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 INSURER A: MID CENTURY INS CO 21687 Hawthorne CA 90250 INSURED INSURER B: TRUCK INS EXCH 21709 INSURER C : P.A. ARCA ENGINEERING, INC. INSURER D: 500 E. CARSON PLAZA DR. INSURER E: AUTOMOBILE X CARSON CA 90746 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 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDNYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR Y Y 604881319 02/01/2023 02/01/2024 EACH OCCURRENCE $ 1,000,000 UnMGETO PREMISES (Ea occurrence) $ 75,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- F -1X JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 1,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNEDFRUFLK AUTOS ONLY AUTOS ONLY Y Y 604881319 02/01/2023 02/01/2024 uumbINLU(Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 'y$ (Per accident) B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 60488-70-47 02/01/2023 02/01/2024 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED I I RETENTION $ $ A ORKERS COMPENSATION- ND EMPLOYERS' LIABILITY Y / N %NY PROPRIETOR/PARTNER/EXECUTIVE FFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under ESCRIPTION OF OPERATIONS below N / A Y A0949-11-21 07/01/2022 07/01/2023 X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carson, its elected and appointed officers, employees, volunteers and agents are named as Additional Insured on GL and Auto policies. GL policy is Primary and Non -Contributory. Thirty (30) days Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF CARSON INSURANCE APPROVED ACCORDANCE WITH THE POLICY PROVISIONS. 701 E CARSON ST AUTHORIZED REPRESENTATIVE CARSON CA 90745 6/1/2023 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 604881319 FARMERS INSURANCE ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COVERAGE FORM APARTMENTOWNERS LIABILITY COVERAGE FORM CONDOMINIUM LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is An Insured of the applicable Coverage Form: 17238 1 st Edition Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and b. If coverage provided to the additional insured is required by a contractor 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 Paragraph D. Liability And Medical Expenses Limits Of Insurance of the applicable Coverage Form: 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 contractor 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. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. J7238-ED102-19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Pagel oft 937238 J7238101 POLICY NUMBER: 604881319 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Countersigned By: 05/10/2023 Named Insured: P.A.ARCA ENGINEERING,INC. Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): CITY OF CARSON (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) 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 Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 05/10/2023 Effective Date This endorsement modifies insurance provided under the following: Y�Lf:I7iK7if;'. BUSINESSOWNERS COMMON POLICY CONDITIONS - BP 00 09 SCHEDULE Name of Person or Organization: CITY OF CARSON E3306 1 st Edition (If no entry appears above, information required to complete this Endorsement must be shown in the Declarations as applicable to this endorsement.) The provisions of the Businessowners Common Policy Conditions are modified by this endorsement as follows: Condition K. Transfer Of Rights Of Recovery Against Others To Us in the Businessowners Common Policy Conditions is amended by the addition of the following: 3. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your work done under a contract with that person or organization and included in the products -completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. E3306 -ED 1 6-97 Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Page 1 of 1 91-3306 E3306101 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE CHANGES IN TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM E3153 1 st Edition With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 05/10/2023 Named Insured: P.A.ARCA ENGINEERING,INC. (Authorized Representative) SCHEDULE Name Of Person(s) Or Organization(s): CITY OF CARSON Additional Premium I $ (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of RecoveryAgainst Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termination of this endorsement or the policy. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. E3153-ED1 6-06 Page 1 of 1 91-3153 E3153101 Policy Changes Endorsement Description ADD ADDITIONAL INTEREST ADDITIONAL INSURED-J7100-ED2 CITY OF CARSON 701 E CARSON ST CARSON, CA 90745 LOCATION: 500 E CARSON PLAZA DR STE 201 CARSON, CA 90746 Removal If Covered Property is removed to a new location that is described on this Policy Permit Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change: after that, this insurance does not apply at the previous location. 91-0277 1ST EDITION 7-02 Indudes Copyrighted Material, Insurance Services Office, Inc, whh its perms ion. E4277102 PAGE 2 OF 2 E4277 -E01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. fah FARMERS INSURANCE PRIMARYAND NONCONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the: BUSINESSOWNERS POLICY SCHEDULE Name of Additional Insured Persons(s) or Orcianization(s): CITY OF CARSON Information required to complete this Schedule, if not shown above, will be shown in the Declarations. X7100 2nd Edition The following is added to Paragraph H. Other Insurance of the Businessowners Common Policy Conditions and supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will notseek contribution from any other insurance available to the additional insured shown in the Schedule, provided that: 1. The additional insured shown in the Schedule is a Named Insured under such other insurance; 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured; and 3. The additional insured shown in this Schedule is also an Additional Insured on this policy. The coverage provided under this endorsement is subject to the terms and conditions of the applicable, underlying Additional Insured endorsement. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy J7100-ED2 05-18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 93-7100 J7100201 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 31 (Ed. 6-20) BLANKET WAIVER OF OUR RIG14TTO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under awritten contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 3.0 % of the California workers compensation premium otherwise due on such remuneration, subject to a minimum charge of $250 All written contracts in the state(s) of: CA This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07/01 /23 Policy No. A0949-11-21 Endorsement No. Insured P.A. ARCA ENGINEERING, INC. 500 E CARSON PLAZA DR # 201 Insurance Company MID-CENTURY INSURANCE COMPANY CARSON CA 907467303 Countersigned By WC 99 06 31 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.