CITY OF SANTA CLARITA
REQUEST FOR PROPOSALS
SANTA CLARITA SPORTS COMPLEX
ROLLER SKATING RINK PROJECT
ELECTRONIC SUBMITTAL REQUIRED BY 11:00 AM ON FRIDAY MARCH 24, 2023
RP DEVELOPMENT SERVICES SUBMITTED DOCUMENTS
• PROPOSAL (Response to Scope of Work and Addendum #1)
• STATEMENT OF OFFER AND SIGNATURE
• COST PROPOSAL
• RESUME FOR Ross Pistone
• STAGING AREA OPTIONS
• INSURANCE CERTIFICATE
• CITY SITE PLAN
• SITE PHOTOS
March 23, 2023
Araz Valijan, MPA
Project Manager
Public Works
City of Santa Clarita
23920 Valencia Boulevard, Suite 300
Santa Clarita, CA 91355
Re: Santa Clarita Roller Skating Rink Proposal for Construction Management Services Ms. Valijan,
Thank you for allowing RP Development Services (RPO) the opportunity to provide a proposal for Construction Management (CM) services on the Santa Clarita Roller Skating Rink Project.
I did take the opportunity to inspect the site and take photos of the completed utility and DigAlert surveys surrounding the property. It should be noted that my site visit was on a Saturday and the facility was very active with both foot and vehicle traffic. It will be a top priority to draft safety guidelines that will be included in the grading contractors and general contractors bid packages to ensure that the requirement to provide ongoing public safety is included in the submitted bids.
Identifying staging area(s) that are adequate in size for employee parking, equipment storage, material storage, and field offices will be required for the bid packages (see attachment).
Alternate public pathways and temporary fencing will be required during construction to restrict access into the work zones. Also, depending on the level of removal and recompaction that is required for the building, the lateral loads from the adjacent gymnasium will need to be analyzed by the Geotechnical Engineer. Without having an onsite stockpile area the Phase I grading will need to be done within the proposed building footprint, this is a common practice for infill projects.
After a full review of the documents attached to your March 10, 2023 email and Addendum #1 that was emailed on March 20, 2023, I have responded to the "Scope of Work" as noted below.
I. INTRODUCTION / BACKGROUND
a. The attached resume provides a complete history of my work experience that will directly contribute to the success of the Roller Skating Rink Project. Most recently, I provided project and construction management support services to the City of Santa Clarita for the Santa Clarita Valley Sheriff's Station project that was completed in 2022. I would recommend that you contact Mr. Damon Letz, City Engineer, for more information on the services that I provided for the project. 1 b. The City of Santa Clarita is accepting proposals for a qualified CM to assist with the building of a 21,500 square foot multi-use, roller skating facility located at the Santa Clarita Sports Complex (20870 Centre Pointe Parkway, Santa Clarita, CA 91350). The new facility will be located on a vacant parcel east of the Gymnasium.
c. This project, when completed, will add the following amenities to the complex; roller skating, basketball, volleyball, pickleball, special event area, restrooms, audio/disc jockey booth, ticket window, staff offices, locker area, stadium seating, and general storage. The exterior will include landscaping and a 12' paved alley way on the west side of the building.
d. The project is scheduled to be completed in the Fall of 2024. e. The project will be constructed in two phase, Phase I Rough Grading and Phase II Building Construction.
f. The proposal describes the services requested for two Task, Task I is for Construction Management and Task II is for a Constructability Review. During the non-mandatory pre-proposal zoom call the City advised the attendees that the proposers would only provide a constructability review at the construction manager level and all other constructability review would be completed by a third party.
II. OBJECTIVES
a. As the Owner and Sole Proprietor of RPD I will be directly managing the construction of the project on a full-time basis. Myself along with the City Project Manager (PM) will manage the day-to-day project activities from design to occupancy. The city PM will be a dedicated full-time resource to the project along with other city resources on an as-needed basis. The city will provide office space for the CM until such time that the Phase II contractor has been selected and onsite construction has commenced. The CM will draft the specifications for fully stocked construction management trailer that will be added to the bid package. b. Initial Critical Path Milestones.
i. 03-24-23 I CM proposals to be submitted electronical by11 :00 AM ii. 03-30-23 I City selects most qualified proposer
iii. 04-25-23 I City Council approves CM contract
iv. 05-01-23 / CM joins city team
v. 05-01-23 / CM starts 60% plan review
vi. 05-02-23 / CM schedules meetings with Architect, Geotech, Civil, wet and dry utility providers
vii. 05-15-23 I CM drafts first milestone schedule
c. The November 2024 completion date for the project is an aggressive goal which will require the streamlining of several steps as outlined in the provided information. The CM will use the information obtain from the design team to draft the first milestone schedule.
d. With the project being located in a high traffic public area safety will be a top priority, the CM will work closely with the project architect to ensure that public safety is addressed in the general conditions.
2 Ill. SCOPE OF WORK
a. TASK 1: CONSTRUCTION MANAGER
i. Read and acknowledged with the following comments.
1. CM / PM job walks will be on an as-needed basis
2. Contractor will draft and maintain a detailed construction schedule.
The CM will review and approve the progress schedule monthly or more frequently if needed to identify potential delay or cost impacts.
3. Redline plans will be the responsibility of the contractor and all revisions to the plans, specifications, general conditions as approved by the project architect and CM will be maintained on Procore.
4. Contractor will schedule all city and fire inspections, CM will schedule deputy inspections, material testing, and soils inspections. All other special inspections will be scheduled by the CM.
5. CM work hours prior to the start of the Phase I grading will be 7:AM to 3:PM, at the start of the Phase I grading the hours will be 7:AM to 4:PM. One hour will be added to each work day for travel to and from the CM's home office, work from home office, and for general communications {phone calls, text messages, emails).
Mileage will be billed at the current IRS rate. No lunch breaks will be taken.
b. TASK 2: CONSTRUCTABILITY REVIEW
i. Read and acknowledged with the following comments.
1. Constructability reviews will be completed by the project architect or third party hired by the city.
2. The CM will work closely with the architect to complete a review of the plans, details, specifications, and general conditions.
3. Due to the projects accelerated schedule it is recommended that only one constructability review be completed at 90%, the CM will conduct ongoing reviews of the construction documents during the design phase to ensure that clear direction is provided to the contractors and contractors sub-contractors.
4. It is assumed that the following task have been included in the architect's scope of work; site plan, grading plan, wet and dry utility plans, as-built of existing utilities, utility points of connection, drawings, scaled details, specifications, general conditions, fire systems design and plan check, cost estimate, BIM modeling or equivalent, first flush, SWPPP, city plan check, progress inspections by the architect and mechanical engineers.
3 IV. SCHEDULE
5. The cost to complete the project by November of 2024 will be included in the submitted Phase II bids. The phase II bid package will include a detailed description of the completed Phase I improvements. The Phase II project description will include the option for the contractor to work 6 days a week.
6. The CM will work with the architect to ensure that the materials and equipment described in the specifications are readily available as needed for a November 2024 completion.
a. I have read and acknowledge all of the milestone dates for the project. b. Is should be noted that 20 months to complete all of the task that are required to place the facility in service by November of 2024 is a highly aggressive schedule that will require the cooperation of all city departments. The CM will work closely with the architect to draft a project description that clearly communicates the required completion date for Phase II construction. This will require the bidders to acknowledge the requirement for a November 2024 Certificate of Occupancy.
V. ORGANIZATION OF THE PROPOSAL
1. INTRODUCTIONS / Provided in Section I
2. QUALIFICATIONS OF CONSTRUCTION MANAGER / I have
attached a copy of my resume for your review. You will see that I have extensive experience working as a Construction
Superintendent, Construction Manager, General Superintendent, Grading Superintendent, Project Manager, Planner, and
Environmental Compliance Manager.
3. WORK STATEMENT/ A list of critical tasks will be drafted after completing initial interviews with the design team.
4. SCHEDULE / This information cannot be provided without direct and complete knowledge of project activities completed to date and pending. If selected to provide CM services for the project, I will prepare a milestone scheduled that will be used to manage the critical path action items for the project. The Phase 11 contractor will be responsible for drafting and submitting a cost loaded schedule to the city for review and approval.
5. TOTAL COST/ The cost for 20 months of CM services are attached to this proposal. CM work hours prior to the start of the Phase I grading will be 7:AM to 3:PM, at the start of the Phase I grading the hours will be 7:AM to 4:PM. One hour will be added to each work day for travel to and from the CM's home office, work from home office, and for general communications (phone calls, text messages, emails). Mileage will be billed at the current IRS rate. No lunch breaks will be taken.
4 6. PREVAILING WAGE/ As owner and sole proprietor of RDP I will be the only person providing CM services for the project.
7. STATEMENT OF OFFER AND SIGNATURE / Included in the
proposal package.
VI. EVALUATION AND SELECTION PROCESS
a. Read and acknowledged.
VII. INSURANCE REQUIREMENTS
a. Certificate valid through March 31st is attached, a certificate from April 1, 2023 to March 31, 2024 has been ordered naming the City of Santa Clarita as the certificate holder.
VIII. RESPONSE TO REQUEST
a. The proposal will be submitted prior to March 24, 2023 by 11 :00 AM.
IX. ATTACHMENTS
a. Reviewed and acknowledged.
Thank you for your consideration, if you have any questions, please feel free to contact me at (661) 810-2534.
Sincerely,
If��
Ross Pistone
Sole Proprietor
RP Development Services
5206 Village 5
Camarillo, CA 93012
5 March 23, 2023
Araz Valijan, MPA
Project Manager
Public Works
City of Santa Clarita
23920 Valencia Boulevard, Suite 300
Santa Clarita, CA 91355
EVEL AM
ERV/C S
Re: Statement of Offer and Signature for the Santa Clarita Roller Skating Rink Project Ms. Valijan,
As owner and Sole Proprietor of RP Development Services I am authorized to make the following statements.
1. This proposal is valid for 90 days from the date of this letter.
2. The cost for providing construction management services for a 20-month time period starting on May 1, 2023 and ending on December 31, 2024 has been provided in the submitted proposal and is a "not to exceed" price.
3. The City of Santa Clarita Professional Services Agreement as written is acceptable to RP Development Services.
I Ross Pistone, as Owner and Sole Proprietor of RP Development Services agree and accept the three statements as noted above.
Sincerely,
Ross Pistone
Sole Proprietor
RP Development Services
5206 Village 5
Camarillo, CA 93012
March 23, 2023
Araz Valijan, MPA
Project Manager
Public Works
City of Santa Clarita
23920 Valencia Boulevard, Suite 300
Santa Clarita, CA 91355
PMENT
VI
Re: 2023 I 2024 Construction Management Cost Proposals for the Santa Clarita Roller Skating Rink Project
Ms. Valijan,
I am pleased to submit the attached cost proposals to the City of Santa Clarita. The provided cost is based on the following assumptions.
• City Council approval is obtained on April 25, 2023
• Construction Management Services start on May 1, 2023 • Construction Management Services end on December 31 , 2024 • Construction Management Services will be provided for a 20-month time period The submitted cost excludes all union holidays for both years which will be the only days the selected contractor is not required to work. I have deducted 2 weeks of vacation time in 2023 and 2 weeks in 2024. The vacation days will be taken in short increments and only when they will not impact the projects critical path schedule.
Thank you for your consideration, if you have any questions, please feel free to contact me at (661) 810-2534.
Sincerely,
Ross Pistone
Sole Proprietor
RP Development Services
5206 Village 5
Camarillo, CA 93012
5206 Villages
Camarillo CA. 93012
2023 / $156.00 Per Hour
May Constructability Review
June Constructability Review
July Constructability Review
August Constructability Review
September Constructability Review
October Constructability Review
November Constructability Review
December Constructability Review
Daily Milage (107M x 1s10 x s.655)
Cell Phone ($100 Per Month)
(661) 810-2534
Ross Pistone
198 $
198 $
200 $
230 $
200 $
220 $
190 $
190 $
156_00
156_00
156.00
156.00
156.00
156.00
156.00
156.00
rpd [email protected]
Roller Skating Rink Project
$
$
$
$
$
$
$
$
$
$
$
$
Subtotal $
Less 10 Vacation Oays $
Less Vacation Milage $
TOTAL $
30,888_00
30,888_00
31,200.00
35,880.00
31,200.00
34,320.00
29,640.00
29,640.00
11,704.00
800.00
266,160.00
(15,600.00)
(701.00)
249,859.00
5206 Village 5
Camarillo CA. 93012
(661) 810-2534
Ross Pistone
2024 / $162.00 Per Hour (3.9% Cost of Living Increase)
January Construction Management 220 $
February Construction Management 190 $
March Construction Management 210 $
April Construction Management 220 $
May Construction Management 220 $
June Construction Management 200 $
July Construction Management 220 $
August Construction Management 220 $
September Construction Management 200 $
October Construction Management 230 $
November Construction Management 180 $
December Construction Management 200 $
Daily Milage (107M X 2510 X $.655)
Cell Phone ($100 Per Month)
162.00
162.00
162.00
162.00
162.00
162.00
162.00
162.00
162.00
162.00
162.00
162.00
[email protected]
Roller Skating Rink Project
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Subtotal $
Less 10 Vacation Day, $
Less Vacation Milage $
TOTAL $
35,640.00
30,780.00
34,020.00
35,640.00
35,640.00
32,400.00
35,640.00
35,640.00
32,400.00
37,260.00
29,160.00
32,400.00
17,591.00
1,200.00
425,411.00
(16,200.00)
(701.00)
408,510.00
Ross PISTONE
5206 Village 5, Camarillo 93012
Cell (661) 810-2534
[email protected]
CAREER SUMMARY
I have maintained two careers during my 40+ years of work experience. My primary career is in the Real Estate Industry specializing in all levels of management. My second career is functioning part time as a First Responder Emergency Medical Technician (38 years).
PROFESSIONAL EXPERIENCE
12/22 to Present: RP Development Services, Camarillo, CA Sole Proprietor I Senior Project Manager
Provide project management services to California State Parks. Complete all steps required to place the fire protection systems in service at both the Ranger and Resource offices. This includes permitting through Cal Fire, drafting scopes of work, bidding, contracting, construction supervision, testing, and final inspections. 09/22 to 10/22: RP Development Services, Camarillo, CA
Sole Proprietor I Senior Project Manager
Provide project management services to the City of San Marino for the following projects; Police Station remodel/replacement pros and cons, Fire Station bathroom remodel architecture, draft RFQ for emergency operations center upgrades, draft RFQ for City Campus emergency generator circuit study and upgrades.
03/22 to 9/22: RP Development Services, Camarillo, CA
Sole Proprietor I Senior Project Manager
Provided project management services to the City of Santa Clarita during the Sheriff's Station warranty period. Responded to request for service as directed by station management. Coordinated and supervised contractor and sub-contractor's activities to ensure that security measures were followed at all times. Complete warranty items to the satisfaction of the Sheriff's Department Facility Maintenance Division. 02/16 to 2/22: MNS ENGINEERS, Santa Barbara, CA
Senior Project Manager
Assigned to the City of Santa Clarita as Project Manager for the Los Angeles County Sheriff's Station project with a total budget of $70M. I assumed full responsibility for this project starting with the CEQA process and ending with full transfer of the facility to the Los Angeles County Sheriff's Department. The station was placed in service on November 18, 2021. Primary responsibilities included but were not limited to budget, contingency expenditures, oversite of design and engineering services, site development, offsite roadway improvements, extension of wet and dry utilities, LEED commissioning, LEED Silver certification, request for information, change orders, scheduling, status reports, value engineering, and approval of contractors means and methods. Worked closely City management, inspectors, CalTrans (helipad), Board of State and Community Corrections (detention) and specialty consultants.
12/00 to Present: CALIFORNIA STATE PARKS, HUNGRY VALLEY SVRA. Gorman, CA Senior Puk Aide °Emergency Medical Technician" (paid and volunteer) Respond to request for emergency medical aid, provide care to the sick and injured, assist Park Rangers (Peace Officers) as directed, maintain first aid supplies, evaluate new patient care equipment. outfit code 3 vehicles. maintain mobile and portable radios. coordinate with local 911 agencies. function as the Incident Commander during special events, Wildland Firefighting. perform other duties as directed by management. 12/05 to 12/10:
Owner
RP DEVELOPMENT SERVICES. Santa Clarita, CA
Provided the following project management services: land acquisition, land planning due diligence, CEQA, NEPA. onsite and offsite land development, design, scheduling, budgeting, and estimating.
• Primary client was the Los Angeles County Fire Department. RP Development managed the acqulsHlon, entHlements, site planning. archHecture, budgeting, scheduling. construction, and maintenance of Fire Stations throughout the County of Los Angeles. Developed standardized site / floor plans for use at various locations for both new and replacement stations. All new fire stations were designed at the LEED Sliver level and accommodated dual gender staffing.
02/04 to 06/05: EMPIRE LAND, Ontario, CA
President
Recruited to manage all Southern California land acquisitions and land development activities.
• Developed best practices, processes and procedures, Including measurement tools and risk management programs.
10/85 to 02/04: NEWHALL LAND AND FARMING, Santa Clarita, CA Vice President
Initially recruited as General Superintendent of Residential Construction managing 40+ employees. Within two years, promoted to Vice President of Residential Construction.
Within three years, my role expanded to Vice President of Residential, Commercial and, Industrial onsite and offsite construction. Additional responsibilities included; environmental compliance, purchasing, disaster preparedness, and contracting. In 1998 promoted to Vice President of Operations for Newhall Land and a member of the Executive Management Committee.
NEWHALL LAND AND FARMING PROTECTS
Single family and Multi Family Projects (Partial List):
Arbor Park (MF) Arroyo West (MF)
Chelsea (SF) Cottage Hill (SF)
Las Ventanas (MF) San Marino (SF)
Bungalows (SF)
Franciscan Hills (MF)
Siena (MF)
Residential Land Development, Master Planned Communffles (Partial List):
Bridgeport Lake Creekside / 500 DU East Creek
Northbridge Northbridge Point Northpark
South River Summit Westridge
2 Commercial/ Industrial/ Land Development/ Infrastructure (Partial List):
Bridgeport Elementary School (site development)
Commerce Center Industrial, 1,000 acres
Hilton Garden Inn Hotel (including vertical construction) Smyth lndus1rial Park
Westridge TPC Golf Course and club house
Bridges: A venue Scott, Decoro, Newhall Ranch, Copperhill, Bouquet Canyon 01ns to 09/85: PARDEE CONSTRUCTION, Los Angeles, CA
Superintendent
Initially hired as a Customer Service Manager. Within four years promoted to Construction Superintendent. As a Superintendent I was responsible for scheduling, budgets. inspections, grading. storm drain, sewer, water, dry utilities, streets. sidewalks, single family and multifamily construction.
COMMUN11Y SERVICE
Northbridge Point Homeowners Association President/ 7 Years Henry Mayo Newhall Memorial Hospital Foundation / 6 Years Henry Mayo Newhall Memorial Hospital Golf Classic Committee / 6 Years Santa Clarita Valley Boys & Girls Club/ 1 Year
William S. Hart Pony Baseball/ 3 Years
Building Industry Association Governmental Relations/ 6 Years Los Angeles County Sheriff's Department Citizens Advisory Committee/ 7 Years Los Angeles County Land Development Advisory Committee/ 5 Years Los Angeles County Sheriff's Department High Risk Volunteer EMT/ 5 Years California State Parks, Hungry Valley. Emergency Medical Technician / 22 Years
EDUCATION
Building Repair and Building Codes
Certified Construction Inspector
Environmental Compliance Inspector
Emergency Medical Technician (expires 11/2023)
Wildland Firefighter II (expired 06/2016)
01-17-23
3 Roller Skating Rink Possible
Staging and Parking Areas
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City of santa Clarita, it's officials and employees are Additional Insured for General Liability on a primary and non-contributory basis, but only If required by s 2,000.000
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C. With respect only to the insurance provided by this endorsement, the condition entitled Other Insurance of the BUSINESSOWNERS COMMON POLICY CONDITIONS is amended to delete paragraphs 2. and 3., and replace them with the following:
2. This insurance is excess over any other insurance available to the additional insured, whether primary, excess, contingent or on any other basis. But if required by the written contract or written agreement, this insurance will be primary and noncontributory relative to insurance on which the additional insured is a Named Insured.
3. When this insurance is excess, we will have no duty under Business Liability insurance to defend the additional insured against any "suit'' if any other insurer has a duty to defend the additional insured against that "suit'' if no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers.
When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of:
(a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and
(b) The total of all deductible and self-insured amounts under all that other insurance.
We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part.
D. Additional Insured - Extended Coverage
When an additional insured is added by this or any other endorsement attached to this Coverage Part, Who Is An Insured is amended to make the following natural persons insureds.
If the additional insured is:
a. An individual, then his or her spouse is an insured; b. A partnership or joint venture, then its partners, members and their spouses are insureds; c. A limited liability company, then its members and managers are insureds; or d. An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are additional insureds; but only with respect to locations and operations covered by the additional insured endorsement's provisions, and only with respect to their respective roles within their organizations.
Please see the Estates, Legal Representatives and Spouses provision of this endorsement for additional coverage and restrictions applicable to spouses of natural person insureds.
E. Blanket Waiver of Subrogation
The condition entitled Transfer of Rights of Recovery Against Others To Us of the BUSINESSOWNERS COMMON POLICY CONDITIONS is amended to delete paragraph 2. and replace it with the following:
2. We waive any right of recovery we may have against any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement because of payments we SB300176E (Ed. 10-19)
Page2 of3
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DocuSlgn Envelope ID: 0783987A-82DC-491D-99AD-36D8D923D220 C'NA
make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included within the "products-completed operations hazard."
2. Amendment- Aggregate Limits of Insurance (Per Project) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Coverage A.1., and for all medical expenses caused by accidents under Coverage A.2., which can be attributed only to ongoing operations at a single construction project:
1. A separate Construction Project General Aggregate limit applies to each construction project The Construction Project General Aggregate limit is equal to the amount of the General Aggregate limit shown in the Declarations.
2. The Construction Project General Aggregate limit is the most we will pay for the sum of all damages payable under Coverage A.1., except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard," and for medical expenses payable under Coverage A.2. regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits."
3. Any payments made under Coverage A.1. for damages or under Coverage A.2. for medical expenses shall reduce the Construction Project General Aggregate limit for the applicable construction project.
Such payments shall not reduce the General Aggregate limit shown in the Declarations nor shall they reduce any Construction Project General Aggregate limit applicable to other construction projects.
4. The limits shown in the Declarations for Liability and Medical Expenses, Damage to Premises Rented to You, and Medical Expenses continue to apply. However, instead of being subject to the General Aggregate limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate limit
B. All:
1. Damages because of "personal and advertising injury", regardless of the number of construction projects involved;
2. Damages under Coverage A.1. 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 A.2. 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, and shall not reduce any Construction Project General Aggregate Limit.
C. 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, and not reduce the General Aggregate limit nor any Construction Project General Aggregate limit.
D. If a construction project has been abandoned, delayed, or 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.
E. The provisions of the Limits Of Insurance section not otherwise modified by this endorsement shall continue to apply as stipulated.
All other terms and conditions of the Policy remain unchanged.
SB300176E (Ed. 10-19)
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DocuSign Envelope ID: 0783987A-B2DC-491D-99AD-36O8O923O220 CNA
Workers Compensation And Employers Liability Insurance
Policy Endo ·sement
I
� : •'i•·..- ... �.-i' rr • ,[ ... •_��:<,--:' '� � -�--. ;" · • ·i, i.!�·"'.;:J!",'"'.'VO\C'F·� ,·7-:-";'"c,,-�,-�:,, , ....... • . ,>··�;1i-�.:..-r.-�f'�il{ �.'!'I •!-;.r, ',17!•'-- _r�-:/4-:, "S'·" ,, .... -�--, -�-,. ••, �-n .. -�•�;.;� ..,., ... , t.- ,:r:t:::t/'*":.-� BLANKET WAIVER <iF OUR,RIGH{i6RECOVER.:FHOM''0JHERS, · ··:". -�· , · · · < · :,"f:j ' • • • • Y\ • •• .. � _•,•/• ,'r ;-:�,��' £/::;�-:�,�.:t.:�:�:::, •��;7�•�\,-Yi����•c:rr?��l,�:�•f,• •�l:/•.�,. � •.l� �,: �•• 0 ,• �-_, • r < • 1
1 ;� •,)��
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%.
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 Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
Form No: G-19160-B ( 11-1997)
Endorsement Effective Date:4/1/2022 Endorsement Expiration Date:4/1/2023 I Endorsement No: 2; Page: 1 of 1
Underwriting Company: Valley Forge Insw-ance
c, Copyright CNA All Rights Reserved.
Policy No: WC 7012614924
J
Policy Page: 28 of 41
Exhibit A - Project Site Plan