FLO-SERVICES, INC.
3O 1O FLOYD ST.*BURBANK
TEL: (818) 847 2188*FAx
cA 91504-2599
1818) 847 -2256
w w w , , t o - s e r v i . e r i n . . < o m ,( Llc*taa492 August 18, 2025
Proposal #25-019
Page I of5
City of Santa Clarita
23920 Y alencia Blvd.. #295
Santa Clarita CA 9l 355
Attention: Kelly Kacmar
KKacmar@Santa-C larita. gov
Re1'erence: Agreement For Contract Y ear 2025/2026 - Prevailing Wage Contract Limited services - Level Readings/Monitoring of Observation Wells, Hydroauger Inspections, and Maintenance at DBAA #3, #6, # I 8, #19. #20 and #24 Dear Kelly:
We are pleased to present our altemative proposal to perform limited maintenance/ inspections only and does not include any additional services or repairs. We would like to clariry our proposal limits our liability to our attached insurance certificates.
Pricing is as follows:
l. DBAA 3 - Observation well and hydroauger inspections $2,425.00 each x 6 times per year $ 14,550.00
2. DBAA6
Preventative Maintenance on Nathan Hill Pump Station -
$3,450.00 x 4 times per year $ 13.800.00
il
b. Observation well and hydroauger inspections
$3,450.00 each x 6 times per year s 20.700.00
$ 7.480.00C Hydraulic Calibration on the Totalizer of the flow meter EORt"t SER-1-2004
Proposal #25-019
3. DBAA I8
a. Limited Maintenance on Bakerton,Nathan Hills Pump Station $2,675.00 x 4 times per year
b. Observation welI inspections
$2.550.00 each x 6 times per .vear
c. Hydraulic Calibration on the Totalizer ofthe flow meter
4. DBAA 19
a. Limited Maintenance on above ground Components -
$3.250.00 x 4 times per year
b. Observation well and hydroauger inspections
$2,950.00 each x 6 times per year
$ 10.700.00
s 15.300.00
$ 7,480.00
s 13.000.00
$ 17.700.00
$ 37.875.00
c. Prime and Run Pump - $2,650.00 x 3 times per year
5. DBAA2O
$ 7.950.00
a. Preventative Maintenance - $2,650.00 x 3 times per year $ 7"9s0.00 b. Observation well inspections
$2,950.00 each x 6 times per year $ 17.700.00
c. Totalizer Calibration (new totalizers)
6. DBAA 24 - Monitoring/Extraction Well Inspection
$12,625.00 each x 3 times per year
Annual DBAA cost
$ 4,925.00
$197.110!00
Note: As previously mentioned, there are major issues with failures at Bakerton Pump Station, DBAA 19 well pumps, and the majority of the pumps at DBAA 24, which require repair and/or complete replacement. These repairs and/or replacements are now bevond our capabilities.
This proposal does not include any additional services, replacements, emergency repairs, call- outs, etc. l-hese can be discussed on an item by item basis. roRr'4 sER-1-2004
Proposal #25-019
John Krukowski, our Principal, employee's rate of$265.00 per hour, portal to po(al, plus mileage to assist City personnel with review of equipment, drawings, meetings. etc.. on an as needed basis. ifand when required.
Califomia sales tax will be added to all equipment and material paid by FLO-SERVICES insurance policies
This Agreement constitutes the entire contract between FLO-SERVICES and the CUSTOMER with respect to service ofthe equipment covered by this Agreement and no representation or statement not expressed herein shall be binding on FLO-SERVICES.
The terms and conditions herein shall prevail and supersede any variance with the CUSTOMER terms and conditions.
If this agreement is found to be acceptable, please sign and retum one copy to Flo-Services.
Thank you for the opporhnity to be of service.
Truly Yours,
Kru wskio
President
EORI.,I SER-1-2004
Bonds. when required, are additional and will be added at cost + 157o of the total amount being bonded.
FLO-SERVICES work and responsibility is expressly limited to providing materials to perfbrm the services listed in this proposal. Design. application and direction for work and materials are to be provided by and responsibility of the CUSTOMER. Flo-Services total liability including indemnity. liquidated damages and consequential damages is limited to the coverage olfered and Pmpooal #25{19
t [.R\ts ot s.\t_t-
I. ACCEPTANCE. "SELLER'is Flo-Senices. lnc. who may tunction as a SUB-CONTRACTOR. RliPAlR AND SERVICh ORCANIZATION OR VENDOR. ..BUYtlR- is the CUSTOMER who may function as a CONTRACTO& OWNER- ETC. These terms govem the purchasc and sale ofequipnrcnt. contractor's services. etc.. retened to in SI:I.I.ER"S proposal or acknorvlcdgemcnt. SELLER rejccls all additionalor different terms ir an) ofBUYER S tbmts or documents unless spwifically accepted by SEt,l-ER in wdting. 2, PAYMENT. Terms are Net 30 days from date o[shipment and invoic€. subject to approval ofcrcdit. SELLERmay proc€ed on a "when ready" basis and partial invoicc tbr $e equipment that has shipped and /or services rendered. lnterest at one perc€nt pcr montl or at the legal maximum mte lvill be assessed lor late payment. Flo-Services. Inc. is a registcr€d small business. SBA # 1885940. Payment terms ale govcmed by the Prompt Paymcnt Act. f,. RETENTIONS. unless herein authorized by SELLER- are nol allo$ed. {. B.\CK CIiARG ES The BLryER a$ees to pay rcasonable BACK CIIARGES (based on actual cost plus profit. overhead and ta\es) for an} special seniccs. additional equipmenL repaic etc. made necessarl- by the omissions. mistalcs. accidenls. negligence or miscalculations of the BUYllR. IINCINEER or OWNI-R.
Commensurate witi the ugency. naturE and scope oithe back charSe. SEI-I-l:R shall give BUYER advancc notice ofthe intended back charge, but such advance notice shall not be a prcrequisitc for BACK CIIARCIIS against lhe BUYER. Any BACK CHARGITS from the intended BUYER. not authorized in uriting b) SELLE[I- will not be recognized.
5, DELMRY, SELLER shall not be liable for delays due to fire, flood. labor issues, war. civil disorders, delay in transportation. inability to obtain materials, accidenG, acts ofCod or other causes beyond SEI,LER'S rEasonable mntrol.
6. RESPONSIBILITY. SEI,LER shall not be responsible for damage to equipment if misus€d. impmpedy stored, installed or maintained. SELLER SHALL NOT BE I-IABLI] FOR CONSEQUENTIAL. INCIDENTAI-. SPECIAT-. PLINITIVE. COLLATERAL. [-IQUIDATED OR OTIIT:R INDIRECT DAMA(][S.
CONSEQL]ENTIAI- DAMAGES FOR TIIE PTIRPOSI'S OF THIS ACREIMENT SHALL INCI-[If'[ BUI'NOT BE LIMITT]I)'I'O. LOSS OF T-ISE. IN('OMI].
PROFIT. I-OSS OF OR DAMAGE TO PROPERTY. ETC. These limitations appl! rvhether $e liabilit) is based upon contmct. lort. stdct liabiliD or an) other theor,.
7. \1'ARRAN-I'I', For benefit ofthe original user. SELLER wan'ants all new equipment sold to be free liom deGcts in material and workmanship. and will replace or rcpair. F.O.B. at ils factories or other location designated by it. any part or parts rctumed to it which SELLERS examinalion shall show to have failed under normal use and service by the original user within orle year following initial shipmcnt to the BUYER. '[his waranty docs not mver damage by decomposition Ii"om chemical action or wear caused by abmsive materials nor does it cover damage resultin8 fmm misuse. alteration. accident orneglect. or from improper operation. maintenance. installation. modilication or adjustnent. Such repair or replacement shall be tiee for all items cxcept for lhose items that arc consumable and normalll replaced during maintenance. fHIS WARRANTY IS EXPRESSLY MADE IIY SELLER AND ACCUP'fllD BYBUYERlN l.lUtl Of ALL OTHER WARRANTIES. WHETH[R WRITTEN. ORAL. EXPRT]SS OR IMPLIED.
E. COIIPI,IANCE fVITg L,IWS. BUYER shall bc solcl) responsible for slrcu.ing arl-t necessar)' permits and for compiiance with aII safcty. heal*- sanilalion and any other laws. ordinances drd regulations in comection with tie desien. installation ard operation ofthe cquipment.
9. INDEMNII'ICATION. It is undeNtood that SELLER has relied upofl data furnished by and on behalfof BtryER with respect to the safety aspects and applicarion ofthe equipment and dlat it is BUYERS responsibility to assurc that the equipment rvill. whon installed and put in use. be in compliarce with requirements fixed by law and otherwise lcgally adequate to safeguard against injuries or damage to persons or property. BIIYE.R hereby agrces to dcfcnd. indemni$ and hold harmlcss SELLER, its agents and employees against any ard all losses. costs. damages. claims. liabilities or expenses. arising out ofor rcsulting from any injury or damage to any person or propedy caused by lhc inadequacy ofsaltty leatures. devices or chalacteristics in tle equipment or in thc installalion. use or opemtion ofthe same. except claims for repair or rcplaccment ofdefective parts arc prcvided in Paragmph 7 hereof. Within the policl limilations ofthe SEI-LERS insuance policies. SILI,ER will indemniti. defend and hold BUYER harmless lnrm an] claim, caus€ ofaction or iiability incuned by BUYER as a result ofthird party claims for personal injul'. death or damage to tangible propeny. to the extent caused by SELLERS sole negligence. SEI-t,llR shall have the sole authority to direct the defens€ ofand s€ttle any indemnified claim. SELLER's indemnification is conditioned on BUYER (a) promptly notirying SELLER ofany claim. ald (b) providing reasonable cooper-ation in the defense ofany claim.
E. TTTLD & LIEN RIGHTS. After delivery to Buyer. Seller $'ill have all such riehts. including security interesls and lieDs. in the equipment as larvfully may be confened upon Seller by contract under any applicable pmvision of law.
9. MISCEI,I,AN EOUS. Goods may not be retumed without previous written p€rmission aod are subjcct to a restocking charge. TheSELLLRmay cancel agreement only upnn written notice and payment ofreasonable canc€llation charges, including anticipated profit. Attomey's l'ees and court costs necessary to enforcr ticse terms ofsalc willbepaid to the prevailiog party. No part ofthe Agreement may be changed or cancelled except by aw tlen document signed by SELLER and BUYER. No cours€ ofdealing or perlb.mance- usage oftzde or lailure io enforce any term shallbe used to modify fre Agreemenl Ifany ofthesc terms is uneoforccable. such term shall b€ limited only to the extent necessar) to make it enforceable ard all other terms shall remain in full force and elTecl.
BUYER may not assign or permit atry other translk of the Agreement witiout SELLERS p.ior *ritten consenl The Agreement shall be govemed bl the laws of the State of Calilomia u itlout r€gard to its conllict oflaus provisioos.
Acceptance ofthis pruposal with the terms referred to herein may be accomplished by executing this document orby providing a IIUYERS purcha-se order/contract.
Accepted: SELLER
Flo-Services- lnc.
Acccptcd: BTJYER VICIS. lN('
ll) John liruliorvsk i
l)ate: D^c, g -(8'Z^o2,{
llr
CONTRAC IORS I,ICIlNSE NO. 988192
l)atc
FORM SER-1-2004
Proposal #25-019
NOTICE TO PROPERTY OWNER
If bills arc not paid in full for the labor, scrvices, equipment, or matcrials furnished or to be furnished, a mechanic's lien leading to the loss, through court forcclosure proceeding, ofall or pan of your property being so improved may be placed against the property even though you hal,e paid your contractor in firll. You may wish to protect ]'oursclf against this conscclucnce by (1) requiring your contractor to furnish a signctl releirse by the pcrson or firm giving you this norice Lrfore making paFnent to your contractor or (2) any other methotl or device that is appropriate under the circumstances, such as a contractor's payment bond.
CONTRACTORS ARE REQIJIRED BY LAWTO BE LICENSED AND REGULATED BY THE CONTRACTOR'S STATE LICENSE BOARD u'hich has jtrrisdiction to invcstigirte coml.rlair.rts lgainst contactors if a complaint rcgarding a patcnt act or omission is filctl u'ithin tour years of thr date of the allcgcd violation. A complaint regarding i latent act or omission pertnining to structural dcfccts must bc filcd within ten years of thc date of the allegcd violation.
Any questions concerning a contractor may lr rcferrecl to:
Registrar Contractor's State License Board
P.O. Box 26OOO
Sacramento, Calif ornia 95826
CONTRACTORS STATE LICENSE BOARD
STATL (X C,.\LI T-oRtiL,,,
DEIIAITTMENT OF
CONSUMER AFFAIRS
CONTRACTORS - LICENSE NO.988497
FLO-SERVICES, INC.
roRM sER-1-2004
30 IO FLOYD 5T,*BURBANK. CA 9I504.?599
ACORT)"
o3t03t2425
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 AFFORDEO 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.
IMPORTANI ll the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have AOOITIONAL INSURED provisions or be endorsed. lf SUBROGATION lS WAMD, subject to the terms and conditions of the policy, ce(ain policies may require an endorsemenL A statement on lhis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
Brown & Brown Retarllnsuranc€ Services
License #0F56560
1001 Ma Avenue Suite 201
Carpinteria cA 93013
(80s)965 0071 (805) 690 3200
Laura Decker@bbrown com
INSURER(S) AFFOROIN6 COVERAGE
tNsuRERA. Admiral lnsurance Company
Flo-Servrces lnc
3010 Floyd Slreet
Eurbank cA 91504
tNsuRER B . Oregon lrutual lnsurance Company 14907
rNsuRER c Omaha Nalonai Casualty Company
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 25.26 GL BA XS WCCOVERAGES REVISION NUIlIBER rNso
s 1.000.000
DAMAGE TO RENTED
PREM SES (Ea @cu.ien@) s 100.ooo
s 10.000
s 2 000.000
COM M ERCIAL GENERAL LIABILIIY
Policy conlalns on OCIP Excluson
GEN LAGGREGATE L M TAPPLIES PER
X
LocPoLcY xl JECi
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE ]NSURED NAMEO AAOVE FOR THE POLICY PERIOD INDICATED NOTWTHSTANDING ANY REOUIREMENI TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTI] RESPECT TO WlICH THIS
CERTIFICATE IVIAY BE ISSUED OR IVIAY PERTAIN THE INSURANCE AFFORDEO AY THE POLICIES DESCRIBEO HEREIN IS SUEJECT TO ALL THE TERMS, EXCLUSIONS AND CONOITIONS OF SUCH POLICIES LITIITS SHOV\4! MAY HAVE AEEN REDUCED BY PAIO CLAIMS 0226/2026 i "e
nsollaL a
^ov 'rurunt
FElECC3539402 02t2612025 s 1 000.000
PRCOLICTS COMP OPAGG s 2.000 ooo
s
B OW!ED
IlRED
SCHEOUTEO
NON O\n EO
AUTOMOBILE LIABILIIY
cMo5023925176 02t26i2025 az26t2a26
S
s 1.000 000
BOO LYINJURY lPeroecon)
BOO LY INJURY (Per acode.o
X
s 2 000.ooo
s 2.000.000
X
oEo
EXCESS LIAB
S
X
E L EACE]ACCIDENT s 1.000 000
EL DISEASE EA EMPLOYEE s 1.000 000
C
WORKERS COMPENSAT]ON
ANO EM PLOYERS' LIABILITY
ANY PROPRIFIOR/PARTNER/FXECI]TIVF
OFFICER/MEMBER EXCLUOEO'
DESCRIPTiON OF OPERATIONS beltr
N
F E|EXS4523202
a3to1t2a25oNCC1701253301 03/01/2026
E L OISEASE. POLICY LIMIT I 1,000 000
Conlactorc Pollutron Liabrlly
02126t2025
Occurrence
Aggregale
$1.000,000
$2.000 00002t2612026
OESCRIPTION OF OPEFA1ONS / LOCATIONS / VEHICLES {ACORD 101 , Addnio.ar Rem.rxs Schedd., 6ay b€ afiach.d if morc sp... is Equi@d) City ot Santa Claita ils respective elecled and appointed boards, ofllcials, offi@rs. agents. employees are included asAddrtlonat lnsureds under the General Liability andAuto Liabillly per attached foms ECC'319-0712 and M2855A(8'19). as required by wrilen contract ceneralLrabilty andAulo Liabrlty poloes are Pnmary and Non Contfl bulory per the attached forms ECC 548-031 7 and M28 55A (81 9). as equired by wntten conlracl \ hiver of Subrogatlon appliestoihe\ /orkerc Compensation per the attached form lryC ON 04 WSA(Ed 01-19) as required by wrilten contracl FElECC3s39402
CERTIFICATE HOLOER CANCELLATION
SHOULD ANY OF THEABOVE DESCRTBED POLICIES AE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WLL BE DELIVERED
'NACCOROANCE WITH THE POLICY PROVISIONS
L*:x!!/4"
AUTHORIZEO REPRESENTATIVE
C(y of Santa Clarila
23920 Valencia Blvd Ste 300
Sanla Clar ta cA 91355
@ 1988-2015 ACORD CORPORATION. All rights rcserued
The ACORD name and logo are registercd marks ofACORDACORO 25 (2016i03) ffi *"r^ l
iGENERALAGGREGAIF
I
0212612025 I 0212612026 .^^^-^.--i L:::YI-rla
Flo-Services lnc
Endorsement Number: 4
Automatic Additional lnsured - Owners, Lessees or Contractors THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ln consideration of an additional premium of $Aoplied, this endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY
CONTRACTORS POLLUTION LIABILIry
SCHEDULE
Name of Person or Organization
Any person(s) or organization(s) whom the Named lnsured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified In that contract.
The person or organization shown in this Schedule is Included as an insured, but only with respect to that person's or organization's vicarious liability arlsing out of your ongoing operations performed for that insured.
ECC-319-0712 O 2018, Freberg Environmental, lnc. Page 1 of 1 This endorsement, effective 0212612025, attaches to and forms a part of Policy Number FEI-ECC-35394-02.
Flo-Services lnc
Endorsement Number: 18
Automatic Primary and Non-Contributory lnsurance Endorsement Designated Work Or Project(s)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the Coverage Part(s) indicated below:
CONTRACTORS POLLUTION LIABILIry
COMMERCIAL GENERAL LIABILITY
SCHEDULE
,Name of Person or Organization
Any person(s) or organization(s) whom the Named lnsured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract.
ln consideration of an additional premium of $Aoolied, and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. lt is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory to this insurance.
ECC-548-03'17 O 2018, Freberg Environmental, lnc Page '1 of 1 This endorsemenl, efteclive 0212612025, attaches to and forms a part of Policy Number FE l-ECC-35394-02.
C'lO CAO 5O23925176 FLO SERVICES INC :FiECTM: 02126/',2023 pROCaSSEO: O1/17/2a25 OREGON I!4UTUAL INSURANCE COIMPA|IY
COMMERCIAL AUTO CLUSTER ENOORSEMENI
[,42655A (E-19r
THIS ENDORSEMENT CHANGES THE POL'CY. PLEASE READ IT CAREFULLY Thrs endorsement modifies insu.ance provaded under the following; BUSINESS AUTO COVERAGE FORl\TI
With respect to coverage provided by this endorsement. the provisions of the Business Aulo Coverage Forrn apply unless modifled by this endorsement
COVERAGE SUMMARY
This is a summary of the coverages provided by this
endorsemeut.
1. Bail Bonds...... ...... .. ............1
2. Broadened Pol|ution................. ..... . .. .. . .. . ..... . .1
3. Business Property of Olhers......... ...... ............1
4. Employees as lnsureds, Olher Than Retail
Delivery...... . . .............. 1
5. Glass Repair Deduclible Waiver ........ .............1
6. Hired Auto Loss of Use................ . . . . . . . . . . . . . . . . . . . . 1
7. Hired Auto Physical Damage............ .. ...........1
8. Loan Lease Gap ..... ..................... ..................2
9. Personal Effecls.................. .......... ..................2 1 0. Rental Reimbursemenl................. ................... 2
11. Towin9........... ...............2
'12. Additional lnsured by Conlracl or Agreement....2
13. Waive. of Subrogation by Contract
or Agreement....... . .............3
1. Bail Bonds
Section ll - Liability Coverage, A. Coverage, 2.
Coverage EXensions, a. Supplemenlary Payments,
Paragraph {2) is replaced wilh the following:
(2) Up to 92,500 for cost of bail bonds (including
bonds for related traffic law violations)
required because oi an "accident" we cover
We do not have to furnish these bonds.
2. Broade[qd Pollution
The following is added lo Section ll - Liability
Coverage, B. Exclusions,l 1. Pollution:
Paragraphs a. and b" above do not apply to
"accidents" that occur away from premises
Owned by or renled lo an "insured" wilh respect
to "pollutants" canied in or upon a covered
"auto" up to the firsl S1 ,000 of damage for any
one "accident".
3. Business Property of Others
The following is added to Section ll - Liabilily
Coverage. B. Exclusions, 6- Care, Cuslody or
Conlrol:
Thas exclusion does nol apply to "propefty
damage" to propefty of others up to an amount
not exceeding $1,000 in any one "accident".
Coverage is excess over any other valid and
collectible insurance.
4. Employees as lnsureds, Other Than Retail
Detivery
The following is added to Section ll - Liabihty
Coverage, A. Coveaage, l. Who ls An lnsured:
An "employee" of yours is an "irlsured" whi,e
using a covered "aulo" you do not own, hire ol-
borrow in your business or your personal affairs.
However, this paragraph does not apply to
"auto" used tor retai{ delivery.
5. Glass Repair Deductible Waiver
The following is added to Seclion lll - Physical
Damage Coverage. A. Coverage, 3. a. Glass
breakage:
No deductible applies if glass damage is
repaired rather than replaced.
6. Hired Auto Loss ofUse
Section lll - Physical Damage Coverage, A.
Coverage, 4. Coverage Extensions. b. Loss Of Use
Expenses, the last senlence is replaced with:
However, the most we will pay for any expenses
tor loss of use is $75 per day. to a maximum of
$1.000.
7. Hired Auto Physical Damage
The following is added lo Section lll - Physical
Damage Coverage. A. Coverage, 4. Coverage
Extensions:
Hired Auto Physical Damage
lf a Covered Auto Designation Symbol 1 or B
applies to Liability Coverage, and if at least one
covered "auto" you own is covered for
Comprehensive or Specifled Causes of Loss
and Collision covemge, then the physical
damage coverage provided extends io those
"autos" you lease, hire, rent or borrow. This
does not include any "auto" you lease, hire, rent
or borrow trom any of your "employees",
partners (if you are a partnership), members (if
you are a limited liability company) or members
of their households. The deductible will be equal
to the highest deductible applicable to covered
"aulos" you own
M2855A (8-19)
lncluies copynghled maler,al of Lnsurance Services Oifice lnc lyilh 'ts
permissio.
The most we will pay under this coverage is
the least of:
1. 9s0.000; or
2. The actual value at the time of loss: or
3. The cost of repairing or replacing the
damaged or stolen propeny with other
property of like kind or quality.
8. Loan Lease Gap
The following is added to Section lll - Physical
Damage Coverage. A. Coverage:
Loan Lease GaP
ln the event of a total "loss" lo a covered "auto"
that is covered for Comprehensive or Specified
causes of Loss and Collision coverage. we will
pay lhe "outstanding balance" on the lease ol
loan forthat covered "auto" up to $2.500
9. Personal Efiects
The following is added to Seclion lll - Physical
Damage Coverage, A. Coverage, 4. Coverage
Exlensions:
Personal Effects
For any owned "auto" that is involved in a
covered "loss", we will pay up to 5500 for
"personal effecls" that are lost or damaged as a
result of the covered "loss". \.yilhout applying a
deductible.
10. Rental Reimbursemenl
The following is added to Section lll - Physical
Damage Coverage, A. Coverage, 4. Coverage
Exensions:
Rental Reimbursement
lf a covered "auto" owned by you is covered for
Comprehensive or Specilied Causes oi Loss
and Collision cove.age, we will pay tor rental
reimbursemerlt expenses incurred by you for the
rental of an "auto" because of "loss" to a
covered "auto". Payment applies in addition to
the olherwise applicable amount of each
coverage you have on a covered "auto". No
deductibles apply to this coverage.
We wilt pay only for those expenses incurred
during the policy period beginning 24 hours after
the "loss" and ending, regardless ofthe policy's
expiration, with the lesser of the following
numbea of days:
'1. The number of days reasonably required to
repair or replace the covered "auto". lf "loss"
is caused by theft, this number of days is
added to the number of days it takes to
locate the covered "auto" and retum it to
you. or
2. Up to $75 per day up to 30 calendar days.
This coverage does not apply while there
are spare or reserve "autos" available to you
for your operati0ns.
lt "loss" results irom the total theft of a
covered "aulo" of the pnvate passenger
type, we will pay under this coverage only
that amounl of your rental Teimbursement
expenses which is not already provided for
under another Physrcal Damage Coverage
Extensron.
1 'l . Towinq
Seclion lll - Physical Damage Coverage, A.
Coverage, 2. Towing is replaced with the following:
We will pay up to $100 for towing and labor
costs incurred each time a covered "auto" of the
private passenger or Light Local Service
(0 - 10,000 lbs. GVW type is disabled.
However. the labor must be oeffonned at the
place of disablement.
'12. Additional lnsured by Contract or Agreement
A. The following is added to Section ll - Liability
Coverage. A. Coverage. 1. Who ls An lnsured:
When you have agreed in a written contaacl
or agreement to include a person or
organization as an additional "insured". such
person or organization is included as an
"insured" sutrect to the following:
1. Such person or organization is an
additional "insured" on,y to the extent
such person or organization is liable for
"bodily injury" or "property damage"
because of the conduct of an "insured"
under Paragraphs a. or b. under Sedion
ll - Liabilily Coverage, Paragraph A.1.
Who ls An Insured, caused by an
"accident" and resulting from the
ownership. maintenance or use of a
covered "auto": andlrDl ttrD2l
2. The written contract or agreement
described above must have been
executed prior to the "accident" that
caused the "bodily intury" or "property
damage" and be in effect at lhe time of
such "accident"; and
3. The insurance afforded to any such
additional 'insured" does not apply to
any "accident" beyond the period of time
required by the written contract or
agreement described above.
B. The most we will pay on behalf of such
additional "insured(s)" is the lesser of:
1 The Limits of lnsurance specified in lhe
w.itten contract or aqreement described
above, or
M2855A (8-19)
lnclucjes copynghled malerial ol lnsurance Services Oifice nc v/ilh ils perm;ssion
2. The Limits of lnsurance shown in the
Declarations.
This provision shall not increase the Limit of
lnsurance shown in the Declarations in this
policy or coverage part.
C. The following change is made to Section ll -
Liability Coverage, A. Coveraqe, 1. Who is An
insured:
Paragraph 1.c. is deleted in its entirety.
D. The following changes are made to Section lV -
Business Auto Conditions. B. General
Conditions, Paragraph 5. Other lnsurance:
'1. The following is added to Paragraph 5.a.:
lf required by the written contracl or
agreemenl described above, the insurance
afforded to the additional "insured" under
this provision will be primary lo, and will not
seek cortribution from. the addilional
"insured s" own insurance.
2. Paragraph 5.c. is deleted in its entirety.
E. Section V - Definitions, "insured contract" is
amended lo add the following:
An "insured contract" does not include lhat
part of any contract or agreement:
That pertains to the ownership.
maintenance or use of an "auto" and
which indemnifies a person or
organization for other than the vicarious
laability of such person or organizat,on
lor "bodily injury" or "property damage"
caused by your operation or use oi a
covered "auto".
However, a person or organization is an
additional "insured" under this provision
only to the extent such person or
orqanization iS not named as an
"insured" by separale endorsemenl to
this policy.
13. Waiver of Subrogation by Contract or Agreement
The following is added 10 Seclion lV - Business
Auto Conditions, A. Loss Conditions. Paragraph 5.
Transfer Of Rights Of Recovery Agairlst Others To
Usl
We waive any right of recovery we have againsl
a person or organization because of payments
we make for "bodily injury" or "property damage"
when you and such person or organization have
agreed in writing in a contract or agreemenl to
waive such righl of recovery, pfovided:
1. Such written eontract or agreement was:
a. Made prior to the "accident" or "loss"
resulting in the covered "bodily injury" or
"property damage"i and
b. Was in eftect at the time of the covered
"bodily injury" or "property damage".
2. The covered "bodily injury" or "property
damage" must arise out of the operations
specified in such wrltten contract or
agreement.
3. At our request you must provide us with a
copy of the aforementioned written contract
or agfeement.
Additional Oef initions
The lollowing Paragraphs are added to Section V -
Definitions;
Q. "Personal effects' means your tangible property
that is worn or carried by you, except tools
jewelry, money or securities.
R. "Outstanding balance" means the amount you
owe on the lease or loan at the time of the "loss"
less any ovedue leasel,oan payments, seaurity
deposils not relurned by the lessoa, costs for
extended warranlies or insurance purchased
with the loan or lease, or carry-over balances
from previous loans or leases.
M2855A 16-19)
nclldes copyrighled nraterial of lnsu.ance Services Office nc v/ith ils permission
WORI(ERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wcoN04wsA {Ed.01n9}
WAIVEE OF OUR RIGHT TO BECOVER FROM OTHERS ENDOBSEMENT,CALIFOBNIA !4/e have the right to recover our paymenls from anyoie liable Ior an injlry covered by lhis policy. We will nol enforce our flght against lhe persolr cr organizalion named in the Schedule. (This agreelr]enl aDplies only to the exient thal you perlorm work under a written contract that requires you to obtain this agreement from Lrs.) Yoii musi maintain payroll records accurately segregating lhe remuneration of your employees while engaged in the work described in the Schedule.
Blanket Warver: The additional premium for this endorsement shall be 2% of lhe California workers compensation premrLrn-l atherwise due on such remuneralion.
Specifrc Waiver: The additional premium fcr lhrs endorsemenl shall be 5% ol the California wcrkers' compensatjon premrum otherwrse due on such remuneration.
Person or Orgahization
Blarket Waiver of Subrogation
Schedule
Job Description
As respects to all CA jotls perfcrnred by iite famed insured during the policy pe.iod where by yJritten contract a waiver oF subrogation is reauired prior to the conrmencement of work. ih;s endorsement changes the policy to which it is attach€d and is effective on the date issued unless otherwise stated. ffha infotmation below is raquired only when this endoriame.t is issued subsequent to preparation of the policy.) €ndorsenrent Eflective O3lO1l2O25 Policv No. ONCCI T012533-0.1 Endo.semcnr No lnsurer, lnsurance Company Ornaha Nalional Casualty Company Flo-Services. lnc.
Countersignsd 8y