HomeMy WebLinkAboutBalance Hydrologics 2007-03-30 AGREEMENT FOR
PROFESSIONAL CONSULTING SERVICES
This A reement, made and entered into this �
9 � day of March, 2007 ("Effective Date"),
by and between CITY OF UKIAH, CALIFORNIA, hereinafter referred to as "City" and Balance
Hydrologics, a corporation [sole proprietorship, corporation, partnership, limited partnership,
limited liability company, etc.] organized and in good standing under the laws of the state of
California, hereinafter referred to as "Consultant".
RECITALS
This Agreement is predicated on the following facts:
a. City requires consulting services related to a hydrogeologic study of the City of Ukiah's
Wastewater Treatment Plant evaporation/percolation ponds.
b. Consultant represents that it has the qualifications, skills, experience and properly
licensed to provide these services, and is willing to provide them according to the terms
of this Agreement.
c. City and Consultant agree upon the Scope-of-Work and Work Schedule attached hereto
as Attachment "A", describing contract provisions for the project and setting forth the
completion dates for the various services to be provided pursuant to this Agreement.
TERMS OF AGREEMENT
1.0 DESCRIPTION OF PROJECT
1.1 The Project is described in detail in the attached Scope-of-Work (Attachment "A").
2.0 SCOPE OF SERVICES
2.1 As set forth in Attachment "A".
2.2. Additional Services. Additional services, if any, shall only proceed upon written
agreement between City and Consultant. The written Agreement shall be in the form of
an Amendment to this Agreement.
3.0 CONDUCT OF WORK
3.1 Time of Completion. Consultant shall commence performance of services as required
by the Scope-of-Work upon receipt of a Notice to Proceed from City and shall complete
such services within three and one-half years from receipt of the Notice to Proceed.
Consultant shall complete the work to the City's reasonable satisfaction; even if contract
disputes arise or Consultant contends it is entitled to further compensation.
SW-Proltivcsngrccment-.Ian2lN17
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4.0 COMPENSATION FOR SERVICES
4.1 Basis for Comqensation. For the performance of the professional services of this
Agreement, Consultant shall be compensated on a time and expense basis not to
exceed a guaranteed maximum dollar amount of $ 114,994. Labor charges shall be
based upon hourly billing rates for the various classifications of personnel employed by
Consultant to perform the Scope of Work as set forth in the attached Exhibit B, which
shall include all indirect costs and expenses of every kind or nature, except direct
expenses. The direct expenses and the fees to be charged for same shall be as set
forth in Exhibit B. Consultant shall complete the Scope of Work for the not-to-exceed
guaranteed maximum, even if actual time and expenses exceed that amount.
4.2 Chanqes. Should changes in compensation be required because of changes to the
Scope-of-Work of this Agreement, the parties shall agree in writing to any changes in
compensation. "Changes to the Scope-of-Work" means different activities than those
described in Attachment "A" and not additional time to complete those activities than the
parties anticipates on the date they entered this Agreement.
4.3 Sub-contractor Pavment. The use of sub-consultants or other services to perform a
portion of the work of this Agreement shall be approved by City prior to commencement
of work. The cost of sub-consultants shall be included within guaranteed not-to-exceed
amount set forth in Section 4.1.
4.4 Terms of Payment. Payment to Consultant for services rendered in accordance with this
contract shall be based upon submission of monthly invoices for the work satisfactorily
performed prior to the date of the invoice less any amount already paid to consultant,
which amounts shall be due and payable thirty (30) days after receipt by City. The
invoices shall provide a description of each item of work performed, the time expended
to perform each task, the fees charged for that task, and the direct expenses incurred
and billed for. Invoices shall be accompanied by documentation sufficient to enable City
to determine progress made and to support the expenses claimed.
5.0 ASSURANCES OF CONSULTANT
5.1 Independent Contractor. Consultant is an independent contractor and is solely
responsible for its acts or omissions. Consultant (including its agents, servants, and
employees) is not the City's agent, employee, or representative for any purpose.
It is the express intention of the parties hereto that Consultant is an independent
contractor and not an employee, joint venturer, or partner of Ukiah for any purpose
whatsoever. Ukiah shall have no right to, and shall not control the manner or prescribe
the method of accomplishing those services contracted to and performed by Consultant
under this Agreement, and the general public and all governmental agencies regulating
such activity shall be so informed.
Those provisions of this Agreement that reserve ultimate authority in Ukiah have been
inserted solely to achieve compliance with federal and state laws, rules, regulations, and
interpretations thereof. No such provisions and no other provisions of this Agreement
shall be interpreted or construed as creating or establishing the relationship of employer
and employee between Consultant and Ukiah.
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Consultant shall pay all estimated and actual federal and state income and self-
employment taxes that are due the state and federal government and shall furnish and
pay worker's compensation insurance, unemployment insurance and any other benefits
required by law for himself and his employees, if any. Consultant agrees to indemnify
and hold City and its officers, agents and employees harmless from and against any
claims or demands by federal, state or local government agencies for any such taxes or
benefits due but not paid by Consultant, including the legal costs associated with
defending against any audit, claim, demand or law suit.
Consultant warrants and represents that it is a properly licensed professional or
professional organization with a substantial investment in its business and that it
maintains its own offices and staff which it will use in performing under this Agreement.
5.2 Conflict of interest. Consultant understands that its professional responsibility is solely
to City. Consultant has no interest and will not acquire any direct or indirect interest that
would conflict with its performance of the Agreement. Consultant shall not in the
performance of this Agreement employ a person having such an interest.
6.0 INDEMNIFICATION
6.1 Insurance Liabilitv. Without limiting Consultant's obligations arising under Paragraph 6.2
Consultant shall not begin work under this Agreement until it procures and maintains for
the duration of this Agreement insurance against claims for injuries to persons or
damages to property, which may arise from or in connection with its performance under
this Agreement.
A. Minimum Scope of Insurance
Coverage shall be at least as broad as:
1. Insurance Services Office ("ISO") Commercial General Liability Coverage
Form No. CG 00 01 11 85.
2. ISO Form No. CA 0001 (Ed. 1/87) covering Automobile Liability, Code 1
"any auto" or Code 8, 9 if no owned autos and endorsement CA 0025.
3. Worker's Compensation Insurance as required by the Labor Code of the
State of California and Employers Liability Insurance.
4. Errors and Omissions liability insurance appropriate to the consultanYs
profession. Architects' and engineers' coverage is to be endorsed to
include contractual liability.
B. Minimum Limits of Insurance
Consultant shall maintain limits no less than:
1. General Liability: $1,000,000 combined single limit per occurrence for
bodily injury, personal injury and property damage. If Commercial
General Liability Insurance or other form with a general aggregate limit is
used, the general aggregate limit shall apply separately to the work
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performed under this Agreement, or the aggregate limit shall be twice the
prescribed per occurrence limit.
2. Automobile Liabilitv: $1,000,000 combined single limit per accident for
bodily injury and property damage.
3. Worker's Compensation and Employers Liabilitv: Worker's compensation
limits as required by the Labor Code of the State of California and
Employers Liability limits of$1,000,000 per accident.
4. Errors and Omissions liabilitv: $1,000,000 per occurrence.
C. Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by
the City. At the option of the City, either the insurer shall reduce or eliminate
such deductibles or self-insured retentions as respects to the City, its officers,
officials, employees and volunteers; or the Consultant shall procure a bond
guaranteeing payment of losses and related investigations, claim administration
and defense expenses.
D. Other Insurance Provisions
The policies are to contain, or be endorsed to contain, the following provisions:
1. General Liabilitv and Automobile Liabilitv Coveraqes
a. The City, it officers, officials, employees and volunteers are to be
covered as additional insureds as respects; liability arising out of
activities performed by or on behalf of the Consultant, products
and completed operations of the Consultant, premises owned,
occupied or used by the Consultant, or automobiles owned, hired
or borrowed by the Consultant. The coverage shall contain no
special limitations on the scope-of-protection afforded to the City,
its officers, officials, employees or volunteers.
b. The Consultant's insurance coverage shall be primary insurance
as respects to the City, its officers, officials, employees and
volunteers. Any insurance or self-insurance maintained by the
City, its officers, officials, employees or volunteers shall be excess
of the Consultant's insurance and shall not contribute with it.
c. Any failure to comply with reporting provisions of the policies shall
not affect coverage provided to the City, its officers, officials,
employees or volunteers.
d. The ConsultanYs insurance shall apply separately to each insured
against whom claim is made or suit is brought, except with respect
to the limits of the insurer's liability.
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2. Worker's Comqensation and Employers Liabilitv Coveraqe
The insurer shall agree to waive all rights of subrogation against the City,
its officers, officials, employees and volunteers for losses arising from
Consultant's performance of the work, pursuant to this Agreement.
3. Professional Liabilitv Coveraqe
If written on a claims-made basis, the retroactivity date shall be the
effective date of this Agreement. The policy period shall extend from
March 3i' , 2007 to May 9, 2010.
4. All Coveraqes
Each Insurance policy required by this clause shall be endorsed to state
that coverage shall not be suspended, voided, canceled by either party,
reduced in coverage or in limits except after thirty (30) days prior written
notice by certified mail, return receipt requested, has been given to the
City.
E. Acceptability of Insurers
Insurance is to be placed with insurers with admitted California insurers with an
A.M. Best's rating of no less than A- for financial strength, AA for long-term credit
rating and AMB-1 for short-term credit rating.
F. Verification of Coveraqe
Consultant shall furnish the City with Certificates of Insurance and with original
Endorsements effecting coverage required by this Agreement. The Certificates
and Endorsements for each insurance policy are to be signed by a person
authorized by that insurer to bind coverage on its behalf. The Certificates and
Endorsements are to be on forms provided or approved by the City. All
Certificates and Endorsements are to be received and approved by the City
before Consultant begins the work of this Agreement. The City reserves the right
to require complete, certified copies of all required insurance policies, at any
time. If Consultant fails to provide the coverages required herein, the City shall
have the right, but not the obligation, to purchase any or all of them. In that
event, after notice to Consultant that City has paid the premium, the cost of
insurance may be deducted from the compensation otherwise due the contractor
under the terms of this Contract.
G. Subcontractors
If Consultant uses subcontractors or sub-consultants, it shall cover them under
its policies or require them to separately comply with the insurance requirements
set forth in this Paragraph 6.1.
6.2 Indemnification. Notwithstanding the foregoing insurance requirements, and in addition
thereto, Consultant agrees to indemnify the City for any claim, cost or liability that arises
out of, or pertains to, or relates to the negligence, recklessness, or willful misconduct of
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the Consultant and its agents in the performance of services under this contract, but this
indemnity does not apply to liability for damages for death or bodily injury to persons,
injury to property, or other loss, arising from the sole negligence, willful misconduct or
defects in design by the City, or arising from the active negligence of the City.
"Indemnify," as used herein includes the expenses of defending against a claim and the
payment of any settlement or judgment arising out of the claim. Defense costs include
all costs associated with defending the claim, including, but not limited to, the fees of
attorneys, investigators, consultants, experts and expert witnesses, and litigation
expenses.
References in this paragraph to City or Consultant, include their officers, employees,
agents, and subcontractors.
7.0 CONTRACT PROVISIONS
7.1 Ownership of Work. All documents furnished to Consultant by City and all documents or
reports and supportive data prepared by Consultant under this Agreement are owned
and become the property of the City upon their creation and shall be given to City
immediately upon demand and at the completion of Consultant's services at no
additional cost to City. Deliverables are identified in the Scope-of-Work, Attachment "A".
7.2 Governinq Law. Consultant shall comply with the laws and regulations of the United
States, the State of California, and all local governments having jurisdiction over this
Agreement. The interpretation and enforcement of this Agreement shall be governed by
California law and any action arising under or in connection with this Agreement must be
filed in a Court of competent jurisdiction in Mendocino County.
7.3 Entire Aqreement. This Agreement plus its Attachment(s) and executed Amendments
set forth the entire understanding between the parties.
7.4 Severabilitv. If any term of this Agreement is held invalid by a court of competent
jurisdiction, the remainder of this Agreement shall remain in effect.
7.5 Modification. No modification of this Agreement is valid unless made with the agreement
of both parties in writing.
7.6 Assiqnment. Consultant's services are considered unique and personal. Consultant
shall not assign, transfer, or sub-contract its interest or obligation under all or any portion
of this Agreement without City's prior written consent.
7.7 Waiver. No waiver of a breach of any covenant, term, or condition of this Agreement
shall be a waiver of any other or subsequent breach of the same or any other covenant,
term or condition or a waiver of the covenant, term or condition itself.
7.8 Termination. This Agreement may only be terminated by either party: 1) for breach of
the Agreement; 2) because funds are no longer available to pay Consultant for services
provided under this Agreement; or 3) City has abandoned and does not wish to complete
the project for which Consultant was retained. A party shall notify the other party of any
alleged breach of the Agreement and of the action required to cure the breach. If the
non-breaching fails to cure the breach within the time specified in the notice, the contract
titd-NrotSvcsAerccmcnt-1:�v007
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shall be terminated as of that time. If terminated for lack of funds or abandonment of the
project, the contract shall terminate on the date notice of termination is given to
Consultant. City shall pay the Consultant only for services performed and expenses
incurred as of the effective termination date. In such event, as a condition to payment,
Consultant shall provide to City all finished or unfinished documents, data, studies,
surveys, drawings, maps, models, photographs and reports prepared by the Consultant
under this Agreement. Consultant shall be entitled to receive just and equitable
compensation for any work satisfactorily completed hereunder, subject to off-set for any
direct or consequential damages City may incur as a result of Consultant's breach of
contract.
7.10 Duplicate Oriqinals. This Agreement may be executed in duplicate originals, each
bearing the original signature of the parties. When so signed, each such document shall
be admissible in administrative or judicial proceedings as proof of the terms of the
Agreement between the parties.
8.0 NOTICES
Any notice given under this Agreement shall be in writing and deemed given when
personally delivered or deposited in the mail (certified or registered) addressed to the
parties as follows:
ANN BURCK, PROJECT MANAGER
CITY OF UKIAH
DEPT. OF PUBLIC UTILITIES
411 WEST CLAY STREET
UKIAH, CALIFORNIA 95482-5400
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9.0 SIGNATURES
IN WITNESS WHEREOF, the parties have executed this Agreement the Effective Date:
CONSULTANT �
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BY: / f�`l Gi-,rL�- �j U �p o�--
Date
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IRS IDN Number
CITY OF UKIAH
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BY: -��� --� � ' I �, .--� �
CANDACE HORSLEY Date
CITY MANAGER
ATTEST
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GAIL PETERSEN Date
CITY CLERK
APPROVED AS TO FORM:
D ID . RAPPO T
CITY ATTORNEY, CITY OF UKIAH
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ATTACHMENT A
SCOPE OF SERVICES FOR
CITY OF UKIAH WASTEWATER TREATMENT PLANT
HYDROGEOLOGIC PERCOLATION POND STUDY
INTRODUCTION
The City of Ukiah (City) has developed the enclosed scope of services for this RFP.
The primary role of the selected Consultant will be to provide services to assist the City
with complying with the California Regional Water Quality Board North Coast Region
(Board) Order No. 1-2006-0049/NPDES No. CA0022888 (Order) for the Ukiah
Wastewater Treatment Facility (effective November 9, 2006) for a hydrogeologic study
of the percolation ponds. The primary objective for the Consultant is to design, perform
and report a scientifically sound and defensible study that satisfies the Board Order.
The selected Consultant will work under the direction of the Project Manager in the City
of Ukiah Utilities Department.
SCHEDULE
The project will extend over as much as three and one-half years. Consultants shall
predicate their proposal on these schedule constraints.
Prepare Hydrogeologic Study Workplan 3/23/07 5/9/07
Installation of At Least One Monitoring Well 5/9/07 7/13/07
Conduct Hydrogeologic Study 5/9/07 5/9/09
Prepare Hydrogeologic Study Report 5/9/09 11/9/09
Project Management, Coordination and 2�g�07 5/9/10
QA/QC
GENERAL DESCRIPTION OF SERVICES
This RFP solicits the services of a Consultant to:
1. Prepare Hydrogeologic Study Workplan
2. Conduct Hydrogeologic Study
3. Prepare Hydrogeologic Study Report
4. Project Management, Coordination and QA/QC
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PAGId 9 OP 8
These tasks are described in more detail below. The deliverables produced by the
Consultant will be used by the City in its efforts to comply with the Board Order.
DETAILED DESCRIPTION OF TASKS
The following is a description of the tasks identified to complete the required
assignment. Consultant shall expand upon this description of work and/or add tasks to
fully identify work products.
Task 1-Prepare Hydrogeologic Workplan
Submit for Regional Board approval, a workplan for a hydrogeologic study to determine
the fate and transport of wastewater pollutants discharged via the City's percolation
ponds. The workplan proposal should be designed to investigate:
• current and/or projected surveyed elevations of pond features referenced to
mean sea level (e.g., pond bottom, peak water surface level) and nearby
surface water features (e.g., channel bed, top of bank, seasonal average and
maximum water surFace elevations);
• site specific lithology;
• depth to groundwater across seasonal variations;
• seasonal groundwater gradients;
• transmissivity of areal soil;
• concentration gradients of targeted wastewater constituents measured at
various points extending away from the disposal area towards the Russian
River. The Consultant may use conservative indicator pollutants for the
purpose of this study.
The Draft workplan shall contain milestones and a time schedule for completion of the
study. The study time schedule shall be as short as practicable, and in no case, extend
beyond three and a half years following the effective date of the Board Order. The
study time schedule shall include provisions for the submittal of semi-annual progress
reports. This task includes up to two meetings with Board staff.
Task 2-Conduct Hydrogeologic Study
The Consultant shall perform the hydrogeologic study described in the final study
workplan approved by the Board. For the purposes of the Consultant's proposal, the
study shall be assured to include:
• Review of Background Data.
StA-ProfSvcsAgreemem�lan2007
PAGE 10 OP 8
• Development of Fieldwork Safety Plan.
• Design, Permitting, Construction, and Development of Monitoring Wells (As
the result of a Consent Decree, one monitoring well must be installed by
7/13/07. The Board Order also requires one well by May 9, 2008. The
Consultant should assume installation of two monitoring wells.)
• Monitoring of Water Levels and Water Quality in Five Monitoring Wells
(Assume Two Years).
• Groundwater Flow and Fate and Transport Modeling Between the Percolation
Ponds and Russian River.
Task 3-Prepare Hydrogeologic Study Report
Consultant shall submit a report describing the findings and conclusions of the
hydrogeologic study that monitors and models the fate and transport of wastewater
pollutants. The report shall include all pertinent information from groundwater
monitoring wells used to collect data, including, but not limited to well locations and well
logs. The report shall include conclusions and recommendations for further work if
appropriate. This task includes up to two meetings with Board staff.
Task 4-Project Management Coordination and QA/QC
Consultant shall manage all of its staff, subconsultants and subcontractors (including
drilling subcontractor and analytical laboratory), and coordinate all activities with the
City's Project Manager. Consultant will present the study workplan and study findings
to City staff and/or City council. This task includes quality assurance/quality control
(QA/QC) of all work products. Consultant shall provide written monthly status reports to
the City and semi-annual progress reports for the City to deliver to the Board.
Task 5-Optional Tasks
In addition to the above four tasks, the Consultant is requested to provide a description
and cost estimate for one or more tasks that the Consultant recommends and/or
envisions may benefit by the City.
Deliverables
The Consultants shall provide 15 copies of an Administration Draft, Draft and Final of
both the Study Workplan and Study Report and a presentation of the Study findings.
Std-ProtSvcsAgreement-Ja�i2007
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Client#: 727 BALANHYDR
ACORDrM CERTIFICATE OF LIABILITY INSURANCE 3/30/07 oonrvr�
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey, Renton &Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 12675 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Oakland, CA 94604-2675
510 465-3090 INSURERS AFFORDING COVERAGE NAIC#
INSURED
Balance Hydrologics, Inc. wsuReR,c: Fidelity&Guaranty Ins. Co.
wsuRER B: St. Paul Protective Insurance Co.
841 Folger Avenue iNSUReR c: Greenwich Insurance Company
Berkeley, CA 94710-2800 iNSUReR�: Hartford Casualty Insurance Co.
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' POLICY EFFECTIVE POLICY EXPIR.4TION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS
A GENERAL LIABILITY BK01516221 �OIZSIOS �OIZ6IO7 EACH OCCURRENCE $') OOO OOO
X COMMERCIAL GENERAL LIABILITY PREMGE TO RENTE� $� OOO OOO
CLAIMS MADE a OCCUR MED EXP(Any one person) $�Q QQQ
X C011t�aCtUBI LIBb. PERSONAL&ADVINJURY 5� QQQ QQQ
GENERALAGGREGATE SZ OOO OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG SZ OOO OOO
X POLICY PR� LOC
JECT
D AUTOMOBILELIABILITY 57UECTM2149 �ZI3O/O6 'IZI3O/O7 COMBINEDSINGLELIMIT
X ANY AUTO (Ea accident) $1 e��0,��0
ALL OWNED AUTOS
BODILY INJURY �
SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE �
(Per accident)
GARAGELIABILITY AUTOONLY-EAACCIDENT $
ANV AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG S
A EXCESS/UMBRELLA LIABILITY BK01516221 'I O/ZF)�OF) �O/ZB�O7 EACH OCCURRENCE $2 OOO OOO
X OCCUR ❑ CLAIMS MADE AGGREGATE $2 OOO OOO
$
DEDUCTIBLE $
RETENTION $ $
B WORKERSCOMPENSATIONAND BW02185959 O7IO'I/O6 O7/O�/O7 X WCSTATU- OTH-
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $�I�OOO�OOO
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $��OOO�OOO
If yes,describe under
SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $�,OOO�OOO
(�` OTHER professional PEC001747302 11/09/06 11/09/07 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
General liability policy excludes claims arising out of the performance of professional
services
Project: 207035.
The City of Ukiah, Its Officers,Officials, Employees and Volunteers are
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ukiah DATE THEREOF,THE ISSUING INSURER WILL jtI�Q�V(Jajj}j4j MAIL �� DAVS WRITTEN
Department of Public Utilities NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,JffJ(RR91 K
411 West Clay Street k'1P1V/6RlIddXJJQbJGAk4iDiRR74ClUGIG7dXp1F7AlQXXkCpXEF1QIlRCt4i1NJ[Df9�CliAXUGRDC6WAi�cXX
Covelo, CA 95428-5400 xR�aAO�w�exx
AUTHORIZED REPRESENTATIVE
Q �_ •
ACORD 25(2001/08) 1 of 2 #M177550 CCB o ACORD CORPORATION 1988
DESCRIPTIONS (Continued from Page 1)
additional insureds to General and Auto Liability per policy form wording.
Insurance is Primary and Non-Contributory with Severability of Interest
Clause.
See attachments.
AMS 25.3(2001/08) 2 of 2 #M177550
NBmed Insured: Balance Hydrologics, Inc.
Policy Number: Bxo1516221
Owner, Lessee Or Contractor - Scheduled Person Or Organization
ADDITIONAL INSURED ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
LIABILITY COVERAGE PART.
Owners, Lessees Or Contractors - Scheduled Persons Or
Organizations Schedule
Name of Person or Organization:
Schedule Cont. The City of Ukiah, Its Officers, Officials, Employees
and Volunteers
Location of Covered Operations:
All Operations of the Named Insured
The following is added to SECTION II. WHO IS AN that does not arise out of your negligence;
INSURED, 2:
(2) "Bodily injury", "property damage",
Owner, Lessee Or Contractor- "personal injury" or"advertising injury"
Scheduled Person Or Organization for which such person or organization
has assumed liability in a contract or
Each person or organization shown in the agreement, except for liability for
Owners, Lessees Or Contractors- Scheduled damages that such person or
Persons Or Organizations Schedule, but only organization would have in the absence
with respect to that person's or organization's of that contract or agreement;
liability arising out of"your work"for that
person or organization. (3) "Poperty damage"to:
However, such person or organization is not (a) Property owned, used or occupied by
an insured with respect to any: or loaned or rented to such person or
organization;
(1) "Bodily injury", "property damage",
"personal injury" or"advertising injury"
CLBF 22 40 11 02 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 2
Copyright,Insurance Services Office,Inc.,2001
(b) Property in the care, custody or
control of such person or
organization over which such person
or organization is, for any purpose
exercising physical control; or
(c) "Your work" performed for such
person or organization;
(4) "Bodily injury", "property damage",
"personal injury" or"advertising injury"
arising out of any architect's, engineer's
or surveyor's rendering of, or failure to
render, any"professional service"when
such person or organization is an
architect, engineer or surveyor; or
(5) "Bodily injury" or"property damage"that
occurs after"your work"for such person
or organization has been completed.
"Your work"will be deemed completed
at the earliest of the following times:
(a) When all of the work on the project
to be done at the Location of
Covered Operations shown in the
Owners, Lessees or Contractors-
Scheduled Persons Or Organizations
Schedule has bee completed; or
(b) When that part of the work out of
which the "bodily injury" or
"property damage"arises has been
put to its intended use by any person
or organization, other than another
contractor or subcontractor working
on the same project.
"Your work"that may need service,
maintenance, correction, repair or
replacement, but which is otherwise
deemed completed above, will also be
deemed completed.
All other terms of your policy remain the same.
CL/BF 22 40 11 02 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 2
Copyright,Insurance Services Office,Ina,2001
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different
date is indicated below.
(The following"attaching clause"needs to be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement forms a part of Policy No. BW02185959
Issuedto: Balance Hydrologics, Inc .
By: St . Paul Protective Insurance Co.
Premium (if any)TBD
We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us).
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2-5% of the California workers compensation premium otherwise
due on such remuneration.
Schedule
Person or Organization Job Description
City of Ukiah The City of Ukiah, Its Officers,
Department of Public Utilities Officials, Employees and Volunteers
411 West Clay Street
Covelo, CA 95428-5400
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WC 04 03 06 Countersigned by
(Ed. 4-84) Authorized Representative