(2023-153-82
AMENDMENT NO. 2 TO THE PROFESSIONAL
SERVICES AGREEMENT BETWEEN THE
CITY OF MANTECA AND DEWBERRY ENGINEERS, INC.
This Amendment No. 2 ("Amendment") to Agreement #C2023-153 ("Agreement") is made and entered into this I day of ptember 202, by and between Dewberry Engineers, Inc., a California corporation ("Consultant") and the City of Manteca, a public body, corporate and politic ("City").
RECITALS
A. On December 7, 2023, the City of Manteca approved an Agreement with Consultant to provide professional services for construction management and inspection services for the Retroreflective Traffic Sign Project (CIP 16027/HSIPL 5242-033).
B. City now desires to amend the Agreement in order to include additional scope and fee to be undertaken by Consultant.
Consultant represents that it has the necessary professional skills and experience to satisfactorily provide consulting services in a timely manner.
D. City desires to engage Consultant for the purposes of completing the scope of services identified.
NOW, THEREFORE, the parties hereby agree as follows:
Statement of Work. Attachment 1 to the Agreement is hereby amended by adding the tasks set forth in Attachment 1 to this Amendment, attached hereto and incorporated herein by reference, , "Statement of Work and Activities #2".
Paragraph 4 of the Agreement is hereby amended to read as follows:
Compensation. Compensation to be paid to Consultant shall be in accordance with the Schedule of Charges set forth in Attachment 1, which is incorporated herein by reference. In addition to the Compensation for the Agreement and Amendment No. 1, compensation for Amendment No. 2 services shall in no event exceed $30,000.00 (THIRTY THOUSAND DOLLARS) without additional authorization from the City. In no event shall total compensation for work performed pursuant to this Agreement, Amendment No. 1, and Amendment No. 2 exceed $340,800.35 (THREE HUNDRED FORTY THOUSAND EIGHT HUNDRED DOLLARDS AND THIRTY-FIVE CENTS) without additional authorization from the City. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to the City at the time of payment."
1 Except as otherwise provided in this Amendment, the Agreement shall continue in full force and effect.
THIS SPACE INTENTIONALLY LEFT BLANK
2 TO EFFECTUATE THIS AMENDMENT, each of the parties has caused this Agreement to be executed by its duly authorized representative as of the date set forth in the introductory paragraph on page 1 above.
CITY OF MANTECA: CONSULTANT:
Dewberry Engineers Inc.
(Type name of Consultant/form of organization)
OT OF MATER Root fije
ATTEST: By: 8/16/2024
(Signature)
Rob Shackelford, PE, Assoc Vice President
Cassandra Candini-Tilton, (Type name and title)
Director of Legislative Services
COUNTERSIGNED By: Rost fil 8/16/2024
(Signature)
Rob Shackelford, Associate Vice President
Shay Narayan Adriana Taylor (Type name and title)
sitester of mana Revenue Me hay Nagan on behalf of
COUNTERSIGNED: Address: Dewberry Engineers Inc.
11060 White Rock Road
Itephanie Van fleyn Rancho Cordova, CA 95670
Stephanie Van Steyn,
Director of Human Resources Telephone: 925-808-9927
APPROVED AS TO FORM:
L. David Nefouse, City Attorney
Danielła Green, Assistant City Attorney
3 ATTACHMENT 1
STATEMENT OF WORK AND ACTIVITIES #2
Dewberry Engineers Inc. | 209.707.3330
• Dewberry®
903 West Center Street, Suite 1 www.dewberry.com
Manteca, CA 95337-7315
August 14, 2024
Beshoy Demyan, PE, Senior Engineer
City of Manteca
Engineering Department
1001 W. Center St.
Manteca, CA 95337
RE: Dewberry Request for Budget Amendment No. 2
Dear Beshoy,
Dewberry is requesting a second amendment to increase the CM contract budget due to the project running longer than originally anticipated. The City has indicated that the project may run as late as September 28, 2024. This second amendment will allow us to continue with our scope of services as agreed to in the contract. The request allows for an additional two to three weeks of construction nanagement services, depending on the number of crews used by the contractor and whether they continue to work overtime and weekends, which were not anticipated in our original scope.
Dewberry requests the following:
Estimated completion September 28, 2024 Hours Rate *
Additional RE time 20 hrs. $254.00/hr. $5,080.00
Additional Inspector time 70 hrs. $185.00/hr. $12,950.00 Additional Inspector OT 35 hrs. $206.00/hr. $7,210.00
Additional time for DBE sub (VSCE) ump sum $2,255.00 $4,255.00 Additional GIS time 5 hrs. $101.00/hr. $505.00
Total additional budget amount requested by amendment $30,000.00 *Includes 7/1/24 escalation per original agreement
We respectfully request an amendment in the amount of $30,000.00 per the above summary. Should the City choose not to issue an amendment, Dewberry seeks direction from the City as to how it wishes to proceed.
Please contact me if you have any questions.
Sincerely,
Rot fife
Rob Shackelford, PE, CCM
Project Manager/Associate Vice President
ACORD® DATE (MM/DDAYYY)
CERTIFICATE OF LIABILITY INSURANCE
06/26/2024
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement • is certificate does not confer rights to the certificate holder in lieu of such endorsement:
CONTACTI
PRODUCERARSH USA, LLC. NAME: Ashley Oliver
PHONE 410 347 3631 TAIC, No):
1050 CONNECTICUT AVENUE, SUITE 700 (A/C. No. Ext):
WASHINGTON, DC 20036-5386 E-MAIL
ADDRESS: Ashley. [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
CN102736896-7/1-1.1a-24-25 GAWP INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURER B: The Travelers Indemnity Company Of America 25658 DEWBERRY ENGINEERS INC.
11060 WHITE ROCK ROAD, SUITE 200 INSURER C: Travelers Property Casualty Co. Of America 25674 RANCHO CORDOVA, CA 95670 37540
INSURER D: Beazley Insurance Company, Inc.
INSURER E: N/A N/A
INSURER F:
COVERAGES CERTIFICATE NUMBER: CLE-007074406-05 REVISION NUMBER: 19
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD EXCLUSONS AND CONTIN OF SUCH RICES ME SON I EN ROUGE BE PAD CARE HERE SURE TO A PIE EENS.
INSR |
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS
A X COMMERCIAL GENERAL LIABILITY x x/ P-630-7792B312-COF-24 07/01/2024 07/01/2025 EACH OCCURRENCE 5,000,000
DAMAGE TO RENTED
| CLAIMS-MADE |X OCCUR PREMISES (Ea occurrence) 1,000,000 X CONTRACTUAL INS. COV. MED EXP (Any one person) 10,000 (INSURED CONTRACTS) PERSONAL & ADV INJURY 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5,000,000 X POLICY LOC PRODUCTS - COMP/OP AGG 5,000,000
OTHER: COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY x x 810-1N788974-24-43-G 07701/2024 07/01/2025 2,000,000 (Ea accident
X ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED VON-OWNED
AUTOS ONLY AUTOS ONLY PT AREND MAGE
COMP / COLL DED: $ 1,000
UMBRELLA LIAB OCCUR CUP-4J583077-24-43 07/01/2024 07/01/2025 EACH OCCURRENCE 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE 5,000,000
DED RETENTIONS $
WORKERS COMPENSATION | UB-6P972264-24-43-G 07/01/2024 07/01/2025 X STATUTE
AND EMPLOYERS' LIABILITY Y/ N
ANYPROPRIETOR/PARTNER/EXECUTIVE N NIA E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED?
(Mandatory in NH) EL. DISEASE - EA EMPLOYEE S 1,000,000 /es, describe und
ESCRIPTION OF OPERATIONS belo E.L. DISEASE • POLICY LIMIT S 1,000,000 PROFESSIONAL LIABILITY V11B5E241501 07/01/2024 07/01/2025 PER CLAIM/AGGREGATE 5,000,000 RETRO. DATE: FULL PRIOR ACTS
ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requirec E: DEWBERRY PROJECT/JOB/PLN #50167471, BU2320, RETROREFLECTIVE TRAFFIC SIGN PROJEC
THE CITY, ITS ELECTED AND APPOINTED OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECT TO THE GENERAL LIABILITY, AUTO LIABILITY, AND UMBRELLA POLICIES. WAIVER OF SUBROGATION IS APPLICABLE WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECTS TO GENERAL LIABILITY, AUTO LIABILITY AND WORKERS COMPENSATION. THE GENERAL AND AUTO LIABILITY INSURANCE IS PRIMARY AND NON-CONTRIBUTORY OVER ANY EXISTING INSURANCE AND LIMITED TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED AND WHERE REQUIRED BY WRITTEN CONTRACT. CONTINUED ON ACORD 101
CERTIFICATE HOLDER CANCELLATION
CITY OF MANTECA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1001 WEST CENTER STREET, SUITE E THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MANTECA, CA 95337 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA LLC
Kabi A colorad
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102736896
LOC#: Washington
ACORD® ADDITIONAL REMARKS SCHEDULE Page 2_ of 2
AGENCY NAMED INSURED
MARSH USA, LLC. DEWBERRY ENGINEERS INC.
11060 WHITE ROCK ROAD, SUITE 200
POLICY NUMBER RANCHO CORDOVA, CA 95670
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Certificate of Liability Insurance CONTINUED FROM DESCRIPTION OF OPERATIONS:
UMBRELLA IS FOLLOW FORM OF PRIMARY SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS.
AS RESPECTS THE PROFESSIONAL LIABILITY COVERAGE EVIDENCED ABOVE, IF THIS POLICY IS CANCELLED BY THE INSURER, OTHER THAN FOR NON-PAYMENT OF PREMIUM, THE INSURER WILL PROVIDE 30 DAYS WRITTEN NOTICE TO CERTIFICATE HOLDER. AS RESPECTS THE GENERAL LIABILITY, AUTOMOBILE LIABILITY, AND WORKERS' COMPENSATION
COVERAGES EVIDENCED ABOVE, NOTICE OF CANCELLATION WILL BE PROVIDED BY THE INSURER(S) TO THE CERTIFICATE HOLDER PER THE ATTACHED AS REQUIRED BY WRITTEN CONTRACT.
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: P-630-7792B312-COF-24 ISSUE DATE: 06-24-24
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED - WRITTEN
CONTRACTS (ARCHITECTS, ENGINEERS AND
SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following is added to SECTION II - WHO IS plies only to such "bodily injury" or "property AN INSURED: damage" that occurs before the end of the pe riod of time for which the "written contract re
Any person or organization that you agree in a
"written contract requiring insurance" to include as quiring insurance" requires you to provide an additiona | insured on this Coverage Part, but: such coverage or the end of the policy period, whichever is earlier.
a. Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and 2. The following is added to Paragraph 4.a. of SEC-
TION IV - COMMERCIAL GENERAL LIABILITY
b. If, and only to the extent that, the injury or CONDITIONS:
damage is caused by acts or omissions of
you or your subcontractor in the performance The insurance provided to the additional insured of "your work" to which the "written contract is excess over any valid and collectible "other in- requiring insurance" applies. The person or surance", whether primary, excess, contingent or organization does not qualify as an additional on any other basis, that is available to the addi- insured with respect to the independent acts tional insured for a loss we cover. However, if you or omissions of such person or organization. specifically agree in the "written contract requiring insurance" that this insurance provided to the ad-
The insurance provided to such additional insured ditional insured under this Coverage Part must is limited as follows:
apply on a primary basis or a primary and non-
c. In the event that the Limits of Insurance of contributory basis, this insurance is primary to this Coverage Part shown in the Declarations "other insurance" available to the additional in- exceed the limits of liability required by the sured which covers that person or organization as "written contract requiring insurance", the in- a named insured for such loss, and we will not surance provided to the additional insured share with that "other insurance". But this insur- shall be limited to the limits of liability required ance provided to the additional insured still is ex- by that "written contract requiring insurance". cess over any valid and collectible "other insur- This endorsement shall not increase the limits ance", whether primary, excess, contingent or on of insurance described in Section III - Limits any other basis, that is available to the additional Of Insurance. insured when that person or organization is an d. This insurance does not apply to the render- additional insured under any "other insurance". ing of or failure to render any "professional 3. The following is added to SECTION IV - COM- services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS:
or omissions. Duties Of An Additional Insured
é. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi- jury" or "property damage" caused by "your tional insured:
work" and included in the "products-
completed operations hazard" unless the a. The additional insured must give us written "written contract requiring insurance" specifi- notice as soon as practicable of an "occur- cally requires you to provide such coverage rence" or an offense which may result in a for that additional insured, and then the insur- claim. To the extent possible, such notice should include:
ance provided to the additional insured ap-
CG D4 14 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 2
COMMERCIAL GENERAL LIABILITY
i. How, when and where the "occurrence" any provider of other insurance which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover. However, this condition does not affect persons and witnesses; and whether this insurance provided to the addi- tional insured is primary to that other insur-
iii. The nature and location of any injury or
ance available to the additional insured which
damage arising out of the "occurrence" or
offense. covers that person or organization as a
named insured
b. If a claim is made or "suit" is brought against
the additional insured, the additional insured 4. The following is added to the DEFINITIONS Sec- i. Immediately record the specifics of the "Written contract requiring insurance" means that claim or "suit" and the date received; and part of any written contract or agreement under which you are required to include a person or or-
il. Notify us as soon as practicable. ganization as an additional insured on this Cover- The additional insured must see to it that we age Part, provided that the "bodily injury" and receive written notice of the claim or "suit" as "property damage" occurs and the "personal in- soon as practicable. jury" is caused by an offense committed:
c. The additional insured must immediately send a. After the signing and execution of the contract us copies of all legal papers received in con- or agreement by you; nection with the claim or "suit", cooperate with b. While that part of the contract or agreement is us in the investigation or settlement of the
setene a of the in effect; and
claim or defense against the "suit", and oth-
erwise comply with all policy conditions. c. Before the end of the policy period. d. The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
UMBRELLA
POLICY NUMBER:CUP-4J583077-24-43 ISSUE DATE: 06/24/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT OF WHO IS AN INSURED - DESIGNATED
PERSON OR ORGANIZATION AS REQUIRED BY
WRITTEN CONTRACT OR AGREEMENT - COVERAGE A
This endorsement modifies insurance provided under the following:
EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE
SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS
ANY PERSON OR ORGANIZATION THAT YOU AGREE IN A WRITTEN CONTRACT TO INCLUDE AS AN ADDITIONAL INSURED ON THIS POLICY, PROVIDED THAT SUCH WRITTEN CONTRACT: 1. WAS SIGNED AND EXECUTED BY YOU BEFORE, AND IS IN EFFECT WHEN, THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS OR THE "PERSONAL INJURY" OFFENSE IS COMMITTED; AND 2.
SPECIFICALLY REQUIRES THAT THE INSURANCE PROVIDED BY THIS POLICY TO SUCH PERSON
OR ORGANIZATION APPLY ON A PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBUTORY PROVISIONS a. The amount by which the minimum limits of The following is added to Paragraph A., COVERAGE insurance you agreed to provide such person or organization in that written contract or
A - EXCESS FOLLOW-FORM LIABILITY, of
agreement exceed the total limits of
SECTION II - WHO IS AN INSURED: of all applicable "underlying insurance
With respect to Coverage A, any person or insurance"; or organization qualifying insured in the b. The limits of insurance of this policy; "underlying insurance" and shown in the Schedule Of whichever is less; and Designated Persons Or Organizations also qualifies
2. Coverage under this policy does not apply to
insured. If you have agreed to provide
such person or organization if the minimum limits
insurance for that person or organization in a written of insurance you agreed to provide such person contract or agreement:
or organization in that written contract or
1. The limits of insurance afforded to such person agreement are wholly within the total limits of or organization will be: insurance of all available applicable "underlying insurance"
EU 02 97 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1
COMMERCIAL AUTO
POLICY NUMBER: 810-1N788974-24-43-G ISSUE DATE: 06-21-24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
VIRGINIA BLANKET CANCELLATION
AND NONRENEWAL NOTICE
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
AUTO DEALERS COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
In the event of cancellation or nonrenewal or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or nonrenewal or material change to:
SCHEDULE
Can plation or again ton oftis pohale green, bunder any contract or agreement that notice of
1. Yrga stead on, a ter the rest samed insured receives nice from us he cancelation or cheese material change of this policy; and
2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement.
3. Number of days advance notice:
Cancellation for nonpayment of premium: Days
Cancellation other than nonpayment of premium: 30 Days
Nonrenewal: Days
Material change: Days
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CA F2 36 03 21 © 2021 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
POLICY NUMBER: P-630-7792B312-COF-24 ISSUE DATE: 06-24-24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED PERSON OR ORGANIZATION - NOTICE OF
CANCELLATION PROVIDED BY US
This endorsement modifies insurance provided under the following:
ALL COVERAGE PARTS INCLUDED IN THIS POLICY
SCHEDULE
CANCELLATION: Number of Days Notice: 30
PERSON OR
ORGANIZATION:
ANY PERSON OR ORGANIZATION
(CONTINUED ON IL T8 06)
ADDRESS:
SEE IL T8 06
FAIRFAX
VA
22031
PROVISIONS
IL T4 05 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 POLICY NUMBER: P-630-7792B312-COF-24 GENERAL PURPOSE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULEX.
DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US IL T4 05 05 19
THIS ENDORSRMENT MODIFIES INSURANCE PROVIDED VADER TAB FOLLOWING:
ALL COVERAGE PARTS INCLUDED IN THIS POLICY
CONTINUATION OF FORM IL TA 05, PERSON OR ORGANIZAȚION:
ANY PERSON OR ORGANIZATION IO WHOM YOU HAVE AGREED IN & WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF:
1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE JAME
AND ADDRESS OF SUCH PERSON OR
ORGANIZATION, AFTER THE FIRST NAMED INSURED SHOW IN THE DECLARATIONS RECEIVES
NOTICE FROM US OF THE
CANCELLATION OF THIS POLICY; AND
2. NE RECEIVE SUCE WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINTING OF
THE APPLICABLE NUMBER OF DAYS
SHOWN IN THIS SCEEDULE.
ADDRESS:
THE ADDRESS FOR TEAT PERSON OR ORGANIZAIION INCLUDED IN SUCH MRITTEN REQUEST FROM YOU TO US.
IL T8 06 Page 1
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES
ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW
YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE
FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF
THE NEW YORK INSURANCE LAW AND REGULATIONS.
Effective date of this Endorsement: 01-Jul-2024
This Endorsement is attached to and forms a part of Policy Number: V115E241501 Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters"
DEWBERRY NOTICE OF CANCELLATION TO CERTIFICATE HOLDER
This endorsement modifies insurance provided under the following:
ARCHITECTS AND ENGINEERS PROFESSIONAL LIABILITY INSURANCE POLICY In consideration of the premium charged for the Policy, it is hereby understood and agread that in addition to the provisions of the Cancellation section of the Conditions, if this policy is cancelled by us, other thar for non-payment of premium, we will provide 30 days written notice to the following party(ies):
As per list to be provided by the Named Insured or its Broker of Record.
All other terms and conditions of this Policy remain unchanged. scene S
Authorized Representative
EDB005NYFTZ Page 1 of 1
032011 ed.
Class Code: 2-14180
WORKERS COMPENSATION
TRAVELERSJ EMPLOYERS LABILITY POLICY
ONE TOWER SQUARE
HARTFORD CT 06183 ENDORSEMENT WC 99 06 R4 (00) - 001
POLICY NUMBER: UB-6P972264-24-43-G
NOTICE OF CANCELLATION OR NONRENEWAL
TO DESIGNATED PERSONS OR ORGANIZATIONS
The following is added to PART SIX - CONDITIONS :
Notice Of Cancellation Or Nonrenewal To Designated Persons Or Organizations If we cancel or non-renew this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation or non-renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect.
You are responsible for providing us with the information necessary to accurately complete the Schedule below.
If we cannot mail or deliver a notice of cancellation or nonrenewal to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation or nonrenewal.
SCHEDULE
Name and Address of Designated Persons or Organizations: Number of Days Notice:
ANE PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NON RENEWAL OF THIS POLIC 30 WILL BE GIVEN, BUT ONLY IF:
1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQU
EST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS
ORGANIZATION, AFTER THE FIRST NA
MED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NON RENEWAL OF THIS POLICY; AND
2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE
BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT.
ADDRESS:
THE ADDRESS FOR THAT PERSON OR ORGA
NIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US.
All other terms and conditions of this policy remain unchanged.
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
DATE OF ISSUE: 06-21-24 ST ASSIGN: Page 1 ofi
© 2013 The Travelers Indemnity Company. All rights reserved.
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES
ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW
YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE
FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF
THE NEW YORK INSURANCE LAW AND REGULATIONS.
Effective date of this Endorsement: 01-Jul-2024
This Endorsement is attached to and forms a part of Policy Number: V11B5E241501 Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters"
REDUCED RETENTION ENDORSEMENT AND INDEMNITY AGREEMENT
This endorsement modifies insurance provided under the following:
ARCHITECTS AND ENGINEERS PROFESSIONAL LIABILITY INSURANCE POLICY In consideration of the premium charged for the Policy, it is hereby understood and agreed that as respects any "Claim" arising out of operations pursuant to a contract or agreement where the "Named Insured" has agreed by virtue of such contract or agreement that the Retention amount shall be less than the amount stated in Item No. 6 of the Declarations, then the amount of Self-Insured Retention applicable to such "Claim" shall be such lesser amount. and the Limits of Liability shown in Item 7 of the Declarations as respect such "Claim" shall be increased by the amount of the difference between the amount shown in Item No. 6 of the Declarations and such lesser amount.
In consideration of the issuance of this endorsement, the "Named Insured" hereby agrees to promptly indemnify us upon demand for the difference between the amount of Self-Insured Retention and such lower amount of Deductible or Retention as required by such contract or agreement, and to reimburse us for all costs, expenses and attorney's fees which may be incurred in enforcing this indemnity agreement.
All other terms and conditions of this Policy remain unchanged Gene s
Authorized Representative
EDWO17NYFTZ Page 1 of 1
082009 ed.
Class Code: 2-14180