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CONSTRUCTION AGREEMENT
THIS CONSTRUCTION AGREEMENT (“Agreem ent”) is entered into this _____ day of November 2023, by and between the CITY OF ALAMEDA, a municipal corporation (“the City"), and BRANCO CONSTRUCTION, INC., a California corporation whose address is 221 WEST OAK STREET, LODI, CALIFORNIA 95241, (“Contractor”), in reference to the following:
RECITALS:
A. The City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the statutes of the State of California and the City’s Charter.
B. The City is in need o f the following services: Dormitory Conversion and Renovation of existing Dormitory Room at Fire Station No. 4. City staff issued a NOTICE INVITING BIDS on Thursday, August 24, 2023, and after a bidding period of 21 days received 8 timely submitted bids.
Bids were opened on Th ursday, September 14, 2023. Staff reviewed the bids and fo llowing a thorough review of them and the references provided selected th e lowest resp onsive and responsible bidder.
C. Contractor possesses th e sk ill, experience, ab ility, background, certificatio n and knowledge to provide the services described in this Agreement on the terms and conditions described herein.
D. Whereas, the City Council authorized the City Manager to execute this agreement on November 7, 2023.
E. The City and Contractor desire to enter into an agreement for Dormitory Conversion and Renovation of existing Dormito ry Room at Fire Station No. 4, upon the terms and conditions herein.
N
OW, THEREFORE, in consideration of the forgoing, which are incorporat ed herein by reference, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows:
1. TERM:
Contractor shall have Eighty (80) consecutive working days (approximately 17 weeks) from the date the work is to commence pursuant to the Notice to Proceed to diligently prosecute the work to completion.
2. SERVICES TO BE PERFORMED:
Contractor agrees, at its own cost and expense, to furnish all labor, tools, equipme nt, materials, except as other wise specified, and to do all work strictly in accordance with the Specifications, Special Provisions and Plans, which Specifications, Special Provisions and Plans are hereby referred to and expressly made a part hereof with the same force and effect as if the DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Branco Construction 2 01-26-2023
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same were fully incorporated herein. Contractor acknowledges that the work plan included in Exhibit A is tentative and does not commit the City to request Contractor to perform all tasks included therein.
3. COMPENSATION TO CONTRACTOR:
Contractor shall be compensated for services performed pursuant to this Agreement in the amount and manner set forth in Contractor's bid, which is attached hereto as Exhibit A and incorporated herein by this reference. Payment will be made in the same manner that claims o f a like character are paid by the City, with checks drawn on the treasury of the City.
Payment will be made by the City in the following manner: On the first day of each month, Contractor shall submit a written estimate of the total amount of work done t he previous month.
However, the City reserves the right to adjust budget within and between tasks. Pricing and accounting of charges are to be according to the bid packet pricing, unless mutually agreed to in writing.
Payment shall be made for 95% of the value of the work completed as determined by the City. The City shall retain 5% of the value of the work as partial security for the completion of the work by Contractor. Retained amounts shall be paid to Contractor within sixty days of acceptance by the City of the project. Payment shall not be construed as acceptance of defective work. No interest will be paid to Contractor on retained funds.
Total compensation for work is $228,720 with a fifteen percent contingency in the amount of $34,280 for a total not to exceed of $263,000. Use of contingency shall be for items of work outside the original scope and requires prior written authorization by the City.
Prompt Payment Of Withheld Funds To Subcontractors: The City shall hold retainage from the prime contractor and shall, as determined by the City, make prompt and regular incrementa l acceptances of portions of the contract work and pay retainage to the prime contractor based on these acceptances. The prime contractor or subcontractor shall return all monies withheld in retention from all subcontractors within 30 days after receiving payment for work satisfactorily completed and accepted by the City, including incremental acceptances of portions of the contract work. Any delay or postponement of payment may take place only for good cause and with the City’s prior written approval. Any violation of these provisions shall subject the violating prime contractor to the penalties, sanctions, and other remedies specified in Section 7108.5 of the California Business Professions Code. This requirement shall not be construed to limit or impa ir any contractual, administrative or judicial remedies otherwise available to the prime contractor or subcontractor in the event of a dispute involving (a) late pa yment or nonpayment by the prime contractor, (b) deficient subcontractor performance, or (c) noncompliance by a subcontractor with the contract, including but not limited to remedies under California Public Contract Code Section 9204. This clause applies to both DBE and non-DBE subcontractors.
4. TIME IS OF THE ESSENCE:
Contractor and the City agree that time is of the essence regarding the performance of this Agreement.
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It is agreed by the parties to this Agreement that if all the work called for under the Agreement is not completed before or upon the expiration of the time limit as set forth in Paragraph 1 above, damage will be sustained by the City, and it is and will be impracticable to determine the actual damage which the City will sustain in the event of and by reason of such delay. It is therefore agreed that Contractor will pay the City the sum of Five Hundred DOLLARS ($500) per day as liquidated damages for each and every day's delay beyond the time prescribed to complete the work; and Contractor agrees to pay such liquidated damages as herein provided, and in case the same are not paid, agrees that the City may deduct the amount thereof from any money due or that may become due Contractor under the Agreement.
It is further agreed that in case the work called for under the Agreement is not finished and completed in all parts and requirements within the time specified, the City shall have the right to extend the time for completion or not, as may seem best to serve the interest of the City; and if the City decides to extend the time limit for the completion of the Agreement, it shall further have the right to charge Contractor, its successors, heirs, assigns or suret ies, and to deduct from the fina l payment for the work, all or any part, as it may deem proper, of the actual costs and overhead expenses which are directly chargeable to the Agreement, and which accrue during the period of such extensions.
Contractor shal l not be assessed with liquidated damages during any delay in the completion of the work caused by an act of God or of the public enemy, acts of the City, fire, flood, epidemic, quarantine restriction, strikes, freight embargoes, and unusually severe weather or delays of subcontractors due to such causes; provided that Contractor shall, within one (1) day from the beginning of such delay, notify the City in writing of the causes of delay. The City shall ascertain the facts in good faith and the extent of t he delay, and its findings of the facts thereon shall be final and conclusive.
5. STANDARD OF CARE:
Contractor agrees to perform all services and work hereunder in a manner commensurate with the prevailing standards of like professionals in the San Francisco Bay Area and agrees that all services and work shall be performed by qualified and experienced personnel who are not employed by the City nor have any contractual relationship with the City.
6. INDEPENDENT PARTIES:
Contractor hereby declares that it is engage d as an independent business and it agrees to perform its services as an independent contractor. The manner and means of conducting the work are under the control of Contractor, except to the extent they are limited by statute, rule or regulation and the express terms of this Agreement. No civil service status or other right of employment will be acquired by virtue of Contractor's services and work. None of the benefits provided by the City to its employees, including but not limited to unemployment insurance, workers' compensation plans, vacation and sick leave are available from the City to Contractor, its employees, subcontractors, suppliers or agents. Deductions shall not be made for any state or federal taxes, FICA payments, PERS payments, or other purposes normally associated with an employer-employee relationship from any fees due Contractor. Payments of the above items, if required, are the responsibility of Contractor.
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7. IMMIGRATION REFORM AND CONTROL ACT (IRCA) :
Contractor assumes any and all res ponsibility for verifying the identity and employme nt authorization of all of its employees performing work hereunder, pursuant to all applicable IRCA or other federal, or state rules and regulations. Contractor shall indemnify, defend (with counse l acceptable to the City) and hold the City harmless from and against any loss, damage, liability , costs or expenses arising from any noncompliance of this provision by Contractor.
8. NON-DISCRIMINATION:
Consistent with the City’s policy and state and federal law that harassment and discrimination are unacceptable employer/employee conduct, neither Contractor nor Contractor’s employees, agents, subcontractors or suppliers shall harass or discriminate against any job applicant, City employee, or any person on the basi s of any kind of any statutorily (federal, state or local) protected class, including but not limited to race, religious creed, color, national origin, ancestry, disability (both mental and physical), including HIV and AIDS, medical condition (e.g.. cancer), genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, pregnancy, political affiliation, military and veteran status or legitimate union activities. Contractor agrees that any violations of this provision shall constitute a material breach of this Agreement.
9. HOLD HARMLESS:
To the fullest extent permitted by law, Contractor shall indemnify, defend (with counse l acceptable to the City) and hold harmless the City, its City Council, boards, commissions, officia ls , employees, agents and volunteers (“Indemnitees”) from and against any and all loss, damages, liability, obligations, claims, suits, judgments, costs and expenses whatsoever, including reasonable attorney’s fees and costs of litigati on (“Claims”), arising from or in any manner connected to Contractor’s performance of its obligations under this Agreement or out of the operations conducted by Contractor even if the City is found to have been negligent. If the Claims filed against Indem nitees allege negligence, recklessness or willful misconduct on the part of Contractor, Contractor shall have no right of reimbursement against Indemnitees for the costs of defense even if negligence, recklessness or willful misconduct is not found on the part of Contractor. Contractor shall not have any obligations to indemnify Indemnitees if the loss or damage is found to have resulted solely from the negligence or the willful misconduct of the City.
The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement.
As to Claims for professional liability only, Contractor’s obligation to defend Indemnitee s (as set forth above) is limited as provided in California Civil Code Section 2782.8.
Contractor’s obligation to indemnify, defend and hold harmless Indemnities shall expressly survive the expiration or early termination of this Agreement.
10. INSURANCE:
a. On or before the commencement of the terms of this Agreement, Contractor shall furnish City’s Risk Manager with certificates showing the type, amount, class of operations covered, effective dates and dates of expiration of insurance coverage in compliance with paragraphs 10.b. (1) thr ough (5). Such certificates, which do not limit Contractor's indemnification, shall also contain substantially the following statement:
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“Should any of the above insurance covered by this certificate be canceled or coverage reduced before the expiration date thereof, the insurer affording coverage shall provide thirty (30) days advance written notice to the City of Alameda, Attention: Risk Manager.” Contractor shall maintain in force at all times during the performance of this Agreement all appropriate co verage of insurance required by this Agreement with an insurance company licensed to offer insurance business in the State of California with a current A.M. Best’s rating of no less than A:VII or Standard & Poor’s Rating (if rated) of at least BBB unless otherwise acceptable to the City. Endorsements naming the City, its City Council, boards, commissions, officials, employees, agents and volunteers as additional insured shall be submitted with the insurance certificates.
A. COVERAGE:
Contractor shall maintain insurance coverage and limits at least as broad as:
(1) Workers’ Compensation:
Statutory coverage as required by the State of California. (2) Liabilit y:
Commercial general liability coverage in the following minimum limits:
Bodily Injury: $1,000,000 each occurrence
$2,000,000 aggregate - all other
Property Damage: $1,000,000 each occurrence
$2,000,000 aggregate
If submitted, combined single limit policy with per occurrence limits in the amounts of $2,000,000 and aggregate limits in the amounts of $4,000,000 will be considered equivalent to the required minimum limits shown above. Additiona l Insured Endorsement naming the City, its City Council, boards, commissions, officials, employees, agents, and volunteers is required. (3) Automotive:
Comprehensive automobile liability coverage (any auto) in the following minimum limits:
Bodily injury: $1,000,000 each occurrence
Property Damage: $1,000,000 each occurrence
or
Combined Single Limit: $2,000,000 each occurrence
Additional Insured Endorsement naming the City, its City Council, boards, commissions, officials, employees, agents, and volunteers is required. (4) Pollution Prevention:
Legal liability required for hazardous materials excavation in the amount of $2,000,000 each occurrence. Additional Insured Endorsement naming the City, its DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Branco Construction 6 01-26-2023
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City Council, boards, commissions, officials, employees, agents, and volunteers is required.
(5) Builders Risk:
Insurance utilizing an “All Risk” (Special Perils) coverage form, with limits equal to the completed value of the project and no coinsurance penalty provisions. The coverage and limits shall be (1) the minimum coverage and limits specifi ed in this Agreement; or (2) the broader coverage and maximum limits of the coverage carried by or available to the Contractor; whichever is greater. Any insurance proceeds in excess of or broader than the minimum required coverage and/or minimum required limits, which are applicable to a given loss, shall be available to the City.
B. SUBROGATION WAIVER:
Contractor hereby agrees to waive rights of subrogation which any insurer of Contractor may acquire from Contractor by virtue of the payment of any loss. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applie s regardless of whether the City has received a waiver of subrogation endorsement from the insurer.
The Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of the City for all work performed by the Contractor, its employees, agents and subcontractors.
C. FAILURE TO SECURE:
If Contractor at any time during the term hereof should fail to secure or mai ntain the foregoing insurance, the City shall be permitted to obtain such insurance in Contractor's name or as an agent of Contractor and shall be compensated by Contractor for the costs of the insurance premiums at the maximum rate permitted by law and computed from the date written notice is received that the premiums have not been paid.
D. ADDITIONAL INSURED:
The City, its City Council, boards, commissions, officials, employees and volunteers shall be named as an additional insured under all insurance coverages, except worker’s compensation insurance. The naming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible portion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured shall not be required to contribute anything toward any l oss or expense covered by the insurance provided by this policy. The additional insured coverage under the Contractor’s policy shall be primary and non-contributory and will not seek contribution from the City’s insurance or self-insurance.
E. SUFFICIENCY OF INSURANCE:
Contractor shall furnish the following bonds from a bonding company acceptable to the City’s Risk Manager. Faithful Performance Bond and Labor and Material Bond are only require d for work over $25,000. Therefore, those estimates that are under $25,000 will not need to budge t for the bond premiums and those estimates over $25,000 will need to be sure to budget for the bond premiums.
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The insurance limits required by the City are not represented as being sufficient to protect Contractor. Contractor is advised to consult Contractor's insurance broker to determine adequate coverage for Contractor.
11. BONDS:
Contractor shall furnish the following bonds from a bonding company acceptable to the City’s Risk Manager:
A. Faithful Performance: A bond in the amount of 100% of the total contract price - plus the construction contingency - guaranteeing the faithful performance of this contract, and B. Labor and Materials: A bond for labor and materials in the amount of 100% of the total contract price - plus the construction contingency.
12. PROHIBITION AGAINST TRANSFERS:
Contractor shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of the City Manager. Any attempt to do so without said consent shall be null and void, and any assignee, sublessee, hypothecate or transferee shall acquire no right or interest by reason of such attempted assignment, hypothecation or transfer. However, Contractor’s claims for mone y from the City under this Agreement may be assigned to a bank, trust company or other financia l institution without prior written consent. Written notice of such assignment shall be promptly furnished to the City by Contractor.
The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Contractor, or of the interest of any general partner or joint venturer or syndicate member or cotenant, if Contractor is a partnership or joint venture or syndicate or cotenancy, whic h shall result in changing the control of Contractor, shall be construed as an assignment of this Agreement. Control means fifty percent (50%) or more of the voting power of the entity.
13. SUBCONTRACTOR APPROVAL:
Unless prior written consent from the City is obtained, only those people and subcontractors whose names are listed in Contractor's bid shall be used in the performance of this Agreement.
Requests for additional subcontracting shall be submitted in writing, describing the scope of work to be subcontracted and the name of the proposed subcontractor. Such request shall set forth the total price or hourly rates used in preparing estimated cost s for the subcontractor's services. Approval of the subcontractor may, at the option of the City, be issued in the form of a Work Order.
In the event that Contractor employs subcontractors, such subcontractors shall be require d to furnish proof of workers' compensation insurance and shall also be required to carry general and automobile liability insurance in reasonable conformity to the insurance carried by Contractor. In addition, any work or services subcontracted hereunder shall be subject to each provision of this Agreement.
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14. PERMITS AND LICENSES:
Contractor, at its sole expense, shall obtain and maintain during the term of this Agreement, all appropriate permits, certificates and licenses, including a City Business License that may be required in connection with the performance of services and work hereunder.
15. REPORTS:
Each and every report, draft, work product, map, record and other document reproduced, prepared or caused to be prepared by Contractor pursuant to or in connection with this Agreement shall be the exclusive property of the City.
No report, information nor other data given to or prepared or assembled by Contractor pursuant to this Agreement shall be made available to any individua l or organization by Contractor without prior approval by the City.
Contractor shall, at such time and in such form as the City may require, furnish reports concerning the status of services and work required under this Agreement.
16. RECORDS:
Contractor shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by the City that relate to the performance of services and work under this Agreement.
Contractor shall maintain adequate records of services and work provided in sufficie nt detail to permit an evaluation of services and work. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Contractor shall provide free access to such books and records t o the representatives of the City or its designees at all proper times, and gives the City the right to examine and audit same, and to make transcripts therefrom as necessary, and to allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be kept separate from other documents and records and shall be maintained for a period of three (3) years after receipt of final payment.
If supplemental examination or audit of the records is necessary due to concerns raised by the City's preliminary examination or audit of records, and the City’s supplemental examination or audit of the records discloses a failure to adhere to appropriate internal financial controls, or other breach of contract or failure to act in good faith, then Contractor shall reimburse the City for all reasonable costs and expenses associated with the supplemental examination or audit.
17. NOTICES:
All notices, demands, requests or approvals to be given under this Agreement shall be give n in writing and conclusively shall be deemed served when delivered personally or on the second business day after the deposit thereof in the United States Mail, postage prepaid, registered or certified, addressed as hereinafter provided.
All notices, demands, requests, or approvals from Contractor to the City shall be addressed to the City at:
City of Alameda
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Public Works Department
950 West Mall Square, Room 110
Alameda, CA 94501
ATTENTION: Jack Dybas, Architect, Project Manager
Ph (cell): (510) 871-0343 / Fax: (510) 769-6030
Email: [email protected]
All notices, demands, requests, or approvals from the City to Contractor shall be addressed to Contractor at:
Branco Construction, Inc.
Project Management
PO Box 2532
Lodi, CA 95241
ATTENTION: George Branco Jr. (Project manager)
Ph: (209) 712-6561 / Email: [email protected]
18. SAFETY:
Contractor will be solely and completely responsible for conditions of all vehicles owned or operated by Contractor, including the safety of all persons and property during performance of the services and work under this Agreement. This requirement will apply continuously and not be limited to normal working hours. In addition, Contractor will comply with all safety provisions in conformance with U.S. Department of Labor Occupational Safety and Health Act, any equivale nt state law, and all other applicable federal, state, county and local laws, ordinances, codes, and any regulations that may be detailed in other parts of the Agreement. Where any of these are in conflic t, the more stringent requirements will be followed. Contractor’s failure to thoroughly familia rize itself with the aforementioned safety provisions will not reli eve it from compliance with the obligations and penalties set forth herein.
Contractor will immediately notify the City’s Risk Manager within 24 hours of any incide nt of death, serious personal injury or substantial property damage that occurs in connection with the performance of this Agreement. Contractor will promptly submit to the City a written report of all incidents that occur in connection with this Agreement. This report must include the following information: (i) name and address of injured or deceased person(s); (ii) name and address of Contractor’s employee(s) involved in the incident; (iii) name and address of Contractor’s liability insurance carrier; (iv) a detailed description of the incident; and (v) a police report.
19. LAWS TO BE OBSERVED:
Contractor shall comply with all applicable laws, state, federal, and all ordinances, rules and regulations enacted or issued by the City. In addition, Contractor shall keep itself fully informed of all existing and future state and federal laws and all municipal ordinances and regulations of the City which in any manner affect those engaged or employed in the work, or the materials used in the work, or which in any way affect the conduct of the work, and of all such orders and decrees of bodies or tribunals having any jurisdiction or authority over the same.
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20. HEALTH AND SAFETY REQUIREMENTS.
Provider acknowledges that the City shall have the right to impose, at the City’s sole discretion, requirements that it deems are necessary to protect the health and safet y of the City employees, residents, and visitors. Provider agrees to comply with all such requirements, including, but not limited to, mandatory vaccinations, the use of personal protective equipme nt (e.g. masks), physical distancing, and health screenings. Provider also agrees to make available to the City, at the City’s request, records to demonstrate Provider’s compliance with this Section.
21. DEPARTMENT OF INDUSTRIAL RELATIONS COMPLIANCE AND
PREVAILING WAGE REQUIREMENTS ON PUBLIC WORKS PROJECTS:
Effective January 1, 2015, no Contractor or Subcontractor may be listed on a bid proposa l for a public works project (submitted after March 1, 2015) unless registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5 (with the limited exceptions from this requirement for bid purposed only under Labor Code Section 1771.1(a)). Register at https://efiling.dir.ca.gov/PWCR
No Contractor or Subcontractor may be awarded a contract for public w ork on a public works project (awarded on or after April 1, 2015) unless registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5.
This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations.
The Prime Contractor is required to post job site notices prescribed by regulations. See 8 Calif. Code Regulation §16451(d).
Effective April 1, 2015, All Contractors and Subcontractors must furnish electronic certified payroll records directly to the Labor Commissioner at:
https://apps.dir.ca.gov/ecpr/das/altlogin
22. HOURS OF LABOR :
As provided in Article 3 (commencing at § 1810), Chapter 1, Part 7, Division 2 of the Labor Code, eight (8) hours of labor shall constitute a legal day's work. The time of service of any worker employed at any time by Contractor or by any subcontractor on any subcontract under this Agreement, upon the work or upon any part of the work contemplated by this Agreement, is limit e d and restricted to eight (8) hours during any one calendar day and forty (40) hours during any one calendar week, except as hereinafter provided. Notwithstanding the provision hereinabove set forth, work performed by employees of Contractor in excess of eight (8) hours per day and forty (40) hours during any one week shall be permitted upon this public work, provided that the employees’ compensation for all hours worked in excess of eight (8) hours per day at not less than one and one-half (1-1/2) times the basic rate of pay.
Contractor shall pay the City a penalty of Twenty-five Dollars ($25.00) for each worker employed in the execution of this Agreement by Contractor, or by any subcontractor, for each calendar day during which such worker is required or permitted to work more than eight (8) hours in any calendar day and forty (40) hours in any one (1) calendar week, in violation of the provisions of Article 3 (commencing at § 1810), Chapter 1, Part 7, Division 2 of the Labor Code, unless DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Branco Construction 11 01-26-2023
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compensation for the workers so employed by Contractor is not less than one and one-half (1-1/2) times the basic rate of pay for all hours worked in excess of eight (8) hours per day.
Holiday and overtime work, when permitted by law, shall be paid for at a rate of at least one and one-half (1½) times the above specified rate of per diem wages, unless otherwise specified.
Holidays shall be defined in the Collective Bargaining Contract applicable to each particular craft, classification, or type of worker employed.
23. APPRENTICES:
Attention is directed to the provisions in Sections 1777.5 and 1777.6 of the Labor Code concerning the employment of apprentices by Contractor or any subcontractor under it on contracts greater than $30,000 or 20 working days. Contractor and any subcontractor under it shall comply with the requirements of Sections 1777.5 and 1777.6 in the employment of apprentices.
Section 1777.5 of the Labor Code requires Contractor or subcontractor employing workers in any apprenticeable occupation to apply to the joint apprenticeship committee nearest the site of the public works project, and which administers the apprenticeship program in that trade, for a certificate of approval, if they have not previously applied and are covered by the loca l apprenticeship standards.
Contractor is required to make contributions to funds established for the administration of apprenticeship programs if: (1) Contractor employs registered apprentices or journeymen in any apprenticeable trade on such contracts and if other contractors on the public works site are making such contributions; or (2) if Contractor is not a signatory to an apprenticeship fund and if the funds administrator is unable to accept Contractor' required contribution. Contractor or subcontractor shall pay a like amount to the California Apprenticeship Council.
Information relative to apprenticeship standards, wage schedules, and other requirements may be obtained from the Director of Industrial Relations, ex-officio the Administrator of Apprenticeship, San Francisco, California, or from the Division of Apprenticeship Standards and its branch offices.
24. LABOR DISCRIMINATION:
No discrimination shall be made in the employment of persons upon public works because of the rac e, color, sex, religion, age, national origin, sexual orientation or physical disability of such persons and every Contractor for public works violating this section is subject to all the penalties imposed for a violation of the provisions of the Labor Code, and, in particular, Section 1735.
25. REGISTRATION OF CONTRACTORS:
Before submitting bids, contractors shall be licensed in accordance with the provisions of Chapter 9, Division 3, of the Business and Professional Code of the State of California.
26. URBAN RUNOFF MANAGEMENT:
Contractor shall avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, contractor shall use as little as necessary.
Contractor shall take all steps necessary to k eep wash water out of the streets, gutters and storm drains.
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Contractor shall develop and implement erosion and sediment control to prevent pollution of storm drains. Such control includes but is not limited to:
a. Use storm drain inlet protection devices such as sand bag barriers, filter fabric fences, block and gravel filters. (Block storm drain inlets prior to the start of the rainy season (October 15), on site de -watering activities and saw -cutting activities; shovel or vacuum saw-cut slurry and remove from the site).
b. Cover exposed piles of soil or construction material with plastic sheeting. All construction materials must be stored in containers.
c. Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain as well as at the end of the each work day. At the comple tion of the project, the street shall be washed and the wash water shall be collected and disposed of offsite in an appropriate location.
d. After breaking old pavement, Contractor shall remove all debris to avoid contact with rainfall or runoff.
e. Contractor shall maintain a clean work area by removing trash, litter, and debris at the end of each workday. Contractor shall also clean up any leaks, drips, and other spills as they occur.
The objective is to ensure that the City and County of Alameda County-Wide Clean Water Program is adequately enforced. These controls should be implemented prior to the start of construction, up-graded as required, maintained during construction phases to provide adequate protection, and removed at the end of construction.
These recommendations are intended to be used in conjunction with the State’s Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalit ies , Section 7.1.01 of the Standard Specifications and any other appropriate documents on storm water quality controls for construction.
Failure to comply with this program will result in the issuance of noncompliance notices, citations, project stop orders or fines. The fine for noncomplia nce of the above program is two hundred and fifty dollars ($250.00) per occurrence per day. The State under the Federal Clean Water Act can also impose a fine on the contractor, pursuant to Cal. Water Code §13385.
27. COMPLIANCE WITH MARSH CRUST ORDINANCE:
Contractor shall perform all excavation work in compliance with the City’s Marsh Crust Ordinance as set forth at Section 13-56 of the Municipal Code. Prior to performing any excavation work, Contractor shall verify with the Building Official whether the excavation work is subject to the Marsh Crust Ordinance. Contractor shall apply for and obtain permits from Building Services on projects deemed to be subject to the Marsh Crust Ordinance.
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28. COMPLIANCE WITH THE CITY’S INTEGRATED PEST MANAGEMENT POLICY:
Contractor shall follow the requirements of the City's Integrated Pest Management (IPM) Policy to ensure the City is in compliance with its Municipal Regional Stormwater NPDES Permit, Order R2-2022-0018, issued by the San Francisco Bay Regional Water Quality Control Board. Contractor shall use the most current IPM technologies available to ensure the long-term prevention or suppression of pest problems and to minimize negative impacts on the environment, non-target organisms, and human health for the control or management of pests in and around City buildings and facilities, parks and golf courses, urban landscape areas, rights-of-way, and other City properties.
Contractor will consider the City IPM Policy’s hierarchy of options or alternatives liste d below, in the following order before recommending the use of or applying any pesticide on City property: (1)
a. No controls (e.g. tolerating the pest infestation, use of resistant plant varieties or allowing normal life cycle of weeds);
b. Physical or mechanical controls (e.g. hand labor, mowing, exclusion); c. Cultural controls (e.g. mulching, disking, alternative vegetation) and good housekeeping (e.g. cleaning desk area);
d. Biological controls (e.g., natural enemies or predators); e. Reduced-risk chemical controls (e.g., soaps or oils); and f. Other chemical controls.
Prior to applying chemical controls Contractor shall complete a checklist for the City’s pre- approval that explains why a chemical control is necessary. For annual contr acts that require regular application of chemical controls the contractor shall submit one checklist prior to the initiation of the project demonstrating that the hierarchy has been reviewed and no other options exist. (See Exhibit C ). Additionally, Contr actor shall provide documentation to the City’s project manager of the implementation of the IPM technique s hierarchy described in the City’s IPM Policy.
Contractor shall avoid the use of the following pesticides that threaten water quality, huma n health and the environment:
a. Acute Toxicity Category I chemicals as identified by the Environmental Protection Agency (EPA);
b. Organophosphate pesticides (e.g., those containing Diazinon, chlorpyrifos or malathion);
c. Diamides (chlorantraniliprole and cyantraniliprole); d. Neonicotinoids (e.g., imidacloprid, acetamiprid, and dinotefuran); e. Pyrethroids (bifenthrin, cyfluthrin, beta -cyfluthrin, cypermethrin, deltamethrin, esfenvalerate, lambda-cyhalothrin, metofluthrin, permethrin, and tralomethrin), carbamates (e.g., carbaryl and aldicarb), diuron, fipronil and its degradates, and indoxacarb; and
f. Copper-based pesticides unless their use is judicious, other approaches and techniques have been considered, and the threat of impact to water quality is DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Branco Construction 14 01-26-2023
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prevented.
Contractor shall sign the Contractor Verification Form (attached as Exhibit B) indica ting the intent to implement the City’s IPM Policy, and return a signed copy to the City’s projec t manager.
Contractor shall provide to the City’s project manager an annual report of all pesticide usage in support of City operations including pesticide name, active ingredient(s), target pest(s), the total amounts used and the reasons for any increase in use of any pesticide. Contractor shall provide a copy of any current IPM certifications(s) to the City’s projec t manager prior to initiation of the service work.
A copy of the City's IPM Policy may be obtained from the City’s project manager and is also on file with the City Clerk.
If this Agreement pertains to the use of any items listed above, Contractor will need to fill out and send in the Contractor Verification Form and Contractor Check List. ADD EXHIBIT B IF PEST CONTROL.
29. PURCHASES OF MINED MATERIALS REQUIREMENT :
Contractor shall ensure that all purchases of mined materials such as construction aggregate, sand and gravel, crushed stone, road base, fill materials, and any other mineral materials must originate from a surface mining operation identified on the AB3098 List per the Surface Mining and Reclamation Act of 1975 (SMARA).
Within five days of award of contract, Contractor shall submit a report to the City whic h lists the intended suppliers for the above materials and demonstrates that the suppliers are in compliance with the SMARA requirements. The AB3098 List is maintained by the Department of Conservation’s Office of Mine Reclamation (OMR) and can be viewed at:
www.conservation.ca.gov/OMR/ab_3098_list/index.htm. Note that the list changes periodic a lly and should be reviewed accordingly.
30. TERMINATION:
In the event Contractor fails or refuses to perform any of the provisions hereof at the time and in the manner required hereunder, Contractor shall be deemed in default in the performance of this Agreement. If such default is not cured within a period of two (2) business days after receipt by Contractor from the City of written notice of default, specifying the nature of such default and the steps necessary to cure such default, the City may terminate the Agreement forthwith by giving to Contractor written notice thereof.
The City shall have the option, at its sole discretion and without cause, of terminating this Agreement by giving seven (7) days’ prior written notice to Contractor as provided herein. Upon termination of this Agreement, each party shall pay to the other party that portion of compensation specified in this Agreement that is earned and unpaid prior to the effective date of termination.
31. ATTORNEYS’ FEES AND COSTS:
In the event of any litigation, including administrative proceedings, relating to this Agreement, including but not limited to any action or suit by any party, assignee or beneficiary DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Branco Construction 15 01-26-2023
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against any other party, beneficiary or assignee, to enforce, interpret or seek relief from any provision or obligation arising out of this Agreement, the parties and litigants shall bear their own attorney’s fees and costs. No party or litigant shall be entitled to recover any attorneys’ fees or costs from any other party or litigant, regardless of which party or litigant might prevail.
32. PCC SECTION 9204 SUMMARY - CLAIMS SUBMITTED BETWEEN 01-01-2017 AND 01-01-2027 :
Notwithstanding anything else to the contrary stated in the Information For Bidders (IFB) or the Contract Documents, all claims, regardless of dollar amount, submitted between January 1, 2017 and January 1, 2027 shall be governed by PCC Section 9204 and this section.
The following provisions and procedures shall apply:
A. For the purposes of this section, the term “Claim”, “Contractor”, “mediation”, “Public Entity” “Public works project” and “Subcontractor” shall have the meaning provided for in PCC Section 9204.
B. Contractor shall submit each Claim (whether for a time extension, payment for money or damages) in writing and in compliance with PCC Section 9204. Contractor must include reasonable documentation to support each claim.
C. Upon receipt of a Claim, the City shall conduct a reasonable review and respond in writing within 45 days of receipt and shall identify in a written statement what portions of the claim are disputed and undisputed. Undisputed portions of the Claim shall be process and paid within 60 days of the written statement. Undisputed amounts not paid in a timely manner shall bear interest at 7% per annum. The City and Contractor may mutually agree to extend the 45 day response time.
D. If the City needs approval from the City Council to provide a written statement, the 45 days may be extended to 3 days following the next duly noticed public meeting pursuant to PCC Section 9204(d)(1)(C).
E. If the City fails to timely respond to a Claim or if Contractor disputes the City’s response, Contractor may submit a written demand for an informal meet and confer conference with the City to settle the issues in dispute. The demand must be sent via registered or certified mail, return receipt requested. Upon receipt, the City shall schedule the conference within 30 days.
F. Within 10 business days following the informal meet and confer conference, the City shall submit to Contractor a written statement describing any issues remaining in dispute and that portion which is undisputed. Undisputed portions of the Claim shall be process and paid within 60 days of the written statement. Undisputed amounts not paid in a timely manner shall bear interest at 7% per annum. The issues remaining in dispute shall be submitted to non-binding mediation. If the City and Contractor mutually agree on a mediator, each party shall pay equal portions of all associated costs. If within 10 business days, the City and Contractor cannot agree on a mediator, each party shall select a mediator ( paying all costs associated with their selected mediator), and those mediators shall select a qualified neutral third party to mediate the dispute d issues. The City and Contractor shall pay equal portions of all associated costs of such third party mediator.
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G. Unless otherwise agreed by the City and Contractor, any mediation conducted hereunder shall excuse any further obligation under Public Contract Code Section 20104.4 to mediate after litigation has commenced.
H. The City reserves all rights and remedies that it has pursuant to the Construction Contract, plans and specification, at law or in equity which are not in conflict with PCC 9204.
This Section shall be automatically extended if legislation is lawfully pas sed whic h extends the terms of Public Contract Code Section 9204 beyond January 1, 2027.
33. CONFLICT OF LAW:
This Agreement shall be interpreted under, and enforced by the laws of the State of California excepting any choice of law rules which may direct the application of laws of another jurisdiction. The Agreement and obligations of the parties are subject to all valid laws, orders, rules, and regulations of the authorities having jurisdiction over this Agreement (or the successors of those authorities.) A ny suits brought pursuant to this Agreement shall be filed with the courts of the County of Alameda, State of California.
34. ADVERTISEMENT:
Contractor shall not post, exhibit, display or allow to be posted, exhibited, displayed any signs, advertising, show bills, lithographs, posters or cards of any kind pertaining to the services performed under this Agreement unless prior written approval has been secured from the City to do otherwise.
35. WAIVER:
A waiver by the City of any breach of any term, covenant, or condition contained herein, shall not be deemed to be a waiver of any subsequent breach of the same or any other term, covenant, or condition contained herein, whether of the same or a different character.
36. INTEGRATED CONTRACT:
This Agreement represents the ful l and complete understanding of every kind or nature whatsoever between the parties hereto, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions hereof. Any modification of this Agreement will be effective only by written execution signed by both the City and Contractor.
37. INSERTED PROVISIONS:
Each provision and clause required by law to be inserted into the Agreement shall be deemed to be enacted herein, and the Agreement shall be read and enforced as though each were included herein. If through mistake or otherwise, any such provision is not inserted or is not correctly inserted, the Agreement shall be amended to make such insertion on application by either party.
38. CAPTIONS:
The captions in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit or amplify the terms or provisions of this Agreement.
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39. COUNTERPARTS:
This Agreement may be executed in any number of counterparts (including by fax, PDF, DocuSign, or other electronic means), each of which shall be deemed an original, but all of whic h shall constitute one and the same instrument.
40. SIGNATORY:
By signing this Agreement, each signatory warra nts and represents that he/she executed this Agreement in his/her authorized capacity and that by his/her signature on this Agreement, he/she or the entity upon behalf of which he/she acted, executed this Agreement.
41. CONTROLLING AGREEMENT:
In the event of a conflict between the terms and conditions of this Agreement (as amended, supplemented, restated or otherwise modified from time to time) and any other terms and conditions wherever contained, including, without limitation, terms and conditions included within exhibits, the terms and conditions of this Agreement shall control and be primary.
[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]
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co Construction 18 01-26-2023
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IN WITNESS WHEREOF, the parties have caused the Agreement to be executed on the day and year first above written.
BRANCO CO
NSTRUCTION CITY OF ALAMEDA,
a California corporation a municipal corporation
George Branco Jr. Jennifer Ott
President City Manager
RECOM
MENDED FOR APPROVAL
Lucy Branco Erin Smith
Public
Works Director
APPROVE
D AS TO FORM:
City Attorney
Treasurer
Contractor License No._______________
DIR
No.___________________________
Len As lanian
Assistant City Attorney
1030309
License Type Number: PW-LR-1000465393
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B
Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B Exhibit A
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?
INSR ADDLSUBRLTR INSDWVD
PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURED INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :
POLICY NUMBERPOLICY EFFPOLICY EXPTYPE OF INSURANCELIMITS(MM/DD/YYYY)(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIABEXCESS LIABWORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE$DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY$GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$PRO-POLICYLOC PRODUCTS - COMP/OP AGGJECT OTHER: $COMBINED SINGLE LIMIT$(Ea accident)ANY AUTO BODILY INJURY (Per person)$OWNEDSCHEDULEDBODILY INJURY (Per accident)$AUTOS ONLYAUTOSHIREDNON-OWNEDPROPERTY DAMAGE$AUTOS ONLYAUTOS ONLY(Per accident)$OCCUR EACH OCCURRENCECLAIMS-MADEAGGREGATE$DEDRETENTION$ PEROTH-STATUTEERE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEE$If yes, describe underE.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGENAIC #
COMMERCIAL GENERAL LIABILITY
Y / NN / A(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDERCANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
$
$$$$
The ACORD name and logo are registered marks of ACORD
10/2/2023
License # 0C36861(209) 334-3030(209) 334-353510833Branco Construction, Inc.P.O. Box 2532Lodi, CA 9524119232 A 1,000,000XVIGP02242410/12/202210/12/2023100,0005,0001,000,0002,000,0002,000,0001,000,000B 64894490411/5/202211/5/20231,000,000A VIFX0015265/16/202210/12/20231,000,000 Job: Fire Station No. 4 Dormitory Conversion
City of AlamedaPublic Works Department950 West Mall Square, Room 110Alameda, CA 94501 BRANCON-01SSWANSON
Alliant Insurance Services, Inc.Todd Garibaldi Insurance641 South Ham Ln Ste ALodi, CA 95242Gemini Insurance CompanyAllstate Insurance Company Aggregate
X XXX XXX X
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VE 09 73 04 20 Includes copyrighted material of Insurance Services Office, Inc. with its permission
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other Commercial General Liability insurance available to an additional insured under your policy, but only if:
(1) The additional insured is a Named Insured under such other Commercial General Liability insurance; and
(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 Commercial General Liability insurance available to the additional insured.
Coverage granted to an additional insured remains subject to all terms, conditions, limitations, and exclusions set forth in the endorsement form that conferred the additional insured status. In the event of conflict between this endorsement and an endorsement conferring additional insured status, then the endorsement conferring additional insured status shall govern the scope of coverage available to the additional insured.
All other terms and conditions of this Policy remain unchanged.
Policy Number: VIGP022424 VE 09 73 04 20
Insured Name: BRANCO CONSTRUCTION
Number: 37 Effective Date: 10/12/202 2
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B
IL 02 70 07 20
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL 02 70 07 20 © Insurance Services Office, Inc., 2020 Page 1 of 4 CALIFORNIA CHANGES – CANCELLATION
AND NONRENEWAL
This endorsement modifies insurance provided under the following:
CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART
COMMERCIAL AUTOMOBILE COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
CRIME AND FIDELITY COVERAGE PART
EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART
EQUIPMENT BREAKDOWN COVERAGE PART
FARM COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
MEDICAL PROFESSIONAL LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
A.Paragraphs 2. and 3. of the Cancellation
Common Policy Condition are replaced by the
following:
2. All Policies In Effect For 60 Days Or Less
If this policy has been in effect for 60 days or
less, and is not a renewal of a policy we have
previously issued, we may cancel this policy by
mailing or delivering to the first Named Insured,
at the mailing address shown in the policy, and
to the producer of record, advance written
notice of cancellation, stating the reason for
cancellation, at least:
a.10 days before the effective date of
cancellation if we cancel for:
(1)Nonpayment of premium; or
(2)Discovery of fraud by:
(a)Any insured or his or her
representative in obtaining this
insurance; or
(b)You or your representative in
pursuing a claim under this policy.
b.30 days before the effective date of
cancellation if we cancel for any other
reason.
3. All Policies In Effect For More Than 60 Days
a.If this policy has been in effect for more
than 60 days, or is a renewal of a policy we
issued, we may cancel this policy only upon
the occurrence, after the effective date of
the policy, of one or more of the following:
(1)Nonpayment of premium, including
payment due on a prior policy we issued
and due during the current policy term
covering the same risks.
(2)Discovery of fraud or material
misrepresentation by:
(a)Any insured or his or her
representative in obtaining this
insurance; or
(b)You or your representative in
pursuing a claim under this policy.
(3)A judgment by a court or an
administrative tribunal that you have
violated a California or Federal law,
having as one of its necessary elements
an act which materially increases any of
the risks insured against.
Insured Full Copy
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(4)Discovery of willful or grossly negligent
acts or omissions, or of any violations of
state laws or regulations establishing
safety standards, by you or your
representative, which materially
increase any of the risks insured
against.
(5)Failure by you or your representative to
implement reasonable loss control
requirements, agreed to by you as a
condition of policy issuance, or which
were conditions precedent to our use of
a particular rate or rating plan, if that
failure materially increases any of the
risks insured against.
(6)A determination by the Commissioner of
Insurance that the:
(a)Loss of, or changes in, our
reinsurance covering all or part of
the risk would threaten our financial
integrity or solvency; or
(b)Continuation of the policy coverage
would:
(i)Place us in violation of California
law or the laws of the state where
we are domiciled; or
(ii)Threaten our solvency.
(7)A change by you or your representative
in the activities or property of the
commercial or industrial enterprise,
which results in a materially added,
increased or changed risk, unless the
added, increased or changed risk is
included in the policy.
b.We will mail or deliver advance written
notice of cancellation, stating the reason for
cancellation, to the first Named Insured, at
the mailing address shown in the policy,
and to the producer of record, at least:
(1)10 days before the effective date of
cancellation if we cancel for
nonpayment of premium or discovery of
fraud; or
(2)30 days before the effective date of
cancellation if we cancel for any other
reason listed in Paragraph 3.a.
B.The following provision is added to the
Cancellation Common Policy Condition:
7. Residential Property
This provision applies to coverage on real
property which is used predominantly for
residential purposes and consisting of not more
than four dwelling units, and to coverage on
tenants' household personal property in a
residential unit, if such coverage is written
under one of the following:
Commercial Property Coverage Part
Farm Coverage Part – Farm Property – Farm
Dwellings, Appurtenant Structures And
Household Personal Property Coverage Form
a.If such coverage has been in effect for 60
days or less, and is not a renewal of
coverage we previously issued, we may
cancel this coverage for any reason, except
as provided in b. and c. below.
b.We may not cancel this policy solely
because the first Named Insured has:
(1)Accepted an offer of earthquake
coverage; or
(2)Cancelled or did not renew a policy
issued by the California Earthquake
Authority (CEA) that included an
earthquake policy premium surcharge.
However, we shall cancel this policy if the
first Named Insured has accepted a new or
renewal policy issued by the CEA that
includes an earthquake policy premium
surcharge but fails to pay the earthquake
policy premium surcharge authorized by the
CEA.
c.We may not cancel such coverage solely
because corrosive soil conditions exist on
the premises. This restriction (c.) applies
only if coverage is subject to one of the
following, which exclude loss or damage
caused by or resulting from corrosive soil
conditions:
(1)Commercial Property Coverage Part –
Causes Of Loss – Special Form; or
(2)Farm Coverage Part – Causes Of Loss
Form – Farm Property, Paragraph D.
Covered Causes Of Loss – Special.
Insured Full Copy
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IL 02 70 07 20 © Insurance Services Office, Inc., 2020 Page 3 of 4 d.If a state of emergency under California
Law is declared and the residential property
is located in any ZIP Code within or
adjacent to the fire perimeter, as
determined by California Law, we may not
cancel this policy for one year, beginning
from the date the state of emergency is
declared, solely because the dwelling or
other structure is located in an area in
which a wildfire has occurred. However, we
may cancel:
(1)When you have not paid the premium,
at any time by letting you know at least
10 days before the date cancellation
takes effect;
(2)If willful or grossly negligent acts or
omissions by the Named Insured, or his
or her representatives, are discovered
that materially increase any of the risks
insured against; or
(3)If there are physical changes in the
property insured against, beyond the
catastrophe-damaged condition of the
structures and surface landscape, which
result in the property becoming
uninsurable.
C.The following is added and supersedes any
provisions to the contrary:
Nonrenewal
1.Subject to the provisions of Paragraphs C.2.
and C.3. below, if we elect not to renew this
policy, we will mail or deliver written notice,
stating the reason for nonrenewal, to the first
Named Insured shown in the Declarations, and
to the producer of record, at least 60 days, but
not more than 120 days, before the expiration
or anniversary date.
We will mail or deliver our notice to the first
Named Insured, and to the producer of record,
at the mailing address shown in the policy.
2. Residential Property
This provision applies to coverage on real
property used predominantly for residential
purposes and consisting of not more than four
dwelling units, and to coverage on tenants'
household property contained in a residential
unit, if such coverage is written under one of
the following:
Commercial Property Coverage Part
Farm Coverage Part – Farm Property – Farm
Dwellings, Appurtenant Structures And
Household Personal Property Coverage Form
a.If this policy provides coverage as
described in the preceding paragraph, and
we elect not to renew this policy, we will
mail or deliver written notice, stating the
reason for nonrenewal, to the first Named
Insured shown in the Declarations, and to
the producer of record, at the mailing
address shown in the policy, at least 75
days, but not more than 120 days, before
the expiration or anniversary date.
If we fail to give the first Named Insured
shown in the Declarations notice of
nonrenewal at least 75 days prior to the
policy expiration, as required in the
paragraph above, this policy, with no
change in its terms and conditions, shall
remain in effect for 75 days from the date
that the notice of nonrenewal is delivered or
mailed to the Named Insured. A notice to
this effect shall be provided by us to the first
Named Insured with the notice of
nonrenewal.
b.We may elect not to renew such coverage
for any reason, except as provided in
Paragraphs c., d. and e. below.
c.We will not refuse to renew such coverage
solely because the first Named Insured has
accepted an offer of earthquake coverage.
However, the following applies only to
insurers who are associate participating
insurers as established by Cal. Ins. Code
Section 10089.16. We may elect not to
renew such coverage after the first Named
Insured has accepted an offer of
earthquake coverage, if one or more of the
following reasons applies:
(1)The nonrenewal is based on sound
underwriting principles that relate to the
coverages provided by this policy and
that are consistent with the approved
rating plan and related documents filed
with the Department of Insurance as
required by existing law;
Insured Full Copy
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B
(2)The Commissioner of Insurance finds
that the exposure to potential losses will
threaten our solvency or place us in a
hazardous condition. A hazardous
condition includes, but is not limited to, a
condition in which we make claims
payments for losses resulting from an
earthquake that occurred within the
preceding two years and that required a
reduction in policyholder surplus of at
least 25% for payment of those claims;
or
(3)We have:
(a)Lost or experienced a substantial
reduction in the availability or scope
of reinsurance coverage; or
(b)Experienced a substantial increase
in the premium charged for
reinsurance coverage of our
residential property insurance
policies; and
the Commissioner has approved a plan
for the nonrenewals that is fair and
equitable, and that is responsive to the
changes in our reinsurance position.
d.We will not refuse to renew such coverage
solely because the first Named Insured has
cancelled or did not renew a policy, issued
by the California Earthquake Authority, that
included an earthquake policy premium
surcharge.
e.We will not refuse to renew such coverage
solely because corrosive soil conditions
exist on the premises. This restriction (e.)
applies only if coverage is subject to one of
the following, which exclude loss or
damage caused by or resulting from
corrosive soil conditions:
(1)Commercial Property Coverage Part –
Causes Of Loss – Special Form; or
(2)Farm Coverage Part – Causes Of Loss
Form – Farm Property, Paragraph D.
Covered Causes Of Loss – Special.
f.If a state of emergency under California
Law is declared and the residential property
is located in any ZIP Code within or
adjacent to the fire perimeter, as
determined by California Law, we may not
nonrenew this policy for one year,
beginning from the date the state of
emergency is declared, solely because the
dwelling or other structure is located in an
area in which a wildfire has occurred.
However, we may nonrenew:
(1)If willful or grossly negligent acts or
omissions by the Named Insured, or his
or her representatives, are discovered
that materially increase any of the risks
insured against;
(2)If losses unrelated to the postdisaster
loss condition of the property have
occurred that would collectively render
the risk ineligible for renewal; or
(3)If there are physical changes in the
property insured against, beyond the
catastrophe-damaged condition of the
structures and surface landscape, which
result in the property becoming
uninsurable.
3.We are not required to send notice of
nonrenewal in the following situations:
a.If the transfer or renewal of a policy, without
any changes in terms, conditions or rates,
is between us and a member of our
insurance group.
b.If the policy has been extended for 90 days
or less, provided that notice has been given
in accordance with Paragraph C.1.
c.If you have obtained replacement coverage,
or if the first Named Insured has agreed, in
writing, within 60 days of the termination of
the policy, to obtain that coverage.
d.If the policy is for a period of no more than
60 days and you are notified at the time of
issuance that it will not be renewed.
e.If the first Named Insured requests a
change in the terms or conditions or risks
covered by the policy within 60 days of the
end of the policy period.
f.If we have made a written offer to the first
Named Insured, in accordance with the
timeframes shown in Paragraph C.1., to
renew the policy under changed terms or
conditions or at an increased premium rate,
when the increase exceeds 25%.
Insured Full Copy
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
Schedule
Name Of Person(s) Or Organization(s):
Any person or organization you have agreed in a written and executed contract, prior to an “occurrence”, that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer
Of Rights Of Recovery Against Others To Us
of Section IV – Conditions:
We waive any right of recovery against the
person(s) or organization(s) shown in the
Schedule above because of payments we make
under this Coverage Part. Such waiver by us
applies only to the extent that the insured has
waived its right of recovery against such
person(s) or organization(s) prior to loss. This
endorsement applies only to the person(s) or
organization(s) shown in the Schedule above.
All other terms and conditions of this Policy remain unchanged.
Policy Number: VIGP022424 CG 24 04 12 19
Insured Name: BRANCO CONSTRUCTION
Number: 31 Effective Date: 10/12/202 2
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s): Location(s) Of Covered Operations
Any person or organization when you have agreed
in a written and executed contract prior to an
"occurrence", that such person or organization be
added as an additional insured on your policy.
All locations for which you have agreed in a written
and executed contract prior to an "occurrence."
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" 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 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
additional exclusions apply:
This insurance does not apply to "bodily injury"
or "property 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
Policy Number: VIGP022424 CG 20 10 04 13
Insured Name: BRANCO CONSTRUCTION
Number: 38 Effective Date: 10/12/202 2
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2
2. That portion of "your work" out 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.
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B
SCHEDULE OF FORMS
Named Insured: Branco Construction, Inc. POLICY NO.: VIGP022424 C097
FORM NUMBER End. # TITLE
SCHED 07 16 Page 1 of 2
CMNDEC 01 22 Common Declarations
CGLDEC 07 19 Commercial General Liability Coverage Part Declarations SCHED 07 16 Schedule of Forms
VE 06 00 06 14 01 Common Policy Conditions
CG 00 01 12 07 Commercial General Liability Coverage Form VE 67 09 12 18 02 Claims Reporting
IL 00 21 09 08 03 Nuclear Energy Liability Exclusion (Broad Form) VE 04 94 09 13 04 Lead Exclusion
VE 66 08 09 13 05 Asbestos Exclusion
VE 06 05 04 14 06 Deductible Liability Insurance - Per Occurrence VE 0442 07 09 07 Tainted Drywall Exclusion
VE 0539 02 11 08 Knowledge of Occurrence
VE 0553 07 11 09 Non-Stacking of Limits Endorsement
CG 21 96 03 05 10 Silica or Silica-Related Dust Exclusion CG 21 67 12 04 11 Fungi or Bacteria Exclusion
CG 22 79 04 13 12 Exclusion - Contractors - Professional Liability VE 02 21 06 13 13 Torch Down Roofing Exclusion
CG 21 47 12 07 14 Employment Related Practices Exclusion VE 05 97 08 13 15 Total Pollution Exclusion With A Hostile Fire Exception VE 04 95 09 13 16 Punitive Damages Exclusion
CG 24 26 04 13 17 Amendment of Insured Contract Definition VE 01 07 10 13 18 Exclusion - Exterior Insulation and Finish Systems VE 01 84 12 13 19 Designated Construction Project(s) General Aggregate Limit - Subject To A Maximum Aggregate
VE 06 39 09 14 20 Exclusion - Cross Liability - Named Insured VE 6640 09 14 21 Exclusion - Continuous or Progressive Damage Claims CG 21 70 01 15 22 Cap on Losses From Certified Acts of Terrorism TRIPRA_P 05 21 23 Disclosure of Premium And Estimated Premium For Terrorism Insurance Coverage
VE 05 06 02 19 24 Amendment - Premium Audit
VE 06 81 09 15 25 Exclusion - Violation of Trade or Economic Sanctions Laws or Regulations
VE 05 88 01 18 26 Premium Basis
CG 21 07 05 14 27 EXCLUSION Access or Disclosure of Confidential or Personal Information and Data-Related Liability Limited Bodily Injury Exception Not Included
VE 06 85 08 21 28 Service Of Suit California
VE 01 92 05 16 29 Wrap Up Exclusion
VE 05 81 07 18 30 Subcontractor and Independent Contractor Conditional Amendment of Deductible
CG 24 04 12 19 31 Waiver Of Transfer Of Rights Of Recovery Against Other To Us VE 08 99 01 19 32 Limited New Residential Construction Exclusion DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B FORM NUMBER End. # TITLE
SCHED 07 16 Page 2 of 2
VE 09 05 01 18 33 Direct Condominium Conversion Exclusion VE 05 62 04 18 34 Exclusion Your Work In New York
VE 09 35 08 20 35 Exclusion - Snow or Ice Removal
VE 09 66 04 20 36 Exclusion - Communicable Disease
VE 09 73 04 20 37 Primary and Noncontributory Other Insurance Condition CG 20 10 04 13 38 Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization
CG 20 37 04 13 39 Additional Insured Owners, Lessors or Contractors Completed Operations
VE 09 77 01 21 40 Exclusion - Specified Properties And Structures CG 20 10 04 13 41 Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization
CG 24 04 12 19 42 Waiver Of Transfer Of Rights Of Recovery Against Other To Us VE 05 95 04 20 43 Primary and Noncontributory - Other Insurance Condition - Scheduled Person or Organization
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 Policy Number: VIGP022424 CG 20 10 04 13
Insured Name: Branco Construction, Inc.
Number: 41 Effective Date: 10/02/2023
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s): Location(s) Of Covered Operations
City of Alameda
Public Works Department
950 West Mall Square, Room 110
Alameda, CA 94501
Additional Premium: $150
All locations for which you have agreed in a written
and executed contract prior to an "occurrence."
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" 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 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
additional exclusions apply:
This insurance does not apply to "bodily injury"
or "property damage" occurring after:
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2
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
2. That portion of "your work" out 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.
California Premium:
NonTaxable Fees:
Taxable Fees:
Surplus Lines Tax:
Stamping Fee:
$450.00
$13.50
$1.13
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VIGP022424 CG 24 04 12 19
Insured Name: Branco Construction, Inc.
Number: 42 Effective Date: 10/02/2023
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
Schedule
Name Of Person(s) Or Organization(s):
City of Alameda
Public Works Department
950 West Mall Square, Room 110
Alameda, CA 94501
Additional Premium: $150
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer
Of Rights Of Recovery Against Others To Us
of Section IV – Conditions:
We waive any right of recovery against the
person(s) or organization(s) shown in the
Schedule above because of payments we make
under this Coverage Part. Such waiver by us
applies only to the extent that the insured has
waived its right of recovery against such
person(s) or organization(s) prior to loss. This
endorsement applies only to the person(s) or
organization(s) shown in the Schedule above.
All other terms and conditions of this Policy remain unchanged.
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B VE 05 95 04 20 Includes copyrighted material of Insurance Services Office, Inc. with its permission
Policy Number: VIGP022424 VE 05 95 04 20
Insured Name: Branco Construction, Inc.
Number: 43 Effective Date: 10/02/2023
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
Schedule
Name of Person(s) Or Organization(s):
City of Alameda Public Works Department, 950 West Mall Square, Room 110 Alameda, CA 94501 Additional Premium: $$150
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other Commercial General Liability insurance available to the person(s) or organization(s) shown in the Schedule, but only if that person(s) or organization(s):
(1) Is an additional insured under this policy;
(2) Is a Named Insured under such other Commercial General Liability insurance; and (3) Has agreed with you in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other Commercial General Liability insurance available to the additional insured.
Coverage granted to an additional insured remains subject to all terms, conditions, limitations, and exclusions set forth in the endorsement form that conferred the additional insured status. In the event of conflict between this endorsement and an endorsement conferring additional insured status, then the endorsement conferring additional insured status shall govern the scope of coverage available to the additional insured.
All other terms and conditions of this Policy remain unchanged.
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B PN 04 99 01 I(Ed. 02-22)
PN 04 99 01 I 1 of 2(Ed. 02-22)
POLICYHOLDER NOTICEYOUR RIGHT TO RATING AND DIVIDEND INFORMATIONI. Information Available to YouA. Information Available from Us - Everest Premier Insurance Company(1) General questions regarding your policy should be directed to: Everest Premier Insurance Company1340 Treat Blvd., Pacific PlazaSuite 450Walnut Creek, CA 94597Telephone: 510-273-4660(2)Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated.(3)Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours.For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve-month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating.B. Information Available from the Workers’ Compensation Insurance Rating Bureau of California(1) The WCIRB is a licensed rating organization and the California Insurance Commissioner’s designated statistical agent. As such, the WCIRB is responsible for administering the California Workers’ Compensation Uniform Statistical Reporting Plan—1995 (USRP) and the California Workers’ Compensation Experience Rating Plan—1995 (ERP). WCIRB contact information is: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service; 888.229.2472 (phone); 415.778.7272 (fax); and [email protected] (email). The regulations contained in the USRP and ERP are available for public viewing through the WCIRB’s website at wcirb.com.(2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone) and 415.778.7272 (fax).(3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form/Worksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB’s website at wcirb.com/ratesheet. The Experience Rating Form/Worksheet will include a Loss-Free Rating, which is the experience modification that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only.II. Dispute ProcessYou may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1.A. Our Dispute Resolution Process.If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers’ compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined below.You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to: Everest Premier Insurance Company, 1340 Treat Blvd, Pacific Plaza, Suite 450, Walnut Creek, CA 94597 Telephone : 510-273-4660 Fax : 510-273-4692.After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B PN 04 99 01 I(Ed. 02-22)
PN 04 99 01 I2 of 2(Ed. 02-22)
request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below.B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP).You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service. Customer Service can be reached at 888.229.2472 (phone), 415.778.7272 (fax) and [email protected] (email).If you are dissatisfied with the WCIRB’s decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Complaints and Reconsideration. The WCIRB’s contact information is 888.229.2472 (phone), 415.371.5204 (fax) and [email protected] (email).C. California Department of Insurance – Appeals to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is:Administrative Hearing BureauCalifornia Department of Insurance1901 Harrison Street, 3rd Floor MailroomOakland, CA 94612415.538.4243You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed.III. Resources Available to You in Obtaining Information and Pursuing DisputesA. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159 (phone), 415.371.5288 (fax) and [email protected] (email).B. California Department of Insurance – Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C.This notice does not change the policy to which it is attached.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B EVEREST PREMIER INSURANCE COMPANY NOTICE TO CALIFORNIA WORKERS’ COMPENSATION POLICYHOLDERSLoss Control Consultation ServicesCalifornia law (Labor Code Section 6354.5) requires workers’ compensation insurers to maintain and provide occupational safety and health loss control consultation services to policyholder places of employment that may pose hazards. Everest Premier Insurance Company makes loss control consultation services available to our California Workers’ Compensation policyholders appropriate to their individual business needs. This notice is provided to you as an Everest Premier Insurance Company policyholder and describes our loss control consultation services that are available, upon request, at no additional cost to you. Workplace surveysWe can conduct a survey of your premises to identify safety and health hazards and existing physical and management controls of those hazards, which have the potential to affect the frequency and severity of workplace injuries and illnesses. When uncontrolled hazards are noted, we will provide you with written recommendations for improvement. Included in the on-site survey is an evaluation of your loss control management program including discussions with management and where appropriate, non-management personnel with permission of the employer.Review of injury recordsWe can assist you through analysis of employee accidents and previous loss experience in identifying underlying accident causes. A review of loss records with the appropriate personnel can help you identify those factors most related to the specific loss you have experienced.Plan DevelopmentWe can assist you in developing a comprehensive safety and health program to help minimize workplace accidents, including, where appropriate, modifications to your Section 3203 Employer Injury and Illness Prevention Program if needed to address concerns in the plan to improve your loss control experience.If the insured would like more information regarding these services or would like to obtain these services please contact: Everest Premier Insurance Company100 Everest WayWarren, NJ 07059Phone: (800) 438-4375 Fax: (908) 604-3526E-Mail: [email protected]’ compensation insurance policyholders may direct questions or complaints about the insurer’s loss control consultation services by contacting: State of California, Department of Industrial Relations, Loss Control Services Coordinator, The Commission of Health, Safety & Workers’ Compensation, 455 Golden Gate Avenue, 10th Floor, San Francisco, CA 94102 (415) 703-4220.EN WC 1 CA (Ed. 04-18)
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DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B EN WC 2 CA (Ed. 04 18)Page 1 of 1
CALIFORNIA EVEREST WORKERS’ COMPENSATION PRIVACY PRACTICES NOTICEEverest Premier Insurance Company (“Everest”) respect and protect the privacy of nonpublic personal financial and medical information. This Notice will advise you of:the categories of non-public personally identifiable information Everest collects from you or from third parties about you or about participants, beneficiaries or claimants under your insurance coverage;Everest’s disclosure practices concerning such information; andthe type of security policies and procedures that are in place to protect the confidentiality and security of nonpublic personal information provided to Everest.This notice does not apply to company information. 1. Information CollectedEverest collects personally identifiable information from you or from third parties about you, or about participants, beneficiaries or claimants under your insurance coverage as part of the insurance application, and during the underwriting, claims, administration and servicing process. We collect information from the following sources:Information we receive from you on applications or other forms which may include policyholder information, beneficiary or claimant name, addresses, phone number, social security number, household information, date of birth, job descriptions, payroll information, medical information related to underwriting and claims, and insurance coverage information; information we receive about and stemming from your transactions with us or others including claims or accident information, medical information relating to claims, claimant information, witness names and contact information; information we receive from consumer reporting agencies, federal and state agencies including state motor vehicle departments and licensing agencies, and inspection services. 2. Disclosure PracticesWe do not disclose nonpublic personal information about you, current or former beneficiaries or claimants under your insurance policy to third parties, except as permitted by law.3. Security StandardsWe maintain physical, electronic, and procedural safeguards in place to guard against unauthorized disclosure of nonpublic personal information of current or former customers, beneficiaries or claimants under your insurance policy.We also use computer hardware and software tools to guard system and data privacy and integrity. Our computer systems are also protected by additional measures such as password security, network routers and firewalls intended to prevent unauthorized access. INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 00 00 13 (CA)Includes copyrighted material of National Council on Compensation Insurance, Inc. used with its permission WC 00 00 05 (01 22)WC 00 00 13 (CA)WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYINFORMATION PAGE Reissue Rewrite Policy No: 7600024198231Prior Policy No: NEWEVEREST PREMIER INSURANCE COMPANY A stock company NCCI Carrier Code Number: 27507100 Everest WayWarren, NJ 07059Telephone Number: 800-438-4375 Item 1. Named Insured:BRANCO CONSTRUCTION INC Mailing Address:PO BOX 2532LODI, CA 95240 Individual Partnership Corporation Joint Venture Other FEIN: 84-4414424Other Workplaces not shown above SEE EXTENSION OF INFORMATION PAGE – NAMED INSURED AND OTHER WORKPLACES SCHEDULEItem 2. The policy period is from03/12/2023to03/12/2024effective 12:01 a.m. Standard Time at the insured’s mailing address.Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here:CAB. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A.The Limits of our liability under Part Two are:Bodily Injury by Accident$1,000,000each accidentBodily Injury by Disease$1,000,000policy limitBodily Injury by Disease$1,000,000each employeeC. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WYD. This policy includes these endorsements and schedules:SEE EXTENSION OF INFORMATION PAGE – SCHEDULE OF FORMS AND ENDORSEMENTS.Item 4.The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.All information required on the Extension Page is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE – CLASSIFICATION SCHEDULE/PREMIUM ELEMENTS.Minimum Premium $2,000 Total Estimated Annual Premium $13,392.00Expense Constant If Indicated below, interim adjustments of premium shall be made: Semi-annually Quarterly MonthlyProducer:ARROWHEAD GENERAL INSURANCE AGENCY, INC.Countersigned byAddress:701 B STREETSUITE 2100SAN DIEGO CA 92101INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 00 00 08 (01 18) EVEREST PREMIER INSURANCE COMPANY (A stock company) Policy Number:7600024198231NCCI CARRIER CODE NUMBER: 27507 EXTENSION OF INFORMATION PAGESCHEDULE OF FORMS AND ENDORSEMENTS (ITEM 3D)Named Insured: BRANCO CONSTRUCTION INCEffective Date: 03/12/2023 12:01 A.M. Standard Time
The forms and endorsements listed as follows form a part of the policy:Form and Endorsement Number Edition DateTitlePN 04 99 01 I 02-22 CA POLICYHOLDER NOTICEWC 00 00 05 01-22 WC & EL INS. POLICY INFO. PAGEWC 00 00 06 01-18 EXT. INFO. PAGE-CLASS SCH./PRM. ELMTS.WC 00 00 07 01-18 EXT. INFO. PAGE-NAMED INSD., ID & WORKPLWC 00 00 08 01-18 EXT. INFO. PAGE-SCH. OF FORMS & ENDTS.WC 00 00 00 C 01-15 INSURANCE POLICYWC 99 04 57 05-18 FINAL PREMIUM AMENDMENT - CALIFORNIAWC 99 06 75 11-05 CA MEDICAL PROVIDER NETWORK ENDTPN 04 99 02 B 05-02 CA WC INSURANCE RATING LAWSPN 04 99 04 12-01 CA POLICYHOLDER NOTICE - CIGAWC 00 04 06 A 08-95 PREMIUM DISCOUNT ENDTWC 00 04 19 01-01 PREMIUM DUE DATE ENDORSEMENTWC 04 03 01 D 02-18 CA POLICY AMENDATORY ENDORSEMENTWC 04 03 03 C 07-18 CA OFFICERS & DIRECTORS COVG/EXCLUSIONWC 04 03 06 04-84 CA WAIVER OF OUR RIGHT TO RECOVERWC 04 03 10 01-95 DUTY TO DEFEND - CALIFORNIAWC 04 03 60 B 01-15 CA EMPLOYERS' LIAB COV AMENDATORY ENDTWC 04 06 01 B 01-22 CA CANCELATION ENDTWC 04 06 04 A 01-23 CA COVID19 REPORTING ENDTWC 00 04 21 F 08-22 CATASTROPHE (OTHER THAN CERT ACTS) ENDTWC 00 04 22 C 01-21 TERRORISM RISK PGM REAUTH ACT DISCL ENDTPN 04 99 06 D 01-20 CA POLICYHOLDER NOTICE - DUAL WAGE/ERECTWC 99 00 06 11-17 SIGNATURE PAGE - CALIFORNIAINSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C(Ed. 1-15)WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYIn return for the payment of the premium and subject to all terms of this policy, we agree with you as follows:GENERAL SECTIONA.The PolicyThis policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy.B.Who is InsuredYou are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership’s employees.C.Workers Compensation LawWorkers Compensation Law means the workers or workmen’s compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen’s compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits.D.StateState means any state of the United States of America, and the District of Columbia.E.LocationsThis policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces.
PART ONEWORKERS COMPENSATION INSURANCEA.How This Insurance AppliesThis workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death.1. Bodily injury by accident must occur during the policy period.2. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.B.We Will PayWe will pay promptly when due the benefits required of you by the workers compensation law.C.We Will DefendWe have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits.We have no duty to defend a claim, proceeding or suit that is not covered by this insurance.D. We Will Also PayWe will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend:1. reasonable expenses incurred at our request, but not loss of earnings;2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance;3. litigation costs taxed against you;4. interest on a judgment as required by law until we offer the amount due under this insurance; and5. expenses we incur.E. Other InsuranceWe will not pay more than our share of benefits and costs covered by this insurance and other1 of 6 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY(Ed. 1-15)insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid.F.Payments You Must MakeYou are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because:1. of your serious and willful misconduct;2. you knowingly employ an employee in violation of law;3. you fail to comply with a health or safety law or regulation; or4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law.If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly.G.Recovery From OthersWe have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them.H.Statutory ProvisionsThese statements apply where they are required by law.1. As between an injured worker and us, we have notice of the injury when you have notice.2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs.3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us.4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law.
5. This insurance conforms to the parts of theworkers compensation law that apply to:a. benefits payable by this insurance;b. special taxes, payments into security or other special funds, and assessments payable by us under that law.6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law.Nothing in these paragraphs relieves you of your duties under this policy.PART TWOEMPLOYERS LIABILITY INSURANCEA.How This Insurance AppliesThis employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death.1. The bodily injury must arise out of and in the course of the injured employee’s employment by you.2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page.3. Bodily injury by accident must occur during the policy period.4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada.B.We Will PayWe will pay all sums that you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance.The damages we will pay, where recovery is permitted by law, include damages:1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against 2 of 6 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C(Ed. 1-15)such third party as a result of injury to your 2. For care and loss of and3.For consequential bodily injury to a spouse, child, parent, brother or sister of the injured provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee’s employment by and4.Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer.C.ExclusionsThis insurance does not cover:1. Liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike 2. Punitive or exemplary damages because of bodily injury to an employee employed in violation of 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive 4. Any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar 5. Bodily injury intentionally caused or aggravated by 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these 7.Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions;8. Bodily injury to any person in work subject to the Longshore and Harbor Workers’ Compensation Act (33 U.S.C. Sections 901 et seq.), the Nonappropriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651–1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901–944), any other federal workers or workmen’s compensation law or other federal occupational disease law, or any amendments to these 9. Bodily injury to any person in work subject to the Federal Employers’ Liability Act (45 U.S.C. Sections 51 et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those 10.Bodily injury to a master or member of the crew of any vessel, and does not cover punitive damages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law;11.Fines or penalties imposed for violation of federal or state and12.Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws.D.We Will DefendWe have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits.We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance.E.We Will Also PayWe will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend:1. Reasonable expenses incurred at our request, but not loss of 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this 3. Litigation costs taxed against 4. Interest on a judgment as required by law until we offer the amount due under this and5. Expenses we incur.3 of 6 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY(Ed. 1-15)F.Other InsuranceWe will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid.G.Limits of LiabilityOur liability to pay for damages is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below.1. Bodily Injury by Accident. The limit shown for “bodily injury by accident—each accident” is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident.2.Bodily Injury by Disease. The limit shown for “bodily injury by disease—policy limit” is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for “bodily injury by disease—each employee” is the most we will pay for all damages because of bodily injury by disease to any one employee.Bodily injury by disease does not include disease that results directly from a bodily injury by accident.3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance.H.Recovery From OthersWe have your rights to recover our payment from anyone liable for an injury covered by this insurance. You will do everything necessary to protect those rights for us and to help us enforce them.I.Actions Against UsThere will be no right of action against us under this insurance unless:1. You have complied with all the terms of this and
2. The amount you owe has been determined with our consent or by actual trial and final judgment.This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part.PART THREEOTHER STATES INSURANCEA.How This Insurance Applies1.This other states insurance applies only if one or more states are shown in Item 3.C. of the Information Page.2.If you begin work in any one of those states after the effective date of this policy and are not insured or are not self-insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page.3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them.4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within thirty days.B.NoticeTell us at once if you begin work in any state listed in Item 3.C. of the Information Page.PART FOURYOUR DUTIES IF INJURY OCCURSTell us at once if injury occurs that may be covered by this policy. Your other duties are listed here.1. Provide for immediate medical and other services required by the workers compensation law.2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need.3. Promptly give us all notices, demands and legal4 of 6 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C(Ed. 1-15)papers related to the injury, claim, proceeding or suit.4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit.5. Do nothing after an injury occurs that would interfere with our right to recover from others.6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost.PART FIVEPREMIUMA.Our ManualsAll premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance.B.ClassificationsItem 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy.C.RemunerationPremium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of:1. all your officers and employees engaged in work covered by this policy; and2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations.
D.Premium PaymentsYou will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid.E.Final PremiumThe premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy.If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise:1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium.2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancelation table and procedure. Final premium will not be less than the minimum premium.F.RecordsYou will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them.G.AuditYou will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision.5 of 6 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY(Ed. 1-15)PART SIXCONDITIONSA.InspectionWe have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision.B.Long Term PolicyIf the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force.C.Transfer of Your Rights and DutiesYour rights or duties under this policy may not be transferred without our written consent.
If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured.D.Cancelation1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect.2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice.3. The policy period will end on the day and hour stated in the cancelation notice.4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to comply with the law.E.Sole RepresentativeThe insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. 6 of 6 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 99 04 57Page 1 of 2(Ed. 05 18) 2018, Everest Reinsurance Company Includes copyrighted material of National Council on Compensation Insurance, Inc., used with its permission. 1992, National Council on Compensation Insurance, Inc. Includes copyrighted material of Workers’ Compensation Insurance Rating Bureau of California, used with its permission 2001-2004, Workers’ Compensation Insurance Rating Bureau of California WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 57 (Ed. 05 18)FINAL PREMIUM AMENDMENT – CALIFORNIAThis endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page.PART FIVE – PREMIUM, E. Final Premium of the policy is replaced by the following:The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy.If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise:1. If we cancel for reasons other than non-payment of premium, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium.2. If you cancel, or if we cancel due to non-payment of premium, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancelation table and procedure. Final premium will not be less than the minimum premium.If this policy is canceled or if there is a reduction in coverage, the unearned premium shall be returned to the insured or to the insured’s premium finance company. If the policy is not auditable, the unearned premium shall be returned within 80 business days after we either receive notice of the event that generated the unearned premium, or receive notice from a premium finance company of a cancellation. If the policy is audible, the unearned premium shall be returned within 80 business days after the insured provides all requested audit information to us or our designee. However, we will not return any unearned premium within 80 business days if the final unearned premium amount cannot be determined due to the insured’s failure, in breach of a policy requirement, to cooperate with us in a premium audit or if the amount of the unearned premium determined by a premium audit remains in dispute.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B 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 3/12/2023Policy No. 7600024198231Endorsement No. Insured BRANCO CONSTRUCTION INCPremium INCL.Insurance Company EVEREST PREMIER INSURANCE COMPANYCountersigned by ___________________________________________ WC 99 04 57Page 2 of 2(Ed. 05 18) 2018, Everest Reinsurance Company Includes copyrighted material of National Council on Compensation Insurance, Inc., used with its permission. 1992, National Council on Compensation Insurance, Inc. Includes copyrighted material of Workers’ Compensation Insurance Rating Bureau of California, used with its permission 2001-2004, Workers’ Compensation Insurance Rating Bureau of California Any unearned premium that we fail to return within the time periods specified above shall bear interest at the rate of 10 percent per annum from and after the date on which the unearned premium was required to be returned. The return of unearned premium to the insured or premium finance company shall be deemed complete upon the deposit of the unearned premium in the United States Mail, prepaid, addressed to the named insured or premium finance company at the last known address, or to an agent or broker with an assignment.
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DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 01 D(Ed. 2-18)
POLICY AMENDATORY ENDORSEMENT–CALIFORNIAIt is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions:1.Minors Illegally Employed – Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury.2.Punitive or Exemplary Damages – Uninsurable. This policy does not cover punitive or exemplary damages where insurance of liability therefor is prohibited by law or contrary to public policy.3.Increase in Indemnity Payment – Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100).If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Department of Insurance.4.Application of Policy. Part One, “Workers Compensation Insurance”, A, “How This Insurance Applies”, is amended to read as follows:This workers compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee’s exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period.5.Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code.6.Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate policy had been written for each consecutive period.7.Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant.8. Part Five, “Premium”, E, “Final Premium”, is amended to read as follows: The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned By POLICY NUMBER:
DATE OF ISSUE:
WC 04 03 01 D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY(Ed. 2-18)
If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: a. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium.b. If you cancel, final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short-rate cancelation table and procedure. Final premium will not be less than the pro rata share of the minimum premium.It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom.
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DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 03 C(Ed. 7-18) Copyright 2018 by the Workers’ Compensation Insurance Rating Bureau of California. All Rights Reserved.
ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCEOFFICERS AND DIRECTORS COVERAGE / EXCLUSIONCALIFORNIAIf the employer named in Item 1 of the Information Page is a quasi-public or private corporation, this policy applies to all officers and members of boards of directors while rendering actual service for the corporation for pay, as employees, except those excluded below who1. individually own at least 10 percent of the corporation’s issued and outstanding stock, or2. individually own at least 1 percent of the corporation’s issued and outstanding stock if that officer’s or member’s parent, grandparent, sibling, spouse, or child owns at least 10 percent of the corporation’s issued and outstanding stock and that officer or member is covered by a health insurance policy or a health care service plan, or3. are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law (Corporations Code, Sections 12200 - 12704) who state that he or she is covered by both a health care service plan or health insurance policy, and a disability insurance policy that is comparable in scope and coverage, as determined by the Insurance Commissioner, to a workers’ compensation policy.If the employer named in Item 1 of the Information Page is a private corporation, or a private cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation, as an employee, except if excluded below.The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE:Officers, Directors and Trustees Excluded Title
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DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 04 03 03 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY(Ed. 7-18) WC 04 03 03 C(Ed. 7-18) Copyright 2018 by the Workers’ Compensation Insurance Rating Bureau of California. All Rights Reserved.
Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations in this endorsement.It is further agreed that “remuneration” when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing.FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES, AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.).
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DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned By WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 60 B(Ed. 01-15) 2015 by the Workers’ Compensation Insurance Bureau of California. All Rights Reserved.
EMPLOYERS’ LIABILITY COVERAGE AMENDATORY ENDORSEMENT CALIFORNIAThe insurance afforded by Part Two (Employers’ Liability Insurance) by reason of designation of California in item 3 of the information page is subject to the following provisions:A. “How This Insurance Applies,” is amended to read as follows:A. How This Insurance AppliesThis employers’ liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical injury, including resulting death.1.The bodily injury must arise out of and in the course of the injured employee’s employment by you.2.The employment must be necessary or incidental to your work in California.3.Bodily injury by accident must occur during the policy period.4.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.5.If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada.C. The “Exclusions” section is modified as follows (all other exclusions in the “Exclusions” section remain as is):1.Exclusion 1 is amended to read as follows:1. liability assumed under a contract.2.Exclusion 2 is deleted.3.Exclusion 7 is amended to read as follows:7. damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, termination of employment, or any personnel practices, policies, acts or omissions.4.The following exclusions are added:1.bodily injury to any member of the flying crew of any aircraft.2.bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the workers’ compensation law(s) applicable to you or otherwise fail to comply with that law.3.liability arising from California Labor Code Section 2810.3 which relates to labor contracting.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B POLICY NUMBER:
DATE OF ISSUE:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 B(Ed. 01-2022) WC 04 06 01 B(Ed. 01-22)
CALIFORNIA CANCELATION ENDORSEMENTThis endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page.The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions:Cancelation:1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect.2. We may cancel this policy for one or more of the following reasons:a. Non-payment of premium;b. Failure to report payroll;c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us;d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us;e. Material misrepresentation made by you or your agent;f. Failure to cooperate with us in the investigation of a claim;g. Material failure to comply with federal or state safety orders or written recommendations of our designated loss control representatives;h. The occurrence of a material change in the ownership of your business;i. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss;j. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation;k. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties.3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (k), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided.4. If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States.5. The policy period will end on the day and hour stated in the cancelation notice.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned By WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 04 A(Ed. 01-23) WC 04 06 04 A(Ed. 01-23)
COVID-19 REPORTING REQUIREMENT ENDORSEMENT CALIFORNIA In addition to the requirements under Part 4, “Your Duties if Injury Occurs” of your policy, if you have five or more employees and an employee that is not described in California Labor Code section 3212.87 tests positive for COVID-19, you are required to report the following information as provided below. Pursuant to California Labor Code Section 3212.88(i), when you know, or reasonably should know, that an employee has tested positive for COVID-19 between September 17, 2020 and January 1, 2024, you must report to your claims administrator in writing via electronic mail or facsimile within 3 business days all of the following: (1) An employee has tested positive. For purposes of this reporting, do not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a claim form pursuant to California Labor Code Section 5401. (2) The date that the employee tests positive, which is the date the specimen was collected for testing. (3) The specific address or addresses of the employee’s specific place of employment during the 14-day period preceding the date of the employee’s positive test.(4) The highest number of employees who reported to work at the employee’s specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment.Labor Code Section 3212.88(j) states that the intentional submission of false or misleading information or the failure to report the above information as required may subject you to a civil penalty in the amount of up to $10,000 to be assessed by the Labor Commissioner.For the purposes of these reporting requirements, California Labor Code Section 3212.88(m) provides the following: (1) “COVID-19” means the 2019 novel coronavirus disease.(2) “Test” or “testing” means a PCR (Polymerase Chain Reaction) test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA. “Test” or “testing” does not include serologic testing, also known as antibody testing. “Test” or “testing” may include any other viral culture test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA which has the same or higher sensitivity and specificity as the PCR test.(3) “A specific place of employment” means the building, store, facility, or agricultural field where an employee performs work at the employer’s direction. “A specific place of employment” does not include the employee’s home or residence, unless the employee provides home health care services to another individual at the employee’s home or residence. Note:This endorsement is only applicable until January 1, 2024, unless the repeal date of California Labor Code Section 3212.88 is extended. INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned By WC 99 06 75 (11 05)EVEREST PREMIER INSURANCE COMPANYCALIFORNIA PROVIDER NETWORKENDORSEMENT AGREEMENTThe Everest Premier Insurance Company Medical Provider Network is established in accordance with California Labor Code 4600 Et Seq and approved by the California Division of Workers’ Compensation Administrative Director. As part of your duties under this policy, you have agreed to: 1) Implement the Everest Premier Insurance Company Medical Provider Network by distributing the Medical Provider Network Employee Handbook to all current employees and to all new employees at time of hire.2) Adhere to all Medical Provider Network requirements stated in the Everest Premier Insurance Company Medical Provider Network package.3) Notify Everest Premier Insurance Company when all current employees have received the Medical Provider Network Employee Handbook.4) Arrange an initial medical evaluation and begin treatment within the Medical Provider Network when an employee notifies you of an occupational injury or files a claim for Workers’ Compensation with you.5) Notify the employee of his or her right to be treated by a physician of his or her choice from within the Medical Provider Network after the first visit.6) Inform employees of their right to pre-designate a physician of his or her choice if you offer a group health plan or insurance. Provide the ‘Employee Physician Pre-Designation Form’ included in the Everest Premier Insurance Company's Medical Provider Network Package in English and Spanish language, as appropriate, to employees desiring to pre-designate a physician of their choice.INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B PN 04 99 06 D(Ed. 01-20)POLICYHOLDER NOTICEPAYROLL RECORD AND AUDIT REQUIREMENTS FOR DUAL WAGE CONSTRUCTION OR ERECTION CLASSIFICATIONS Your policy includes one or more construction or erection classifications. Dual wage classifications are pairs of classifications that describe the same construction or erection operation yet are assigned based upon whether the employee’s hourly wage is above or below a specified threshold. Each pair of dual wage classifications contains one “high wage” classification that is assignable to payrolls earned by employees whose regular hourly wage equals or exceeds a specified wage threshold and one “low wage” classification that is assignable to payrolls earned by employees whose regular hourly wage is less than the specified threshold.Payroll Record RequirementsThe assignment of a high wage classification is contingent on verifying that the employee’s hourly wage equals or exceeds the specified wage threshold. The determination of the regular hourly wage for any non-salaried employee must be supported by one of the following sources:Original time cards or time book entries for each employee. Original records must include the operations performed, the total hours worked each day and the times the employee started and ended each work period throughout the workday. At job locations where all of the employer’s operations cease for a uniform unpaid meal period, recording the start and stop times of the uniform break period is not required. A valid collective bargaining agreement that shows the regular hourly wage rate by job classification of a worker. If using a collective bargaining agreement, the records must include an employee roster by job classification that permits the reconciliation of individual employees to the job classifications set forth in the collective bargaining agreement.The non-salaried employee’s regular hourly wage shall be determined by dividing that employee’s total remuneration by the hours worked during the pay period, irrespective of whether the employee is paid on an hourly, piecework, production or commission basis.The payroll earned by any non-salaried employees for whom the records specified above are not maintained and/or made available will be assigned to the low wage classification that describes the operations performed. The regular hourly wage of salaried employees is determined by dividing the total annual remuneration by 2000 hours. If an employee is salaried for less than 12 months, the regular hourly wage for the salaried period is calculated on a prorated basis.Audit RequirementsIf your policy has an effective date on or after January 1, 2020 and produces a final premium of $10,500 or more, a physical audit is required at least once a year; if it produces a final premium of less than $10,500 and develops payroll in a high wage classification, a physical audit of the policy is required unless the policy is a renewal and a physical audit was completed for one of the two immediately preceding policy periods. A “physical audit” is defined as an audit of payroll, whether conducted at the policyholder’s location or at a remote site, that is based upon an auditor’s examination of the policyholder’s books of accounts and original payroll records (in either electronic or hard copy form) as necessary to determine and verify the exposure amounts by classification. If you hold a C-39 Roofing Contractor license from the California Contractors State License Board, a physical audit is required on the complete policy period of each policy regardless of the amount of final premium. See California Insurance Code Section 11665(a) for additional requirements regarding the audit of C-39 license holders. INSURED COPY DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B WC 99 00 06 11 17 Everest Reinsurance Company, 1997
POLICY NUMBER: 7600024198231NAMED INSURED: BRANCO CONSTRUCTION INCINSURER: EVEREST PREMIER INSURANCE COMPANYTHE EFFECTIVE DATE OF THIS ENDORSEMENT IS AS FOLLOWS: FROM: 03/12/2023 TO: 03/12/2024 SIGNATURE PAGE – CALIFORNIAThis policy is signed by officers of the Company shown on the Declarations page of this policy.For: Everest Premier Insurance Company
INSURED COPY
DocuSign Envelope ID: C787E320-C183-41E2-A3CF-96ABC832CF49 DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B LOAN #
AUTHORIZED REPRESENTATIVE
NAME AND ADDRESS
ADDITIONAL INTEREST
LOSS PAYEE
ADDITIONAL INSURED
MORTGAGEE
REMARKS (Including Special Conditions)
EVIDENCE OF PROPERTY INSURANCE
DATE (MM/DD/YYYY)
COMPANY
THIS REPLACES PRIOR EVIDENCE DATED:
EFFECTIVE DATE
EXPIRATION DATE
CONTINUED UNTIL
TERMINATED IF CHECKED
POLICY NUMBER
LOAN NUMBER
INSURED
CODE:
SUB CODE:
AGENCY
CUSTOMER ID #:
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THEADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THECOVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.
AGENCY
ADDRESS:
E-MAIL
FAX
(A/C, No):
(A/C, No, Ext):
PHONE
DEDUCTIBLE
AMOUNT OF INSURANCE
COVERAGE / PERILS / FORMS
COVERAGE INFORMATION
LOCATION/DESCRIPTION
PROPERTY INFORMATION
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 THISEVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
The ACORD name and logo are registered marks of ACORD
ACORD 27 (2009/12)
© 1993-2009 ACORD CORPORATION. All rights reserved.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10/24/2023
US ASSURE INSURANCE SERVICES OF FLORIDA, INC. D/B/A INLINK
INSURANCE SERVICES
P.O. BOX 10197
JACKSONVILLE, FL 32247-0197
American Zurich Insurance Company
[email protected]
A0212325
Branco Construction, Inc.
P.O. Box 2532
Lodi, CA 95241
ER74209246
10/23/2023 10/23/2024
2595 Mecartney Rd.
Alameda, CA 94502
Builders Risk Coverage Form
Renovations and Improvements
All Covered Property at all Locations
$1,000
$228,720
$228,720
City of Alameda
950 Wst Mall Square, Room 110
Alameda, CA 94501
✘
DocuSign Envelope ID: 66ED481C-940E-4209-81BD-435C2B02104B ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?
INSR ADDLSUBRLTR INSDWVD
PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURED INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :
POLICY NUMBERPOLICY EFFPOLICY EXPTYPE OF INSURANCELIMITS(MM/DD/YYYY)(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIABEXCESS LIABWORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE$DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY$GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$PRO-POLICYLOC PRODUCTS - COMP/OP AGGJECT OTHER: $COMBINED SINGLE LIMIT$(Ea accident)ANY AUTO BODILY INJURY (Per person)$OWNEDSCHEDULEDBODILY INJURY (Per accident)$AUTOS ONLYAUTOSHIREDNON-OWNEDPROPERTY DAMAGE$AUTOS ONLYAUTOS ONLY(Per accident)$OCCUR EACH OCCURRENCECLAIMS-MADEAGGREGATE$DEDRETENTION$ PEROTH-STATUTEERE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEE$If yes, describe underE.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGENAIC #
COMMERCIAL GENERAL LIABILITY
Y / NN / A(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDERCANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
$
$$$$
The ACORD name and logo are registered marks of ACORD
10/26/2023
License # 0C36861(209) 334-3030(209) 334-353535378Branco Construction, Inc.P.O. Box 2532Lodi, CA 95241 A 1,000,000CPLM0L12005610/26/202310/26/2024ContractorsPollution2,000,000Specific Project CoverageDeductible2,500 City of Alameda Project - Address 2595 Mecartney Road Bayfarm Island, Alameda, CA 94502 City of AlamedaPublic Works Department950 West Mall Square, Room 110Alameda, CA 94501 BRANCON-01SSWANSON
Alliant Insurance Services, Inc.Todd Garibaldi Insurance641 South Ham Ln Ste ALodi, CA 95242Evanston Insurance Company XX