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HomeMy WebLinkAboutDu-All Safety ApprovalAGREEMENT THIS AGREEMENT is made and entered into on the 23rd day of January, 2025 by and between the TOWN OF LOS ALTOS HILLS (hereinafter referred to as "TOWN") and Du - All Safety Approval (hereinafter referred to as "CONTRACTOR"). In consideration of their mutual covenants, the parties hereto agree as follows: 1. CON RACTOR. Shall provide or furnish the following specified services and/or materials: Hazardous Materials Business Plan 2. EXHIBITS. The following attached exhibits are hereby incorporated into and made a part of this Agreement: Proposal from CONTRACTOR dated January 23, 2025 3. TERMS. The services and/or materials furnished under this Agreement shall commence January 24, 2025 and shall be completed by June 30, 2025, unless terminated pursuant to Section 5(f). 4 COMPENSATION. For the full performance of this Agreement: a. TOWN shall pay CONTRACTOR an amount not to exceed Five Thousand Eight Hundred Fifty dollars and zero cents ($5,850.00) within thirty (30) days following receipt of invoice and completion/delivery of services/goods as detailed in Sections 1, 2, and 3 of this Agreement and only upon satisfactory delivery/completion of goods/services in a manner consistent with professional/industry standards for the area in which CONTRACTOR operates. TOWN is not responsible for paying for any work done by CONTRACTOR or any subcontractor above and beyond the not to exceed amount. b. Town shall not reimburse for any of CONTRACTOR's costs or expenses to deliver any services/goods. Town shall not be responsible for any interest or late charges on any payments from Town to CONTRACTOR. c. CONTRACTOR is responsible for monitoring its own forces/employees/agents/ subcontractors to ensure delivery of goods/services within the terms of this Agreement. TOWN will not accept or compensate CONTRACTOR for incomplete goods/services. Town of Los Altos Hills Page 1 of 4 Short form Updated 4126/22 5. GENERAL TERMS AND CONDITIONS,. a. HOLD HARMLESS. CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of personal injury (including death) and property damage of any nature, caused by or arising out of the performance of CONTRACTOR under this Agreement. With regard to CONTRACTOR'S work product, CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of any nature to the extent caused by the negligent performance of CONTRACTOR under this Agreement. b. INSURANCE. CONTRACTOR shall file with the TOWN a certificate of insurance before commencing any services under this Agreement as follows: i. WORKERS COMPENSATION INSURANCE: Minimum statutory limits. COMMERCIAL GENERAL LIABILITY AND PROPERTY DAMAGE INSURANCE: General Liability and Property Damage Combined. $1,000,000.00 per occurrence including comprehensive form, personal injury, broad form personal damage, contractual and premises/operation, all on an occurrence basis. If an aggregate limit exists, it shall apply separately or be no less than two (2) times the occurrence limit. iii. AUTOMOBILE INSURANCE: $1,000,000.00 per occurrence. iv. ERRORS AND OMISSIONS INSURANCE: $1,000,000.00 aggregate. v. NOTICE OF CANCELLATION: The City requires 30 days written notice of cancellation. Additionally, the notice statement on the certificate should not include the wording "endeavor to" or "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives." vi. CERTIFICATE OF INSURANCE: Prior to commencement of services, evidence of insurance coverage must be shown by a properly executed certificate of insurance and it shall name "The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers" as additional insureds. vii. To prevent delay and ensure compliance with this Agreement, the insurance certificates and endorsements must be submitted to: Town of Los Altos Hills Page 2 of 4 Short form Updated 4/26/22 Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 c. NON-DISCRIMINATION. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, age, ancestry, religion or sex of such person. d. INTEREST OF CONTRACTOR. It is understood and agreed that this Agreement is not a contract of employment and does not create an employer-employee relationship between the TOWN and CONTRACTOR. At all times CONTRACTOR shall be an independent contractor and CONTRACTOR is not authorized to bind the TOWN to any contracts or other obligations without the express written consent of the TOWN. In executing this Agreement, CONTRACTOR certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of TOWN. e. CHANGES. This Agreement shall not be assigned or transferred without advance written consent of the TOWN. No changes or variations of any kind are authorized without the written consent of the City Manager. This Agreement may only be amended by a written instrument signed by both parties. f. TERMINATION. This Agreement may be terminated by TOWN upon seven (7) days written notice to CONTRACTOR. Monies owed for work satisfactorily completed shall be paid to CONTRACTOR within 14 days of termination, g. RECORDS. All reports, data, maps, models, charts, studies, surveys, calculations, photographs, memoranda, plans, studies, specifications, records, files, or any other documents or materials, In electronic or any other form, that are prepared or obtained pursuant to this Agreement and that relate to the matters covered hereunder shall be the property of the TOWN. CONTRACTOR hereby agrees to deliver those documents to the TOWN at any time upon demand of the TOWN. It is understood and agreed that the documents and other materials, including but not limited to those described above, prepared pursuant to this Agreement are prepared specifically for the TOWN and are not necessarily suitable for any future or other use. Failure by CONTRACTOR to deliver these documents to the TOWN within a reasonable time period or as specified by the TOWN shall be a material breach of this Agreement. TOWN and CONTRACTOR agree that until final approval by TOWN, all data, plans, specifications, reports and other documents are preliminary drafts not kept by the TOWN in the ordinary course of business and will not be disclosed to third parties without prior written consent of both parties. All work products submitted to the TOWN pursuant to this Agreement shall be deemed a "work for hire." Upon submission of any work for hire pursuant to this Agreement, and acceptance by the TOWN as complete, non- exclusive title to copyright of said work for hire shall transfer to the TOWN. The compensation recited in Section 4 shall be deemed to be sufficient consideration Town of Los Altos Hills Page 3 of 4 snot foffn Updated 4/26122 for said transfer of copyright. CONTRACTOR retains the right to use any project records, documents and materials for marketing of their professional services. h. CONTRACT ADMINISTRATION. The TOWN hereby designates [insert applicable staff title] and the City Manager as Contract Administrator for this agreement. The CONTRACTOR shall only take direction regarding the services provided under this Agreement from the Contract Administrator. Furthermore, CONTRACTOR agrees that the Contract Administrator shall be included any meeting, teleconference or written communication between any Town representative including Committee members and the CONTRACTOR. The TOWN may modify the Contract Administrator at any time upon providing written notice to the CONTRACTOR. i. ENTIRE AGREEMENT. This Agreement represents the entire agreement between the Parties. Any ambiguities or disputed terms between this Agreement and any attached Exhibits shall be interpreted according to the language in this Agreement and not the Exhibits. 6. INVOICING. Send all invoices to the contract coordinator at the address below. This Agreement shall become effective upon its approval and execution by TOWN. In witness whereof, the parties have executed this Agreement the day and year first written above. CONTRACT COORDINATOR and representative for TOWN: WooJae Kim Public Works Director Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 Town of Los Altos Hills Short form Updated 4/26122 CONTRACTOR: 2 TOWN O S OS HILL : 1 A Bv: P ter Pirnejad,, Manager Date Page 4 of 4 Foran W9 Request for Taxpayer (Rev. October 2007) Identification Number and Certification Department of the Treasury internal Revenue service on your Income tax return) Business name, if different from Give form to the requester. Do not send to the IRS. Check eppropriet. box: ❑ Individual/Sole proprietor ❑ Corporation ❑ Partnership Exempt Limited liability company. Enter the tax clessification (D --disregarded entity, C --corporation, Partnership) / __� ❑ payee Other (see inetrucdcns) 10�- City, state, and ZIP List account number(e) here suits no.) __tt ,V(,�5 ST r"N *�S sf Requester's name and address (optionaQ 1 Town of Los Altos nils 26379 Frettfont Road l los Altos ltilis, CA 91022 Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid social asourity number backup withholding. For Individuals, this is your social security number (SSN). However, for a resident I alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entitles, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter. Cy L4 ; -8111 2-01L (0 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certfficatlon Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the i?structi?ns on pie 4. Sign Signature of Here I U.S. person ► Date ► 1-2:-�, General Instructions Definition of a U.S. person. For federal tax purposes, you are Section references are to the Internal Revenue Code unless considered a U.S. person tf you are: otherwise noted. • An individual who is a U.S. citizen or U.S. resident alien, Purpose of Form • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United A person who is required to file an Information return with the States, IRS must obtain your correct taxpayer identification number (M) * An estate (other than a foreign estate), or to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or • A domestic trust (as defined in Regulations section 301.7701-7). abandonment of secured property, cancellation of debt, or contributions you made to an IRA Special rules for partnerships. Partnerships that conduct a Use Form W-9 on if you are a U.S. arson (including a y p ( g trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of Income resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner Is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a 2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding If you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a Income. U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on The person who gives Form W-9 to the partnership for foreign partners' share of effectively connected income. purposes of establishing its U.S. status and avoiding withholding on its allocable share of net Income from the partnership Note. If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it Is following cases: substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity, Cot. No. 10231X Form W-9 (Rev. 10-2007) Short -form Agreement Instructions and Checklist Professional Services (unrelated to public projects): ❑ Obtain a detailed quotation from the qualified vendor/contractor. ❑ Determine availability of funds in the current budget — consult finance for appropriate budget number if necessary ❑ Request approval from the City Manager ❑ Complete the agreement template: o Section 1 — Detail the goods and/or services the vendor/contractor will provide to the Town. o Section 2 — Attach the detailed quotation as an exhibit. o Section 3 — Provide the contractor with a deadline to provide the goods/or services. If services are on-going, the contracts should expire no later than the end of the current fiscal year. A new contract will be prepared in June for the next fiscal year. C Send the complete agreement, exhibit(s), to the contractor along with the standard transmittal memo and the IRS Form W-9 (included below). ❑ Contractor should return at least one signed original copy and a completed W-9 to the Town. If you receive the documents, please forward everything to finance. Public Works Proiects: The California Labor Code beginning at section 1720 deals with this issue. Labor Code sections 1720 and 1771 define public works as work done under contract and paid for in whole or in part out of public funds that involves one or more of the following: Construction; Alteration, Demolition, Installation; Repair/ Maintenance work. Contractor shall comply with all prevailing wage laws, rules and regulations on public works projects, A complete definition may be found at: http://www.leginfo.ca.gov/calaw.html. ❑ Submit a request for quotations to the Town's authorized vendor list for the services requested. ❑ Determine availability of funds in the current budget — consult finance for appropriate budget number if necessary ❑ Prepare a written recommendation to the City Manager to award the contract to the vendor whose bid is most advantageous to the Town with a compelling reason why the selected bid is most advantageous. ❑ With City Manager approval, complete the agreement template: o Section 1 - Detail the goods and/or services the vendor/contractor will provide to the Town. o Section 2 — Attach the detailed quotation as an exhibit. c Section 3 — Provide the contractor with a deadline. If services are on- going, the contracts should expire no later than the end of the current fiscal year. A new contract will be prepared in June for the next fiscal year. ❑ Send the complete agreement, exhibit(s), to the contractor along with the standard transmittal memo and the IRS Form W-9 (included below). C Contractor should return at least one signed original copy and a completed W-9 to the Town. If you receive the documents, please forward everything to finance. 5098744.1 DU -ALL SAFETY January 23, 2025 WooJae Kim Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 Mr. Kim, Please find the following scope and quote to update the required Hazardous Materials Business Plan (HMBP) for the following four Town of Los Altos Hills sites: Westwind Community Barn, Corporation Yard, Purissima Sewer Lift Station, and Town Hall. Scope to include, but not limited to the following items: Scope of Work: 1) Conduct site visit at facility location to gather facility contact information, hazardous materials inventory and emergency response information. 2) Complete all sections of HMBP: Facility Information, Hazardous Materials Inventory and Emergency Response. Create Emergency Response Contingency Plan. Review all chemical SDS for input into the HMBP. 3) Update Figure 1: Facility Location Map, Figure 2: Site Plan and Figure 3: Storage Map for facility. Map will include all necessary elements as required by the HMBP regulations. The required features are: north orientation, loading areas, internal roads, adjacent streets, storm and sewer drains, access and exit points (roll up door, pedestrian entry -exit), emergency shutoffs for water, gas and electric, evacuation staging areas, hazardous materials handling and storage areas, and emergency response equipment to include fire riser location, onsite fire hydrants, spill kits, fire extinguishers, eye wash stations, first aid kits. Ensure all is compliant with the Santa Clara County Department of Environmental Health (CUPA). 4) Conduct records review of hazardous waste documentation as it relates to the HMBP and DTSC regulations. Verify hazardous waste contractor documents and manifests with the State of California and verify that the annual verification questionnaire is being completed. Create account and establish questionnaire if not. Verify EPA ID numbers with the state of California. 5) Discuss inspection requirements with contact for future compliance. Review on site procedures and update client as needed. Conduct hazardous materials inspection for the month of January with client on site. 6) Create employee training plan as related to hazardous materials and both State and City regulations. Training may include hazardous waste, DOT, and HMBP. Staff will receive a certificate for all completed trainings. Training will either be conducted on site or via Zoom or Teams. Multiple trainings in one day may occur if needed depending on the number of staff requiring training. Billing Procedure: Client agrees to pay a total cost of our discounted $1,950 day rate, with an estimate of three days of work (one day for site visits, one day for plan update on CERS and one day for training) upon completion of the project outlined in the above -listed Scope of Work. Total cost for the project is $5,850. Acceptance I accept the terms of this agreement. I hereby authorize Du All Safety to perform the work stated and I further agree to remit the amounts stated for any services performed by, or equipment provided by Du All Safety, in a timely manner. This proposal is valid for 60 days. Client Acceptance Signature: Printed Name: Title: Dated: Purchase order number: Du -All Safety Approval Signature: Printed Name: Title: Dated: 0 ACoRV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) F 01 /24/2025 THIS CERTIFICATE IS ISSUED ASA 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 Leanna Stellman NAME: Leavitt United Insurance Services, Inc. PHONE (775) 782-5489 FAX, (775) 782-3630 A1C No Extl: A/CNo 1662 US Highway 395 N. Ste 101 E-MAIL SS: leanna-stellman@leavitt.com LIC # 1028838 INSURER(S) AFFORDING COVERAGE NAIC # Minden NV 89423 INSURERA: Homeland Insurance Company of New York 34452 INSURED INSURER B: James River Insurance Company 12203 Du -All Safety INSURERC: Employers Preferred Insurance Company 10346 INSURER D : Underwriters at Lloyds of London 15792 45950 Hotchkiss Street INSURER E: Fremont CA 94539 INSURER F : GUVEKAGES CERTIFICATE NUMBER! Z4 -z5 iviaster RIF\/IAinm NI IMRPR• 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 CONTRACTOR 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 AUULSUBR INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 A Y 793011547 0003 11/01/2024 11/01/2025 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY ❑PRG F—]2,000,000 JECT LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ OTHER: I I Pollution Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _ BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS CA43601172-05 11/01/2024 11/01/2025 BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY /� AUTOS ONLY PROPERTY DAMAGE $ Per accldenl UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LIAB CLAIMS -MADE 7930115480003 11/01/2024 11/01/2025 AGGREGATE $ 2,000,000 DED I I RETENTION $ $ C' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA EIG240384808 11/01/2024 11/01/2025 X SPER TATUTE ETH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 D PROFESSIONAL LIABILITY Retroactive 03 April 2013 B0621 PDUAL000724 11/01/2024 11/01/2025 Aggregate $2,000,000 Per Claim $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The Town of Los Altos Hills, Its elective and appointed officers, employees, and volunteers are included as Additional Insureds with respect to General Liability, when required in written contract per policy provisions, conditions, and exclusions. _UCK 1Ir it mi C MULUMM CANCELLATIUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Los Altos Hills ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Road AUTHORIZED REPRESENTATIVE, - Los Altos Hill CA 94022�4�V J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 793-01-15-47-0003 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSESS OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that the Named Insured agreed to add as an additional insured in a written contract or written agreement that was fully executed by the Named Insured prior to the performance of the Named Insured's work that is the subject of such written contract or written agreement. Location And Description Of Completed Operations: Any location, and completed operations at such location, where required by the written contract or written agreement in which the Named Insured agreed to add the person or organization qualifying as an additional insured under this endorsement. A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage or environmental damage caused, in whole or in part, by your work at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the products - completed operations hazard. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a 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 1. Limits of Insurance in SECTION III — LIMITS OF INSURANCE AND DEDUCTIBLE: 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. All other terms and conditions remain the same. OBENV GE 351 (09 20) Contains copyrighted material of Insurance Services Office, Inc. with Its permission. Page 1 of 1 Copyright 2020, Intact Insurance Group USA LLC E -INSURED Policy Number: 793-01-15-47-0003 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - FORM III This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization that the Any location, and completed operations Named Insured agreed to add as an at such location, where required by the additional insured in a written contract written contract or written agreement in or written agreement that was fully which the Named Insured agreed to add executed by the Named Insured prior to the person or organization qualifying as the performance of the Named Insured's an additional insured under this work that is the subject of such written endorsement. contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage, environmental damage or personal and advertising injury caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a 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 additional exclusions apply: This insurance does not apply to bodily injury, property damage or environmental damage occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Copyright 2019, Intact Insurance Group USA LLC E -INSURED 2. That portion of your workout of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions remain the same. OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 Copyright 2019, Intact Insurance Group USA LLC