Alameda City Council
September 17, 2024

FIFTH AMENDMENT TO AGREEMENT
This FIFTH AMENDMENT TO AGREEMENT (“Fifth Amendment”), is entered into this ___ day of _______, 2024 (the “Effective Date”), by and between the CITY OF ALAMEDA, a municipal corporation (the "City"), and CDM SMITH, INC., a Massachusetts corporation, whose address is 220 Montgomery Street, Suite 1418, San Francisco, CA 94104 (the "Provider"), with reference to the following facts and circumstances:

RECITALS:

A. On April 18, 2018, an agreement was entered into by and between City and Provider ("Original Agreement") in an amount not to exceed $372,928.

B. On June 10, 2019, the parties entered into a First Amendment of the Agreement ("First Amendment") to extend the term of the Agreement to June 30, 2020.

C. On November 7, 2019, the parties entered into a Second Amendment of the Agreement (“Second Amendment”) to extend the term of the Agreement to June 30, 2023, to modify the services performed, to increase the total compensation in an amount not to exceed $2,572,928 and to include the federal provisions required by Caltrans.

D. On December 7, 2022, the parties entered into a Third Amendment of the Agreement (“Third Amendment”) to extend the term of the Agreement to June 30, 2025, to modify the services performed, and to increase the total compensation in an amount not to exceed $3,158,930.

E. On May 31, 2023, the parties entered into a Fourth Amendment of the Agreement (“Fourth Amendment”) to extend the term of the Agreement to June 30, 2026, to modify the services performed, and to increase the total compensation in an amount not to exceed $3,578,930.

F. City and Provider desire to modify the Agreement on the terms and conditions set forth herein.

NOW, THEREFORE, in consideration of the foregoing, which are incorporated herein by reference, and for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, City and Provider agree as follows:

1. Paragraph 1 (“Term”) of the Agreement is modified to read as follows:
“The term of this Agreement shall commence on the 18th day of April 2018, and shall terminate on the 30th day of June 2027, unless terminated earlier as set forth herein.”

2. Section 2 (“Services to be Performed”) of the Agreement is modified to read as follows:
“Provider agrees to do all necessary work at its own cost and expense, to furnish all labor, tools, equipment, materials, except as otherwise specified, and to do all necessary work included in Exhibit A 5 as requested. The Provider acknowledges that the work plan included in Exhibit A 5 is tentative and does not commit the City to request Provider to perform all tasks included therein.”

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 CDM Smith, Inc. – Fifth Amendment to Agreement – Central Avenue 2

3. Section 3 (“Compensation to Provider”) of the Agreement is modified to read as follows:

“a. By the 7th day of each month, Provider shall submit to the City an invoice for the total amount of work done the previous month. Pricing and accounting of charges are to be according to the fee schedule as set forth in Exhibit B 5 and incorporated herein by this reference. Extra work must be approved in writing by the City Manager or his/her designee prior to performance and shall be paid on a Time and Material basis as set forth in Exhibit B5.”

“b. The total compensation under this Fifth Amendment to Agreement shall not exceed $200,000. Total compensation for this Agreement is $3,778,930.”

5. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect.

Signatures on Next Page

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 CDM Smith, Inc. – Fifth Amendment to Agreement – Central Avenue 3 IN WITNESS WHEREOF, the parties have caused this modification of Agreement to be executed on the day and year first above written.

CDM SMITH, INC. CITY OF ALAMEDA
A Massachusetts Corporation A Municipal Corporation
William E. Hurrell, P.E. Jennifer Ott
Vice President City Manager

RECOMMENDED FOR APPROVAL
Erin Smith
Public Works Director
APPROVED AS TO FORM:

City Attorney
Len Aslanian
Assistant City Attorney

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63

The purpose of Amendment No. 5 is to supplement funding for work associated with additional Caltrans coordination while finalizing the project design and obtaining Caltrans approval to advance the project the Construction (CON) phase. Additionally, new information regarding potentially impacted soils near Alameda Point has triggered the need for a supplemental soils study to support appropriate construction safety, materials handling and disposal specifications in the construction contract.

The amendment will also extend the contract term through June 30, 2027. This allows for additional construction time to cover contingencies and the addition of complex features such as roundabouts and associated landscaping, lighting, and drainage components.

The following sections describe the additional work activities and the related deliverables.

1. Project Management
Project management activities will be extended through the currently estimated completion of the construction, with additional time for contingencies and completion of post construction activities. The CDM Smith Project Manager will continue to serve as the primary point of contact through completion of the work. The Project Manager will be responsible for coordinating internal staffing, managing subconsultants, and coordinating with City staff to obtain required information and communicate problems or unanticipated conditions. Project management also includes tracking project budget and completion status, developing and submitting monthly progress reports, project invoice preparation, document control and project administrative tasks.

Assumption(s):
• It is assumed that the construction phase will achieve substantial completion status by approximately June 30, 2026.

Deliverable(s):
• Monthly invoices with progress reports
• Subcontractor management
• Document control

2. Coordination and Team Meetings
CDM Smith will prepare for, attend, and facilitate project related meetings to provide status updates, share information and coordinate project bid and construction activities.

Project coordination meetings will be held with City staff, the design team, the Construction Manager (CM), the Construction Contractor, and other attendees as deemed appropriate to address any technical issues during bidding and construction phase.

Central Avenue Safety Improvement Project
Scope of Work: Amendment 5

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 Alameda Central Avenue Safety Improvement Project: Amendment 5 • Scope of Work

The following meetings are added:
• Up to ten (10) additional construction progress meetings and other construction meetings as requested by the City. The meetings will occur monthly to review the project status and current issues, submittal status, RFI status, CCO status, and the Contractor’s look-ahead schedule. Meetings to be held via Teams or on-site during the construction phase. • Up to eighteen (18) internal team meetings to discuss the project progress, budget, and remaining tasks during the construction phase services.

Deliverable(s):
• Agendas and meeting notes will be prepared for the meetings identified above. Draft agendas will be distributed one day prior to the meeting and meeting notes will be distributed within one week of the meeting.
• Presentations, sign-in sheets, design details and other materials will be provided as appropriate for the specific meeting.

3. Public Outreach and Meetings
No changes are needed for this task.

1. Caltrans Project Development
No changes are needed for this task.

2. Traffic Analysis
No changes are needed for this task.

3. Environmental
New information regarding the potential presence of contaminated soils near the western end of the project corridor requires further investigation to support proper safety practices during construction. The presence of aerially deposited lead was detected during project planning and recent discussions with the Navy indicate additional contaminants may also be present. More information is needed to guide proper soils handling and disposal and design of appropriate water quality measures.

CDM Smith will complete a soil sampling and characterization study to support the development of soil management specifications, construction health and safety measures, and to confirm that the infiltration of stormwater in this area will not cause further spread of contamination.

Assumptions:
• Up to twenty soil samples will be collected and analyzed.

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 Central Avenue Safety Improvement Project: PS&E Ph ase • Scope of Work

• Sampling will be limited to depths less than 5 feet deep using a manual hand auger.

Deliverables:
• Development of a Soils Sampling and Analysis Work Plan. • Soil sample collection and analysis.
• Review and revise specifications for soil management and disposal during the construction phase.
• Review and revise current stormwater management design and incorporate potential safeguards to prevent mobilization of contaminants.

4. Support Services
No changes are needed for this task.

5. Engineering Plans, Specifications and Estimates
Multiple additional review cycles were initiated by Caltrans after the 100 percent design submittal. The design of the Caltrans-owned portion of the project was approved by Caltrans, but an additional design effort was then conducted to incorporate the Fourth Street roundabout, which is City-owned. Upon complete of the roundabout design, the complete design package was resubmitted to Caltrans. This triggered an additional comprehensive review of the previously approved Caltrans-owned portion of the project.

The design package was circulated to all Caltrans functional design groups, which in-turn generated a new series of comments that required an additional three cycles of design revisions and resubmittals to address. These design revisions included minor roadway and electrical changes that required additional coordination with CDM Smith sub- consultants.

6. Construction Bid Support
No changes are needed for this task.

7. Engineering Services During Construction
Due to the additional project design elements including roundabouts, lighting improvements, landscaping, and green stormwater the period of construction will be extended by up to six months for a total estimated construction period of eighteen (18) months. CDM Smith will provide additional construction phase engineering services through the anticipated construction completion date currently estimated at midway through 2026.

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 Alameda Central Avenue Safety Improvement Project: Amendment 5 • Scope of Work

Request for Information (RFIs):

CDM Smith will provide clarification and interpretation of drawings and specifications, as requested by the City or CM, in response to requests for information (RFIs) from the Contractor. RFIs shall be submitted to the CM who will then determine whether Consultant support is required to develop a response. CDM Smith anticipates up to twenty (20) additional RFIs for a total of forty (40) for the project.

Submittals:

CDM Smith will review the submittals and provide written responses with comments, and recommendations (e.g., no exceptions noted, amend, and resubmit). CDM Smith anticipates up to twenty (20) additional submittals for a total of thirty (30) for the project.

Record Drawings:

CDM Smith will review the Contractor’s working record drawing markups for general completeness and advise the Contractor of additions or clarifications that are needed.

Based on the Contractor’s redline markups, and other markups provided by the City or CM, CDM Smith will draft a complete set of record drawings for the completed project.

CDM Smith will submit one set of record drawings in electronic PDF format identifying changes to the design made during construction.

Assumption(s):
• The City’s independent CM will have primary responsibility for the management of the construction work and the selected Construction Contractor. The CM will serve as the liaison between Caltrans Construction staff, the City and CDM Smith. • The Construction Contractor will submit RFI’s, submittals and other requests to the CM, who will then review and respond and forward information to the City and CDM Smith as appropriate.

Deliverable(s):
• Attendance and documentation of up to twenty-four (24) field visits. • Written responses for up to forty (40) RFIs.
• Written responses for up to thirty-five (30) submittals.

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 6/10/2024
Jensen,
David
Hurrell,
Bill
Schuster,
Stefan
Gunther,
Jake
Soudari,
Ramakanth
Ruppert,
Daneel
Hunsdale,
William
Wood,
Christine
Niemiec,
Magdalena
Hours
Total Labor Cost
Other
Direct
Costs
Pacific
Legacy
CHS
Consulting Soil Lab Total Cost
1 Project Management
8 0 30 40 40 40 158 34,311 $ 34,311 $
2 Coordination and Team Meetings
8 30 40 40 118 29,310 $ 29,310 $
3 Public Outreach and Meetings
0 -$ -$
4 Caltrans Project Development
0 -$ -$
5 Traffic Analysis
0 -$ -$
6 Environmental Documentation
20 48 68 11,897 $ 1,000 $ 15,000 $ 27,897 $
7 Support Services
0 -$ -$
8 Engineering Plans, Specifications, and Estimates
8 30 38 5,043 $ 5,043 $
9 Construction Bid Support
Construction Bid Support 16 30 20 66 12,646 $ 12,646 $ 10 Construction Engineering Services
Construction Phase Services (Total) 0 0 60 80 0 40 60 0 240 4 4,749 $ 5,000 $ 10,000 $ 10,000 $ 69,749 $ Total Hours 8 8 156 158 80 90 108 40 40 688 137,956 $ 6,000 $ 10,000 $ 10,000 $ 15,000 $ 178,960 $ Task Completed
Task Completed
Task Completed
Alameda Central Avenue Safety Improvement Project Bid and Construction Engineering Services
Task Completed
Task

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 9 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ABCEF Holder Identifier : 7777777707070700077761616045571110767617017315446207543026663417311073751476157220120762514447167555207473515323774003074677375271267640762671402321730207626401532163120076727242035772000777777707000707007 7777777707070700073525677115456000762115542473013407230005164231175077751015607355610777510507136647207432223706037511074626377074671000706333365302641107023327352173110077756163351765540777777707000707007 Certificate No : 570103245887

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY )
12/27/2023
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AM END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P OLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONST ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AU THORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

PRODUCER
Aon Risk Services Northeast, Inc.

Boston MA Office
53 State Street
Suite 2201
Boston MA 02109 USA
PHONE
(A/C. No. Ext):

E-MAIL
ADDRESS :

INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 15792 Underwriters At Lloyds London INSURER A :
19682 Hartford Fire Insurance Co. INSURER B :
29459 Twin City Fire Insurance Company INSURER C :
22357 Hartford Accident & Indemnity Company INSURER D :
35378 Evanston Insurance Company INSURER E :

INSURER F :

FAX
(A/C. No .): 800-363-0105

CONTACT
NAME:

CDM Smith Inc.
75 State Street Suite 701
Boston MA 02109 USA
COVERAGES CERTIFICATE NUMBER : 570103245887 REVISION NUMBER :

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A BOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH R ESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUR ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S UBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . Limits shown are as requested

POLICY EXP
(MM /DD /YYYY )

POLICY EFF
(MM /DD /YYYY )
SUBR
WVD
INSR
LTR
ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED
PREMISES (Ea occurrence )
MED EXP (Any one person )

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP /OP AGG
X
X
X X
GEN 'L AGGREGATE LIMIT APPLIES PER :
$2,000,000
$1,000,000
$15,000
$2,000,000
$4,000,000
$4,000,000
B 01/01/2024 01/01/2025 08CSEQU4161
PRO-
JECT
OTHER :

AUTOMOBILE LIABILITY

ANY AUTO
OWNED

AUTOS ONLY

SCHEDULED
AUTOS

HIRED AUTOS
ONLY

NON-OWNED

AUTOS ONLY
BODILY INJURY ( Per person)

PROPERTY DAMAGE
(Per accident)
X
BODILY INJURY (Per accident)
$2,000,000 B 01/01/2024 01/01/2025 COMBINED SINGLE LIMIT (Ea accident)
08 UEN QU4162

EXCESS LIAB
OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE
DED

UMBRELLA LIAB

RETENTION
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT
$1,000,000
X OTH-
ER
PER STATUTE D 01/01/2024 01/01/2025
AOS
08WBRQU4163
C 01/01/2024 01/01/2025
$1,000,000
Y / N
(Mandatory in NH)

ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / AN
WI

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY
If yes, describe under
DESCRIPTION OF OPERATIONS below
$1,000,000
08WNQU4160
Each Claim PSDEF2400033 01/01/2024 01/01/2025
Professional/Claims Made $1,000,000 Aggregate
Architects & Engineers
Professional
A $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Name: Central Avenue Safety Improvement Project.

The City of Alameda, its City Council, boards, commissions, officials, employees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of the City of Alameda in accordance with the policy provisions of the General Liability and Automobile Liability policies.

CANCELLATION CERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVE
City of Alameda, Base Reuse and
Transportation Planning Department
Attn: Gail Payne, Senior Transportation
Coordinator
2263 Santa Clara Avenue, Room 130
Alameda CA 94501 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE LLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS .

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 8/19/2024

01.01.24 - 01.01.25 Professional
AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE
LOC #:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER : ACORD 25 FORM TITLE : Certificate of Liability Insurance EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED AGENCY
See Certificate Number :

See Certificate Number :

Aon Risk Services Northeast, Inc.
10518329
570103245887
570103245887
Page _ of _
CDM Smith Inc.

Policy: PSDEF2400033
Beazley (Syndicates 2623/0623) - 25%
BRIT (Syndicate 2987) - 25%
Munitus (Syndicates 4242/457/4711/5555) - 12.5%
Re/Rn (Syndicate 1458) - 10%
Convex (Syndicate 1984) - 7.50%
Castel Underwriting (Syndicate 2525) - 5%
Professional Policy: 42CNP31339704 - 3M po 20M
National Fire & Marine Insurance Company - 15%
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2

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

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

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.

All locations as required by a written contract or
agreement entered into prior to an 'occurrence' or
offense
Any person or organization for whom you have agreed in
a written contract or agreement, prior to an “occurrence" or offense, that such person or organization on be added as an additional insured to your policy.
08 CSE QU4161
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63

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;
whichever is less.

This endorsement shall not increase the
applicable limits of insurance.

Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63

COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

PRIMARY AND NONCONTRIBUTORY –

OTHER INSURANCE CONDITION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS 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 insurance available to
an additional insured under your policy provided
that:
(1) The additional insured is a Named Insured
under such other 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 insurance available to the
additional insured.

POLICY NUMBER: 08 CSE QU4161
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 POLICY NUMBER: 08 UEN QU4162 COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: CDM Smith, Inc
Endorsement Effective Date: 01/01/2024

SCHEDULE
Name Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Each person or organization shown in the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision
A.1. IIcontained in Paragraph of Section – Covered
Autos Liability Coverage in the Business Auto and
D.2.Motor Carrier Coverage Forms and Paragraph of
ISection – Covered Autos Coverages of the Auto
Dealers Coverage Form.

CA 20 48 10 13 Page 1 of 1© Insurance Services Office, Inc., 2011 Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ÝÑÓÓÛÎÝ×ßÔ ßËÌÑ
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Ò¿³»¼ ײ­«®»¼æ CDM Smith,Inc.

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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE May31st
1 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 CDM Smith, Inc. – Fourth Amendment to Agreement – Central Avenue   6HFWLRQ
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 2 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 IN WITNESS WHEREOF, the parties have caused this modification of Agreement to be executed on the day and year first above written.

CDM SMITH, INC. CITY OF ALAMEDA
A Massachusetts Corporation A Municipal Corporation
William E. Hurrell, P.E. Jennifer Ott
Vice President City Manager

RECOMMENDED FOR APPROVAL
Andrew Thomas
Planning, Building and Transportation
Director
APPROVED AS TO FORM:

City Attorney
Celena H. Chen
Chief Planning Counsel
CDM Smith, Inc. – Fourth Amendment to Agreement – Central Avenue 3 























 


DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 5/31/2023
3 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 


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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 4 OF 19
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††‹–‹‘ƒŽ
‘‘”†‹ƒ–‹‘™‹–Š‹––‡Ž•‘ƒ†••‘
‹ƒ–‡•‹•ƒ–‹
‹’ƒ–‡†ˆ‘”–Š‡ ‘—”–Š–Ǥ
”‘—†ƒ„‘—–†‡•‹‰Ǥ‡
Š‹
ƒŽ‘‘”†‹ƒ–‹‘‡‡–‹‰•™‹ŽŽ„‡•
Š‡†—Ž‡†„›‹–Š
ƒ†Š‡Ž†˜‹ƒ‹
”‘•‘ˆ–‡ƒ•Ǥ‡‡–‹‰•™‹ŽŽ„‡Š‡Ž†‡ƒ
Š‘–Šƒ†„‡ƒ––‡†‡†„›
–Š‡‹–Š”‘Œ‡
–ƒƒ‰‡”ƒ†—’–‘–™‘–‡
Š‹
ƒŽ•’‡
‹ƒŽ‹•–•ƒ•ƒ’’”‘’”‹ƒ–‡–‘
†‹•
—••
—””‡––‡
Š‹
ƒŽ‹••—‡•Ǥ
x ’–‘ˆ‹˜‡ƒŽ–”ƒ•
‘•–”—
–‹‘
‘‘”†‹ƒ–‹‘‡‡–‹‰•–‘”‡˜‹‡™
—””‡–
‘•–”—
–‹‘
‹••—‡•’‡”–ƒ‹‹‰–‘–Š‡ƒŽ–”ƒ•Ǧ‘™‡†’‘”–‹‘‘ˆ–Š‡’”‘Œ‡ –ƒ”‡ƒǡ’”‘Œ‡
–•–ƒ–—•ƒ†
—’
‘‹‰
‘•–”—
–‹‘ƒ
–‹˜‹–‹‡•ƒ†ƒŽ–”ƒ•”‡Žƒ–‡†”‡“—‹”‡‡–•Ǥ‡‡–‹‰•™‹ŽŽ„‡ Š‡Ž†˜‹ƒ‡ƒ•‘”‘Ǧ•‹–‡†—”‹‰–Š‡
‘•–”—
–‹‘’Šƒ•‡Ǥ
‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
x ‰‡†ƒ•ƒ†‡‡–‹‰‘–‡•™‹ŽŽ„‡’”‡’ƒ”‡†ˆ‘”–Š‡‡‡–‹‰•‹†‡–‹ˆ‹‡†ƒ„‘˜‡Ǥ”ƒˆ– ƒ‰‡†ƒ•™‹ŽŽ„‡†‹•–”‹„—–‡†‘‡™‡‡’”‹‘”–‘–Š‡‡‡–‹‰ƒ†‡‡–‹‰‘–‡•™‹ŽŽ„‡ †‹•–”‹„—–‡†™‹–Š‹‘‡™‡‡‘ˆ–Š‡‡‡–‹‰Ǥ
x ”‡•‡–ƒ–‹‘•ǡ•‹‰Ǧ‹•Š‡‡–•ǡ†‡•‹‰†‡–ƒ‹Ž•ƒ†‘–Š‡”ƒ–‡”‹ƒŽ•™‹ŽŽ„‡’”‘˜‹†‡†ƒ• ƒ’’”‘’”‹ƒ–‡ˆ‘”–Š‡•’‡
‹ˆ‹
‡‡–‹‰Ǥ
͵Ǥ —„Ž‹
—–”‡ƒ
Šƒ†‡‡–‹‰•
‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ
ͶǤ ƒŽ–”ƒ•”‘Œ‡
–‡˜‡Ž‘’‡–
‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ
ͷǤ ”ƒˆˆ‹
ƒŽ›•‹•
‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ























 


DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 5 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗W^Θ
WŚĂƐĞx^ĐŽƉĞŽĨtŽƌŬ



͸Ǥ ˜‹”‘‡–ƒŽ
x ‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ
͹Ǥ —’’‘”–‡”˜‹
‡•
—’’Ž‡‡–ƒŽ•—”˜‡›‹ˆ‘”ƒ–‹‘‹•‡‡†‡††—‡–‘‡™
‘•–”—
–‹‘™‹–Š‹–Š‡’”‘Œ‡
–
ƒ”‡ƒ„›–Š‡Žƒ‡†ƒ‘—–›
Š‘‘Ž‹•–”‹
–ƒ†ƒŽ–”ƒ•Ǥ
‡™‹ˆ‘”ƒ–‹‘ˆ”‘ƒ•–ƒ›—‹
‹’ƒŽ–‹Ž‹–›‹•–”‹
–”‡“—‹”‡•ƒ††‹–‹‘ƒŽ—–‹Ž‹–›

‘‘”†‹ƒ–‹‘™‘”–‘ƒ˜‘‹†ƒ†Ȁ‘”‹–‹‰ƒ–‡’”‘Œ‡
–”‡Žƒ–‡†‹’ƒ
–•–‘ƒ‰‹‰™ƒ–‡”
‹ˆ”ƒ•–”—
–—”‡Ǥ
‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
x —’’Ž‡‡––‘’‘‰”ƒ’Š‹
ƒ†”‹‰Š–‘ˆ™ƒ›•—”˜‡›†ƒ–ƒˆ‘”‡™Ž›
‘•–”—
–‹‘ˆ‡ƒ–—”‡•
ƒ††‹–‹‘ƒŽƒ”‡ƒ•Ǥ
x ‘‘”†‹ƒ–‹‘‡‡–‹‰•™‹–Šǡ”‡˜‹•‡†—–‹Ž‹–›†‘
—‡–•ƒ†ƒ††‹–‹‘ƒŽ†‡•‹‰
†‡–ƒ‹Ž•ƒ†•’‡
‹ˆ‹
ƒ–‹‘•ˆ‘”™ƒ–‡”Ž‹‡’”‘–‡
–‹‘‡ƒ•—”‡•Ǥ
ͺǤ ‰‹‡‡”‹‰Žƒ•ǡ’‡
‹ˆ‹
ƒ–‹‘•ƒ†•–‹ƒ–‡•
Š‡‹–‡•‡‡ˆˆ‘”–•”‡“—‹”‡†–‘
‘’Ž‡–‡–Š‡‘‡Š—†”‡†’‡”
‡–†‡•‹‰•—„‹––ƒŽ„›–Š‡
•–‹’—Žƒ–‡††‡ƒ†Ž‹‡
”‡ƒ–‡†ƒ‡‡†–‘ƒ••‹‰ƒ††‹–‹‘ƒŽ•–ƒˆˆ”‡•‘—”
‡•–‘–Š‡’”‘Œ‡
–Ǥ
‘’Ž‡–‹‘‘ˆ–Š‡™‘”„›–Š‡†‡ƒ†Ž‹‡™ƒ•”‡“—‹”‡†„›ƒŽ–”ƒ•ƒ•ƒ ‘†‹–‹‘‘ˆ
ƒ’’”‘˜ƒŽˆ‘”–Š‡
‘•–”—
–‹‘‰”ƒ–ˆ—†‹‰Ǥ
–”‡“—‹”‡†–Š‡‡‰ƒ‰‡‡–‘ˆƒ††‹–‹‘ƒŽ
†‡•‹‰•–ƒˆˆ–‘
‘’Ž‡–‡ƒŽƒ”‰‡ƒ‘—–‘ˆ™‘”—†‡”ƒ
‘’”‡••‡†•
Š‡†—Ž‡ǤƒŽ–”ƒ•
’”‘˜‹†‡†‡š–‡•‹˜‡†‡•‹‰
‘‡–•ˆ”‘—Ž–‹’Ž‡‰”‘—’•‘ˆ™Š‹
Š‡
‡••‹–ƒ–‡†‘”‡
–Šƒ‡š’‡
–‡††‡•‹‰”‡˜‹•‹‘•ƒ†”‡•—„‹––ƒŽ•Ǥ

††‹–‹‘ƒŽ†‡•‹‰™‘”‹•ƒŽ•‘‡‡†‡†ƒ•ƒ”‡•—Ž–‘ˆ‡™‰”ƒ–ˆ—†‹‰ˆ‘”–Š‡ ‹
‘”’‘”ƒ–‹‘‘ˆƒ–Š‹”†”‘—†ƒ„‘—–‹–‘–Š‡’”‘Œ‡
–ƒ––Š‡ ‘—”–Š–ȀƒŽŽ‡ƒŽ˜†
‹–‡”•‡
–‹‘ǤŠ‡’”‡˜‹‘—•Ž›†‡˜‡Ž‘’‡†‹–‡”‹†‡•‹‰ˆ‘”–Š‡ ‘—”–Š–ȀƒŽŽ‡ƒŽ˜† ‹–‡”•‡
–‹‘™‹ŽŽ„‡”‡’Žƒ
‡†™‹–Š–Š‡‡™”‘—†ƒ„‘—–†‡•‹‰Ǥ‡™†‡•‹‰
Šƒ‰‡•ƒ”‡
ƒŽ•‘„‡‹‰‹
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‹ˆ‹
˜‡Ȁƒ‹–‹–‡”•‡
–‹‘ǤŠ‡‘‡Ǧ™ƒ›”‡•‹†‡–‹ƒŽ
ƒ

‡••’‘”–‹‘‘ˆƒ‹–™‹ŽŽ„‡‘†‹ˆ‹‡†–‘‡Ž‹‹ƒ–‡–Š‡†‹”‡ –
‘‡
–‹‘™‹–Š–Š‡
ƒ
‹ˆ‹
˜‡Ȁƒ‹–”‘—†ƒ„‘—––‘ˆ—”–Š‡”‹
”‡ƒ•‡•ƒˆ‡–›Ǥ‡™ƒ

॥
‘‡
–‹‘™‹ŽŽ
„‡
‘•–”—
–‡†ƒ’’”‘š‹ƒ–‡Ž›‘‡Š—†”‡†ˆ‡‡–‘”–Š‘ƒ‹–Ǥ

Š‡•‡†‡•‹‰”‡˜‹•‹‘•‹
Ž—†‡”‘ƒ†™ƒ›ǡ„‹‡™ƒ›ƒ†•‹†‡™ƒŽ”‡
‘ˆ‹‰—”ƒ–‹‘ǡ
ƒ†Œ—•–‡–‘ˆ†”ƒ‹ƒ‰‡ƒ†™ƒ–‡”“—ƒŽ‹–›ˆ‡ƒ–—”‡•ǡ—–‹Ž‹–›”‡Ž‘ ƒ–‹‘•ǡ•–”‡‡–Ž‹‰Š–‹‰ƒ†
Žƒ†•
ƒ’‹‰Ǥ††‹–‹‘ƒŽ
‘‘”†‹ƒ–‹‘‹•‡‡†‡†™‹–Š‘–Š‡”
‘•—Ž–ƒ–•ˆ‘””‘—†ƒ„‘—–

‘
‡’–†‡˜‡Ž‘’‡–ƒ†ˆ‘”–Š‡†‡•‹‰‘ˆˆ‡ƒ–—”‡•
‘‡
–‹‰–‘ƒ†Œƒ
‡–•–”‡‡–
‹’”‘˜‡‡–••—
Šƒ•–Š‡‹
‘ŽȀƒ”•ŠƒŽŽȀƒ
‹ˆ‹

’”‘˜‡‡–”‘Œ‡
–Ǥ

 























 


DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 6 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ůĂŵĞĚĂĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗ŵĞŶĚŵĞŶƚϰx^ĐŽƉĞŽĨtŽƌŬ 

••—’–‹‘ȋ•Ȍǣ
x Š‡‹–‡”‹‹’”‘˜‡‡–•ƒ––Š‡
‹ƒŽ˜‡ȀŠ‡”ƒ–‹–‡”•‡
–‹‘™‹ŽŽ”‡ƒ‹‹
–Š‡’”‘Œ‡
–†‡•‹‰Ǥ
x Š‡‡–”ƒŽ˜‡—‡ƒ†‹
‘ŽȀƒ”•ŠƒŽŽȀƒ
‹ˆ‹
˜‡—‡’”‘Œ‡
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‹–‡”ˆƒ
‡Œ—•–‡ƒ•–‘ˆ–Š‡ƒ
‹ˆ‹
˜‡Ȁ‡
‘†–‹–‡”•‡
–‹‘Ǥ

‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
x ƒ‡Ƭ•—„‹––ƒŽ•ƒ•†‡•
”‹„‡†‹–Š‡‘”‹‰‹ƒŽ•
‘’‡ǡ”‡˜‹•‡†™‹–Š”‘—†ƒ„‘—–
†‡•‹‰
Šƒ‰‡•Ǥ
ϵ͘ ‘•–”—
–‹‘‹†—’’‘”–
‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ
ͳͲǤ ‰‹‡‡”‹‰‡”˜‹
‡•—”‹‰‘•–”—
–‹‘
Š‡‡ƒ•–‡”’‘”–‹‘‘ˆ–Š‡’”‘Œ‡
–ƒ”‡ƒ„‡–™‡‡‡„•–‡”–ƒ†Š‡”ƒ–Ȁ
‹ƒŽ˜‡
‹•‘™‡†„›ƒŽ–”ƒ•Ǥƒ•‡†‘–Š‡Ž‡˜‡Ž‘ˆ’”‡˜‹‘—•ƒŽ–”ƒ• ‘‘”†‹ƒ–‹‘†—”‹‰–Š‡
†‡•‹‰’Šƒ•‡ǡƒ††‹–‹‘ƒŽ
‘•–”—
–‹‘’Šƒ•‡
‘‘”†‹ƒ–‹‘™‹–ŠƒŽ–”ƒ•‹•’‡
–‘”•ǡ
”‡•‹†‡–‡‰‹‡‡”•ƒ†‘–Š‡”•–ƒˆˆ™‹ŽŽ„‡”‡“—‹”‡†ˆ‘”™‘”‹–Š‹•ƒ”‡ƒǤ‹–Š™‹ŽŽ ’”‘˜‹†‡–Š‡•—’’Ž‡‡–ƒŽ
‘•–”—
–‹‘’Šƒ•‡•‡”˜‹
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Ž—†‹‰•—’’‘”––‘–Š‡‹–›ǡ–Š‡
‘•–”—
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–‹‘‘–”ƒ
–‘”™‹–Š–Š‡‹–‡”’”‡–ƒ–‹‘‘ˆƒ†
”‡•’‘•‡–‘ƒŽ–”ƒ•”‡“—‹”‡‡–•ƒ†”‡“—‡•–•”‡Žƒ–‡†–‘ ‘’Ž‹ƒ
‡™‹–Š•–ƒ–‡
•–ƒ†ƒ”†•ǡ
‘•–”—
–‹‘†‘
—‡–ƒ–‹‘”‡“—‹”‡‡–•ƒ††‡•‹‰
Žƒ”‹ˆ‹
ƒ–‹‘•Ǥ
‹–Š™‹ŽŽƒŽ•‘’”‘˜‹†‡ƒ•Ǧ‡‡†‡†‘Ǧ•‹–‡•—’’‘”––‘
Žƒ”‹ˆ›†‡•‹‰“—‡•–‹‘•ǡ‡˜ƒŽ—ƒ–‡

‘’Ž‹ƒ
‡™‹–Š–Š‡†‡•‹‰ǡƒ†‡˜ƒŽ—ƒ–‡ƒ††‡˜‡Ž‘’
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Šƒ‰‡‘”†‡”
†‘
—‡–•‹ˆ‡
‡••ƒ”›Ǥ
••—’–‹‘ȋ•Ȍǣ
ͳǤ Š‡‹–›ǯ•‹†‡’‡†‡–™‹ŽŽŠƒ˜‡’”‹ƒ”›”‡•’‘•‹„‹Ž‹–›ˆ‘ ”–Š‡ƒƒ‰‡‡–‘ˆ –Š‡
‘•–”—
–‹‘™‘”ƒ†–Š‡•‡Ž‡
–‡†‘•–”—
–‹‘‘–”ƒ
–‘”ǤŠ‡™‹ŽŽ•‡”˜‡ƒ•
–Š‡Ž‹ƒ‹•‘„‡–™‡‡ƒŽ–”ƒ•‘•–”—
–‹‘•–ƒˆˆǡ–Š‡‹–›ƒ†‹–ŠǤ
‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
ͳǤ —’’‘”––Š‡‹–›ƒ†‹”‡•’‘†‹‰–‘ƒŽ–”ƒ•”‡“—‡•–•ƒ †“—‡•–‹‘•‘ ‹–Š’”‘†—
‡††‡•‹‰†‘
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Ž—†‹‰Ƭǡ–‘”™ƒ–‡”‘ŽŽ—–‹‘”‡˜‡–‹‘
ŽƒȋȌǡ”ƒˆˆ‹
ƒƒ‰‡‡–ŽƒȋȌǡ—–‹Ž‹–›ƒ†”‹‰Š–‘ˆ™ƒ›†‘
—‡–•Ǥ
ʹǤ ‡•’‘•‡–‘—’–‘–‡ȋͳͲȌƒŽ–”ƒ•”‡˜‹‡™‹–‡”ƒ–‹‘•‘ˆˆ‹ƒ Ž Ž‘•‡Ǧ‘—–
‘•–”—
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Ž—†‹‰
‘•–•ǡ†‡•‹‰†‘
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–Š‹•–‘”›ƒ†”‹‰Š–
‘ˆ™ƒ›†‘
—‡–ƒ–‹‘Ǥ
























 


DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 7 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ĂǀĞ
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ϭ͘ϭ WƌŽũĞĐƚDĂŶĂŐĞŵĞŶƚ ϴ ϰ ϲϬ ϭϲ ϭϲ ϭϲ ϰϴ ϰϬ ϮϬϴ ϰϭ͕ϴϮϱ Ψ ϰϭ͕ϴϮϱΨ Ϯ ŽŽƌĚŝŶĂƚŝŽŶĂŶĚdĞĂŵDĞĞƚŝŶŐƐ
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 8 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 9 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ABCEFHolder Identifier :                                     
                                Certificate No : 570096932040

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)
12/22/2022
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

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COVERAGES CERTIFICATE NUMBER: 570096932040 REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO D INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested

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ANY PROPRIETOR / PARTNER / EXECUTIVE
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 10 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE
LOC #:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance EFFECTIVE DATE:

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ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits.

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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 11 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 3URIHVVLRQDO/LDE3ROLF\36'()
AGENCY CUSTOMER ID:

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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 12 OF 19
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 13 OF 19
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 14 OF 19
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 15 OF 19
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 17 OF 19
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 18 OF 19
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CERTIFICATE NUMBER:

CERTIFICATE OF PROPERTY INSURANCE
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI OD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONT RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T ERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

POLICY EXPIRATION

DATE (MM/DD/YYYY) LIMITS COVERED PROPERTYPOLICY EFFECTIVE

DATE (MM/DD/YYYY)POLICY NUMBER TYPE OF INSURANCEINSR
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CERTIFICATE HOLDER CANCELLATION

AUTHORIZED REPRESENTATIVE
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ACORD 24 (2016/03)
© 1995-2015 ACORD CORPORATION. All rights reserved.

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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 19 OF 19
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 1 OF 22
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‘‘”†‹ƒ–‹‰™‹–Š‹–›•–ƒˆˆ–‘‘„–ƒ‹”‡“—‹”‡†‹ˆ‘”ƒ–‹‘ƒ† ‘—‹
ƒ–‡’”‘„Ž‡•‘”
—ƒ–‹
‹’ƒ–‡†
‘†‹–‹‘•Ǥ”‘Œ‡
–ƒƒ‰‡‡–ƒŽ•‘‹
Ž—†‡•–”ƒ
‹‰’”‘Œ‡
–„—†‰‡–ƒ†

‘’Ž‡–‹‘•–ƒ–—•ǡ†‡˜‡Ž‘’‹‰ƒ†•—„‹––‹‰‘–ŠŽ›’”‘‰”‡••”‡’‘”–•ǡ’”‘Œ‡ –‹˜‘‹
‡
’”‡’ƒ”ƒ–‹‘ǡ†‘
—‡–
‘–”‘Žƒ†’”‘Œ‡
–ƒ†‹‹•–”ƒ–‹˜‡–ƒ••Ǥ‰‘‹‰“—ƒŽ‹–›ƒ••—”ƒ
‡
™‹ŽŽ
‘–‹—‡™‹–Š’”‡Ǧ†‡ˆ‹‡†Ȁƒ
–‹˜‹–‹‡•ǡ‹Ž‡•–‘‡•ƒ†•
Š‡†—Ž‡•ˆ‘”
‘’Ž‡–‹‘–Šƒ–
‹
Ž—†‡–‡
Š‹
ƒŽ•’‡
‹ƒŽ‹•–”‡˜‹‡™•ƒ†‹†‡’‡†‡–“—ƒŽ‹–›
‘–”‘Ž
Š‡
•Ǥ
••—’–‹‘ȋ•Ȍǣ
•
–‹•ƒ••—‡†–Šƒ––Š‡
‘’Ž‡–‹‘‘ˆ†‡•‹‰ƒ†–Š‡
‘•–”—
–‹‘’Šƒ•‡™‹ŽŽ”‡“—‹”‡ƒ
ƒ††‹–‹‘ƒŽ‡‹‰Š–‡‡ȋͳͺȌ‘–Š•–‘
‘’Ž‡–‡Ǥ
‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
• ‘–ŠŽ›‹˜‘‹
‡•™‹–Š’”‘‰”‡••”‡’‘”–•
• —„
‘–”ƒ
–‘”ƒƒ‰‡‡–
• ‘‘”†‹ƒ–‹‘™‹–Š‘—–•‹†‡ƒ‰‡
‹‡•‹
Ž—†‹‰ƒŽ–”ƒ•ƒ†—–‹Ž‹–‹‡•
• ‘
—‡–
‘–”‘Ž
• —ƒŽ‹–›ƒƒ‰‡‡–
ʹǤ‘‘”†‹ƒ–‹‘ƒ†‡ƒ‡‡–‹‰•
‹–Š™‹ŽŽ’”‡’ƒ”‡ˆ‘”ǡƒ––‡†ǡƒ†ˆƒ
‹Ž‹–ƒ–‡’”‘Œ‡
–”‡Žƒ–‡†‡‡–‹‰•–‘’”‘˜‹†‡•–ƒ–—•
—’†ƒ–‡•ǡ•Šƒ”‡‹ˆ‘”ƒ–‹‘ƒ†
‘‘”†‹ƒ–‡’”‘Œ‡
–†‡•‹‰ƒ†
‘•–”—
–‹‘ƒ
–‹˜‹–‹‡•Ǥ”‘Œ‡
–
ĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ
^ĐŽƉĞŽĨtŽƌŬ͗ŵĞŶĚŵĞŶƚϯ







 












 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 4 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ůĂŵĞĚĂĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗ŵĞŶĚŵĞŶƚϯ •^ĐŽƉĞŽĨtŽƌŬ 


‘‘”†‹ƒ–‹‘‡‡–‹‰•™‹ŽŽ„‡Š‡Ž†™‹–Š‹–›•–ƒˆˆǡ–Š‡†‡•‹‰–‡ƒǡ–Š‡‘•–”— –‹‘ƒƒ‰‡”
ȋȌǡ–Š‡‘•–”—
–‹‘‘–”ƒ
–‘”ǡƒ†‘–Š‡”ƒ––‡†‡‡•ƒ•†‡‡‡†ƒ’’”‘’”‹ƒ–‡–‘ƒ††”‡••

—””‡––‡
Š‹
ƒŽ‹••—‡•Ǥ ‘”‡ƒ
Š‡‡–‹‰ǡ‹–Š™‹ŽŽ’”‡’ƒ”‡ƒƒ‰‡†ƒǡƒ’’”‘’”‹ƒ–‡ ’”‡•‡–ƒ–‹‘ƒ–‡”‹ƒŽ•ǡ‹˜‹–ƒ–‹‘‘–‹
‡•ǡ•‹‰Ǧ‹•Š‡‡–•ǡƒ†‡‡–‹‰‘–‡•Ǥ
Š‡ˆ‘ŽŽ‘™‹‰‡‡–‹‰•ƒ”‡ƒ††‡†ǣ
• ’–‘‡‹‰Š–‡‡‘–ŠŽ›”‘Œ‡
–‘‘”†‹ƒ–‹‘‡‡–‹‰•™‹–Š‹–›•–ƒˆˆƒ†‘–Š‡”•ƒ•
‡‡†‡†–‘’”‘˜‹†‡—’†ƒ–‡•‘’”‘‰”‡••ƒ††‹•
—••’”‘Œ‡
–†‡•‹‰ƒ†
‘•–”—
–‹‘
‹••—‡•Ǥ‡
Š‹
ƒŽ‘‘”†‹ƒ–‹‘‡‡–‹‰•™‹ŽŽ„‡•
Š‡†—Ž‡†„›‹–Šƒ†Š‡Ž†˜‹ƒ
‹
”‘•‘ˆ–‡ƒ•Ǥ‡‡–‹‰•™‹ŽŽ„‡Š‡Ž†‡ƒ
Š‘–Šƒ†„‡ƒ––‡†‡†„›–Š‡‹–Š
”‘Œ‡
–ƒƒ‰‡”ƒ†—’–‘–™‘–‡
Š‹
ƒŽ•’‡
‹ƒŽ‹•–•ƒ•ƒ’’”‘’”‹ƒ–‡–‘†‹•
—••
—””‡–
–‡
Š‹
ƒŽ‹••—‡•Ǥ
• ’–‘•‹š’”‘’‡”–›‘™‡”ǯ•‡‡–‹‰•–‘’”‘˜‹†‡‹ˆ‘”ƒ–‹‘‘ ‘•–”—
–‹‘ƒ
–‹˜‹–‹‡•ǡ
”‡
‡‹˜‡ƒ††‹•
—••
‘‡–•ƒ†“—‡•–‹‘•ƒ†
‘‘”†‹ƒ–‡ƒ

‡••‹••—‡•Ǥ‡‡–‹‰•
–‘„‡Š‡Ž†‹Ǧ’‡”•‘†—”‹‰–Š‡
‘•–”—
–‹‘’Šƒ•‡Ǥ
• ’–‘–‡—–‹Ž‹–›
‘‘”†‹ƒ–‹‘‡‡–‹‰•–‘†‹•
—••’”‘Œ‡
–”‡Žƒ–‡†
‘ˆŽ‹
–•™‹–Š
‡š‹•–‹‰—–‹Ž‹–›‹ˆ”ƒ•–”—
–—”‡ƒ†
‘‘”†‹ƒ–‡—–‹Ž‹–›”‡Ž‘
ƒ–‹‘•ƒ†ƒ‰”‡‡‡–•Ǥ
‡‡–‹‰•–‘„‡Š‡Ž†˜‹ƒ‡ƒ•ƒ†‘Ǧ•‹–‡†—”‹‰–Š‡ˆ‹ƒŽƬ’Šƒ•‡Ǥ • ‡’”‡Ǧ
‘•–”—
–‹‘‡‡–‹‰™‹–Š–Š‡‹–›ǡƒŽ–”ƒ•ǡ–Š‡ǡ–Š‡‘•–”— –‹‘
‘–”ƒ
–‘”ǡƒ’’”‘’”‹ƒ–‡•—„
‘–”ƒ
–‘”•ǡƒ†—–‹Ž‹–›
‘’ƒ‹‡•Ǥ‹–Š™‹ŽŽ
’”‡•‡–‹ˆ‘”ƒ–‹‘‘‡›’”‘Œ‡
–ˆ‡ƒ–—”‡•ƒ†Ž‘
ƒ–‹‘•ǡ•’‡
‹ƒŽ‡˜‹”‘‡–ƒŽ
‹••—‡•ǡƒ†•—’’‘”–†‹•
—••‹‘‘ˆ
‘—‹
ƒ–‹‘’”‘–‘
‘Ž•ǡƒ†‹‹•–”ƒ–‹˜‡
’”‘
‡†—”‡•ǡ’”‘Œ‡
––‡ƒ‡„‡”•ƒ†”‘Ž‡•ǡ’”‘Œ‡
–•
Š‡†—Ž‡ǡ™‘”
‘•–”ƒ‹–•ǡ
’‡”‹–”‡“—‹”‡‡–•ǡƒ†
‘‘”†‹ƒ–‹‘™‹–ŠŽ‘
ƒŽ—–‹Ž‹–‹‡•Ǥ
–‹•ƒ••—‡†–Šƒ––Š‡‹–›
‘”™‹ŽŽŽ‡ƒ†–Š‹•˜‹”–—ƒŽ‡‡–‹‰˜‹ƒ‡ƒ•‘”ƒ‘–Š‡””‡‘–‡‡‡–‹‰’Žƒ–ˆ‘”Ǥ • ’–‘–‡
‘•–”—
–‹‘’”‘‰”‡••‡‡–‹‰•ƒ†‘–Š‡”
‘•–”—
–‹‘‡‡–‹‰•ƒ•
”‡“—‡•–‡†„›–Š‡‹–›Ǥ–ƒ‹‹—ǡ–Š‡‡‡–‹‰•™‹ŽŽ”‡˜‹‡™–Š‡’”‘Œ‡ –•–ƒ–—•ǡ
•—„‹––ƒŽ•–ƒ–—•ǡ
•–ƒ–—•ǡ•–ƒ–—•ǡƒ†–Š‡‘–”ƒ
–‘”ǯ•–Š”‡‡Ǧ™‡‡Ž‘‘ǦƒŠ‡ƒ†
•
Š‡†—Ž‡Ǥ‡‡–‹‰•–‘„‡Š‡Ž†˜‹ƒ‡ƒ•‘”‘Ǧ•‹–‡†—”‹‰–Š‡ ‘•–”—
–‹‘’Šƒ•‡Ǥ
• ’–‘–™‘•‹–‡˜‹•‹–•’‡”‘–Šǡ™‹–Šƒ–‘–ƒŽ‘ˆ—’–‘‡‹‰Š–‡‡ǡ†—”‹‰–Š‡ ‘•–”—
–‹‘
’Šƒ•‡–‘‡˜ƒŽ—ƒ–‡
‘•–”—
–‡†‹’”‘˜‡‡–•ˆ‘”
‘•‹•–‡
›™‹–Š–Š‡†‡•‹‰ƒ†
ƒ•™‡”†‡•‹‰”‡Žƒ–‡†“—‡•–‹‘•ˆ”‘–Š‡‘–”ƒ
–‘”ƒ†‘–Š‡”•ƒ•‡‡†‡†Ǥ‡‡–‹‰•
–‘„‡Š‡Ž†‘Ǧ•‹–‡†—”‹‰–Š‡
‘•–”—
–‹‘’Šƒ•‡Ǥ
‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
• ‰‡†ƒ•ƒ†‡‡–‹‰‘–‡•™‹ŽŽ„‡’”‡’ƒ”‡†ˆ‘”–Š‡‡‡–‹‰•‹†‡–‹ˆ‹‡†ƒ„‘˜‡Ǥ”ƒˆ– ƒ‰‡†ƒ•™‹ŽŽ„‡†‹•–”‹„—–‡†‘‡™‡‡’”‹‘”–‘–Š‡‡‡–‹‰ƒ†‡‡–‹‰‘–‡•™‹ŽŽ„‡ †‹•–”‹„—–‡†™‹–Š‹‘‡™‡‡‘ˆ–Š‡‡‡–‹‰Ǥ
• ”‡•‡–ƒ–‹‘•ǡ•‹‰Ǧ‹•Š‡‡–•ǡ†‡•‹‰†‡–ƒ‹Ž•ƒ†‘–Š‡”ƒ–‡”‹ƒŽ•™‹ŽŽ„‡’”‘˜‹†‡†ƒ• ƒ’’”‘’”‹ƒ–‡ˆ‘”–Š‡•’‡
‹ˆ‹
‡‡–‹‰Ǥ







 












 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 5 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗W^Θ
WŚĂƐĞ •^ĐŽƉĞŽĨtŽƌŬ



ϯ͘WƵďůŝĐKƵƚƌĞĂĐŚĂŶĚDĞĞƚŝŶŐƐ
‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ
ϰ͘ĂůƚƌĂŶƐWƌŽũĞĐƚĞǀĞůŽƉŵĞŶƚ
Š‡ƒŽ–”ƒ•”‘Œ‡
–‡’‘”–ȋȌƒ†‡•‹‰–ƒ†ƒ”†‡
‹•‹‘‘
—‡–ȋȌ
”‡“—‹”‡†ƒ††‹–‹‘ƒŽ‡ˆˆ‘”––‘
‘’Ž‡–‡†—‡–‘–Š‡—ƒ–‹
‹’ƒ–‡†—„‡”‘ˆƒŽ–”ƒ•”‡˜‹‡™
‹–‡”ƒ–‹‘•ƒ†–Š‡Žƒ”‰‡—„‡”‘ˆ”‡˜‹‡™‡”•Ǥ


–™ƒ•‘”‹‰‹ƒŽŽ›ƒ••—‡†–Šƒ–‘‡•‡–‘ˆ”‡˜‹‡™
‘‡–•™‘—Ž†„‡’”‘˜‹†‡†„›–Š‡‹–›
ƒ†‘‡•‡–™‘—Ž†„‡’”‘˜‹†‡†„›ƒŽ–”ƒ•ǤƒŽ–”ƒ•”‡“—‡•–‡†‡‹‰Š–”‡˜‹•‹‘•–‘–Š‡ ƒ†–™‡Ž˜‡”‡˜‹•‹‘•–‘–Š‡’”‹‘”–‘ˆ‹ƒŽ‹œƒ–‹‘Ǥ ϱ͘dƌĂĨĨŝĐŶĂůLJƐŝƐ
—‡–‘–Š‡ƒ˜ƒ‹Žƒ„‹Ž‹–›‘ˆ—’†ƒ–‡†–”ƒˆˆ‹

‘—–ƒ†
‘ŽŽ‹•‹‘†ƒ–ƒ•‡–•ǡƒŽ–”ƒ•”‡“—‡•–‡†ƒ
”‡˜‹•‡†–”ƒˆˆ‹
ƒƒŽ›•‹•ǤŠ‡—’†ƒ–‡††ƒ–ƒ•‡–•™‡”‡‘„–ƒ‹‡†ƒ†”‡ǦƒƒŽ›œ‡†ǡƒ†–Š‡ ”‡•—Ž–•ƒ”‡†‘
—‡–‡†‹–Š‡ƒ†Ǥ
ϲ͘
ŶǀŝƌŽŶŵĞŶƚĂů
††‹–‹‘ƒŽ‡˜‹”‘‡–ƒŽ•–—†‹‡•™‡”‡”‡“—‹”‡†„›ƒŽ–”ƒ•–‘•—’’‘”––Š‡ ƒ††‹–‹‘‘ˆ–Š‡”‘—†ƒ„‘—–•‹–‘–Š‡†‡•‹‰Ǥ—Ž–‹’Ž‡†‘ —‡–•”‡“—‹”‡†ƒ††‹–‹‘ƒŽ
‹ˆ‘”ƒ–‹‘ƒ†ƒƒŽ›•‹•–‘„‡ƒ††‡†ƒ†ƒ††‹–‹‘ƒŽ”‡˜‹‡™ ›
Ž‡•ǤŠ‡ƒ††‹–‹‘ƒŽ
‡˜‹”‘‡–ƒŽ†‘
—‡–ƒ–‹‘ƒ†
‘’Ž‹ƒ
‡ƒ
–‹˜‹–‹‡•‹
Ž—†‡†ǣ
• ‡˜‹•‡†”‘Œ‡
–‡•
”‹’–‹‘
• ††‹–‹‘ƒŽ’—„Ž‹
‘—–”‡ƒ
Šƒ†˜‹”–—ƒŽ”‘‘
• ‹•—ƒŽ
’ƒ
–ƒŽ›•‹•
• ‹”—ƒŽ‹–›–—†›ƒ†
–‡”ƒ‰‡
›‘‘”†‹ƒ–‹‘
• ƒ–—”ƒŽ˜‹”‘‡––—†›
•
ƒœƒ”†‘—•ƒ•–‡
‹–‹ƒŽ‹–‡••‡••‡–
• ƒ–‡”—ƒŽ‹–›••‡••‡–ƒ†–‘”ƒ–‡”ƒ–ƒ‡’‘”– ‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ
• ††‹–‹‘ƒŽ‡˜‹”‘‡–ƒŽƒƒŽ›•‡•ƒ††‘
—‡–ƒ–‹‘ƒ•Ž‹•–‡†ƒ„‘˜‡–‘•—’’‘”–
ƒŽ–”ƒ•ƒ’’”‘˜ƒŽǤ







 












 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 6 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ůĂŵĞĚĂĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗ŵĞŶĚŵĞŶƚϯ •^ĐŽƉĞŽĨtŽƌŬ 

ϳ͘^ƵƉƉŽƌƚ^ĞƌǀŝĐĞƐ
††‹–‹‘ƒŽ‡‰‹‡‡”‹‰•–—†‹‡•Šƒ˜‡„‡‡
‘’Ž‡–‡†–‘•—’’‘”––Š‡ƒ††‹–‹‘‘ˆ–Š‡
”‘—†ƒ„‘—–•‹–‘–Š‡†‡•‹‰ƒ†–‘‡‡––Š‡
‘•–”—
–‹‘‰”ƒ–ˆ—†‹‰†‡ƒ†Ž‹‡•ǤŠ‡
ƒ††‹–‹‘ƒŽ”‡“—‹”‡†‹˜‡•–‹‰ƒ–‹‘•Šƒ˜‡‹
Ž—†‡†ǣ
•
–‡”•‡
–‹‘‘–”‘Ž˜ƒŽ—ƒ–‹‘•ȋ
Ȍ
•

‹‰Š™ƒ›ƒˆ‡–›ƒ—ƒŽȋ
ȌƒŽ›•‹•
• ‘—†ƒ„‘—–’‡”ˆ‘”ƒ
‡
Š‡
•
• ƒŽ›•‹•ƒ†‘—–”‡ƒ
Šˆ‘””‘—†ƒ„‘—–•ƒˆ‡–›ˆ‘”–Š‡˜‹•—ƒŽŽ›‹’ƒ‹”‡†
• 
‹ƒŽȀŠ‡”ƒ‘—†ƒ„‘—–‘”–Š„‘—†–Š”‘—‰Š‘˜‡‡–ƒƒŽ›•‹• • ††‹–‹‘ƒŽ•—”˜‡›ȋ
ƒ•–ƒ–‹‘ƒ”
‡Žƒ–Š‡”ƒȀ
‹ƒŽȌ
• ‘‘”†‹ƒ–‹‘™‹–Šƒ–‹˜‡‡”‹
ƒ–”‹„‡•–‘‹
Ž—†‡”‡
‘‡†‡†ƒ–‹˜‡’Žƒ–
•’‡
‹‡•‹–Š‡”‘—†ƒ„‘—–Žƒ†•
ƒ’‡ƒ”‡ƒ•Ǥ
• –‹Ž‹–›
‘‘”†‹ƒ–‹‘–‘‡˜ƒŽ—ƒ–‡ƒ†”‡•‘Ž˜‡
‘ˆŽ‹
–•™‹–Š”‘—†ƒ„‘—–†‡•‹‰

‘’‘‡–••—
Šƒ•ˆ—ŽŽǦ†‡’–Š’ƒ˜‡‡–”‡
‘•–”—
–‹‘ǡ‡™•–”‡‡–Ž‹‰Š–‹‰ƒ†
†”ƒ‹ƒ‰‡•›•–‡‘†‹ˆ‹
ƒ–‹‘•Ǥ
• ”ƒ‹ƒ‰‡ƒƒŽ›•‹•ƒ••‘
‹ƒ–‡†™‹–Š”‘—†ƒ„‘—–
‘•–”—
–‹‘‹
Ž—†‹‰•‹–‹‰ƒ†
•‹œ‹‰‡™
‘˜‡›ƒ
‡•ǡ‹Ž‡–•ǡƒ†‰”‡‡‹ˆ”ƒ•–”—
–—”‡ˆƒ
‹Ž‹–‹‡•Ǥ
ϴ͘
ŶŐŝŶĞĞƌŝŶŐWůĂŶƐ͕^ƉĞĐŝĨŝĐĂƚŝŽŶƐĂŶĚ
ƐƚŝŵĂƚĞƐ
Š‡’”‘Œ‡
–†‡•‹‰Šƒ•„‡‡”‡˜‹•‡†–‘‹
‘”’‘”ƒ–‡—’–‘ˆ‘—”‡™”‘—†ƒ„‘—–•ƒ––Š”‡‡
‡š‹•–‹‰•‹‰ƒŽ‹œ‡†‹–‡”•‡
–‹‘•ƒ†‘‡•–‘’
‘–”‘ŽŽ‡†‹–‡”•‡
–‹‘Ǥ—‡–‘Ž‹‹–‡†

‘•–”—
–‹‘ˆ—†‹‰ǡ‘‡‘”‘”‡‘ˆ–Š‡”‘—†ƒ„‘—–•™‹ŽŽ„‡
‘•–”—
–‡††—”‹‰ƒˆ—–—”‡
’Šƒ•‡ƒ†–Š‡ƒ••‘
‹ƒ–‡††‡•‹‰™‹ŽŽ„‡Ž‹‹–‡†–‘–Š‡’”‡Ž‹‹ƒ”›Ž‡˜‡Žȋƒ’’”‘š‹ƒ–‡Ž›͵Ͳ ’‡”
‡–†‡•‹‰ȌǤ ‘”–Š‡ˆ—–—”‡’Šƒ•‡”‘—†ƒ„‘—–•ǡ‹–‡”‹†‡•‹‰•™‹ŽŽ„‡†‡˜‡Ž‘’‡†–‘

‘ˆ‘”–Š‡‹–‡”•‡
–‹‘•™‹–Š–Š‡‘–Š‡”’”‘’‘•‡†‹’”‘˜‡‡–•ǡ•—
Šƒ•Žƒ‡”‡†—
–‹‘•
ƒ†‡™„‹‡ˆƒ
‹Ž‹–‹‡•Ǥ‘•–‡•–‹ƒ–‹‰•—’’‘”–™‹ŽŽ„‡’”‘˜‹†‡†–‘•—’’‘”––Š‡’—”•—‹–‘ˆ ƒ††‹–‹‘ƒŽ‰”ƒ–ˆ—†‹‰ˆ‘”—ˆ—†‡†”‘—†ƒ„‘—–•Ǥ
Š‡ƒ††‹–‹‘ƒŽ”‘—†ƒ„‘—–†‡•‹‰ˆ‡ƒ–—”‡•ƒ”‡‹
Ž—†‡†‹‡ƒ
Š†‡•‹‰‹Ž‡•–‘‡ȋ͵ͷΨǡ
͸ͷΨǡͻͷΨǡͳͲͲΨƒ†–Š‡ˆ‹ƒŽ„‹††‹‰†‘
—‡–•ȌǤ
••—’–‹‘ȋ•Ȍǣ
• Š‡”‘—†ƒ„‘—–†‡•‹‰
‘’‘‡–•™‹ŽŽ”‡“—‹”‡ƒƒ††‹–‹‘ƒŽˆ‹˜‡•Š‡‡–•‘ˆ
†‡•‹‰†”ƒ™‹‰•’‡””‘—†ƒ„‘—–ˆ‘”ƒ–‘–ƒŽ‘ˆ—’–‘–™‡–›ƒ††‹–‹‘ƒŽ•Š‡‡–•Ǥ ‡Ž‹˜‡”ƒ„Ž‡ȋ•Ȍǣ







 












 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 7 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗W^Θ
WŚĂƐĞ •^ĐŽƉĞŽĨtŽƌŬ



• ƒ‡Ƭ•—„‹––ƒŽ•ƒ•†‡•
”‹„‡†‹–Š‡‘”‹‰‹ƒŽ•
‘’‡ǡ”‡˜‹•‡†™‹–Š”‘—†ƒ„‘—–
†‡•‹‰•Ǥ
ϵ͘ŽŶƐƚƌƵĐƚŝŽŶŝĚ^ƵƉƉŽƌƚ
‘
Šƒ‰‡•ƒ”‡‡‡†‡†ˆ‘”–Š‹•–ƒ•Ǥ
ϭϬ͘
ŶŐŝŶĞĞƌŝŶŐ^ĞƌǀŝĐĞƐƵƌŝŶŐŽŶƐƚƌƵĐƚŝŽŶ
‹–Š™‹ŽŽ’”‘˜‹†‡
‘•–”—
–‹‘‡‰‹‡‡”‹‰•—’’‘”–ˆ‘”–Š‡’”‘Œ‡
–‹
Ž—†‹‰ƒ•Ǧ
‡‡†‡†‘Ǧ•‹–‡•—’’‘”––‘–Š‡‹–›ˆ‘”
Žƒ”‹ˆ›‹‰†‡•‹‰‹••—‡•ǡ˜‡”‹ˆ›‹‰
‘’Ž‹ƒ
‡™‹–Š
–Š‡
‘–”ƒ
–†‘
—‡–•ǡƒ††”‡••‹‰”‡“—‡•–•ˆ‘”‹ˆ‘”ƒ–‹‘ȋ
•Ȍǡ”‡˜‹‡™‹‰
‘–”ƒ
–‘”
•—„‹––ƒŽ•ǡƒ†‡˜ƒŽ—ƒ–‹‰ƒ†’”‘
‡••‹‰
‘•–”—
–‹‘
Šƒ‰‡‘”†‡”•Ǥ‹–Š™‹ŽŽ
•—’’‘”––Š‡‹–›ǯ•‹†‡’‡†‡–™‹–Š‡‰‹‡‡”‹‰”‡Žƒ–‡†•‡”˜‹ ‡•–‘ˆƒ
‹Ž‹–ƒ–‡–Š‡‹”
ƒƒ‰‡‡–‘ˆ–Š‡’”‘Œ‡
–ǯ•
‘•–”—
–‹‘Ǥ
&ŝĞůĚsŝƐŝƚƐ
‹–Š™‹ŽŽ
‘†—
–‘–ŠŽ›ǡȋ—’–‘‡‹‰Š–‡‡Ȍǡ•‹–‡˜‹•‹–•–‘ƒ•™‡”†‡•‹‰”‡Žƒ–‡† “—‡•–‹‘•ƒ†•—’’‘”––Š‡‹–›ǯ•‘Ǧ•‹–‡”‡’”‡•‡–ƒ–‹˜‡‹‘„•‡”˜‹‰–Š‡‘–”ƒ –‘”ǯ•
™‘”ˆ‘”
‘ˆ‘”ƒ
‡™‹–Š–Š‡‘–”ƒ
–‘
—‡–•ǤŠ‡‹–›ǯ•™‹ŽŽŠƒ˜‡’”‹ƒ”›
”‡•’‘•‹„‹Ž‹–›‹‘„•‡”˜‹‰
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‹Ž‹–‹‡•’”‹‘”–‘„—”‹ƒŽǡ‘„•‡”˜‹‰–‡•–•”‡“—‹”‡†
–‘„‡’‡”ˆ‘”‡†„›–Š‡‘–”ƒ
–‘”‘””‡ˆ‡”‡
‡†‹–Š‡
‘–”ƒ
–†‘
—‡–•ƒ†ƒ

‡’–‹‰
™‘”
‘’Ž‡–‡†„›–Š‡‘–”ƒ
–‘”Ǥ

‹–Š™‹ŽŽ
‘‘”†‹ƒ–‡™‹–Š‹–›ƒ†•–ƒˆˆ–‘
‘„‹‡–Š‡ˆ‹‡Ž†˜‹•‹–•™‹–Š

‘•–”—
–‹‘’”‘‰”‡••‡‡–‹‰•ƒ†‘–Š‡”
‘•–”—
–‹‘‡‡–‹‰•–‘”‡˜‹‡™–Š‡’”‘Œ‡
–
•–ƒ–—•ǡ•—„‹––ƒŽ“—‡•–‹‘•ǡ
ǯ•ǡǯ•ǡƒ†–Š‡‘–”ƒ
–‘”ǯ•
‘•–”—
–‹‘•
Š‡†—Ž‡Ǥ

ƒ
Š•‹–‡˜‹•‹–™‹ŽŽ„‡†‘
—‡–‡†™‹–Š’Š‘–‘‰”ƒ’Š•ƒ†™”‹––‡‘–‡•–‘‹ŽŽ—•–”ƒ–‡ƒ† †‡•
”‹„‡‹–‡•–Šƒ–™‡”‡‹•’‡
–‡†ƒ†Ȁ‘”†‹•
—••‡†ƒ†–‘†‘
—‡–†‡
‹•‹‘•ƒ†‡‘”
†‹”‡
–‹‘’”‘˜‹†‡†–‘–Š‡‘–”ƒ
–‘”ǤŠ‡‘•—Ž–ƒ–•ŠƒŽŽƒŽ•‘ƒ‹–ƒ‹ƒ
‘’›‘ˆ
”‡†Ž‹‡††”ƒ™‹‰ƒ”—’•–‘†‘
—‡–‘„•‡”˜‡††‡•‹‰†‡˜‹ƒ–‹‘•
 ^tWWWŵĞŶĚŵĞŶƚƐ
‹–Š™‹ŽŽ’”‘˜‹†‡ƒ—ƒŽ‹ˆ‹‡†‡˜‡Ž‘’‡”ȋȌ–‘’”‡’ƒ”‡–‘”™ƒ–‡” ‘ŽŽ—–‹‘”‡˜‡–‹‘ŽƒȋȌƒ‡†‡–•–‘†‘
—‡–‘†‹ˆ‹
ƒ–‹‘•–‘–Š‡

‘•–”—
–‹‘•‹–‡•–‘”™ƒ–‡””—‘ˆˆ
‘–”‘Ž•–Šƒ–ƒ”‡†‡–‡”‹‡†–‘„‡‡
‡••ƒ”›„›–Š‡
†‡•‹‰ƒ–‡†—ƒŽ‹ˆ‹‡†”ƒ
–‹–‹‘‡”ȋȌǡ‘”‘–Š‡”“—ƒŽ‹ˆ‹‡†‹†‹˜‹†—ƒŽǤ
ƒ‡†‡–•™‹ŽŽ„‡’”‘˜‹†‡†–‘–Š‡‘–”ƒ
–‘”ˆ‘”‹•‡”–‹‘‹–‘–Š‡‘•‹–‡ƒ†
•—„‹––‡†–‘–Š‡‹–›ˆ‘”—’Ž‘ƒ†–‘–Š‡–‘”™ƒ–‡”—Ž–‹’’Ž‹ ƒ–‹‘ƒ†‡’‘”–”ƒ
‹‰
›•–‡ȋȌǤ
–ƒ••—‡†–Šƒ––Š‡‹–›ǯ•†‡•‹‰ƒ–‡†‡‰ƒŽŽ›‡•’‘•‹„Ž‡‡”•‘ ȋȌǡ™‹ŽŽƒƒ‰‡
‘’Ž‹ƒ
‡”‡Žƒ–‡†•—„‹––ƒŽ•ˆ‘”–Š‡
‡‡”ƒŽ‘•–”—
–‹‘
‡”‹–‹
Ž—†‹‰•—„‹––‹‰–Š‡
ƒ†Ǥ







 












 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 8 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ůĂŵĞĚĂĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗ŵĞŶĚŵĞŶƚϯ •^ĐŽƉĞŽĨtŽƌŬ 

ZĞƋƵĞƐƚƐĨŽƌ/ŶĨŽƌŵĂƚŝŽŶ;Z&/ƐͿ
‹–Š™‹ŽŽ’”‘˜‹†‡
Žƒ”‹ˆ‹
ƒ–‹‘ƒ†‹–‡”’”‡–ƒ–‹‘‘ˆ†”ƒ™‹‰•ƒ†•’‡
‹ˆ‹
ƒ–‹‘•ǡƒ•
”‡“—‡•–‡†„›–Š‡‹–›‘”ǡ‹”‡•’‘•‡–‘”‡“—‡•–•ˆ‘”‹ˆ‘”ƒ–‹‘ȋ •Ȍˆ”‘–Š‡
‘–”ƒ
–‘”Ǥ‹–Š™‹ŽŽ”‡˜‹‡™
•ƒ†™‘”™‹–Š–Š‡‘–”ƒ
–‘”ǡ–Š‡‹–›ƒ†‘–Š‡”•
ƒ•‡‡†‡†ǡ–‘†‡˜‡Ž‘’ƒ’’”‘’”‹ƒ–‡™”‹––‡
Žƒ”‹ˆ‹
ƒ–‹‘•Ǥ‡•‹‰
Žƒ”‹ˆ‹
ƒ–‹‘••ŠƒŽŽ„‡

‘‘”†‹ƒ–‡†™‹–Š–Š‡‹–›ǯ•‘Ǧ•‹–‡”‡’”‡•‡–ƒ–‹˜‡ƒ†‘–Š‡”•–ƒˆˆ–‘ƒ††”‡••“—‡•–‹‘• ”ƒ‹•‡†„›–Š‡‘–”ƒ
–‘”ǡ˜‡†‘”•ǡ‹–›•–ƒˆˆǡ”‡‰—Žƒ–‘”•ǡƒ†‘–Š‡”•Ǥ
••ŠƒŽŽ„‡
•—„‹––‡†–‘–Š‡™Š‘™‹ŽŽ–Š‡†‡–‡”‹‡™Š‡–Š‡”‘•—Ž–ƒ–•—’’‘”–‹•”‡“—‹”‡†–‘ †‡˜‡Ž‘’ƒ”‡•’‘•‡Ǥ
ŽŶƐƚƌƵĐƚŝŽŶŚĂŶŐĞKƌĚĞƌƐ
•”‡“—‡•–‡†„›–Š‡‹–›ǡ‹–Š™‹ŽŽƒ••‹•–‹‡˜ƒŽ—ƒ–‹‰ Šƒ‰‡†
‘†‹–‹‘•ǡ

‘•–”—
–‹‘
‘–”ƒ
–”‡“—‹”‡‡–•ǡƒ†’”‡’ƒ”‹‰†‘
—‡–ƒ–‹‘ƒ†”‡˜‹•‡††‡•‹‰
‹ˆ‘”ƒ–‹‘–‘•—’’‘”–
‘•–”—
–‹‘
Šƒ‰‡‘”†‡”•–‘„‡‹
‘”’‘”ƒ–‡†‹–‘–Š‡
‘–”ƒ
–Ǥ
‹–Š™‹ŽŽ’”‡’ƒ”‡‘””‡˜‹‡™†‘
—‡–ƒ–‹‘ƒ•”‡“—‡•–‡†„›–Š‡‹–›Ǥ
–‹
‹’ƒ–‡†ƒ••‹‰‡–•ƒ›‹
Ž—†‡ǣƒ••‹•–ƒ
‡‹’”‡’ƒ”‹‰”‡“—‡•–•–‘–Š‡‘–”ƒ
–‘”
ˆ‘”’”‘’‘•ƒŽ•ˆ‘”‡š–”ƒ‘”
Šƒ‰‡†™‘”Ǣ‡˜ƒŽ—ƒ–‹‰
‘–”ƒ
–†‘
—‡–•–‘†‡–‡”‹‡‹ˆƒ
‹•ƒ’’”‘’”‹ƒ–‡Ǣ’”‡’ƒ”ƒ–‹‘‘ˆ
‘•–‡•–‹ƒ–‡•ƒ†”‡˜‹‡™‘ˆ‘–”ƒ
–‘”ǯ•’”‘’‘•‡†

‘•–•Ǥ”‡’ƒ”ƒ–‹‘‘ˆ•ƒŽŽ†”ƒ™‹‰•ǡ•‡–
Š‡•‘”•’‡
‹ˆ‹
ƒ–‹‘•ˆ‘”‡š–”ƒ‘”
Šƒ‰‡†™‘”
‹–‡•ƒ›„‡’”‡’ƒ”‡†—†‡”–Š‹•–ƒ•Ǥ
^ƵďŵŝƚƚĂůƐ
‹–Š™‹ŽŽ’”‘˜‹†‡–Š‡™‹–Š•—„‹––ƒŽ”‡˜‹‡™•ƒ•”‡“—‡•–‡†„›–Š‡‹–›Ǥ —„‹––ƒŽ•™‹ŽŽ„‡•
”‡‡‡†–‘†‡–‡”‹‡–Š‡‹”
‘’Ž‡–‡‡••„‡ˆ‘”‡”‡˜‹‡™‹‰–Š‡ȋ‘”
ˆ‘”™ƒ”†‹‰–Š‡–‘–Š‡†‡•‹‰‡”ˆ‘””‡˜‹‡™ȌǤ—„‹––ƒŽ•†‡–‡”‹‡†–‘„‡‹ ‘’Ž‡–‡™‹ŽŽ
„‡”‡–—”‡†–‘–Š‡‘–”ƒ
–‘”ˆ‘”
‘””‡
–‹‘Ǥ—„‹––ƒŽ•™‹ŽŽ„‡”‡˜‹‡™‡†ƒ†™”‹––‡
”‡•’‘•‡•’”‘˜‹†‡†™‹–Š
‘‡–•ǡƒ†”‡
‘‡†ƒ–‹‘•ȋ‡Ǥ‰Ǥ‘‡š
‡’–‹‘•‘–‡†ǡ
ƒ‡†ƒ†”‡•—„‹–ȌǤ—„‹––ƒŽ”‡˜‹‡™™‹ŽŽ†‡–‡”‹‡‹ˆ–Š‡‹–‡•™‹ŽŽǡƒˆ–‡”’”‘’‡” ‹•–ƒŽŽƒ–‹‘ƒ†‹
‘”’‘”ƒ–‹‘‹–Š‡™‘”ǡ
‘ˆ‘”–‘–Š‡”‡“—‹”‡‡–•‘ˆ–Š‡

‘•–”—
–‹‘‘–”ƒ
–‘
—‡–•ƒ†„‡
‘’ƒ–‹„Ž‡™‹–Š–Š‡†‡•‹‰
‘
‡’–‘ˆ–Š‡

‘’Ž‡–‡†’”‘Œ‡
–ƒ•ƒˆ—
–‹‘‹‰™Š‘Ž‡Ǥ—„‹––ƒŽ”‡˜‹‡™ƒ†ƒ’’”‘˜ƒŽ™‹ŽŽ‘–‡š–‡† –‘‡ƒ•ǡ‡–Š‘†•ǡ–‡
Š‹“—‡•ǡ•‡“—‡
‡•‘”’”‘
‡†—”‡•‘ˆ
‘•–”—
–‹‘ȋ‡š
‡’–™Š‡”‡ƒ
’ƒ”–‹
—Žƒ”‡ƒ•ǡ‡–Š‘†ǡ–‡
Š‹“—‡ǡ•‡“—‡
‡‘”’”‘
‡†—”‡‘ˆ
‘•–”—
–‹‘‹•
•’‡
‹ˆ‹
ƒŽŽ›ƒ†‡š’”‡••Ž›
ƒŽŽ‡†ˆ‘”„›–Š‡
‘•–”—
–‹‘‘–”ƒ
–‘
—‡–•Ȍ‘”–‘•ƒˆ‡–›
’”‡
ƒ—–‹‘•‘”’”‘‰”ƒ•‹
‹†‡––Š‡”‡–‘Ǥ—„•–‹–—–‹‘•‘ˆ‡“—‹’‡–ǡƒ–‡”‹ƒŽ•ǡ‘” ‡–Š‘†•Ǣƒ†‹‘”†‡•‹‰
Šƒ‰‡•’”‘’‘•‡†„›–Š‡‘–”ƒ
–‘”•ŠƒŽŽƒŽ•‘„‡”‡˜‹‡™‡†
—†‡”–Š‹•–ƒ•Ǥ
ŽŵƉŝůĞĂŶĚ^Ƶďŵŝƚ&ŝŶĂůWƌŽũĞĐƚŽĐƵŵĞŶƚƐ
‹–Š™‹ŽŽ’”‘˜‹†‡–Š‡‹–›™‹–Šƒ•‡–‘ˆ’”‘Œ‡
–”‡
‘”††‘
—‡–•Ǥ–ƒ‹‹—ǡ
–Š‡•‡™‹ŽŽ‹
Ž—†‡ˆ‹‡Ž†”‡’‘”–•ƒ†’Š‘–‘‰”ƒ’Š•ǡ‡‡–‹‰‘–‡•ƒ†‘–Š‡”

‘””‡•’‘†‡
‡ǡƒ††‘
—‡–ƒ–‹‘‘ˆ•—„‹––ƒŽ•ǡ
•ǡƒ†•–Šƒ–™‡”‡”‡˜‹‡™‡†‘”
’”‡’ƒ”‡†Ǥ”‘Œ‡
–‡
‘”†”ƒ™‹‰•™‹ŽŽƒŽ•‘„‡†‡˜‡Ž‘’‡†ƒ†•—„‹––‡†ƒ•†‡• ”‹„‡†
„‡Ž‘™Ǥ







 












 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 9 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ĞŶƚƌĂůǀĞŶƵĞ^ĂĨĞƚLJ/ŵƉƌŽǀĞŵĞŶƚWƌŽũĞĐƚ͗W^Θ
WŚĂƐĞ •^ĐŽƉĞŽĨtŽƌŬ



ĞǀĞůŽƉZĞĐŽƌĚƌĂǁŝŶŐƐ
‹–Š™‹ŽŽ”‡˜‹‡™–Š‡‘–”ƒ
–‘”ǯ•™‘”‹‰”‡
‘”††”ƒ™‹‰ƒ”—’•ˆ‘”‰‡‡”ƒŽ

‘’Ž‡–‡‡••ƒ†ƒ†˜‹•‡–Š‡‘–”ƒ
–‘”‘ˆƒ††‹–‹‘•‘”
Žƒ”‹ˆ‹
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 11 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 ABCEFHolder Identifier :                                      
                                  Certificate No : 570096406688

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)
11/08/2022
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

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COVERAGES CERTIFICATE NUMBER: 570096406688 REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO D INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested

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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.







 















 

 
DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 12 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE
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ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance EFFECTIVE DATE:

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ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 13 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 3URIHVVLRQDO/LDE3ROLF\36'()
AGENCY CUSTOMER ID:

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THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance EFFECTIVE DATE:

CARRIER NAIC CODE

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Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 
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DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 21 OF 22
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 Certification of Compliance
With the City of Alameda’s Vaccination Requirement
The City of Alameda (“City”) requires all individuals who perform work for the City to be fully vaccinated1 against COVID-19. All service providers and contractors for the City must sign the following statement certifying compliance with this requirement.

By signing below, I certify that all of our personnel who are performing work for the City are fully vaccinated against COVID-19. I also acknowledge that the City reserves the right to review any relevant records to demonstrate our compliance with this requirement.

I declare under penalty of perjury that the foregoing is true and correct.

CDM Smith, Inc. Date: November 14, 2022
By: William E. Hurrell, P.E.

Its Vice President
1 For the purposes of this Certification of Compliance, an individual is considered to be fully vaccinated if two weeks have passed since their second dose in a 2-dose series (such as the Pfizer or Moderna vaccines) or if two weeks have passed since receiving their single-dose vaccine (such as Johnson & Johnson’s Janssen vaccine). 







 

 
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Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 11 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 12 OF 26
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Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 14 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 15 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 16 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 17 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 18 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 19 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 20 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 21 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 22 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 23 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 24 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 25 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63 DocuSign Envelope ID: 6968BCCB-E112-4E0D-84C9-EB122F4654DE 26 OF 26
Docusign Envelope ID: 5DB776A9-1710-49B7-8024-11A369DE6C63