CITY OF RICHMOND
CONTRACT AMENDMENT
Department: Project Manager:
Project Manager E-mail: Project Manager Phone No:
P.R. No: Vendor No: P.O./Contract No:
Description of Services:
Amendment No. ___ modifies the: (2nd or subsequent amendments attach Amendment History page)
Term, Pa yment Limit and Service Plan
Pay ment Limit and Service Plan
Term and Service Plan
Service Plan
The parties to this Contract Amendment do mutually agree and promise as follows:
1. Parties. The parties to this Contract Amendment are the City of Richmond, California, a
municipal corporation (City), and the following named Contractor:
Company Name:
Street Address:
City, State, Zip Code:
Contact Person:
Telephone: Email:
Business License No: / Expiration Date:
A California [ ] corporation, [ ] limited liability corporation [ ] general partnership, [ ] limited partnership, [ ] individual, [ ] non-profit corporation, [ ] individual dba as [specify:]
[ ] other [specify:]
2. Purpose. This Contract Amendment is being entered into to amend the Contract between City and Contractor which
was approved by the City Council of the City of Richmond or executed by the City Manager on ,
which original term commenced
on
and terminates w
ith an original
contract payment limit of $
. Said contract shall hereinafter be referred
to as the "Original Contract" and is incorporated herein by reference.
3. Original Contract Provisions. The parties hereto agree to continue to abide by those terms and conditio
ns of the Original Contract, and any amendments thereto, which are unaffected by this Contract Amendment.
Attachment 2: Witt O' Brien's Contract Amendment 1
Contract Amendment/EJ/TE 09-26-07
4. Amendment Provisions. This Contract Amendment is subject to the Amendment Provisions attached hereto, which are incorporated herein by reference, and which control over any conflicting provisions of the Original Contract, or any amendment thereto.
5. City of Richmond Business License Active Status Maintained. Pursuant to Municipal Code Section 7.04.030, the Contractor must maintain its City of Richmond business license for this Contract Amendment to be deemed to be in effect.
6. Insurance Coverage Updated and Maintained. Pursuant to the Original Contract, the Contractor shall provide the City with updated insurance certificates, and the Contractor shall maintain insurance coverage, for this Contract Amendment to be deemed to be in effect.
7. Signatures. These signatures attest the parties’ agreement hereto:
CITY OF RICHMOND, CALIFORNIA
a municipal corporation
By _______________________
Title:
I hereby certify that the Original Contract
and this Amendment have been approved
by the City Council or executed by the City
Manager.
By _______________________
City Clerk
Approved as to form:
By_______________________
City Attorney
List of Attachments:
1. Amendment Provisions
2. Updated Insurance Certificates
CONTRACTOR:
______________________________
(*The Corporation Chairperson of the Board, President or Vice-President should sign on the line below.)
By____________________________
Title:________________________
(*The Corporation Chief Financial Officer, Secretary or Assistant Secretary should sign on the line below.)
By:___________________________
Title:________________________
(NOTE: Pursuant to California Corporations
Code Section 313, if Contractor is a
corporation or nonprofit organization, this
Contract (1) should be signed by the
Chairperson of the Board, President or
Vice-President
and the Chief Financial
Officer, Secretary or Assistant Secretary; (2)
should have both signatures conform to
designated representative groups pursuant
to Corporations Code Section 313.
Contact Amendment
Instruction Sheet
For Contract Amendment # 1 select one of the following Contract Amendment Provision forms based on one of the following conditions (if this is the 2nd or subsequent amendment to an existing contract, an Amendment History page is required outlining the details of all subsequent amendments in addition to ONE of the amendment provisions pages listed below).
1. Term, Payment Limit and Service Plan (increases both the term and the dollar limit of the contract and may modify the service plan of the original contract to include additional tasks and/or services in relation to the existing contract (if applicable)
2. Payment Limit and Service Plan (increases the dollar limit of the contract, but does not extend the term of the contract and may modify the service plan of the original contract to include additional tasks and/or services in relation to the existing contract (if applicable)
3. Term and Service Plan (extends the term of the contract, but does not increase the dollar amount of the contract and may modify the service plan of the original contract to include additional tasks and/or services in relation to the existing contract (if applicable)
4. Service Plan (modifies the service plan of the original contract to include additional tasks and/or services in relation to the existing contract)
5. Amendment History (if this is the 2nd or subsequent amendment to an existing contract, an Amendment History page is required outlining the details of all subsequent amendments in addition to ONE of the amendment provisions pages listed above (one of items 1-4)
If you need to make any other changes to the contract, you should consider executing a new City of Richmond Standard Contract.
Again, only ONE of the following Amendment Provisions pages and an Amendment History page (if this is the 2nd or subsequent amendment) should be used and attached to this Contract Amendment.
Contract Amendment between the City of Richmond and
Amendment No. P.O./Contract No.
AMENDMENT PROVISIONS (TERM, PAYMENT LIMIT AND SERVICE PLAN)
1. Paragraph 2 (Term) of the Original Contract is hereby amended to extend the Contract term. Paragraph 2 of the Original Contract is amended to read as follows:
"2. Term. The effective date of this Contract is
____________________________________________________________ (Insert original contract commencement date)
and it terminates
___________________________________________________.
(Insert new contract termination date)
unless sooner terminated as provided herein."
2. Paragraph 3 (Payment Limit) of the Original Contract is hereby amended to increase the payment limit by $ . Paragraph 3 of the Original Contract is amended to read as follows:
"3. Payment Limit. City's total payments to Contractor under this Contract shall not exceed $ including expenses."
“The City of Richmond shall not pay for services that exceed the Contract Payment Limit without the prior written approval of the City Manager if the total Contract amount does not exceed $10,000 or without the prior approval of the City Council if the total Contract amount is over $10,000.”
3. The Service Plan (Exhibit A) of the Original Contract is hereby amended to include the following tasks and/or services:
Contract Amendment/EJ/TE 9-26-07
Contract Amendment between the City of Richmond and
Amendment No. P.O./Contract No.
AMENDMENT PROVISIONS (AMENDMENT HISTORY)
The first Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The second Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The third Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The fourth Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The fifth Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
City of Richmond, CA
ARPA Technical Assistance Amended Proposal
1 wittobriens.com
City of Richmond, California –
Technical Assistance related to
the City’s American Rescue Plan
Act Funding (ARPA)
City of Richmond, CA
ARPA Technical Assistance Amended Proposal
2 wittobriens.com
COVER PAGE
Proposal in Response to:
City of Richmond, CA – Technical Assistance related to the City’s America Rescue Plan Act (ARPA) Funding (Contract dated March 22, 2023 – June 30, 2025)
Submitted to:
Mubeen Qader, CPFO, Deputy Director of Finance, City of Richmond, [email protected]
Prime Vendor:
Witt O’Brien’s, LLC
818 Town & Country Blvd.
Suite 200, Houston, TX 77024
(281) 320-9796 | www.wittobriens.com
Contact for Proposal Correspondence:
If you have any questions about our proposal or require additional information about our services or company, please contact Michelle Little at [email protected] and Matthew Hanson at [email protected] with a copy to [email protected].
Submittal Date:
August 29, 2024
Submittal Deadline:
December 31, 2024
Witt O’Brien’s reserves the right to negotiate terms and conditions applicable to any final Agreement and, if selected, will negotiate in good faith to enter into a mutually agreeable formal written Agreement.
City of Richmond, CA
ARPA Technical Assistance Amended Proposal
3 wittobriens.com
Witt O’Brien’s is pleased to submit an amended quote to continue supporting your work for Technical Assistance related to the City’s America Rescue Plan Act (ARPA) Funding.
As noted below, we are prepared to continue supporting the City of Richmond’s ARPA Program through June 2027, as outlined below and originally stated in our Contract.
The Amended Service Plan for the City of Richmond – Technical Assistance related to ARPA is outlined below:
• Continue support beginning December 2024 – June 2027
o WOB will continue to actively work with City of Richmond to adhere to Treasury’s obligation deadline of December 31, 2024 and expenditure deadline of December 31, 2026.
o WOB will support the City of Richmond through June 2027, once all funds have been expended, and any closeout, audit, or other support services are needed. • Eligibility and Procurement support increased
o WOB will continue and increase support for Richmond by drafting eligibility memorandums, drafting/updating Intra Agency Agreements, supporting procurement efforts, including contractor and subrecipient agreements in compliance with ARPA. This includes completion of subrecipient v. contractor determinations, Sam.gov debarment review, etc.
• Record Retention support
o WOB will continue to support the overall document collect and retention effort and maintain the system of record. This includes collecting documentation for each program or project – including but not limited to contracts, agreements, policies and procedures, SOPs, invoices, etc.
• Monitoring and Closeout support increased
o Monitoring support will include risk assessment development and monitoring, as well as follow up to clear/resolve any issues found
▪ WOB will monitor each program, at least once, and provide a detailed overview of scope of work, methodology, summary of findings, best practices, and any issues noted and steps for resolution.
o Closeout support will include development of a Closeout Plan and process ▪ WOB will prepare a Closeout Plan, process, and tools associated with this effort and will review each program or project prior to closeout. • Quarterly Reporting support increased
o WOB will continue to support in the Quarterly Reporting effort to Treasury for all required quarters and reconciliation as needed.
• Increase training and technical assistance, including on-site support as needed o WOB will continue to provide and increase efforts for training and technical assistance. • Audit preparation and other support services as needed o WOB will provide support in order to help prepare for and respond to audits as needed.
City of Richmond, CA
ARPA Technical Assistance Amended Proposal
4 wittobriens.com
The Estimated Level of Effort for the 23 ARPA funded programs and projects as of August 2024 is as follows:
City of Richmond, CA
ARPA Technical Assistance Amended Proposal
5 wittobriens.com
The following tables present the FTEs required during the period of performance (December 2024 – June 2027) followed by the table identifying the work and the labor category(s) providing the support.
For this effort, Witt O’Brien’s will continue to use the Rates found in the current Contract.
The total NTE for this effort will be $273,800 and work will be completed by June, 2027, unless a new mutually agreed upon date is determined.
Should additional support and resources be needed, Witt O’Brien’s and the City of Richmond will work collaboratively to update this proposal.
DECEMBER 2024 – JUNE 2027:
FTEs Rate Labor Category Work Area
1 $286 Project Manager Oversee project and
coordination with City of
Richmond; provide technical
assistance, training, audit
support services, etc. to
support overall ARPA
compliance.
[Use as
needed]
$225 Management Consultant V [Assist in overall ARPA
compliance support and
mobilize resource as
needed]
[Use as
needed]
$175 Management Consultant IV [Assist in overall ARPA
compliance support and
mobilize resource as
needed]
1 $150 Management Consultant III Perform monitoring,
closeout, and reporting
support services. Also,
provide technical assistance
and training as needed for
ARPA compliance.
1 $125 Management Consultant II Perform eligibility and procurement support
services. Also, provide
technical assistance and
training as needed for ARPA
compliance.
[Use as
needed]
$95 Management Consultant I [Assist in overall ARPA
compliance support and
mobilize resource as
needed]
City of Richmond, CA
ARPA Technical Assistance Amended Proposal
6 wittobriens.com
GRANT SOLUTIONS
Activity Description Schedule/Due Date
City of Richmond – Technical
Assistance related to ARPA
Compliance
Project Manager,
Management Consultant III,
and Management
Consultant II
▪ Continue support beginning
December 2024 – June 2027
▪ Eligibility and Procurement support
increased
▪ Record retention support
▪ Monitoring and Closeout support
increased
o Monitoring support will include
risk assessment and
monitoring, as well as follow
up to clear/resolve issues
found
o Closeout support will include
development of a Closeout
Plan and process
▪ Quarterly Reporting support
increased
▪ Increase training and technical
assistance, including on-site support
as needed
▪ Audit preparation and other support
services as needed
Due June, 2027
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 1 of 3
Revised: September 2011
In all instances where CONTRACTOR or its representatives will provide professional services (architects, engineers, construction management, counselors, medical professionals, hospitals, clinics, attorneys, consultants, accountants, etc.) to the City of Richmond (City), the City requires the following MINIMUM insurance requirements and limits.
CONTRACTOR shall procure and maintain for the duration of the contract, agreement, or other order for work, services or supplies, 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 and the results of that work by the CONTRACTOR, its agents, representatives, employees or subcontractors. Maintenance of proper insurance coverage is a material element of the contract. Failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract.
CONTRACTOR agrees that in the event of loss due to any of the perils for which it has agreed to provide Commercial General Liability insurance, CONTRACTOR shall look solely to its insurance for recovery.
CONTRACTOR hereby grants to CITY, on behalf of any insurer providing Commercial General Liability insurance to either CONTRACTOR or CITY with respect to the services of CONSULTANT herein, a waiver of any right to subrogation which any such insurer of said CONTRACTOR may acquire against the CITY by virtue of the payment of any loss under such insurance.
Original, signed certificates and original, separate policy endorsements, naming the City as an additional insured for general liability coverage, as well as a waiver of subrogation for Workers’ Compensation insurance, shall be received and approved by the City before any work may begin. However, failure to do so shall not operate as a waiver of these insurance requirements.
City reserves the right to modify or require additional coverages for specific risk exposures depending on scope of CONTRACTORS work.
Minimum coverage is detailed below. The policy limits of coverage shall be made available to the full limits of the policy. The minimum limits stated herein shall not serve to reduce the policy limits of coverage of CONTRACTOR.
Minimum Scope of Insurance – the following forms shall be provided and coverage shall be at least as broad as the following:
1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001), and including coverage for bodily and personal injury, property damage, and products and completed operations (if applicable).
2. Insurance Services Office Automobile Liability coverage (ISO Form CA 0001, Code 1, Any Auto).
3. Original and Separate Additional Insured Endorsement for General Liability (ISO Form CG 20 10 11/85 or its equivalent) with primary and non-contributory language.
4. Workers’ Compensation Insurance as required by the State of California including Employer’s Liability coverage.
5. Original and Separate Waiver of Subrogation for Workers’ Compensation insurance.
6. Professional Liability or Errors & Omissions Liability Insurance appropriate to the CONTRACTOR’s profession (if required.)
Required Coverage Minimum Limits
Workers’ Compensation and
Employers’ Liability
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease.
If CONTRACTOR is self-insured, provide a certificate of Permission to Self- Insure, signed by the California Department of Industrial Relations and Self- Insurance. If contractor is a sole proprietor (has no employees) than contractor must sign “Contractor Release of Liability” found at:
http://www.ci.richmond.ca.us/index.aspx?nid=61.
General Liability
(primary and excess limits
combined)
$2,000,000 per occurrence for bodily injury, personal injury and property damage. If the policy includes a general aggregate, either the general aggregate shall apply separately to this project, service or location or the minimum required aggregate limit shall be twice the per occurrence limit ($4 million aggregate limit).
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 2 of 3
Revised: September 2011
Automobile Liability $1,000,000 per occurrence for bodily injury and property damage.
PROJECT COST R EQUIRED LIMIT
$0 - $1 million $1 million p/o
$1 million - $5 million $2 million p/o
Over $5 million $5 million p/o
Professional Liability or Errors &
Omissions Liability –
Required for all professionals
including architects, engineers,
consultants, construction
management, counselors, medical
professionals, hospitals, clinics,
attorneys and accountants, & other
consultants as may be required by
the City.
Required Policy Conditions
Additional Insured Endorsement
Applicable to General Liability coverage.
The City of Richmond, its officers, officials, employees, agents and volunteers are to be named as additional insureds for all liability arising out of the operations by or on behalf of the named insured including bodily injury, deaths and property damage or destruction arising in any respect directly or indirectly in the performance of this contract.
ISO form CG 20 10 (11/85) or its equivalent is required. If the Contractor is supplying their product or providing a service then the endorsement must not
exclude products and completed operations
coverage. If it does, then CG 20 37 (10/01) is also required.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61
.
Primary and Noncontributory The contractor’s insurance coverage must be primary coverage as it pertains to the City, its officers, officials, employees, agents and volunteers. Any insurance or self insurance maintained by the City is wholly separate from the insurance of the contractor and in no way relieves the contractor from its responsibility to provide insurance.
Waiver of Subrogation
Endorsement Form
Contractor’s insurer will provide a Waiver of Subrogation in favor of the City for Workers’ Compensation Insurance during the life of this contract.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61.
Deductibles and Self-Insured
Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At the option of the City either the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City or the CONTRACTOR shall procure a financial guarantee in an amount equal to the deductible or self-insured retention guaranteeing payment of losses and related investigations, claims administration and defense expenses.
Contractor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
A. M. Best Rating A:VII or Better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City.
Umbrella/Excess Liability Policies
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverage’s and cover those insured in the underlying policies.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 3 of 3
Revised: September 2011
Claims-Made Policies
If any insurance policy is written on a claims-made form: 1) the retroactive date must be shown, and must be before the date of the contract or the beginning of contract work. 2) Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3) If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, the Contractor must purchase an extended period coverage for a minimum of five (5) years after completion of contract work.
Subcontractors
CONTRACTOR
shall include all subcontractors as insured under its policies or shall furnish to the City for review and approval, separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated herein.
CONTRACTOR agrees to defend and indemnify the City of Richmond for any damage resulting to it from failure of either CONTRACTOR or any subcontractor to take out or maintain the required insurance policies.
The fact that
insurance is obtained by CONTRACTOR, and/or CONTRACTOR’s subcontractors, will not be deemed to release or diminish the liability of CONTRACTOR, including, without limitation, liability under the indemnity provisions of this contract. Damages recoverable by CITY from CONTRACTOR or any third party will not be limited by the amount of the required insurance coverage.
Verification of Coverage
All original certificates and endorsements shall be received and approved by the City before work may begin .
The City of Richmond reserves the right to require complete, certified copies of all required insurance policies including endorsements affecting the coverage at any time.
Original insurance certificates and required policy endorsements shall be mailed or delivered to the Designated Project Manager for the City of Richmond.
Insurance certificates and endorsements may be faxed to the Designated Project Manger. However, CONTRACTOR must mail the original certificates and endorsements to Designated Project Manager once faxed.
Continuous Coverage
CONTRACTOR shall maintain the required insurance for the life of the contract. Should the CONTRACTOR cease to have insurance as required during this time, all work by the CONTRACTOR pursuant to this agreement shall cease until insurance acceptable to the City is provided. In the event that CONTRACTOR fails to comply with the City’s insurance requirements, the City may take such action as it deems necessary to protect the City’s interests. Such action may include but is not limited to termination of the contract, withholding of payments, or other actions as the City deems appropriate.
If services or the scope of work extend beyond the expiration dates of the required insurance policies initially approved by the City, CONTRACTOR must provide updated certificates and endorsements indicating that the required coverage, terms and conditions are still in place. Renewal certificates and updated endorsements shall be mailed to the Designated Project Manager.
Cancellation
CONTRACTOR shall ensure that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days’ prior written notice has been given to the City.
Reporting Requirements
Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees or volunteers.
Consistent with Public Policy
The insuring provisions, insofar as they may be judged to be against public policy shall be void and unenforceable only to the minimum extent necessary so that the remaining terms and provisions herein may be consistent with public policy and thus enforceable.
City of Richmond – Consulting Services for Oversight and Compliance Related to American Rescue Plan Act Funds wittobriens.com 57
03/20/2024
Valent Group, LLC
3500 Blue Lake Drive, Ste. 120
Birmingham AL 35243
Seth Stone
(205) 262-2700 (205) 262-2701
[email protected]
Witt O'Brien's, LLC
and others per attached
818 Town & Country Blvd, Suite 200
Houston TX 77024
Steadfast Insurance Company 26387
Zurich American Ins Co 16535
23-24 COI
A
Professional Liability (see attached)
Pollution Liability (see attached) Y Y GPL8713651-01 08/11/2023 08/11/2024 2,000,000
100,000
5,000
2,000,000
4,000,000
4,000,000
B Y Y BAP8713644-02 08/11/2023 08/11/2024
1,000,000
A
0 Y Y SXS8598576-01 08/11/2023 08/11/2024
10,000,000
10,000,000
B N Y WC 8713648-01 08/11/2023 08/11/2024
1,000,000
1,000,000
1,000,000
Certificate Holder is listed as Additional Insured as respects General Liability, Auto Liability and Excess Liability policies as required by written contract and/or agreement. Waiver of Subrogation applies in favor of the Certificate Holder as respects General Liability, Auto Liability, Excess Liability and Workers Compensation as required by written contract and/or agreement.
City of Richmond
Purchasing Division
450 Civic Center Plaza
Richmond CA 94804
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $
$
$
$PROPERTY DAMAGE
BODILY INJURY
(Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
O'Brien's Response Management, LLC
Witt O'Brien's USVI, LLC
Witt O'Brien's Payroll Management, LLC
Witt O'Brien's PR, LLC
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insureds
Other Named Insureds
OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC
Witt O'Brien's, LLC
Valent Group, LLC
25 Certificate of Liability Insurance: Notes
Additional Coverage Information:
General Liability policy includes the following:
Professional Liability - Claims Made
Each Claim Limit: $2,000,000
Policy Aggregate: $4,000,000
Contractor's Pollution Liability - Occurrence
Each Claim Limit: $2,000,000
Policy Aggregate: $4,000,000
Transportation of Materials by Carrier (Auto, Aircraft, Vessel, Rolling Stock) Endorsement applies as follows:
Transportation Each Incident: $1,000,000
Transportation Aggregate: $1,000,000
Auto Liability includes the following endorsements:
MCS 90
CA9948 - Pollution Liability - Broadened Coverages for Covered Autos Workers Comp policy referenced includes the following endorsements:
Longshore and Harbors Workers Compensation Act Coverage Endorsement Alternate Employer Endorsement (blanket if required by written contract and/or agreement) Maritime Employers Liability Endorsement
Excess Liability provides coverage over the General Liability, Professional Liability, Pollution Liability, Auto Liability and Employer's Liability coverage.
Excess Liability follows terms and conditions of the underlying policies to the extent such terms and conditions are not inconsistent or do not conflict with the terms and conditions of the Excess Liability policy referenced.
Cyber Liability
Insurers C:
Arch Specialty Ins Co NAIC #: 21199 30% quota share
Ascot Specialty Ins Co NAIC #: 45055 20% quota share
Allianz Underwriters Ins Co NAIC #: 36420 20% quota share Fortega Specialty Ins Co NAIC #: 16823 30% quota share
Policy Term: 11/1/2023-11/1/2024
Policy #: C-4LPX-246642-CYBER-2023
Limits:
Network and Information Liability: $2,000,000
Regulatory Defense and Penalty: $2,000,000
Multimedia Content Liability: $2,000,000
PCI Fines and Assessments: $2,000,000
Breach Response: $2,000,000
Crisis Management and Public Relations: $2,000,000
Cyber Extortion: $2,000,000
Business Interruption and Extra Expenses: $2,000,000
Digital Asset Restoration: $2,000,000
Funds Transfer Fraud: $250,000
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
U-CA-424-H CW (10/21)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Coverage Extension Endorsement
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. BAP-8713644-02 Effective Date: 08/11/2023
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II – Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any “employee” of yours is also an “insured” while operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don’t own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form.
B. Amendment – Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II – Covered Autos Liability Coverage are replaced by the following:
(2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work.
C. Fellow Employee Coverage
The Fellow Employee Exclusion contained in Section II – Covered Autos Liability Coverage does not apply.
U-CA-424-H CW (10/21)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
D. Driver Safety Program Liability and Physical Damage Coverage
1. The following is added to the Racing Exclusion in Section II – Covered Autos Liability Coverage:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations.
2. The following is added to Paragraph 2. in B. Exclusions of Section III – Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in B. Exclusions of Section IV – Physical Damage Coverage of the Motor Carrier Coverage Form:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations.
E. Lease or Loan Gap Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Lease Or Loan Gap Coverage
In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less:
a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and b. Any:
(1) Overdue lease or loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and
(5) Carry-over balances from previous leases or loans.
F. Towing and Labor
Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following:
We will pay up to $75 for towing and labor costs incurred each time a covered "auto" that is a "private passenger type", light truck or medium truck is disabled. However, the labor must be performed at the place of disablement.
As used in this provision, "private passenger type" means a private passenger or station wagon type "auto" and includes an "auto" of the pickup or van type if not used for business purposes.
G. Extended Glass Coverage
The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section:
If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced.
H. Hired Auto Physical Damage – Increased Loss of Use Expenses The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the following:
Loss Of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by:
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto";
U-CA-424-H CW (10/21)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
(2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto".
However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000.
I. Personal Effects Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Personal Effects Coverage
a. We will pay up to $750 for "loss" to personal effects which are:
(1) Personal property owned by an "insured"; and
(2) In or on a covered "auto".
b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of:
(1) The reasonable cost to replace; or
(2) The actual cash value.
c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto".
No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following:
(1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value.
(2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones.
(3) Paintings, statuary and other works of art.
(4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment.
Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss".
J. Tapes, Records and Discs Coverage
1. The Exclusion in Paragraph B.4.a. of Section III – Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV – Physical Damage Coverage in the Motor Carrier Coverage Form does not apply.
2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section:
We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices:
(a) Are the property of an "insured"; and
(b) Are in a covered "auto" at the time of "loss".
The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss".
K. Airbag Coverage
The Exclusion in Paragraph B.3.a. of Section III – Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV – Physical Damage Coverage in the Motor Carrier Coverage Form does not apply to the accidental discharge of an airbag.
L. Two or More Deductibles
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
U-CA-424-H CW (10/21)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you by us, the following applies for each covered "auto" on a per vehicle basis:
1. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or
2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible.
M. Temporary Substitute Autos – Physical Damage
1. The following is added to Section I – Covered Autos:
Temporary Substitute Autos – Physical Damage
If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following types of vehicles are also covered "autos" for Physical Damage Coverage:
Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its:
1. Breakdown;
2. Repair;
3. Servicing;
4. "Loss"; or
5. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section:
Temporary Substitute Autos – Physical Damage
We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party.
The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces.
N. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following:
a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate the insurance afforded by this policy.
Include, as soon as practicable:
(1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; (2) The "insured’s" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you.
O. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
U-CA-424-H CW (10/21)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract.
P. Employee Hired Autos – Physical Damage
Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:
(1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official’s duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
Q. Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy.
R. Hired Auto – World Wide Coverage
Paragraph 7.b.(5) of the Policy Period, Coverage Territory Condition is replaced by the following:
(5) Anywhere else in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, S. Bodily Injury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:
"Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.
T. Expected Or Intended Injury
The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II – Covered Auto Liability Coverage is replaced by the following:
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.
U. Physical Damage – Additional Temporary Transportation Expense Coverage Paragraph A.4.a. of Section III – Physical Damage Coverage is replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss".
U-CA-424-H CW (10/21)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
V. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section:
In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or "auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas, either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
W. Return of Stolen Automobile
The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section:
If a covered “auto” is stolen and recovered, we will pay the cost of transport to return the “auto” to you. We will pay only for those covered “autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage.
All other terms, conditions, provisions and exclusions of this policy remain the same.
WC124 (4-84) Page 1 of 1
WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Inc. Uniform Forms TM WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR
AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF
SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT
PERSON AND/OR ORGANIZATION
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 08/11/2023 Effective Policy No. WC 8713648 - 01 Endorsement No.
Insured Ambipar Holding USA, Inc Premium $
Insurance Company Zurich American Insurance Company Countersigned by
STF-ESP-101-F CW (04/13)
Additional Insured-Automatic-Owners, Lessees Or
Contractors
Coverage Part One-Commercial General Liability
Coverage Part Two-Contractor's Pollution Liability
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add’l Prem. Return Prem.
GPL 8713651-
01 08/11/2023 08/11/2024 08/11/2023 23175000 …… ……
Named Insured and Mailing Address: Producer:
AMBIPAR HOLDING USA INC
818 Town & Country Blvd Suite 200
Houston, TX 77024
SYNAPSE SERVICES LLC
198 W HIGH ST
SOMERVILLE, NJ 08876-1862
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY .
This endorsement modifies insurance provided under the following:
Environmental Services Package Policy
[x] COVERAGE PART ONE-COMMERCIAL GENERAL LIABILITY
[x] COVERAGE PART TWO-CONTRACTOR'S POLLUTION LIABILITY
1. Who is an Insured (Section I.) in the COMMON COVERAGE PROVISIONS is amended to include as an additional insured any person(s) or organization(s) whom you are required to add as an additional insured on this policy under a written contract or written agreement.
2. The insurance provided to the additional insured person(s) or organization(s) applies only to:
a. "Bodily injury”, “property damage” or "personal and advertising injury" under COVERAGE PART ONE-
COMMERCIAL GENERAL LIABILITY, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY caused, in whole or in part, by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf; and resulting directly from:
(a) Your ongoing operations performed for the additional insured, which is the subject of the written contract or written agreement; or
(b) “Your work” completed as included in the "products-completed operations hazard", performed for the additional insured, which is the subject of the written contract or written agreement; and/or b. "Claims" arising out of a "pollution event" under COVERAGE PART TWO - CONTRACTOR'S POLLUTION LIABILITY, caused, in whole or in part, by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf , and resulting directly from:
(a) "Covered operations" performed for the additional insured, which is the subject of the written contract or written agreement; or
STF-ESP-101-F CW (04/13)
(b) "Completed operations" of the "covered operations" performed for the additional insured, which is the subject of the written contract or written agreement.
3. However, regardless of the provisions of paragraphs 1. and 2. above, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the written contract or written agreement to provide to such additional insured.
4. With respect to the insurance afforded to the additional insured under this endorsement, the following is added to Section III – Limits Of Insurance and Deductible:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations
5. The insurance provided to the additional insured person or organization does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or 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.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any architectural, engineering or surveying services.
6. The additional insured must see to it that:
a. We are notified as soon as practicable of an "occurrence", offense or “pollution event”, as applicable, that may result in a claim;
b. We receive written notice of a claim or "suit" as soon as practicable; and c. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non-contributory.
7. For the coverage provided by this endorsement:
a. The following paragraph is added to Paragraph 8.a. Other Insurance, Conditions (Section V.) in the COMMON COVERAGE PROVISIONS:
Primary and Noncontributory Insurance
This Insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this endorsement provided that:
(1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. b. The following paragraph is added to Paragraph 8.b. Other Insurance, Conditions (Section V.) in the COMMON COVERAGE PROVISIONS:
This insurance is excess over:
STF-ESP-101-F CW (04/13)
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis.
8. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
STF-ESP-248-A CW (04/10)
Waiver of Transfer of Rights of Recovery Against
Others – Blanket as Required by Contract
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add’l Prem. Return Prem.
GPL 8713651-01 08/11/2023 08/11/2024 08/11/2023 23175000 …… …… Named Insured and Mailing Address: Producer:
AMBIPAR HOLDING USA INC
818 Town & Country Blvd Suite 200
Houston, TX 77024
SYNAPSE SERVICES LLC
198 W HIGH ST
SOMERVILLE, NJ 08876-1862
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
Environmental Services Package Policy
[x] COVERAGE PART ONE – COMMERCIAL GENERAL LIABILITY
[x] COVERAGE PART TWO – CONTRACTOR’S POLLUTION LIABILITY [x] COVERAGE PART THREE - PROFESSIONAL LIABILITY
In consideration of the payment of premium and the Deductible by you and in reliance upon the statements in the Application made a part hereof, we agree with you, subject to all the terms, exclusions and conditions that with respect to the coverage parts indicated above Conditions (Section V.) of the COMMON COVERAGE PROVISIONS, Condition 14.
Subrogation is amended by the addition of the following:
We waive any right of recovery we may have against any person or organization whom you are required to waive your right of subrogation by a written contract or written agreement executed and effective prior to the performance of your services which is the subject of such written contract or written agreement.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.