Cities Index.
Original Agreement - CJ Concrete Construction

Redondo Beach City Council
August 1, 2023

Document
Original Agreement - CJ Concrete Construction
Meeting
August 1, 2023
Body
Redondo Beach City Council
Pages
17
Original file
3.5 MB
Text extracted from the city's file for reading and search. Open the original on redondo.legistar1.com. That file is the official record.

AGREEMENT FOR PROJECT SERVICES

BETWEEN THE CITY OF REDONDO BEACH
AND CJ CONCRETE CONSTRUCTION, INC.

THIS AGREEMENT FOR PROJECT SERVICES (this "Agreement") is made between the City of Redondo Beach, a chartered municipal corporation (" City") and CJ Concrete Construction, Inc., a California corporation (" Consultant" or "Contractor"). parties hereby agree as follows:

Description of Project or Scope of Services. The project description or scope of services to be provided by Contractor, and any corresponding responsibilities of City, or services required to be performed by City are set forth in Exhibit "A."

2. Term and Time of Completion. Contractor shall commence and complete the project or services described in Exhibit "A" in accordance with the schedule set forth in Exhibit "B".

3. Compensation. City agrees to pay Contractor for work performed in accordance with Exhibit "C".

GENERAL PROVISIONS
Independent Contractor. Contractor acknowledges, represents and warrants that Contractor is not a regular or temporary employee, officer, agent, joint venturer or partner of the City, but rather an independent contractor. This Agreement shall not be construed as a contract of employment. Contractor shall have no rights to any benefits which accrue to City employees unless otherwise expressly provided in this Agreement. Due to the independent contractor relationship created by this Agreement, the City shall not withhold state or federal income taxes, the reporting of which shall be Contractor's sole responsibility.

2. Brokers. Contractor acknowledges, represents and warrants that Contractor has not hired, retained or agreed to pay any entity or person any fee, commission, percentage, gift, or any other consideration, contingent upon or resulting from the award or making of this Agreement.

3. City Property. All plans, drawings, reports, calculations, data, specifications, videos, graphics or other materials prepared for or obtained pursuant to this Agreement shall upon request be delivered to the City within a reasonable time, and the rights thereto shall be deemed assigned to the City. If applicable, Contractor shall prepare check prints upon request. Said plans, drawings, reports, calculations, data, specifications, videos, graphics or other materials, shall be specific for the project herein and shall not be used by the City for any other project without Contractor's consent. Notwithstanding the foregoing, Contractor shall not be obligated to assign any proprietary software or data developed by or at the direction of Contractor for Contractor's own use; provided, however, that Contractor shall, pursuant to Paragraph 14 below, indemnify, defend and hold the City harmless from and against any discovery or Public Records Act request seeking the disclosure of any such proprietary software or data.

4. Inspection. If the services set forth in Exhibit "A" shall be performed on City or other public property, the City shall have the right to inspect such work without notice. If such services shall not be performed on City or other public property, the City shall have the right to inspect such work upon reasonable notice.

Inspections by the City shall not relieve or minimize the responsibility of Contractor to conduct any inspections Contractor has agreed to perform pursuant to the terms of this Agreement. Contractor shall be solely liable for said inspections performed by Contractor. Contractor shall certify in writing to the City as to the completeness and accuracy of each inspection required to be conducted by Contractor hereunder.

5. Services. The project or services set forth in Exhibit "A" shall be performed to the full satisfaction and approval of the City. In the event that the project or services set forth in Exhibit "A" are itemized by price in Exhibit "C", the City in its sole discretion may, upon notice to Contractor, delete certain items or services set forth in Exhibit "A", in which case there shall be a corresponding reduction in the amount of compensation paid to Contractor. City shall furnish Contractor to the extent available, with any City standards, details, specifications and regulations applicable to the Project and necessary for the performance of Contractor's services hereunder. Notwithstanding the foregoing, any and all additional data necessary for design shall be the responsibility of Contractor.

6. Records. Contractor, including any of its subcontractors shall maintain full and complete documents and records, including accounting records, employee time sheets, work papers, and correspondence pertaining to the project or services set forth in Exhibit "A". Contractor, including any of its subcontractors shall make such documents and records available for City review or audit upon request and reasonable notice, and shall keep such documents and records, for at least four 4) years after Contractor's completion of performance of this Agreement.

Copies of all pertinent reports and correspondence shall be furnished to the City for its files.

7. Changes and Extra Work. All changes and/ or extra work under this Agreement shall be performed and paid for in accordance with the following:

Only the City Council, City Manager, or the Department Head responsible for the administration of, or supervision of the scope of work under, this Agreement may 2 authorize extra and/ or changed work. Contractor expressly recognizes that other City personnel are without authorization to either order extra and/or changed work or waive contract requirements. Failure of Contractor to secure the written authorization for such extra and/or changed work shall constitute a waiver of any and all right to adjustment in contract price due to such unauthorized work and Contractor thereafter shall be entitled to no compensation whatsoever for performance of such work.

If Contractor is of the opinion that any work which Contractor has been directed to perform is beyond the scope of this Agreement and constitutes extra work, Contractor shall promptly notify the City of the fact. The City shall make a determination as to whether or not such work is, in fact, beyond the scope of this Agreement and constitutes extra work. In the event that the City determines that such work does constitute extra work, City shall provide extra compensation to Contractor on a fair and equitable basis. A written amendment providing for such compensation for extra work shall be executed by Contractor and the City.

8. Additional Assistance. If this Agreement requires Contractor to prepare plans and specifications, Contractor shall provide assistance as necessary to resolve any questions regarding such plans and specifications that may arise during the period of advertising for bids, and Contractor shall issue any necessary addenda to the plans and specifications as requested. In the event Contractor is of the opinion that City's requests for addenda and assistance is outside the scope of normal services, the parties shall proceed in accordance with the changes and extra work provisions of this Agreement.

9. Professional Ability. Contractor acknowledges, represents and warrants that Contractor is skilled and able to competently provide the services hereunder, and possesses all professional licenses, certifications, and approvals necessary to engage in its occupation. City has relied upon the professional ability and training of Contractor as a material inducement to enter into this Agreement.

Contractor shall perform in accordance with generally accepted professional practices and standards of Contractor's profession.

10. Business License. Contractor shall obtain a Redondo Beach Business License before performing any services required under this Agreement. The failure to so obtain such license shall be a material breach of this Agreement and grounds for immediate termination by City; provided, however, that City may waive the business license requirement in writing under unusual circumstances without necessitating any modification of this Agreement to reflect such waiver.

11. Termination Without Default. Notwithstanding any provision herein to the contrary, the City may, in its sole and absolute discretion and without cause, terminate this Agreement at any time prior to completion by Contractor of the project or services hereunder, immediately upon written notice to Contractor. In the event of any such termination, Contractor shall be compensated for: ( 1) all 3 authorized work satisfactorily performed prior to the effective date of termination; and ( 2) necessary materials or services of others ordered by Contractor for this Agreement, prior to Contractor's receipt of notice of termination, irrespective of whether such materials or services of others have actually been delivered, and further provided that Contractor is not able to cancel such orders. Compensation for Contractor in such event shall be determined by the City in accordance with the percentage of the project or services completed by Contractor; and all of Contractor's finished or unfinished work product through the time of the City's last payment shall be transferred and assigned to the City. In conjunction with any termination of this Agreement, the City may, at its own expense, make copies or extract information from any notes, sketches, computations, drawings, and specifications or other data, whether complete or not.

12. Termination in the Event of Default. Should Contractor fail to perform any of its obligations hereunder, within the time and in the manner provided or otherwise violate any of the terms of this Agreement, the City may immediately terminate this Agreement by giving written notice of such termination, stating the reasons for such termination. Contractor shall be compensated as provided immediately above, provided, however, there shall be deducted from such amount the amount of damages if any, sustained by the City by virtue of Contractor's breach of this Agreement.

13. Conflict of Interest. Contractor acknowledges, represents and warrants that Contractor shall avoid all conflicts of interest (as defined under any federal, state or local statute, rule or regulation, or at common law) with respect to this Agreement. Contractor further acknowledges, represents and warrants that Contractor has no business relationship or arrangement of any kind with any City official or employee with respect to this Agreement. Contractor acknowledges that in the event that Contractor shall be found by any judicial or administrative body to have any conflict of interest (as defined above) with respect to this Agreement, all consideration received under this Agreement shall be forfeited and returned to City forthwith. This provision shall survive the termination of this Agreement for one ( 1) year.

14. Indemnity Design Professional Services. In connection with its design professional services and to the maximum extent permitted by law, Contractor shall hold harmless and indemnify City, and its officials, officers, employees, agents, and designated volunteers (collectively, "Indemnitees"), with respect to any and all claims, demands, causes of action, damages, injuries, liabilities, losses, costs or expenses, including reimbursement of attorneys' fees and costs of defense, which arise out of, pertain to, or relate to in whole or in part to the negligence, recklessness, or willful misconduct of Contractor or any of its officers, employees, subcontractors, or agents in the performance of its design professional services under this Agreement.

M
a. Other Indemnities. In connection with any and all claims, demands, causes of action, damages, injuries, liabilities, losses, costs or expenses, including attorneys' fees and costs of defense ( collectively, "Damages" hereinafter) not covered by the foregoing paragraph, and to the maximum extent permitted by law, Contractor shall defend, hold harmless and indemnify the Indemnitees with respect to any and all Damages, which arise out of, pertain to, or relate to the acts or omissions of Contractor or any of its officers, employees, subcontractors, or agents in the performance of this Agreement, except for such loss or damage arising from the sole negligence or willful misconduct of the City. Contractor shall defend Indemnitees in any action or actions filed in connection with any such Damages. Notwithstanding the foregoing, nothing in this Section 14 shall be construed to encompass Indemnitees' active negligence to the limited extent that this Agreement is subject to Civil Code Section 2782( b). Contractor's obligation to indemnify shall not be restricted to insurance proceeds, if any, received by Contractor or Indemnitees. This indemnification obligation shall survive this Agreement and shall not be limited by any term of any insurance policy required under this Agreement. b. Nonwaiver of Rights. Indemnitees do not and shall not waive any rights that they may possess against Contractor because the acceptance by City, or the deposit with City, of any insurance policy or certificate required pursuant to this Agreement.
c. Waiver of Right of Subrogation. Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees.

15. Insurance. Contractor shall comply with the requirements set forth in Exhibit "D." Insurance requirements that are waived by the City's Risk Manager do not require amendments or revisions to this Agreement.

16. Non -Liability of Officials and Employees of the City. No official or employee of the City shall be personally liable for any default or liability under this Agreement.

17. Compliance with Laws. Contractor shall comply with all federal, state and local laws, statutes, ordinances, rules and regulations, and the orders and decrees of any courts or administrative bodies or tribunals, with respect to this Agreement, including without limitation all environmental laws, employment laws, and nondiscrimination laws. a. Acknowledgement. Contractor acknowledges that eight ( 8) hours labor constitutes a legal day's work. Contractor shall comply with and be bound by Labor Code Section 1810. Contractor shall comply with and be bound by the provisions of Labor Code Section 1813 concerning penalties for workers who work excess hours. Contractor shall, as a penalty to the City, forfeit twenty-five dollars ($ 25) for each worker employed in the performance of this Agreement 5 by the 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 one ( 1) calendar day and forty (40) hours in any one calendar week. Pursuant to Labor Code section 1815, work performed by employees of Contractor in excess of 8 hours per day, and 40 hours during any one week shall be permitted upon public work upon compensation for all hours worked in excess of 8 hours per day at not less than 11/ 2 times the basic rate of pay. For every subcontractor who will perform work on the project, Contractor shall be responsible for such subcontractor's compliance with Labor Code Sections 1810, 1813 and 1815, and Contractor shall include in the written contract between it and each subcontractor copies of Labor Code Sections 1810, 1813 and 1815 and a requirement that each subcontractor shall comply with these aforementioned sections. Contractor shall be required to take all actions necessary to enforce such contractual provisions and ensure subcontractor' s compliance, including without limitation, conducting a periodic review of the certified payroll records of the subcontractor and upon becoming aware of the failure of the subcontractor comply with Labor Code Sections 1810, 1813 and 1815, Contractor shall diligently take corrective action to halt or rectify the failure.
b. Prevailing Wages. City and Contractor acknowledge that this project is a public work to which prevailing wages apply. Contractor shall comply with the Agreement to Comply with California Labor Law Requirements set forth in Exhibit "E", which is attached hereto and incorporated by reference.

18. Limitations upon Subcontracting and Assignment. Contractor acknowledges that the services which Contractor shall provide under this Agreement are unique, personal services which, except as otherwise provided herein, Contractor shall not assign or sublet to any other party without the prior written approval of City, which approval may be withheld in the City's sole and absolute discretion. In the event that the City, in writing, approves any assignment or subletting of this Agreement or the retention of subcontractors by Contractor, Contractor shall provide to the City upon request copies of each and every subcontract prior to the execution thereof by Contractor and subcontractor. Any attempt by Contractor to assign any or all of its rights under this Agreement without first obtaining the City's prior written consent shall constitute a material default under this Agreement.

The sale, assignment, transfer or other disposition, on a cumulative basis, of twenty-five percent (25%) or more of the ownership interest in Contractor or twenty-five percent (25%) or more the voting control of Contractor (whether Contractor is a corporation, limited liability company, partnership, joint venture or otherwise) shall constitute an assignment for purposes of this Agreement.

Further, the involvement of Contractor or its assets in any transaction or series of transactions ( by way of merger, sale, acquisition, financing, transfer, leveraged buyout or otherwise), whether or not a formal assignment or hypothecation of this Agreement or Contractor's assets occurs, which reduces Contractor's assets or 6 net worth by twenty-five percent (25%) or more shall also constitute an assignment for purposes of this Agreement.

19. Subcontractors. Contractor shall provide properly skilled professional and technical personnel to perform any approved subcontracting duties. Contractor shall not engage the services of any person or persons now employed by the City without the prior written approval of City, which approval may be withheld in the City's sole and absolute discretion.

20. Integration. This Agreement constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes any previous oral or written agreement; provided, however, that correspondence or documents exchanged between Contractor and City may be used to assist in the interpretation of the exhibits to this Agreement.

21. Amendment. This Agreement may be amended or modified only by a subsequent written amendment executed by both parties.

22. Conflicting Provisions. In the event of a conflict between the terms and conditions of this Agreement and those of any exhibit or attachment hereto, this Agreement proper shall prevail. In the event of a conflict between the terms and conditions of any two or more exhibits or attachments hereto, those prepared by the City shall prevail over those prepared by Contractor.

23. Non -Exclusivity. Notwithstanding any provision herein to the contrary, the services provided by Contractor hereunder shall be non- exclusive, and City reserves the right to employ other contractors in connection with the project.

24. Exhibits. All exhibits hereto are made a part hereof and incorporated herein by reference; provided, however, that any language in Exhibit "A" which does not pertain to the project description, proposal, or scope of services (as applicable) to be provided by Contractor, or any corresponding responsibilities of City, shall be deemed extraneous to, and not a part of, this Agreement.

25. Time of Essence. Time is of the essence of this Agreement.

26. Confidentiality. To the extent permissible under law, Contractor shall keep confidential its obligations hereunder and the information acquired during the performance of the project or services hereunder.

27. Third Parties. Nothing herein shall be interpreted as creating any rights or benefits in any third parties. For purposes hereof, transferees or assignees as permitted under this Agreement shall not be considered "third parties."

28. Governing Law and Venue. This Agreement shall be construed in accordance with the laws of the State of California without regard to principles of conflicts of 7 law. Venue for any litigation or other action arising hereunder shall reside exclusively in the Superior Court of the County of Los Angeles, Southwest Judicial District.

29. Attorneys' Fees. In the event either party to this Agreement brings any action to enforce or interpret this Agreement, the prevailing party in such action shall be entitled to reasonable attorneys' fees (including expert witness fees) and costs.

This provision shall survive the termination of this Agreement.

30. Claims. Any claim by Contractor against City hereunder shall be subject to Government Code §§ 800 et seq. The claims presentation provisions of said Act are hereby modified such that the presentation of all claims hereunder to the City shall be waived if not made within six (6) months after accrual of the cause of action.

31. Interpretation. Contractor acknowledges that it has had ample opportunity to seek legal advice with respect to the negotiation of this Agreement. This Agreement shall be interpreted as if drafted by both parties.

32. Warranty. In the event that any product shall be provided to the City as part of this Agreement, Contractor warrants as follows: Contractor possesses good title to the product and the right to transfer the product to City; the product shall be delivered to the City free from any security interest or other lien; the product meets all specifications contained herein; the product shall be free from material defects in materials and workmanship under normal use for a period of one ( 1) year from the date of delivery; and the product shall be fit for its intended purpose( s). Notwithstanding the foregoing, consumable and maintenance items such as light bulbs and batteries) shall be warranted for a period of thirty (30) days from the date of delivery. All repairs during the warranty period shall be promptly performed by Contractor, at Contractor's expense, including shipping.

Contractor shall not be liable under this warranty for an amount greater than the amount set forth in Exhibit "C" hereto.

33. Severance. Any provision of this Agreement that is found invalid or unenforceable shall be deemed severed, and all remaining provisions of this Agreement shall remain enforceable to the fullest extent permitted by law.

34. Authority. City warrants and represents that upon City Council approval, the Mayor of the City of Redondo Beach is duly authorized to enter into and execute this Agreement on behalf of City. The party signing on behalf of Contractor warrants and represents that he or she is duly authorized to enter into and execute this Agreement on behalf of Contractor, and shall be personally liable to City if he or she is not duly authorized to enter into and execute this Agreement on behalf of Contractor.

35. Waiver. The waiver by the City of any breach of any term or provision of this Agreement shall not be construed as a waiver of any subsequent breach.

SIGNATURES FOLLOW ON NEXT PAGE
1,
IN WITNESS WHEREOF, the parties have executed this Agreement in Redondo Beach, California, as of this 4th day of October, 2022.

CITY OF REDONDO BEACH,
a chartered municipal corporation
ED( u, Signed by:

Vr, tti. t, KA
3D5CA98045B...

For William C. Brand, Mayor
Nils H. Nehrenheim,
Mayor Pro Tempore
ATTEST:

DocuSigned by:

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Eleanor Manzano, City Clerk
APPROVED AS TO FORM:

DocuSigned by:

R( a
669049EDE03D402...

Michael W. Webb, City Attorney
10 CJ CONCRETE CONSTRUCTION, Inc.,
a California corporation
By.

Name:

Title:

DocuSigned by:

Eb C, sMAh
F025F31 D1910452...
o n arno
President
APPROVED:

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DocuSigned by:

AAA), SfVdf #, AA,
ABED8CF35EEF48C...

Diane Strickfaden, Risk Manager
EXHIBIT "A"

PROJECT DESCRIPTION AND/OR SCOPE OF SERVICES
I. CONTRACTOR' S DUTIES
Contractor shall perform the following services.

A. Contractor shall provide all labor, supervision, equipment, materials and supplies needed to provide on- call sidewalk, driveway and curb and gutter replacement services. Concrete Maintenance. All work shall be performed in accordance with the Standard Specifications for Public Works Construction ( current edition).

B. Upon City' s written request as described in Section ILA, Contractor shall prepare a written scope of work for the City's requested tasks, including all components and subtasks, the cost to perform the task, including costs and markup from subcontractors, an explanation of how the cost was determined, and a schedule for completion of the task (collectively Task Proposal"). The costs specified in the Task Proposal shall be in accordance with Exhibit "C".

C. Upon the City' s written approval of the Task Proposal, the Contractor shall commence services for the task. Any language that does not pertain to the scope of work, compensation, or duration of agreement shall be deemed extraneous and not incorporated within this Agreement.

D. Contractor shall identify all personnel used to accomplish the services in the Task Proposal. Contractor shall obtain City's approval of any substitutions of leading personnel for the task as soon as the need for a substitution is known.

E. Contractor shall identify any subcontractor(s) and include the work of subcontractors in the proposed scope of work. Contractor shall not replace the subcontractor for the task without the prior written approval of the City.

F. Contractor shall provide a task number for the City approved task.

G. Contractor shall complete the task and present all deliverables to the City by the completion date provided to City.
11 H. During performance of the services, Contractor shall provide a monthly written summary of progress on all on- call services to keep the City updated as to the status of performance. Contractor shall either draft a report or deliver an email to the City' s designated project manager.

Contractor shall provide all work product for review and acceptance by the City. Upon City's request, Contractor shall revise the work product without additional charge to the City until the City accepts it.

II. CITY' S DUTIES
City will perform the following services.

A. City will provide a written task request with a description of the work to be performed for the task, and the time desired for completion.

B. City, in its sole discretion, may approve, modify or reject the Contractor's Task Proposal.

C. Notwithstanding anything described herein, in the event Article XIX of the City Charter and Chapters 6 and 6. 1 of Title 2 of the Redondo Beach Municipal Code apply to the work described herein, the Contractor shall not be authorized to perform the subject work under this Agreement. 12 EXHIBIT " B"

SCHEDULE FOR COMPLETION
TERM. The term of this Agreement shall commence on October 4, 2022 and continue through October 3, 2024 ("Term"), unless otherwise terminated as herein provided. The Agreement may be extended for an additional 12 months upon a written amendment approved by both parties. Contractor shall perform the services in accordance with the schedule in each Task Proposal. City may approve extensions for performance of the services in each task; provided, however, that the Contractor shall not work beyond the expiration date of this Agreement.
13 EXHIBIT " C"

COMPENSATION
Provided Contractor is not in default under this Agreement, Contractor shall be compensated as provided below.

I. AMOUNT. Contractor shall perform the work for all City approved Task Proposal( s) in accordance with the following hourly rate schedule.

Description Unit Unit Price
Mobilization LS 2, 500. 00
Concrete Sidewalk — 4 -inch thick SF 12. 50
remove and replace)
Concrete Sidewalk — 6 -inch thick SF 15. 00
remove and replace)
Concrete Curb Ramp Ea 6, 800. 00
remove and replace)
Curb Type A2/8 LF 60. 00
remove and replace)
Concrete Driveway Approach SF 15. 00
remove and replace)
Type "A" Curb and Gutter LF 70. 00
remove and replace)
Type "A-2" Curb and Gutter LF 60. 00
remove and replace)
Type "B- 6" Curb and Gutter LF 60.00
remove and replace)
Type "B- 8" Curb and Gutter LF 60. 00
remove and replace)
14 Type " D" Curb and Gutter LF 60. 00
remove and replace)
Curb Access Ramp SF 18. 00
remove and replace)
4" Exposed Aggregate Finish SF 18. 75
remove and replace)
6" Residential Driveway SF 12. 00
remove and replace)
8" Commercial Driveway SF 13. 00
remove and replace)
8" Cross -Gutter SF 17. 00
remove and replace)
8" Spandrel SF 19. 00
remove and replace)
9" Thick Bus Pad SF 19. 00
remove and replace)
Reconstruct Catch Basin Top SF 25. 00
remove and replace)
The hourly rates set forth herein shall be apply for the term of the Agreement.

II. EXPENSES. Expenses incurred by Contractor in performance of this work shall be considered included in the hourly rates in Section I and no additional compensation shall be provided. Contractor may be reimbursed for management of any subcontractor authorized by a Task Order at a rate not exceeding 10% of the subcontractor's authorized fee. Contractor may be reimbursed for extraordinary expenses only with a previously approved written amendment to this Agreement, which shall be at the sole discretion of the City.

III. NOT TO EXCEED AMOUNT. In no event shall the total amount paid to Contractor, including reimbursable expenses, exceed $ 375, 000 during the term of this Agreement.
15 IV. METHOD OF PAYMENT. Contractor shall provide monthly invoices to City for approval and payment for those services performed in the month prior to invoice submission. Invoices must include the following information.

A. Task number.

B. All personnel who performed work on the Task Proposal.

C. Description of the work performed.

D. Number of hours worked
E. Hourly rate.

F. All City approved and documented subcontractor invoices.

G. If applicable, expenses incurred
Within the approved amount for each approved Task Proposal, and with the written approval of the City, a portion of the amount from one line item of the Task may be allocated to another line item of the Task so long as the total amount approved for the Task Proposal as described in Exhibit "A" is not exceeded.

Invoices must be adequately detailed, based on accurate records, and in a form reasonably satisfactory to City, and include the prior written authorization of the City and copies of receipts to substantiate expense requests. Contractor may be required to provide back-up material upon request. If no work is performed in a given month, no invoice is required.

V. SCHEDULE FOR PAYMENT. City agrees to pay Contractor within thirty days of City's receipt of Contractor's monthly invoice; provided that services are completed to the City's reasonable satisfaction and there is no dispute over the amount.

VI. NOTICE. Written notices to City and Contractor shall be given by registered or certified mail, postage prepaid and addressed to or personally served on the following parties.

Contractor: CJ Concrete Construction, Inc.
10142 Shoemaker Ave
Santa Fe Springs, CA 90670
Attn: John C. Sarno
Telephone: 562-777-2222
Email: it ch ll" c"iin biiz
Com: City of Redondo Beach
Public Works Department, Engineering Division
415 Diamond Street
Redondo Beach, CA 90277
Attention: City Engineer
16 All notices, including notices of address changes, provided under this Agreement are deemed received on the third day after mailing if sent by registered or certified mail. Changes in the respective address set forth above may be made from time to time by any party upon written notice to the other party. 17 EXHIBIT " D"

INSURANCE REQUIREMENTS FOR CONTRACTORS
Without limiting Contractor's indemnification obligations under this Agreement, Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Contractor, its agents, representatives, or employees.

Minimum Scope of Insurance
Coverage shall be at least as broad as:

Insurance Services Office Commercial General Liability coverage ( occurrence form CG 0001).

Insurance Services Office form number CA 0001 ( Ed. 1/ 87) covering Automobile Liability, code 1 ( any auto).

Workers' Compensation insurance as required by the State of California.

Employer's Liability Insurance.

Errors and Omissions liability insurance appropriate to the Contractor's profession.

Architects' and Engineers' coverage is to be endorsed to include contractual liability.

Minimum Limits of Insurance
Contractor shall maintain limits no less than:

General Liability: $ 1, 000, 000 per occurrence for bodily injury, personal injury and property damage. The general aggregate limit shall apply separately to this project/location.

Automobile Liability: $ 1, 000, 000 per accident for bodily injury and property damage.

Employer's Liability: $1, 000,000 per accident for bodily injury or disease.

Errors and Omissions liability: $ 1, 000,000 per occurrence.

Deductibles and Self -Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by the City. At the option of the City, either: ( 1) the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the City, its officers, officials, employees and volunteers or (2) the Contractor shall provide a financial guarantee satisfactory to the City guaranteeing payment of losses and related investigations, claim administration and defense expenses.
18 Other Insurance Provisions
The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions:

Additional Insured Endorsement:

General Liability: The City, its officers, elected and appointed officials, employees, and volunteers are to be covered as insureds with respect to liability arising out of work performed by or on behalf of the Contractor. General liability coverage can be provided in the form of an endorsement to the Contractor's insurance, or as a separate owner's policy.

Automobile Liability: The City, its officers, elected and appointed officials, employees, and volunteers are to be covered as insureds with respect to liability arising out of automobiles owned, leased, hired or borrowed by or on behalf of the Contractor.

For any claims related to this project, the Contractor's insurance coverage shall be primary insurance as respects the City, its officers, elected and appointed officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Contractor's insurance and shall not contribute with it.

Each insurance policy required by this clause shall be endorsed to state that coverage shall not be canceled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City.

Each insurance policy shall be endorsed to state that the inclusion of more than one insured shall not operate to impair the rights of one insured against another insured, and the coverages afforded shall apply as though separate policies had been issued to each insured.

Errors and Omissions policy, if written on a claims made basis, shall be maintained by the Contractor for a period of one year after the completion of the project.

Each insurance policy shall be in effect prior to awarding the contract and each insurance policy or a successor policy shall be in effect for the duration of the project.

The maintenance of proper insurance coverage is a material element of the contract and failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract on the Contractor's part.

Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best's rating of no less than A:VII and which are authorized to transact insurance business in the State of California by the Department of Insurance.
19 Verification of Coverage
Contractor shall furnish the City with original certificates and amendatory endorsements effecting coverage required by this clause. The endorsements should be on the City authorized forms provided with the contract specifications. Standard ISO forms which shall be subject to City approval and amended to conform to the City's requirements may be acceptable in lieu of City authorized forms. All certificates and endorsements are to be received and approved by the City before the contract is awarded. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications at any time.

Subcontractors
Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein.

Risk Management
Contractor acknowledges that insurance underwriting standards and practices are subject to change, and the City reserves the right to make changes to these provisions in the reasonable discretion of its Risk Manager.
20 EXHIBIT " E"

AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS

1. Contractor acknowledges that the project as defined in this Agreement between Contractor and the City, to which this Agreement to Comply with California Labor Law Requirements is attached and incorporated by reference, is a " public work" as defined in Division 2, Part 7, Chapter 1 ( commencing with Section 1720) of the California Labor Code (" Chapter 1"), and that this Agreement is subject to ( a) Chapter 1, including without limitation Labor Code Section 1771 and ( b) the rules and regulations established by the Director of Industrial Relations (" DIR") implementing such statutes. Contractor shall perform all work on the project as a public work. Contractor shall comply with and be bound by all the terms, rules and regulations described in 1( a) and 1( b) as though set forth in full herein.

2. California law requires the inclusion of specific Labor Code provisions in certain contracts. The inclusion of such specific provisions below, whether or not required by California law, does not alter the meaning or scope of Section 1 above.

3. Pursuant to Labor Code Section 1771. 4, Contractor shall post job site notices, as prescribed by regulation.

4. Pursuant to Labor Code Section 1773. 2, copies of the prevailing rate of per diem wages for each craft, classification, or type of worker needed to perform the Agreement are on file at City Hall and will be made available to any interested party on request. Contractor acknowledges receipt of a copy of the DIR determination of such prevailing rate of per diem wages, and Contractor shall post such rates at each job site covered by this Agreement.

5. Contractor shall comply with and be bound by the provisions of Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the City, forfeit the maximum amount allowable by law for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the DIR for the work or craft in which the worker is employed for any public work done pursuant to this Agreement by Contractor or by any subcontractor.

6. Contractor shall comply with and be bound by the provisions of Labor Code Section 1776, which requires Contractor and each subcontractor to ( 1) keep accurate payroll records and verify such records in writing under penalty of perjury, as specified in Section 1776, ( 2) certify and make such payroll records available for inspection as provided by Section 1776, and ( 3) inform the City of the location of the records.

7. Contractor shall comply with and be bound by the provisions of Labor Code Sections 1777.5, 1777. 6 and 1777. 7 and California Administrative Code title 8, section 200 et seq. concerning the employment of apprentices on public works projects.

Contractor shall be responsible for compliance with these aforementioned Sections for all apprenticeable occupations. Prior to commencing work under this Agreement, Contractor shall provide City with a copy of the information submitted to any applicable apprenticeship program. Within sixty ( 60) days after concluding work pursuant to this Agreement, Contractor and each of its subcontractors shall submit to the City a verified statement of the journeyman and apprentice hours performed under this Agreement. 21 8. Contractor acknowledges that eight (8) hours labor constitutes a legal day's work. Contractor shall comply with and be bound by Labor Code Section 1810.

Contractor shall comply with and be bound by the provisions of Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the City, forfeit twenty-five dollars ($ 25) for each worker employed in the performance of this Agreement by the 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 one ( 1) calendar day and forty (40) hours in any one calendar week in violation of the provisions of Division 2, Part 7, Chapter 1, Article 3 of the Labor Code.

Pursuant to Labor Code section 1815, work performed by employees of Contractor in excess of 8 hours per day, and 40 hours during any one week shall be permitted upon public work upon compensation for all hours worked in excess of 8 hours per day at not less than 1 and 1/ 2 times the basic rate of pay.

9. California Labor Code Sections 1860 and 3700 provide that every employer will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861, Contractor hereby certifies as follows:

I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract."

10. For every subcontractor who will perform work on the project, Contractor shall be responsible for such subcontractor's compliance with Chapter 1 and Labor Code Sections 1860 and 3700, and Contractor shall include in the written contract between it and each subcontractor a copy of those statutory provisions and a requirement that each subcontractor shall comply with those statutory provisions. Contractor shall be required to take all actions necessary to enforce such contractual provisions and ensure subcontractor's compliance, including without limitation, conducting a periodic review of the certified payroll records of the subcontractor and upon becoming aware of the failure of the subcontractor to pay his or her workers the specified prevailing rate of wages.

Contractor shall diligently take corrective action to halt or rectify any failure.

11. To the maximum extent permitted by law, Contractor shall indemnify, hold harmless and defend ( at Contractor's expense with counsel acceptable to the City) the City, its officials, officers, employees, agents, independent contractors, and volunteers from and against any demand or claim for damages, compensation, fines, penalties or other amounts arising out of or incidental to any acts or omissions listed above by any person or entity ( including Contractor, its subcontractors, and each of their officials, officers, employees and agents) in connection with any work undertaken or in connection with the Agreement, including without limitation the payment of all consequential damages, attorneys' fees, and other related costs and expenses. All duties of Contractor under this Section shall survive termination of the Agreement. 22 AC
DATE (MM/ nonYYv)
CERTIFICATE OF LIABILITY INSURANCE _ JI 11221 2/ 2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

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

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER NAME:

TJCE...... FAX...- ....

Behr Insurance Services Inc. APC Nus MI 888- 988- 2347 ( A o NIL 1420 E Los Angeles Ave #203 ACDDwsvlr lel dJ1t4IYl llk e aTl 4 415 Diamond Street
Redondo Beach CA 90277
ACORD 25 ( 2016/ 03)

AUTHORIZED REPRESENTATIVE
J& v41k4w Atkr
1988- 2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

INSURERS AFFORDING COVERAGE NAIC N
Sinai Vallcy CA 93065 INSURER A VALLEY FORGE INS CO 20508 INSURED INSURER B : CONTINENTAL CAS COm
2 0443
CJ Concrete Construction Inc INSURER C . CONTINENTAL INS CO 15289 10142 S1IOEIVIAKI3Itl4,VI3 INSURER. D'

INSURER E
SANTA FE SPRINGS CCA 90670- 3404 INSURER F;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POL7TERMS, INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO

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

LTR

COMMERCIAL

CLAIMS -MADE
OF

GENERAL

INSURANCE

LIABILITY
OCCUR
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INSId VrIV, D POLICY NUMBER MMIDD/

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MED EXP ( Any one person) $.._...

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A. ._,....._ Y Y 7017691303 11/ 12/ 2021 11/ 12/ 2022 L & ADV INJURY 1, 000, 000 G E ... _ ............................. .. ..... ......... N' L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE : 6 2, 000, 000 POLICY JI",u t' LOC PRODUCTS COMP/OP AGO 1$ 2..00a aQ0
OTHER.

AUTOMOBILE LIABILITY.... ..
rIL1v:... 11! I'T' $
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ANY AUTO X
BODILY INJURY (Per person) y
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OWNED ,.. SCHEDULED
B Y Y 7017691317 11/ 12/ 2021 1 1/ 12( 2022 BODILY INJURY ( Per accident) AUTOS ONLY AUTOS HIRED NON -OWNED T' F<"' IF"I"T"" CJAF ^7"" I..,
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AUTOS ONLY AUTOSONLYcrc.rlvjwm t) I C o ................ Y„ UMBRELLA LIAB , OC CH OCCURRENCE $
11/ 12/ 2a2 .. ......... EGGREGATE--
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EXCESS uA6 CLAIMS- MADE.... 7017691320 1 11/ 12/ 2022 4,, 000
000 000
RETE ION $ 10, 000
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m _._._._.,.._ .-........_.,,,....,,. ........-..

COM L
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AND EMPLOYERS° LIABILITY YIN
ANY PROPRIETOR/ PARTNER/ EXECUTIVE °°°°
N / A
E. L. LF4C11 ACCLEN r $
OFFICERIMEMBEMandatory In EXCLUDED

E L DISEASE - EA
If yes, describe under
DESCRIPTION OF OPERATIONS below E, L DISEASE - POLICY LIMIT$ Vf'i b DESCRIPTION OF OPERATIONS ILOCATIONS /"VEHICLES ( ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Sec ACORD 101
CERTIFICATE. HOLDER CANCEL'LAT'ION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Redondo Beach ACCORDANCE WITH THE POLICY PROVISIONS. 415 Diamond Street
Redondo Beach CA 90277
ACORD 25 ( 2016/ 03)

AUTHORIZED REPRESENTATIVE
J& v41k4w Atkr
1988- 2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARIKS SCHEDULE

TGENCY NAMED INSURED
Behr Insurance Services Inc. CJ Concrete Construction Inc POLICY N-U- M--B" E, R- .. .... . ............ ...

CARRIER I MAIC CODE
EFFECTIVE DATE:

Page 1 of 1 ends

ACORD 101 ( 2008101) @ 2008 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD
WKM-4 MUM=,
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement with respect to such provision do not apply.

1. Additional Insureds

2. Additional Insured - Primary And Non -Contributory To Additional Insured' s Insurance

3. Bodily Injury - Expanded Definition

4. Broad Knowledge of Occurrence/ Notice of Occurrence

5. Broad Named Insured

6. Broadened Liability Coverage For Damage To Your Product And Your Work

7. Contractual Liability - Railroads
11, 111, 11, .. -- --- 1. 1... 11.... ... ............ _- 1- 1 --- - , " I ------- ... ... ... . ---- ---

8. Electronic Data Liability

9. Estates, Legal Representatives and Spouses

10. Expected Or Intended Injury - Exception for Reasonable Force

11. General Aggregate Limits of Insurance - Per Project

12. In Rem Actions

13. Incidental Health Care Malpractice Coverage

14. Joint Ventures/Partnership/Limited Liability Companies

15. Legal Liability - Damage To Premises / Alienated Premises i Property In The Named Insured' s Care, Custody or Control

16. Liquor Liability

17. Medical Payments
1111.. 11- 111- 1111111- - — ---------- -----

18. Non -owned Aircraft Coverage

19. Non -owned Watercraft

25. Waiver of Subrogation - Blanket
111.. 1 ................

26. Wrap -Up Extension: OCIP CCIP, or Consolidated (Wrap -Up) Insurance Programs CNA74705XX ( 1- 15)

Page 1 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement

1. ADDITIONAL INSUREDS
a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through H. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement:
1) is currently in effect or becomes effective during the term of this Coverage Part; and 2) was executed prior to:
a) the bodily injury or property damage; or
b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage.
b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with:
1) a higher limit of insurance than required by such contract or agreement; or 2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A. through H. below.

Any coverage granted by this endorsement shall apply only to the extent permissible by law.

A. Controlling Interest
Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization' s liability for bodily injury, property damage or personal and advertising injury arising out of:

1. such person or organization' s financial control of a Named Insured; or

2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises;
provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured.

B. Co-owner of Insured Premises
A co- owner of a premises co -owned by a Named Insured and covered under this insurance but only with respect to such co -owner's liability for bodily injury, property damage or personal and advertising injury as co-owner of such premises.

C. Lessor of Equipment
Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named Insured' s maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease.

D. Lessor of Land
Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured.

E. Lessor of Premises
CNA74705XX ( 1- 15)

Page 2 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission, Contractors' General Liability Extension Endorsement
An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured.

F. Mortgagee, Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured' s ownership, maintenance, or use of a premises by a Named Insured.

The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured.

G. State or Governmental Agency or Subdivision or Political Subdivisions — Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision' s liability for bodily injury, property damage or personal and advertising injury arising out of:

1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies:
a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. the construction, erection, or removal of elevators; or c. the ownership, maintenance or use of any elevators covered by this insurance; or

2. the permitted or authorized operations performed by a Named Insured or on a Named Insured' s behalf.

The coverage granted by this paragraph does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b. Bodily injury or property damage included within the products -completed operations hazard.

With respect to this provision' s requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured.

H. Trade Show Event Lessor

1. With respect to a Named Insured' s participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization' s liability for bodily injury, property damage or personal and advertising injury caused by:
a. the Named Insured' s acts or omissions; or
b. the acts or omissions of those acting on the Named Insured' s behalf, in the performance of the Named Insured' s ongoing operations at the trade show event premises during the trade show event.

CNA74705XX ( 1- 15)

Page 3 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement

2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products -completed operations hazard.

2. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED' S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph:

If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and noncontributory relative to an additional insured' s own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured' s own insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization.

3. BODILY INJURY — EXPANDED DEFINITION
Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following:

Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease.

4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE
Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the following provisions:

A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or an employee designated by any of the above to give such notice.

B. NOTICE OF OCCURRENCE
The Named Insured' s rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured' s reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence, offense or claim.

5. BROAD NAMED INSURED
WHO IS AN INSURED is amended to delete its Paragraph 3. in its entirety and replace it with the following:

3. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named Insured has management control:
a. on the effective date of this Coverage Part; or
b. by reason of a Named Insured creating or acquiring the organization during the policy period, qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary, contributory, excess, contingent or otherwise, which provides coverage to such organization, or which would have provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or narrower than that provided by this insurance.

But this BROAD NAMED INSURED provision does not apply to:
a) any partnership, limited liability company or joint venture; or CNA74705XX ( 1 - 15)

Page 4 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
b) any organization for which coverage is excluded by another endorsement attached to this Coverage Part.

For the purpose of this provision, management control means:

A. owning interests representing more than 50% of the voting, appointment or designation power for the selection of a majority of the Board of Directors of a corporation; or B. having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer or sell property held by a trust.

4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above, this insurance does not apply to:
a. bodily injury or property damage that first occurred prior to the date of management control, or that first occurs after management control ceases; nor
b. personal or advertising injury caused by an offense that first occurred prior to the date of management control or that first occurs after management control ceases.

5. The insurance provided by this Coverage Part applies to Named Insureds when trading under their own names or under such other trading names or doing -business -as names ( dba) as any Named Insured should choose to employ.

6. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusions k. and I. and replace them with the following:

This insurance does not apply to:
k. Damage to Your Product
Property damage to your product arising out of it, or any part of it except when caused by or resulting from:
1) fire;
2) smoke;
3) collapse; or
4) explosion.

I. Damage to Your Work
Property damage to your work arising out of it, or any part of it and included in the products -completed operations hazard.

This exclusion does not apply:
1) If the damaged work, or the work out of which the damage arises, was performed on the Named Insured' s behalf by a subcontractor; or
2) If the cause of loss to the damaged work arises as a result of:
a) fire;
b) smoke;
c) collapse; or
d) explosion.

B. The following paragraph is added to LIMITS OF INSURANCE:

CNA74705XX ( 1 - 15)

Page 5 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission, Contractors' General Liability Extension Endorsement
Subject to 5. above, $ 100,000 is the most the Insurer will pay under Coverage A for the sum of damages arising out of any one occurrence because of property damage to your product and your work that is caused by fire, smoke, collapse or explosion and is included within the product -completed operations hazard. This sublimit does not apply to property damage to your work if the damaged work, or the work out of which the damage arises, was performed on the Named Insured' s behalf by a subcontractor.

C. This Broadened Liability Coverage For Damage To Your Product And Your Work Provision does not apply if an endorsement of the same name is attached to this policy.

7. CONTRACTUAL LIABILITY — RAILROADS
With respect to operations performed within 50 feet of railroad property, the definition of insured contract is replaced by the following:

Insured Contract means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner is not an insured contract; b. A sidetrack agreement;
c. Any easement or license agreement;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement pertaining to the Named Insured' s business ( including an indemnification of a municipality in connection with work performed for a municipality) under which the Named Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement.

Paragraph f. does not include that part of any contract or agreement:
1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage;
2) Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured' s rendering or failure to render professional services, including those listed in 1) above and supervisory, inspection, architectural or engineering activities.

8. ELECTRONIC DATA LIABILITY
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following:

This insurance does not apply to:
p. Access Or Disclosure Of Confidential Or Personal Information And Data -related Liability Damages arising out of:
1) any access to or disclosure of any person' s or organization' s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or CNA74705XX ( 1- 15)

Page 6 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
2) the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data that does not result from physical injury to tangible property.

However, unless Paragraph ( 1) above applies, this exclusion does not apply to damages because of bodily injury.

This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relation expenses or any other loss, cost or expense incurred by the Named Insured or others arising out of that which is described in Paragraph ( 1) or (2) above.

B. The following paragraph is added to LIMITS OF INSURANCE:

Subject to 5. above, $ 100,000 is the most the Insurer will pay under Coverage A for all damages arising out of any one occurrence because of property damage that results from physical injury to tangible property and arises out of electronic data.

C. The following definition is added to DEFINITIONS:

Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software ( including systems and applications software), hard or floppy disks, CD- ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment.

D. For the purpose of the coverage provided by this ELECTRONIC DATA LIABILITY Provision, the definition of property damage in DEFINITIONS is replaced by the following:

Property damage means:
a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the occurrence that caused it; or
c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate electronic data, resulting from physical injury to tangible property. All such loss of electronic data shall be deemed to occur at the time of the occurrence that caused it.

For the purposes of this insurance, electronic data is not tangible property.

E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the $ 100, 000 limit provided by this ELECTRONIC DATA LIABILITY Provision is part of, and not in addition to, that higher limit.

9. ESTATES, LEGAL REPRESENTATIVES, AND SPOUSES
The estates, heirs, legal representatives and spouses of any natural person Insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives, and spouses only for claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks damages from marital community property, jointly held property or property transferred from such natural person Insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative, or spouse outside the scope of such person' s capacity or status as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are Insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured' s business.

10. EXPECTED OR INTENDED INJURY — EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following:

CNA74705XX ( 1- 15)

Page 7 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission., Contractors' General Liability Extension Endorsement
This insurance does not apply to:

Expected or Intended Injury
Bodily injury or property damage expected or intended from the standpoint of the Insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property.

11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT A. For each construction project away from premises the Named Insured owns or rents, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of:

1. All damages under Coverage A, except damages because of bodily injury or property damage included in the products -completed operations hazard; and

2. All medical expenses under Coverage C,
that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project General Aggregate Limit of any other construction project.

B. All:

1. Damages under Coverage B, regardless of the number of locations or construction projects involved;

2. Damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single construction project, except damages because of bodily injury or property damage included in the products -completed operations hazard; and

3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project,
will reduce the General Aggregate Limit shown in the Declarations.

C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular construction project.

D. When coverage for liability arising out of the products -completed operations hazard is provided, any payments for damages because of bodily injury or property damage included in the products - completed operations hazard will reduce the Products -Completed Operations Aggregate Limit shown in the Declarations, regardless of the number of projects involved.

E. If a single construction project away from premises owned by or rented to the Insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project.

F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated.

12. IN REM ACTIONS
A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the Named Insured, will be treated in the same manner as thmicgh the action wPrP in pprsonam against the Named Insured.

13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE
Solely with respect to bodily injury that arises out of a health care incident:

CNA74705XX ( 1- 15)

Page 8 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1. b.( 1) and 1. b.( 2) with the following:
b. This insurance applies to bodily injury provided that the professional health care services are incidental to the Named Insured' s primary business purpose, and only if:
1) such bodily injury is caused by an occurrence that takes place in the coverage territory. 2) the bodily injury first occurs during the policy period. All bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence; and
B. Under COVERAGES, Coverage A— Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to:
add the following to the Employers Liability exclusion:

This exclusion applies only if the bodily injury arising from a health care Incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits).
ii. delete the exclusion entitled Contractual Liability and replace it with the following:

This insurance does not apply to:

Contractual Liability
the Insured' s actual or alleged liability under any oral or written contract or agreement, including but not limited to express warranties or guarantees.
iii. add the following additional exclusions:

This insurance does not apply to:

Discrimination
any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on an individual' s race, creed, color, age, gender, national origin, religion, disability, marital status or sexual orientation.

Dishonesty or Crime
Any actual or alleged dishonest, criminal or malicious act, error or omission.

Medicare/Medicaid Fraud
any actual or alleged violation of law with respect to Medicare, Medicaid, Tricare or any similar federal, state or local governmental program.

Services Excluded by Endorsement
Any health care incident for which coverage is excluded by endorsement.

C. DEFINITIONS is amended to:
i. add the following definitions:

Health care incident means an act, error or omission by the Named Insured' s employees or volunteer workers in the rendering of:
a. professional health care services on behalf of the Named Insured or b. Good Samaritan services rendered in an emergency and for which no payment is demanded or received.

CNA74705XX ( 1- 15)

Page 9 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
Professional health care services means any health care services or the related furnishing of food, beverages, medical supplies or appliances by the following providers in their capacity as such but solely to the extent they are duly licensed as required:
a. Physician;
b. Nurse;
c. Nurse practitioner;
d. Emergency medical technician;
e. Paramedic;
f. Dentist;
g. Physical therapist;
h. Psychologist;
I. Speech therapist;
j. Other allied health professional; or
Professional health care services does not include any services rendered in connection with human clinical trials or product testing.
ii. delete the definition of occurrence and replace it with the following:

Occurrence means a health care incident. All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a single occurrence;
iii. amend the definition of Insured to:
a. add the following:
the Named Insured' s employees are Insureds with respect to:
1) bodily injury to a co -employee while in the course of the co -employee' s employment by the Named Insured or while performing duties related to the conduct of the Named Insured' s business; and
2) bodily injury to a volunteer worker while performing duties related to the conduct of the Named Insured' s business;
when such bodily injury arises out of a health care incident. the Named Insured' s volunteer workers are Insureds with respect to:
1) bodily injury to a co -volunteer worker while performing duties related to the conduct of the Named Insured' s business; and
2) bodily injury to an employee while in the course of the employee' s employment by the Named Insured or while performing duties related to the conduct of the Named Insured' s business;
when such bodily injury arises out of a health care incident. b. delete Subparagraphs ( a), ( b), ( c) and (d) of Paragraph 2. a.( 1) of WHO IS AN INSURED.

D. The Other Insurance condition is amended to delete Paragraph b.( 1) in its entirety and replace it with the following:

Other Insurance
b. Excess Insurance
CNA74705XX ( 1- 15)

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Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
1) To the extent this insurance applies, it is excess over any other insurance, self insurance or risk transfer instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by the Named Insured to be excess of this coverage.

14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES WHO IS AN INSURED is amended to delete its last paragraph and replace it with the following:

No person or organization is an Insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations, except that if the Named Insured was a joint venturer, partner, or member of a limited liability company and such joint venture, partnership or limited liability company terminated prior to or during the policy period, such Named Insured is an Insured with respect to its interest in such joint venture, partnership or limited liability company but only to the extent that:
a. any offense giving rise to personal and advertising injury occurred prior to such termination date, and the personal and advertising injury arising out of such offense first occurred after such termination date; b. the bodily Injury or property damage first occurred after such termination date; and c. there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; and
If the joint venture, partnership or limited liability company is or was insured under a consolidated ( wrap-up) insurance program, then such insurance will always be considered valid and collectible for the purpose of paragraph c. above. But this provision will not serve to exclude bodily injury, property damage or personal and advertising injury that would otherwise be covered under the Contractors General Liability Extension Endorsement provision entitled WRAP- UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED ( WRAP- UP) INSURANCE PROGRAMS. Please see that provision for the definition of consolidated (wrap- up) insurance program.

15. LEGAL LIABILITY — DAMAGE TO PREMISES / ALIENATED PREMISES / PROPERTY IN THE NAMED

INSURED' S CARE, CUSTODY OR CONTROL
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following:

This insurance does not apply to:
j. Damage to Property
Property damage to:
1) Property the Named Insured owns, rents, or occupies, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property;
2) Premises the Named Insured sells, gives away or abandons, if the property damage arises out of any part of those premises;
3) Property loaned to the Named Insured;
4) Personal property in the care, custody or control of the Insured; 5) That particular part of resp property on which the Named Insured or any oontrootors or subcontractors working directly or indirectly on the Named Insured' s behalf are performing operations, if the property damage arises out of those operations; or 6) That particular part of any property that must be restored, repaired or replaced because your work was incorrectly performed on it.

CNA74705XX ( 1- 15)

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Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
Paragraphs ( 1), ( 3) and ( 4) of this exclusion do not apply to property damage ( other than damage by fire) to premises rented to the Named Insured or temporarily occupied by the Named Insured with the permission of the owner, nor to the contents of premises rented to the Named Insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in LIMITS OF INSURANCE.

Paragraph ( 2) of this exclusion does not apply if the premises are your work.

Paragraphs ( 3), ( 4), ( 5) and ( 6) of this exclusion do not apply to liability assumed under a sidetrack agreement.

Paragraph ( 6) of this exclusion does not apply to property damage included in the products - completed operations hazard.

Paragraphs ( 3) and ( 4) of this exclusion do not apply to property damage to:
i. tools, or equipment the Named Insured borrows from others, nor ii. other personal property of others in the Named Insured' s care, custody or control while being used in the Named Insured' s operations away from any Named Insured' s premises.

However, the coverage granted by this exception to Paragraphs ( 3) and ( 4) does not apply to:
a. property at a job site awaiting or during such property' s installation, fabrication, or erection; b. property that is mobile equipment leased by an Insured; c. property that is an auto, aircraft or watercraft;
d. property in transit; or
e. any portion of property damage for which the Insured has available other valid and collectible insurance, or would have such insurance but for exhaustion of its limits, or but for application of one of its exclusions.

A separate limit of insurance and deductible apply to such property of others. See LIMITS OF INSURANCE as amended below.

B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete its last paragraph and replace it with the following:

Exclusions c. through n. do not apply to damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of premises rented to a Named Insured for a period of 7 or fewer consecutive days.

A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE.

C. The following paragraph is added to LIMITS OF INSURANCE:

Subject to 5. above, $25,000 is the most the Insurer will pay under Coverage A for damages arising out of any one occurrence because of the sum of all property damage to borrowed tools or equipment, and to other personal property of others in the Named Insured' s care, custody or control, while being used in the Named Insured' s operations away from any Named Insured' s premises. The Insurer' s obligation to pay such property damage does not apply until the amount of such property damage exceeds $ 1, 000. The Insurer has the right but not the duty to pay any portion of this $ 1, 000 in order to effect settlement. If the Insurer exercises that right, the Named Insured will promptly reimburse the Insurer for any such amount.

D. Paragraph 6., Damage To Premises Rented To You Llmlt, of LIMITS OF INSURANCE is deleted and replaced by the following:

6. Subject to Paragraph 5. above, ( the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most the Insurer will pay under Coverage A for damages because of property damage to any one premises while rented to the Named Insured or temporarily occupied by the Named Insured CNA74705XX ( 1- 15)

Page 12 of 17 ends

Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 411111! A
T/
Contractors' General Liability Extension Endorsement
with the permission of the owner, including contents of such premises rented to the Named Insured for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of:
a. $ 500,000; or
b. The Damage To Premises Rented To You Limit shown in the Declarations.

E. Paragraph 4.b.( 1)( a)( ii) of the Other Insurance Condition is deleted and replaced by the following:
ii) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by the Named Insured with the permission of the owner; or for personal property of others in the Named Insured' s care, custody or control;

16. LIQUOR LIABILITY
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Liquor Liability.

This LIQUOR LIABILITY provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part.

17. MEDICAL PAYMENTS
A. LIMITS OF INSURANCE is amended to delete Paragraph 7. ( the Medical Expense Limit) and replace it with the following:

7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most the Insurer will pay under Coverage C — Medical Payments for all medical expenses because of bodily injury sustained by any one person. The Medical Expense Limit is the greater of:
1) $ 15, 000 unless a different amount is shown here: @@@@@@@@@@@@@@; or 2) the amount shown in the Declarations for Medical Expense Limit.

B. Under COVERAGES, the Insuring Agreement of Coverage C — Medical Payments is amended to replace Paragraph 1. a.( 3)( b) with the following:
b) The expenses are incurred and reported to the Insurer within three years of the date of the accident; and This Paragraph B. does not apply to medical expenses incurred in the state of Missouri.

18. NON -OWNED AIRCRAFT
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended as follows:

The exclusion entitled Aircraft, Auto or Watercraft is amended to add the following:

This exclusion does not apply to an aircraft not owned by any Named Insured, provided that:

1. the pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot;

2. the aircraft is rented with a trained, paid crew to the Named Insured; and

3. the aircraft is not being used to carry persons or property for a charge.

19. NON -OWNED WATERCRAFT
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete subparagraph ( 2) of the exclusion entitled Aircraft, Auto or Watercraft, and replace it with the following.

This exclusion does not apply to:

CNA74705XX ( 1- 15)

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Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Contractors' General Liability Extension Endorsement
2) a watercraft that is not owned by any Named Insured, provided the watercraft is:
a) less than 75 feet long; and
b) not being used to carry persons or property for a charge.

20. PERSONAL AND ADVERTISING INJURY –DISCRIMINATION OR HUMILIATION A. Under DEFINITIONS, the definition of personal and advertising injury is amended to add the following tort:

Discrimination or humiliation that results in injury to the feelings or reputation of a natural person.

B. Under COVERAGES, Coverage B – Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to:

1. delete the Exclusion entitled Knowing Violation Of Rights Of Another and replace it with the following:

This insurance does not apply to:

Knowing Violation of Rights of Another
Personal and advertising injury caused by or at the direction of the Insured with the knowledge that the act would violate the rights of another and would inflict personal and advertising injury. This exclusion shall not apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is not done intentionally by or at the direction of:
a) the Named Insured; or
b) any executive officer, director, stockholder, partner, member or manager ( if the Named Insured is a limited liability company) of the Named Insured.

2. add the following exclusions:

This insurance does not apply to:

Employment Related Discrimination
Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any Insured.

Premises Related Discrimination
discrimination or humiliation arising out of the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any Insured.

Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity because of discrimination.

The coverage provided by this PERSONAL AND ADVERTISING INJURY – DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization whose status as an Insured derives solely from
Provision 1. ADDITIONAL INSURED of this endorsement; or attachment of an additional insured endorsement to this Coverage Part.

This PERSONAL AND ADVERTISING INJURY – DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part.

21. PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY A. Under COVERAGES, Coverage B – Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Contractual Liability. 7-47.._..
x_....... _...... w_ .................. ,", .......... ....... ._..............._____ .. ......................................................_ CNA74705XX ( 1- 15) Policy No: 7017691303

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Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Com'/ c1
Contractors' General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY provision, the following changes are made to the section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B:

1. Paragraph 2. d. is replaced by the following:
d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insured and the interests of the indemnitee;

2. The first unnumbered paragraph beneath Paragraph 2.f.(2)( b) is deleted and replaced by the following:

So long as the above conditions are met, attorneys fees incurred by the Insurer in the defense of that indemnitee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred by the indemnitee at the Insurer's request will be paid as defense costs. Such payments will not be deemed to be damages for personal and advertising injury and will not reduce the limits of insurance.

C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply if Coverage B —Personal and Advertising Injury Liability is excluded by another endorsement attached to this Coverage Part.

This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part.

22. PROPERTY DAMAGE —ELEVATORS
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs ( 3), ( 4) and 6) of the Damage to Property Exclusion do not apply to property damage that results from the use of elevators.

B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the Other Insurance conditions is amended to add the following paragraph:

This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators.

23. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:

A. Paragraph 1. b. is amended to delete the $ 250 limit shown for the cost of bail bonds and replace it with a 5, 000. limit; and
B. Paragraph 1. d. is amended to delete the limit of $ 250 shown for daily loss of earnings and replace it with a 1, 000. limit.

24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured' s Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure.

25. WAIVER OF SUBROGATION - BLANKET
Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following -
The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of:

1. the Named Insured' s ongoing operations; or

2. your work included in the products -completed operations hazard.

CNA74705XX ( 1- 15) Policy No: 7017691303

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Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

A,
Contractors' General Liability Extension Endorsement
However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement:

1. is in effect or becomes effective during the term of this Coverage Part; and

2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim.

26. WRAP- UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrapup) insurance program by applicable state statute or regulation.

If the endorsement EXCLUSION — CONSTRUCTION WRAP- UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs ( O.C. I. P.) or Contractor Controlled Insurance Programs (C. C. I. P.) is attached, then the following changes apply:

A. The following wording is added to the above -referenced endorsement:

With respect to a consolidated ( wrap- up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of:

1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured' s ongoing operations at the project, or during such operations of anyone acting on the Named Insured' s behalf; nor

2. Bodily injury or property damage included within the products -completed operations hazard that arises out of those portions of the project that are not residential structures.

B. Condition 4. Other Insurance is amend to add the following subparagraph 4. b.( 1)( c):

This insurance is excess over:
c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to the Named Insured as a result of the Named Insured being a participant in a consolidated ( wrap-up) insurance program, but only as respects the Named Insured' s involvement in that consolidated (wrap-up) insurance program.

C. DEFINITIONS is amended to add the following definitions:

Consolidated ( wrap-up) insurance program means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program ( O. C. I. P.) or Contractor Controlled Insurance Program ( C. C. I. P.).

Residential structure means any structure where 30% or more of the square foot area is used or is intended to be used for human residency, including but not limited to:

1. single or multifamily housing, apartments, condominiums, townhouses, co- operatives or planned unit developments; and

2. the common areas and structures appurtenant to the structures in paragraph 1. ( including pools, hot tubs, detached garages, guest houses or any similar structures).

However, when there is no individual ownership of units, residential structure does not include military housing, college/ university housing or dormitories, long term care facilities, hotels or motels. Residential structure also does not include hospitals or prisons.

This WRAP- UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED ( WRAP-UP) INSURANCE PROGRAMS Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part.

CNA74705XX ( 1- 1. 5).... .. .............. Poli
ry........................................_........__........... ............___..........

Policy No: 7017691303

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Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

All other terms and conditions of the Policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below„ and expires concurrently with said Policy.

CNA74705XX ( 1- 15)

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Policy No: 7017691303
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Blanket Additional Insured - Owners, Lessees or
Contractors - with Products -Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:

1. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf:

A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if:

1. the written contract requires you to provide the additional insured such coverage; and

2. this coverage part provides such coverage.

II. But if the written contract requires:

A. additional insured coverage under the 11- 85 edition, 10- 93 edition, or 10- 01 edition of CG2010, or under the 10- 01 edition of CG2037; or
B. additional insured coverage with " arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph 1. above is deleted in its entirety and replaced by the following:

WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract.

III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with:

A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract.

IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of:

A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including:

1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and

2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on annthPr en(inrsPmPnt sttarhed to this coverage part.

V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part:

Primary and Noncontributory Insurance
0§v 10 -16)
m
Policy No: 7017691303

Page 1 of 2 ends

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Lr 1'VA
Blanket Additional Insured - Owners, Lessees or
Contractorsos •
Operations Coverage Endorsement
With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be:

1. primary and non- contributing with other insurance available to the additional insured; or 2, primary and to not seek contribution from any other insurance available to the additional insured.

But except as specified above, this insurance will be excess of all other insurance available to the additional insured.

VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:

The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following:

Any additional insured pursuant to this endorsement will as soon as practicable:

1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;

2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and

3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part.

However, if the written contract requires this insurance to be primary and non- contributory, this paragraph

3. does not apply to insurance on which the additional insured is a named insured.

The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured.

VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition:

Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement:

A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to:

1. the bodily injury or property damage; or

2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage.

Any coverage granted by this endorsement shall apply solely to the extent permissible by law.

All other terms and conditions of the Policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.

CNA75079XXµ(10- 16) ..... ... ......_. ........._._ Policy No: 7017691303

Page 2 of 2 ends

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Waiver of Transfer of Rights of Recovery Against
Others to the Insurer Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE
Name Of Person Or Organization:

Any p3c r =ycm or o gaTiiz at.:i_ on with whon you have agreed in writing in ai c,. orit_r- a.ct. or a etxeexnerit: to waive tarry ricphL of nc: covefy argaax. u' s tt srrr,, h person or org ara. i_ zrat.i ori, but ora d y . i. f: the e ct . r t.:rac or ra<,:3: rrerxrnerit.
l.. Ls : i.rx cat ectt:. or b corner cf oe:° tive di,rriricp t.. r.t term crit tM s, p: oli.cuyp and
W,,as e x.c:-a c-: t.r tt. r r ct prior
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following:

With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured' s ongoing operations or your work included in the products -completed operations hazard.

All other terms and conditions of the Policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the Policy... .......... ry., __....
issued by the designated Insurers,
takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrentlywith said Policy,
CNA75008XX ( 10- 16)

Page 1 of 1 ends

Policy No: CNA75061XX ( 1- 15)
Endorsement No:

Effective Date: 11/ 12/ 2021
Insured Name:

Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.

CNA71527XX
Ed. 10/ 12)

ADDITIONAL INSURED - PRIMARY AND NON- CONTRIBUTORY
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:

SCHEDULE
Name of Additional Insured Persons Or Organizations
Any person or organization that you are required by written contract to make an additional insured under this insurance is an " insured", but only with respect to that person or organization' s legal liability for acts or omissions of a person who qualifies as an " insured" for Liability Coverage under Section II — Who Is An Insured of this Coverage Form."

1. In conformance with paragraph A.1. c. of Who Is An Insured of Section II — LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy.

2. The insurance afforded to the additional insured under this policy will apply on a primary and non- contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the accident" for which the additional insured seeks coverage under this policy.

All other terms and conditions of the Policy remain unchanged.

CNA71527XX ( 10/ 12)

Page 1 of 1 ends

Insured Name: CJ Concrete Construction Inc
Copyright CNA All Rights Reserved,
Policy No:

Endorsement No:

Effective Date:
7017691317
11/ 12/2021
POLICY NUMBER: 7017691317 COMMERCIAL AU
CA 04 44 10
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)l
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 bythe endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated Named Insured: CJConcrete Construction Inc
Endorsement Effective Date: 11/ 12/ 2021

SCHEDULE
Name(s) OfPenswn(s) Or Organizadon(s):

ANY gEF SU0 OF, ORGANIZATION FOR KBDm
OR mazCa YOU ARE REQUIRED BY wRzrzEm
CO0TIAC'T DR AGREEMENT TO O13 AI0 THIS
WAIVER FROM 0S. YOU MUST a R F TO TBA"T
PRIOR ' F0 LOSS.

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

The Transfer Of Rights Of Recovery Against
Others To 0s condition does not apply to the
paroon(a) ororganizoUon( o) shown inthe Schedule,
but only to the extent that subrogation is waived prior to the " accident" or the " loss" under e oon1neot with that person ororganization.

CAO4441013 Copyright, Insurance Services Office, | nu, 2O11 Page 1of1

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY The following item( s)
Insured' s Name (WC 89 06 01)
Policy Number (WC 89 06 02)
Effective Date (WC 89 06 03)

POLICY INFORMATION PAGE ENDORSEMENT
Expiration Date (WC 89 06 04)
Insured' s Mailing Address (WC 89 06 05)
Experience Modification (WC 89 04 06)
Producer' s Name (WC 89 06 07)
Change in Workplace of Insured ( WC 89 06 08)
Insured' s Legal Status ( WC 89 06 10)
Item 3.A. States ( WC 89 06 11)
is changed to read:

WC 89 06 00 B
Ed. 7-01)
Item 3. 8. Limits ( WC 89 06 12)
Item 3. C. States ( WC 89 06 13)
Item 3. D. Endorsement Numbers (WC 89 06 14)
Item 4. * Class, Rate, Other (WC 89 04 15)
Interim Adjustment of Premium ( WC 89 04 16)
Carrier Servicing Office (WC 89 06 17)
Interstate/ Intrastate Risk I. D. Number (WC 89 06 18)
Carrier Number (WC 89 06 19)
FO
Issuing Agency( Producer Office Address (WC 89 06 25)
DTO THIS POLICY:

FzLANKET WAIVER( 0930) STATE: CA RATE: . 02
THE FOLLOWING nl ADDED:

WC 04 03 06 04- 84 CA WAIVER OF i RIGHT
Item 4. Change To:

Premium Basis Rate Per $ 100
Code Total Estimated
Classifications of
No. Annual
Remuneration
Remuneration
SEE ATTACHED WC 9 06 00 B 07-01) EXTENSION
Total Estimated Annual Premium $ 59, 947
Minimum Premium $ 2, 538 Deposit Premium $ 9, 794
All other terms and conditions of this policy remain unchanged.

Estimated
Annual Premium
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 05- 08- 21 Policy No.'WC 73981 00 Endorsement Nn 0.101 Insured CJ Concrete Constructions Inc Premium: $ 949. 00 Santa Fe Springs, CA 90670
Insurance Company
Sirius America Ins Co Countersigned By
WC 89 06 OOB
Ed. 7- 01)
0 2001 National Council on Compensation Insurance, Inc. 28363 ( Ed. 7-01)

POLICY INFORMATION PAGE ENDORSEMENT
Premium Basis
Total Estimated Rate Per
Code Annual $ 100 ofEstimated Annual
Classifications No. Remuneration Remuneration Premium I

TRANSACTION RECAP BY RATING GROUP
Transaction Factor
Stats: CA Rating Group: 0001- 01
Stat Old New Old Term New Term Oos Add/ Return
Code Rate Rate Premium Premium Offset Premium
9897 24 24 33, 498. 00 34, 051A0 00 553. 00
9887 42 42 44, 553. 00 45, 287. 00 00 734, 00
0063 1 1 6, 153. 00 6, 254. 00 00 101. 00
0930 A0 02 00 2, 301. 00 00 2, 301 00
0987 022646 022646 1, 285. 00 1, 306. 00 00 21, 00
0988 A04734 004734 269. 00 273. 00 00 4, 00
0000 000775 000775 44. 00 45. 00 00 1" 00
0000 006579 006579 373. 00 379, 00 00 6. 00
0000 002584 002584 147. 00 149. 00 A0 2, 00
0000 002272 002272 129. 00 131. 00 00 2, 00
Rating Group 0001- 01 Estimated Transaction Premium 949. 00 Cash State Total ( CA) 949. 00
Policy Total Cash Premium 949. 00
WC 89 06 00 B
Ed. 7-01)
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 0484)
WAIVER OF OUR • • OTHERS ENDORSEMENT

CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. ( This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.

The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration.

SCHEDULE

PERSON OR ORGANIZATION JOB DESCRIPTION
Blanket Waiver Any person or organization ars
required by written
contract within states covered
under this policy
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 05- 08- 21 Pnliry Nn. WC 73981 00 Endorsement No. 001 Insured CJ Concrete Constructions Inc Premium $ Incl.

Insurance Company Sirius America Ins Co
Countersigned By
1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.

From the WCIRB's California Workers' Compensation Insurance Forme Manual O 1999.

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