HomeMy WebLinkAboutPacific Infrastructure - Spec 23-02 Dewatering Improvements 2223-214 - Contract - signed 2 COU No. ��2 a►`f
CITY OF UKIAH
Mendocino County, California
AGREEMENT
FOR
THICKENING AND DEWATERING IMPROVEMENTS
Specification No. 23-02
THIS AGREEMENT, made this ' day of a✓Nr , 20_2a, by and between the City
of Ukiah, Mendocino County, California, hereinafter called the City and A�-1F�G fiVr-�i+}sjl�.✓[.TU/�r
hereinafter called the Contractor,
WITNESSETH:
WHEREAS,the City has caused to be prepared in accordance with law, specifications, drawings and other
contract documents for the work herein described and shown and has approved and adopted these contract
documents, specifications and drawings and has caused to be published in the manner and for the time
required by law a notice to bidders inviting sealed proposals for doing the work in accordance with the terms
of this contract and
WHEREAS,the Contractor,in response to the notice to bidders,has submitted to the City a sealed proposal
accompanied by a proposal guaranty in an amount of not less than 10 percent of the bid price for the
construction of the proposed work in accordance with the terms of this contract and
WHEREAS, the City, in the manner prescribed by law, has pub?icly opened, examined and canvassed the
proposals submitted and as a result has determined and declared the Contractor to be the lowest and best
regular responsible bidder for the work and for the sums named in the proposal,
NOW,THEREFORE, THIS AGREEMENT WITNESSETH:
Article 1. Work to be Done and Contract Days Allowed.
That the Contractor shall provide all necessary machinery, tools, apparatus and other means of
construction; shall furnish all materials, superintendence, overhead, expenses, all labor and expenses of
whatever nature necessary for completion of the work in conformity with the Special Provisions and other
contract documents hereto attached and according to such instructions as may be given by the Engineer.
The Contractor sha1 complete the work within three hundred and thirty-five (335) calendar days. Contract
days shall be counted starting with the 10th day fo;!owing receipt of notice that the contract has been
executed by the City. Contractor, at his or her option. may begin work prior to start of counting contract
days, however, in no event shall the Contractor start work without giving notification to the Engineer at least
72 hours prior to the start of work,without obtaining an encroachment permit from the City, or without having
submitted certificates of insurance that have been accepted and approved by the Engineer
Article II. Contract Prices.
That the City shall pay the Contractor the prices stated in the proposal submitted by the Contractor, for
complete performance of the contract by the Contractor.The Contractor hereby agrees to accept the prices
THICKENING AND DEWATERING IMPROVEMENTS 46 Spec No.23-02
as full compensation for all material and appliances necessary to the work,for all labor and use of tools and
other implements necessary to execute the work contemplated in this contract;for all loss or damage arising
out of the nature of the work or from the action of the elements, or from any unforeseen obstructions or
difficulties which may be encountered in the prosecution of the work; for all risks of every description
connected therewith; for all expenses of the work, as herein specified; for all liability and other insurance,
for all overhead and other expenses incident to the work;all according to the Contract Drawings,the Special
Provisions,the Details, the instructions and the requirements of the City_
Article III. Labor Discrimination.
Attention is directed to Section 1735 of the Labor Code, which reads as follows:
"No discrimination shall be made in the employment of persons upon public works because of the
race, color, national origin or ancestry, or religion of such persons and every contractor for public
works violating this section is subject to all the penalties imposed for a violation of this chapter."
In connection with the performance of work under this contract, the Contractor agrees as follows:
(a) The Contractor will not willfully discriminate against any employee or an applicant for
employment because of race, color, religion, ancestry, or national origin. The Contractor will
take affirmative action to ensure that applicants are employed and that employees are treated
during employment without regard to their race, color, religion, ancestry, or national origin.
Such action shall include, but not be limited to, the following: employment, upgrading,
demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay
or other forms of compensation; and selection for training, including apprenticeship. The
Contractor agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the awarding authority setting forth the provisions of
this Fair Employment Practice section.
(b) The Contractor will send to each labor union or representative of workers with which he or she
has a collective bargaining agreement or other contract or understanding, a notice, to be
provided by the awarding authority, advising the said labor union or worker's representative
of the Contractor's commitments under this section, to employees and applicants for
employment.
(c) The Contractor will permit access to his or her records of employment, employment
advertisements, application forms and other pertinent data and records by the Fair
Employment Practices Commission,City of Ukiah or any other appropriate agency of the State
of California designated by the awarding authority, for the purposes of investigation to
ascertain compliance with the Fair Employment Practices section of this contract.
(d) A finding of willful violation of the Fair Employment Practices section of this Contract or of the
Fair Employment Practices Act shall be regarded by the awarding authority as a basis for
determining the Contractor to be not a "responsible bidder" as to future contracts for which
such Contractor may submit bids, for revoking the Contractor's pre-qualification rating, if any
and for refusing to establish, reestablish or renew a pre-qualification rating for the Contractor_
The City of Ukiah shall deem a finding of willful receipt of written notice from the Fair
Employment Practices Act to have occurred upon that it has investigated and determined that
the Contractor has violated the Fair Employment Practices Act and has issued an order under
Labor Code Section 1426 or obtained an injunction under Labor Code Section 1429.
Upon receipt of such written notice from the Fair Employment Practices Commission,the City
shall notify the Contractor that unless he or she demonstrates to the satisfaction of the
awarding authority within a stated period that the violation has been corrected, his or her pre-
qualification rating will be revoked at the expiration of such period.
THICKENING AND Dr-WATERING IMPROVEMENTS 47 Spec No.23-02
(e) The Contractor agrees that should the City determine that the Contractor has not complied
with the Fair Employment Practices section of this Contract, then pursuant to Labor Code
Section 1735 and 1775 the Contractor shall, as a penalty to the City, forfeit for each calendar
day or portion thereof, for each person who was denied employment as a result of such non-
compliance, the penalties provided in the Labor Code for violation of prevailing wage rates.
Such monies may be recovered from the Contractor.The City may deduct any such damages
from any monies due the Contractor.
(f) Nothing contained in this Fair Employment Practices section shall be construed in any manner
of fashion so as to prevent the City or the State of California from pursuing any other remedies
that may be available at law.
(g) Prior to awarding the Contract,the Contractor shall certify to the awarding authority that he or
she has or will meet the following standards for affirmative compliance, which shall be
evaluated in each case by the awarding authority:
(1) The Contractor shall provide evidence, as required by the City that he or she has notified
all supervisors, foremen and other personnel officers in writing of the content of the anti-
discrimination clause and their responsibilities under it.
(2) The Contractor shall provide evidence, as required by the City, that he or she has notified
all sources of employees' referrals (including unions, employment agencies, advertisements,
Department of Employment)of the content of the anti-discrimination clause.
(3) The Contractor shall file a basic compliance report, as required by the City. Willfully false
statements made in such reports shall be punishable as provided by law. The compliance
report shall also spell out the sources of the work force and who has the responsibility for
determining whom to hire, or whether or not to hire.
(4) Personally, or through his or her representatives, the Contractor shall, through
negotiations with the unions with whom he or she has agreements, attempt to develop an
agreement which will:
a. Spell out responsibilities for nondiscrimination in hiring, referral, upgrading and
training.
b. Otherwise implement an affirmative anti-discrimination program in terms of the unions'
specific areas of skill and geography to the end that qualified minority workers will be
available and given and equal opportunity for employment.
(5) The Contractor shall notify the City of opposition to the anti-discrimination clause by
individuals, firms or organizations during the period of its pre-qualification.
(h) The Contractor will include the provisions of the foregoing paragraphs 1 through 5 in every
first tier subcontract so that such provisions will be binding upon each such subcontractor.
The"Fair Employment Practices Certification"must be completed and signed prior to the time of submitting
the bid.
Article N. Parts of the Contract.
That the complete contract consists of the following documents, all of which shall be considered a part of
this agreement.
1. Notice to Bidders
2. Wage Rates
3, General Conditions
THICKENING AND DEWATERING IMPROVEMENTS R Spec No.23-02
4. Technical Specifications
5. Proposal
6. Fair Employment Practices Certification
7. Agreement
8. Contract Bonds
9. Contract Drawings and Construction Details
10. Standard Drawings
11. Indemnification Agreement
IN WITNESS WHEREOF, this contract being executed in duplicate and the parties having caused their
names to be signed by authority of their duly authorized office this day of 20_;�_J.
CITY OF UKIAH, MENDO INO COUNTY, CALIFORNIA
By:
CITY OF UKIAH
Attest: �f
CITY CLERK, CITY OF UKIAH
CONT
Attest: �-
Title: �� c .lAanQQex
4
The foregoing contr .t is approved as to form and legality this day of ,J 20 Z3.
_
C:I a Y EY, CI O ]KI
t
THICKENING AND DEWATERING IMPROVEMENTS 49 Spec No.23-02
INDEMNIFICATION AGREEMENT
This Indemnification Agreement is made and entered in Ukiah, California, on 2' ' 2073
by and between the City of Ukiah (Ukiah)and P A-L.IIr-+L hVRL1*5 TCL&L T 0A T (Contractor).
Contractor is
PexI"DRM►r4 woxlr
for Ukiah.
As a condition of issuing the work order, attached hereto, Ukiah requires assurance that Contractor will
protect Ukiah from damage or damage claims which arise from its performance of the work.
Accordingly, Contractor agrees as follows:
1. Indemnification. Contractor shall indemnify and hold harmless Ukiah and its officers, agents, and
employees from and against any claim, loss, or damage, including the legal and other costs of defending
against any claim of damage or loss which arises out of the Contractor's negligent or wrongful performance
under the work order attached hereto, except for claims, losses, or damages resulting from the sole and
exclusive negligence or other wrongful conduct of Ukiah or its officers, agents and employees.
CONTRACTOR
BY. r�j
TITI F (La tovt
THICKENING AND DEWATERING IMPROVEMENTS bo Spec No.23-02
CITY OF UKIAH
Mendocino County, California
Executed in two counterparts PERFORMANCE BOND
Premium: $28,009.00
BOND No. 070218858
KNOW ALL PERSONS BY THESE PRESENTS:
THAT WHEREAS, the City of Ukiah, organized and operating under the laws of the State of California,
(hereinafter referred to as the 'City") has awarded to Pacific Infrastructure , (hereinafter
referred to as the"Contractor")an agreement for Contract No. 23-02 (hereinafter referred to
as the"Project'). Thickening and Dewatering Improvements
WHEREAS, the work to be performed by the Contractor is more particularly set forth in the Contract for the
Project dated , (hereinafter referred to, together with all attachments and
exhibits thereto, as"Contract Documents"), the terms and conditions of which are expressly incorporated
herein by reference; and
WHEREAS, the Contractor is required by the Contract Documents to perform the terms thereof and to
furnish a bond for the faithful performance of said Contract Documents.
NOW, THEREFORE we, Pacific Infrastructure the undersigned Contractor and
The Ohio Casualty Insurance Company, as Surety, a corporation organized and duly authorized to transact
business under the laws of the State of California, are held firmly bound until the City in the sum of
Two Million Nine Hundred Ninety" ($2,994,000,00* -• -•*),forwhich amountwell and trulyto be made,
we bind ourselves, our heirs ,executors and administrators, successors and assigns,jointly and severally,
firmly by these presents. ;Four Thousand and no/100ths
THE CONDITION OF THIS OBLIGATION IS SUCH that, if the Contractor, his or its heirs, executors,
administrators,successors or assigns, shall in all things stand to and abide by, and well and truly keep and
perform the covenants, conditions and agreements in the Contract Documents and any alteration thereof
made as therein provided, on its part, to be kept and performed at the time and in the manner therein
specified, and in all respects according to their intent and meaning;and shall faithfully fulfill all obligations;
and shall indemnify and save harmless the City, its officials,officers,employees,and authorized volunteers,
as stipulated in said Contract Documents,then this obligation shall become null and void;otherwise it shall
be and remain in full force and effect.
As part of the obligation secured hereby and in addition to the face amount specified therefore, there shall
be included costs and reasonable expenses and fees including reasonable attorneys'fees, incurred by the
City in enforcing such obligation.
As a condition precedent to the satisfactory completion of the Contract Documents, unless otherwise
provided for in the Contract Documents, the above obligation shall hold good for a period of one(1) year
after the acceptance of the work by the City,during which time if Contractor shall fail to make full,complete,
and satisfactory repair and replacements and totally protect the City from loss or damage resulting from or
caused by defective materials or faulty workmanship. The obligations of Surety hereunder shall continue
so tong as any obligation of Contractor remains. Nothing herein shall limit the City's rights or the Contractor
or Surety's obligations under the Contract Documents, law or equity, including, but not limited to,California
Code of Civil Procedure Section 337.15.
THICKENING AND DEWATER;NG IMPROVEMENTS St Spec No.23-02
Whenever Contractor shall be, and is declared by the City to be, in default under the Contract Documents,
the Surety shall remedy the default pursuant to the Contract Documents, or shall promptly, at the City's
option:
i. Take over and complete the Project in accordance with all terms and conditions in the
Contract Documents;or
il. Obtain a bid or bids for completing the Project in accordance with all terms and conditions
in the Contract Documents and upon determination by Surety of the lowest responsive and
responsible bidder, arrange for a contract between such bidder,the Surety and the City, and make
available as work progresses sufficient funds to pay the cost of completion of the Project, less the
balance of the contract price, including other costs and damages for which Surety may be liable.
The term "balance of the contract price* as used in this paragraph shall mean the total amount
payable to Contractor by the City under the Contract and any modification thereto, less any amount
previously paid by the City to the Contractor and any other set offs pursuant to the Contract
Documents.
iii. Permit the City to complete the Project in any manner consistent with California law and
make available as work progresses sufficient funds to pay the cost of completion of the Project,
less the balance of the contract price,including other costs and damages for which Surety may be
liable. The term "balance of the contract price" as used in this paragraph shall mean the total
amount payable to Contractor by the City under the Contract and any modification thereto,less any
amount previously paid by the City to the Contractor and any other set offs by the City pursuant to
the Contract Documents.
Surety expressly agrees that the City may reject any contractor or subcontractor which may be proposed
by Surety in fulfillment of its obligations in the event of default by the Contractor.
Surety shall not utilize Contractor in completing the Project nor shall Surety accept a bid from Contractor
for completion of the Project if the City,when declaring the Contractor in default,notifies Surety of the City's
objection to Contractor's further participation in the completion of the Project.
The Surety, for value received, hereby stipulates and agrees that no change,extension of time,alteration
or addition to the terms of the Contract Documents or to the Project to be performed thereunder shall in
any way affect its obligation on this bond, and it does hereby waive notice of any such change,extension
of time, alteration or addition to the terms of the Contract Documents or to the Project.
[REMAINDER OF PAGE LEFT INTENTIONALLY BLANK]
THICKENING AND DEWATERING IMPROVEMENTS 152 Spec No.23-02
IN WITNESS WHEREOF,we have hereunto set our hands and seals this 161h day of June ,20 23
(Corporate Seal) Pacific Infrastructure
Contractor/Principal
By-... MJ
Title r
(Corporate Seal) The Ohio Casualty Insurance Company
Surety
By
Betty L.Tolentit, A-ttorney-in-Fact
(Attach Attorney-in Fact Certificate) Title Attomey4n-Fact
first $500,000 @$14.40=$7,200
next$2,000,000 @$8.70=$17,400
next $494,000 @ $6.90=$3,409
The rate of premium on this bond is per thousand. The total amount of premium
charges is$28,009.00
(The above must be filled in by corporate attorney.)
THIS IS A REQUIRED FORM.
Any claims under this bond may be addressed to:
(Name and Address of Surety) The Ohio Casualty Insurance Company
255 California St., San Francisco, CA 94111
(Name and Address of Agent or
Representative for service of process in
California, if different from above)
(Telephone number of Surety and Agent 415.537.2510
or Representative for service of process in Califomia)
THICKENING AND DEWATERING IMPROVEMENTS S3 Spec No.23-02
gnneglnnaz
CALIFORNIA ALL — PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT Ls
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of CALIFORNIA }
County of Omn +Yri eL }
On Lae K before me, NOTARY PUBLIC
+ are insert ame and fille of the o fficer
personally appeared M 0 4 plc J�_,� )5_011 1'-�--- ,
who proved to me on the basis of satisfactory ev ence to be the person( whose
name(g) islal6 subscribed to the within instrument and acknowledged to me that
helshefthey executed the same in hislherftheir authorized capacity(ie< and that by
hislher•Aheir signature(syon the instrument the person(s},or the entity upon behalf of
which the person(*) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
RIDDHI M151 RI
Notary Public-California
WITNESS my hand and official seal. _ :�a ,,% " Alameda County
Commission 0 2296473
J`���\1• My Comm.Expires Jul 11,2023
Notary Public Signature (Notary?ublic Seal}
A INSTRUCTIONS FOR COMPLETING THIS FORM
ADDITIONAL OPTIONAL INFORMATION
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgements
from other states may be completed for documents being sent to that state so long
as the wording does not require the California notary to violate California notary
law.
(Title or description of attached document) ° State and County information must he the State and County where the document
signer(s)personally appeared before the notary public for acknowledgmeent.
Date of notari7ittion must be the date that the signer(%)personally appeared which
(Tice or description of attached document continued) must also be the%ante(laic the acknowledgment is completed.
° The notary public must print his or her name as it appears Scithin his or her
Number of Pages Document Date commission followed by a comma and then your title(notary public).
° Print the name(%) of docunhcnt signerts) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER Indicate the correct singular or plural forms by crossing off incorrect I'omhs Ii.e.
heishchhey. is r'are)or circling the correct forms.Failure to correctly indicate this
❑ Individual (s) information may lead to rejection ofdocument recording.
❑ Corporate Officer ° The notary Neal impression must be clear and photographically reproducible.
Impression must not corer text or lines. If seal impression Smudges, re-seal if a
(Title) sufficient area permits.otherwise complete a difrerent acknowledgmem torm.
❑ Partner(s) ° Signature ofthe notary public must match the signature on file with the office of
the county clerk.
❑ Attorney-in-Fact Additional infonmation is not required but could !help to ensure this
❑ Trustee(s) acknowledgment is not misu%cd or attached to a dilTcrcnt document.
Other Indicate title or type ofaltached document.number of pages and date.
❑ Indicate the capacity claimed by the signer. It'the claimed capacity is a
corporate officer.indicate the title(i.e.CFO.CFO.Secretary).
Securely attach this document to the signed document with a staple.
www.TheNotaryLab
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validi of that document.
State of California
County of San Francisco
On _ r� 1 11 before me, M. Moody, Notary Public
(insert name and title of the officer)
personally appeared Betty L. Tolentino
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that helshe/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
ti"hY1L11tiY.tiLtiYhM1
tiM"hY`W.M1SAY.•.1tiL1M11
M MCODY
COMM a2ve6a03
WITNESS my hand an Icial seal. NOTARY PUBLIC0-:ALIFORNW k5
San Franasco County
CO(W481an Expres January B 2026
Signatur (Seal)
This Power of Attorney limits the acts of those named herein,and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutual. The Ohio Casualty Insurance Company Certificate No- 8209187-024126
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company's a corporation duly organized under the:aws of the State of New Hampsh;re,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American nsurance Company Is a corporation duly organized
under the laws of the State of Indiana(herein collectively called the'Companies'),pursuant to and by authority herein set forth.does hereby name,constitute and appoint, Betty L.
Tolentino;Brian Cooper;Brittany Kavan;Courtney Chew;Janet C.Rojo;Julia Ortega;K.Zerounian;Kevin Re;M Moody;Marra De Los Angeles Reynoso;Maureen
O'Connell;Misty R.Hemje,Robert P.Wrixon;Susan Hecker,Susan M.Exline;Thuyduong Le;Virginia L Black
all of the city of Walnut Creek state of CA each individually it there be more than cne named Its true and lawful attorney-in-fact to make,
execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations, n pursuance
Of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies n their own proper
persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corperate seals of the Companies have been affixed
thereto this 28th day of December , 2022 .
Liberty Mutual Insurance Company
P4 tNSIJ PZvi INsp INSUgq The Oh o Casualty Insurance Company
tiJ °°RPO'�r 'tp y`�4°R4ORv>�y �P�o�°11,,yc, West American nsurance Company
a °
ui � 1912 q a o 31919� n �1991 n
N s $ 11 �eA
Co
m David M.Carey,Assistant Secretary Cr
c5 State of PENNSYLVANIA
a�Lr County of MONTGOMERY '- o E
.r On this 28th day of December 2022 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary Of Liberty Mutual Insurance a>
m Company,The Ohio Casualty Company.and West American Insurance Company and that he,as such,being authorized so to do execute the foregoing instrument for the purposes
n therein contained by sign:ng on behalf of the corporations by himself as a duly authorized officer
:a IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsytvan;a,on the day and year first above written. 0
C'rn
PAsT 13-0
� � ��'A°Nwp F( Commalweallh W Pennsyhrenia-Notary Seal }_
Q U�t its q Teresa Paslella,Notary Public N•—
p OF M-r"—ry C—ty C
If
Q kt1
0 My commission expires March 28,2025 By: O
commission number 1126014 _---_ --- - --- - >_
y� snu Member,PenasAwia Assmalmn of Notaries eresa Pastella,Notary Public o
0 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3 co
115
o c Insurance Company,and West American Insurance Company which resdutions are now in full force and effect reading as follows: ti M
a: ARTICLE IV—OFFICERS:Section 12.Power of Attorney. `oo
0 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the—0—
a President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to ad in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety m—_
r_ any and all undertakings,bonds,recognizances and other surety obligations.Such attomeys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall-0
.J have full power to bind the Corporation by their signature and execution of any such nstrtlments and to attach thereto the seal of the Corporation.When so executed,such o 0
Zinstruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the f m
provisions Of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. ti N
ARTICLE XIII—Execution of Contracts:Section 5.Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,
she'appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,
bonds,recognizances and other surety Obligations.Such attorneys-in-tact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety
obligations.
Authorization—By unan mous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this �ay of duW—c—'
V ANSU '14 INS& 1NSU
y 11.hJP°oavo� n gJ `ero��Pgy `VPcoar0
1919 � I 1991
t'd�,�0 "Ig<'aaa, s0 ArAµP��`��a�� rs, 'Mama► cis t3y.Renee C.Llewellyn,Assistant Secrets
ry
LMS-12873 LMIC rX_IC WAIL Mutti DO02r21
CITY OF UKIAH
Mendocino County, California
Executed in two counterparts
Premium included in charge PAYMENT BOND
for performance bond
BOND No. 070218858
KNOW ALL PERSONS BY THESE PRESENTS:
WHEREAS,the City of Ukiah(`City')has awarded to Pacific Infrastructure {'Contractor/Principal")
a contract(City Agreement No. 23-02 ,dated referred to as
the"Agreement')for the work described as Thickening and Dewaten2g The Agreement is incorporated
by this reference into this Payment Bond("Bond');and Improvements
WHEREAS, Contractor/Principal is required to furnish a bond in connection with the Agreement and
pursuant to California Civil Code section 9550;
NOW, THEREFORE, we Pacific Infrastructure the undersigned
Contractor/Principal,and {'Surety'),a corporation organized and existing under
the laws of the State of New Hampshire ,and duly authorized to transact business under the laws
of the State of California, as Surety, are held firmly bound until the City, and to any and all persons,
companies, or corporations entitled by law to file stop payment notices under California Civil Code Section
9100, or any person, company, or corporation entitled to make a claim on this bond, in the sum of
$2,994,000.00 Two Million" ,for which payment will and truly be made, we bind ourselves, our heirs,
executors and administrators, successors and assigns,jointly and severally, firmly by these presents,
*Nine Hundred Ninety Four Thousand and no/100ths
THE CONDITION OF THIS OBLIGATION IS SUCH that if Contractor/Principal, its heirs, executors,
administrators, successors, or assigns, or subcontractor, shall fail to pay any person or persons named In
Civil Code section 9100;or fail to pay for any materials,provisions,or other supplies, used in, upon,for, or
about the performance of the work contracted to be done, or for any work or labor thereon of any kind, or
for amounts due under the Unemployment Insurance Code, with respect to work or labor thereon of any
kind; or shall fail to deduct, withhold, and pay over to the Employment Development Department, any
amounts required to be deducted, withheld, and paid over by Unemployment Insurance Code Section
13020 with respect to work and labor thereon of any kind, then Surety will pay for the same, in an amount
not exceeding the amount herein above set forth, and in the event suit is brought upon this bond, also will
pay such reasonable attorneys' fees as shall be fixed by the court, awarded and taxed as provided in
California Civil Code Section 9550, et seq.
It is further stipulated and agreed that the Surety of this bond shall not be exonerated or released from the
obligation of the bond by any change,extension of time for performance,addition, alteration or modification
in,to,or of any contract,plans,or specifications,or agreement pertaining or relating to any scheme or work
of improvement herein above described; or pertaining or relating to the furnishing of labor, materials, or
equipment therefor; nor by any change or modification of any terms of payment or extension of time for
payment pertaining or relating to any scheme or work of improvement herein above described; nor by any
rescissions or attempted rescission of the contract,agreement or bond; nor by any conditions precedent or
subsequent in the bond attempting to limit the right of recovery of claimants otherwise entitled to recover
under any such contract or agreement or under the bond; nor by any fraud practiced by any person other
than the claimant seeking to recover on the bond; and that this bond be construed most strongly against
the Surety and in favor of all persons for whose benefit such bond is give; and under no circumstances
shall the Surety be released from liability to those for whose benefit such bond has been given, by reason
of any breach of contract between the Owner and Contractor/Principal or on the part of any oblige named
in such bond;that the sole condition of recovery shall be that the claimant is a person described in California
Civil Code section 9100,and who has not been paid the full amount of his or her claim; and that the Surety
does hereby waive notice of any such change,extension of time,addition, alteration or modification herein
mentioned, including but not limited to the provisions of section 2819 and 2845 of the California Civil Code.
THICKENING AND DEWATERING IMPROVEMENTS SA Spec No.23-02
Any notice to Surety may be given in the manner specified in the Agreement and delivered or transmitted
to Surety as follows:
Attu: Atsushi Miyamoto
Address:. 255 California St.
City/State/Zip: San Francisco, CA 94111
Phone: 415.537.2510
Fax.-
Email: atsushi.Myamoto@iibertymutual.com
IN WITNESS WHEREO, two identical counterparts of this Bond, each of which shall for all purposes be
deemed an original thereof, have been duly executed by Contractor/Principal and Surety above named,on
thel"ay of June 2023.
Pacific Infrastructure (SEAL)
Contractor/Principal l
sy L_I
Cohrrictors pr se
435 vtcter 2
+ Contractor/Principal's Address
Mt tsor tc,n LA- Cklf _ —_---
City,State,Zip
The Ohio Casualty Insurance Company (SEA!_}
Surety ,
Sur 's Representative
Betty L Toll ntino,Attomey4n-Fact
255 California St.
Surety's Address
San Francisco,CA 94111
City,State,Zip
415-537.2510
Telephone Number
NOTE: Signatures of those executing for Surety must be properly acknowledged, the bond must be
accompanied by a properly acknowledged Power of Attorney from the Surety authorizing its agent to bind
it to this bond.A copy of such Power of Attorney must be in file with the City.
THICKENING AND DE WATERING IMPROVEMENTS 55 Spec No 23-02
FCALIFORNIA ALL - PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of CALIFORNIA }
County of /&am ed a }
On before me, /`C )aH l I_S'TIZ I , NOTARY PUBLIC ,
lRere insert name�il)e officer
personally appeared < <_ CIA a,pQ!::l S 01/1
who proved to me on the basis of satisfactory Wince to be the person(srwhose
names} isla+ subscribed to the within instrument and acknowledged to me that
helsh>Atey executed the same in his/herAMir authorized capacity(ics-), and that by
hislhell it signature(�5) on the instrument the person(s)eor the entity upon behalf of
which the person(s)-acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
n•. RIOOMMISTRI
Notary Public•California
WITNESS my hand and official seal. _ Alameda County
z ' Commission;2796473
My Comm.Expires Jul t i.2023
O 11 �I
Notary Public S nature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgements
From other states may be completed for documents being sent to that state so long
as the wording does not require the California notary to violate California notary
law.
(Title or description of attached document) State and(:ounly information muss be the Stale and County where the document
signer(s)personally appeared before the notary public for acknowledgment.
° Date of notari7sation must be the date that the signer(s)personally appeared which
(Title or description of attached document continued) must also be the same date the acknowledgment is completed.
° The notary public must print his or her name as it appears within his or her
Number of Pages Document Date commission followed by a comma and then your title(notary public).
° Punt the nantcls) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER Indicate the correct singular or plural forms by crossing off incorrect fomts(i.e.
hclshelthey, is,are)or circling the correct terms.Failure to correctly indicate this
❑ Individual (s) information may lead to rejection of document recording.
❑ Corporate Officer The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or line+. If seat impression smudges. rc-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
❑ Partner(s) Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attorney-in-Fact Additional infonmation is not required but could help to ensure this
p Trustee(s) acknowledgment is not misused or attached to a different docrttmettl.
Other Indicate title or type oranached document,number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO.CFO.Secretary).
Securely attach this document to the signed document with a staple.
www.TheNotaryLab.com
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validi of that document.
State of California
County of San Francisco
On ) 1. before me, M. Moody, Notary Public
(insert name and title of the officer)
personally appeared Betty L. Tolentino
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
�S`.'ALY:.•''.Y.tiY.V W Y.YYA4Y�Y.:Y.YM1ti5M1YNY
M MCODY
COMAS A2'86403
WITNESS m hand an �cial seal. ^an A: NOTARY PUBLIC OCALIFORNIA
y San Franpsco Counl
2{r Comrmssion Expires January a.2M
7.wrvxratiY,yyv.•ntiyyYr
Signature (Seal)
This Power of Attorney limits the acts of those named herein,and they have no authority to
bind the Company except in the manner and to the extent herein stated.
_• L��//iberty
,, Liberty Mutual Insurance Company
mu uil. The Ohio Casualty Insurance Company Certificate No: 8209187-024125
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Companyes a corporation duly organized
under the laws of the State of Indiana(herein collectively called the'Companies'),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Betty L.
Tolentmo;Brian Cooper,Brittany Kavan;Courtney Chew,Janet C Rojo;Julia Ortega;K Zerounian;Kevin Re;M.Moody;Maria De Los Angeles Reynoso,Maureen
O'Connell;Misty R.Hemje,Robert P.Wrixon,Susan Hecker;Susan M.Exline;Thuyduong Le;Virginia L Black
all of the city of Walnut Creek state of CA each individually if there be more than one named its hue and lawful attorney-in-fact to make,
execute,seal,acknowledge and delver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety ob::gations,in pursuance
of these presents and shall be as binding upon the Companies as'f they have been duly signed by the president and attested by the secretary of the Cornpan'es in their own proper
persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscr bed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 28th day of December , 2022
Liberty Mutual Insurance Company
P4 INSI/ tY INS&p %Nsluj The Ohio Casualty Insurance Company
AJ �ORpO"4rA�p qJ�o�O'4r tit c,P oRpOW 'F� West American Insurance Company
J = oM v $ Fob
vi � Y1912 0 os1919� n � � 1991 0
By-
m
its David M.Carey,Assistant Secretary
`r m Slate of PENNSYLVANIA
County of MONTGOMERYs p E
.� On this 28th day of December 2022 before me personalty appeared David M.Carey who acknowledged himself to be the Assistant Secretary of;.iberty Mutual Insurance
C-13 Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such being authorized so to do,execute the foregoing instrument for the purposes`•L
therein contained by sign ng on behalf of the corporations by himself as a duly authorized officer. i
-3 IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. NN
f0 p PAST O
�T
O � Q� f l"� Canmonweallh of PemsyNada-Notary Seal
y ql q Teresa Pasteria,Notary Public M
onV-"County
O Cn
OF My commission espies Match 28,2025 By 0 N
a Cemmission number 112W44 ere5a Pasiella,Notary Public Q `o
Z1L"i4' ,G Member,Pemsylvenla Association of Notaries
CD
10 N
Q? This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3 co
0•S- Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 0 M
ARTICLE IV—OFFICERS:Section 12.Power of Attorney. `o 0
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the:
President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as suretycc
W any and all undertakings,bands,recognizances and other surety obligations.Such atiomeys-in-fact,subject to the limitations set forth in their respective powers of attomey,shall-a
.-� " have full power io bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed,such o m
Zv instruments shall be as banding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the-0- ka
provisions of this article may be revoked at any lime by the Board,the Chairman,the President or by the officer or officers granting such power or authority. ti n
ARTICLE XIII—Execution of Contracts:Section 5.Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,
bonds,rekogoizances and other surety obligations.Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,reeognizances and other surety
obligations.
Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a oertified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this A�y of .},
{NSUR �SY INSV 1NSUrq
P 4 P 4y P a aro 4ti
�`� °aPayr 4 `1 oar°fir G '4r
1912 0 o f 1919 a 1991 0 By:
54c-�
s/7 * t� a'H1 1• s�� } ��a Renee C.Llewellyn,Assistant Secretary
LMS-12873 LMIC OCIC WAIC Mufti Co QW1
Executed in two counterparts
Bond No. 070218858
Prenroum included in charge
for performance bond
CITY OF UKIAH
Mendocino County, Califomia
DEFECTIVE MATERIAL AND WORKMANSHIP(MAINTENANCE)BOND
KNOW ALL MEN BY THESE PRESENTS,
That we, Pacific Infrastructure
as PRINCIPAL
and The Ohio Casualty Insurance Company
, as SURETY,
are held and firmly bound unto the City of Ukiah as Obligee,in the penal sum of
One Hundred Forty Nine Thousand and no/10Dths $14 ��►►nn77/1�f��
19,WV.00------- -- �,
(5 PERCENT OF THE FINAL CONTRACT AMOUNT) ll
to which payment well and truly to be made, we do bind ourselves, our and each of our heirs, executors,
administrators'successors and assigns jointly and severally,firmly by these presents.
WHEREAS,the said Principal entered into a Contract with the City of Ukiah dated
for
Thickening and Dewatering Improvements
WHEREAS, said Contract has been completed, and was approved on the day of
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall
guarantee that the worts will be free of any defective materials or workmanship which become apparent
during the period of one (1) year following completion of the Contract, then this obligation shall be void,
otherwise to remain in full force and effect,provided however,any additional warranty or guarantee whether
expressed or implied is extended by the Principal or Manufacturer only,and the surety assumes no liability
for such a guarantee.
Signed, sealed, a dated this 16th day of June ,2023
(Seal)
BY:—Mia _ -(Seal)
Pacific Infrastructure (Seal)
Prin ' al
BY: B�tty)-- Tot!nfino,Attorney-in-Fact _ (Seal)
The Ohio Casualty Insurance Company (Seal)
Surety
THICKENING AND DEWATERING IMPROVEMENTS 57 Spec No.23-02
F
CALIFORNIA ALL - PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of CALIFORNIA }
County of�,�I�rntdPA, }
On ��} �p?f,��z_3 before me, a1onH\,(�'� f S NOTARY PUBLIC ,
ere insert name a"13 Id ee o�lricer
personally appeared Pq a,s, I - a..t qiz )-7 S p o
who proved to me on the basis of satisfactory Ive satisfactory to be the person(s�rwhose
name(s-) is/ale subscribed to the within instrument and acknowledged to me that
helshefthtey executed the same in hisl ltrtIuI"!r authorized capacity , and that by
his/herftheir signature(g) on the instrument the person(,s�, or the entity upon behalf of
which the person(s�acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
RIDulil MIST RI
WITNESS my hand and official seal. _ : Notary Public California
z ��,.+� Alameda County n
_ Commission 4 2296473
My Comm.Expires Jut 11,2023
Z r l
Notary (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgements
From other states may be completed for documents being sent to that state so long
as the wording does not require the California notary to violate California notary
law.
(Title or description of attached document) ° Slate and County information must be the Stale and County where the document
signer(s)personally appeared before the notary public for acknowledgment.
° bate of polarization mast be the date that the signer(s)personally appeared which
(rUe or description of attached document continued) must also be the same dale the acknowledgment is completed.
° The notary public must print his or her name as it appears within his or her
Number of Pages Document Date commission followed by a comma and then your title(notary public).
° Print dic nantc(x) of document signerls) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER ° Indicate the correct singular or plural forms by crossing off incorrect forims Kc.
h&shellhey, is are)or circling the correct t'orms.Failure to correctly indicate this
El Individual (s) information may lead to rejection ofdocumem recording.
❑ Corporate Officer ° The notary seal impression must he clear and photographically reproducible.
Impression must tint cover text or lines. If seal impression smudges.re-seal if a
(Title) sutlicient area pCmtiis.otherwise complete a different acknowledgment form.
❑ Partner(s) Signature of the notary public must match the signature on tile with the office of
die county clerk.
❑ Attorney-in-Fact Additional infonualion is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached ua a difereni document.
Other Indicate title or type of attached document.number of pages and date.
❑ Indicate the capacity claimed by the signer. It'llic claimed capacity is a
corporate officer,indicate the title(i.e.CEO.CFO,Secretar}•l.
Securely attach this document to the signed document with a staple.
www.TheNotaryL:a
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of San Francisco
On before me, M.Moody, Notary Public
(insert name and title of the officer)
personally appeared _ Betty L. Tolentino
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
,.,...w.rtititim+,•,,r,,ti,,twnti�.w.+Nv+..,ti,..,
WITNESS m hand d official l. M.McooY #
my an o sea COMM 42386e03 #
NOTARY PUBLIC oCALIFORNIA Iz
f # ' San Francisco County
$ CO MMISSIOn Expres}a,W3,y 8.2o26 {
Signature (Seal)
T119 Power of Attorney limits the acts of those named herein,and they have no authority to
bind the Company except in the manner and to the extent herein staled.
- L��ibe Liberty Mutual Insurance Company
Mutual. The Ohio Casualty Insurance Company Certificate No: 8209187-024125
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company s a corporation duly organized under the laws of the State of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana(herein collectively called the'Compa.iies"),pursuant to and by authority herein set forth,does hereby name,constitule and appoint,_Betty L
Tolentino;Brian Cooper;Brittany Kavan;Courtney Chew;Janet C.Rojo;Julia Ortega,K Zerounian;Kevin Re;M.Moody;Maria De Los Angeles Reynoso;Maureen
O'Connell;Misty R.Hemje;Robert P.Wrixon;Susan Hecker;Susan M.Exime;Thuyduong Le,Virginia L Black
all of the city of Walnut Creek state of CA each individually if there be more than one named,its true and lawful attorney-in-fact to make,
execute,seal,acknowledge and deliver.for and on its behalf as surety and as its act and deed any and a undertakings,bonds,reougnizances and other surety obligations,in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 28th day of December , 2022 .
Liberty Mutual Insurance Company
x 1HSU 411 INS& tNsu,q The Ohio Casualty Insurance Company
�JQ°�A�oae yn yJ*�°AP°R�T�y �4P�o �r4y� West American Insurance Company
eo n+ W 3 "�a fi
1912 0 1919 1991 0
Yl Y 0 `Z y eer O 4 O ua E
b��/T*as�dL o Nh�*PS��aD rs'�Mott•hadL By r '� U
Co
to David M.Carey,Assistant Secretary Cr
to State of PENNSYLVANIA
N County of MONTGOMERY ss o
L) 0) On this 28th day of December 2022 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance ay
Company,The Ohio Casualty Company.and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes=n
therein contained by signing on behalf of the corporations by himself as a duly authorized officer. y
of
3 IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. <
m a► t Pay a0
O L Q�y°NwF r$1 C.ammw wearm of Penns*ania-Notary Seal
N ti 'rtA Y Teresa Paslella,Notary Public � N•—
p d OF Montgomery County C E
My commission expires March 28,2025 By: .6t) .. .- 0 N
e v Commission number1126at4 Teresa Paslella,Notary Public ¢ o
aj.- t.s 45 Member.PewsyWn*AswaaUon of Notann ry
o� qAy yt)6" p o
N�
Q? This Power of Attorney is Trade and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual o0
o•� Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 0
a? ARTICLE IV—OFFICERS:Section 12.Power of Attorney. o09
0
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the
President may prescribe,shall appoint such allomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as suretytoany and all undertakings,bonds,recognizances and other surety obligations.Such attomeys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall-0 ro
16
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such o m
Z instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under the Co
provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. 0.2
ARTICLE XIII—Execution of Contracts:Section 5.Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attomeys-in-fact.as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,
F I
bonds,reoognizances and other surety obligations.Such attomeys-in fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,reoognizanoes and other surety
obligations.
Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do
hereby certify that the orig-al power of attorney of which the foregoing is a hull,We and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this AL y of 2
MU KV INS& %%su
�J1t4 RPo��y� y,�°"Poryr'egy .Grc,°pP°fir yp
1912 0 1919 1991
By.
d8j1*,,,*ciao l A*P� s r�,�Ma*N a Renee C.Llewellyn,Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co=1
.q►`�o® CERTIFICATE OF LIABILITY INSURANCE UATE(MM1 06J2312023 Y)
023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT- If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Joshua Jones
NAME:
The Liberty Company Insurance Brokers PHONE (888)918-3960 FAX
A1C No Ext: (AIC,No):
Lic#OD79653 A-MAIL : jjones@libertyoompany.com
5955 De Soto Ave,Ste 250 INSURER(S)AFFORDING COVERAGE NAIC N
Woodland Hills CA 91367 INSURER A: Continental Casualty Company 20443
INSURED INSURER B: Transportation Insurance Co 20494
Pacific Infrastructure Corporation INSURER G: State Compensation Ins Fund(CA) 35076
435 Boulder CT INSURER D: Homeland Insurance Company of New York 34452
Suite#200 INSURER E:
Pleasanton CA 94566 INSURER F:
COVERAGES CERTIFICATE NUMBER: 22123 GL,BA,WC,Poll REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 CONDITION$OF SUCH POLICIES.LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM$
IEXP
IN.TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMrr1DiYYYY MMIDD YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000
CLAIMS-MADE 19 OCCUR PREMISES Ea occurrence s 50.000
MED EXP(Any oneperson) $ 10.000
A Y Y 7036126854 11/01/2022 11/01/2023 PERSONAL BAOV INJURY 9 1.000.000
nGEN LIMITAPPLIE$PER: GENERAL AGGREGATE s 2.000.000
POLICY JET LOC PRODUCTS-COMPIOPAGG $ 2,OOD,OOD
OTHER: I S
AUTOMOBILE LIABILITY COMBINED SINGLE LIM T s 1,000.000
Ea acei den
l
x ANYAUTO BODILY INJURY(Per person) s
B OWNED SCHEDULED Y 7036134100 lV0112022 11/01/2023 BODILY INJURY(Per arr-dents $
AUTOSONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE s
AUTOSONLY AUTOS ONLY PeracudId ent
3
x UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 8.000.000
A EXCESS LIAO CLAIMS-MADE 7036125866 11,01.,2022 11101/2023 AGGREGATE S 8.000.000
DED I X1 RETENTION S 0 s
WORKERS COMPENSATION X STATUTE ERPER H
AND EMPLOYERS'LIABILITY Y r N
ANY PROPRIETORIPARTNER;EXECUTIVE E.L EACH ACCIDENT $ 1,000,000
C OFFLCERIMEMBEREXCLUDED? NIA Y 92871932D22 11?01r2022 11/01/2023
(Mandatary in NH) E.L DISEASE-EA EMPLOYEE S 1,000,000
If yes,desuibe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S
Pollution Liability Aggregate $5,000,000
D 793000$750010 11101:2022 11/01/2023 Contractors Pollution $3.000,000
Deductible $5,000
DESCRIPTION OF OPERATIONS!LOCATIONS r VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required)
Re:Thickening and Dewatering Improvements-Sepecifcation#23-02.
Whereby required by written contract or agreement.City of Ukiah,its officia-s.officers,volunteers,and employees are included as Additional Insureds under
the Commercial General Liability and Automobile Liability on a Primary/Non Contributory basis.Waiver of Subrogation in favor of the Additional Insured
applies to the General Liab lity.30-day Notice of Cancellat on?10 days for non payment of premium;applies in favor of the Certificate Holder.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Ukiah ACCORDANCE WITH THE POLICY PROVISIONS.
300 Seminary Avenue
AUTHORIZED REPRESENTATIVE
Ukiah CA 95482-5400
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART
as follows. K any other endorsement attached to this policy amends any provision also amended by this endorsement,
then that other endorsement controls with respect to such provision, and the changes made by this endorsement with
respect to such provision do not apply.
TABLE OF CONTENTS
1. AddRional Insureds
2. Additional Insured-Primary And Non-Contributory To Additional Insured's Insurance
3. Bodily Injury--Expanded Definition
4. Broad Knowledge of Occurrence!Notice of Occurrence
5. Broad Named Insured
6. Broadened Liability Coverage For Damage To Your Product And Your Work
7. Contractual Llabllity-Railroads
6. Electronic Data Liability
9. Estates,Legal Representatives and Spouses
10. Expected Or Intended Injury—Exception for Reasonable Force
11. General Aggregate Limits of Insurance—Per Project
12. In Rem Actions
13. Incidental Health Care Malpractice Coverage
14. Joint Ventums/Partnership/Limited Liability Companies
15. Legal Liability —Damage To Premises / Alienated Premises ! Property In The Named Insured's Care,
Custody or Control
16. Liquor Liability
17. Medical Payments
18. Non-owned Aircraft Coverage
19. Non-owned Watercraft
20. Personal And Advertising Injury—Discrimination or Humiliation
21. Personal And Advertising Injury-Contractual Liability
22. Property Damage-Elevators
23. Supplementary Payments
® 24. Unintentional Failure To Disclose Hazards
25. Waiver of Subrogation—Blanket
26. Wrap-Up Extension:OCIP CCIP,or Consolidated(Wrap-Up)Insurance Programs
t�
Q
CNA74705XX(1-15) T Policy No: 7036126854
Page 1 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
CopyAght CNA A3 Aights Resavad. Indudos oopyrightod maWai of Insurance Sarvk*s 4tk*,Inc.,with ha perm Ww.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
1. ADDITIONAL INSUREDS
a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs
A.through H.below whom a Named Insured is required to add as an additional insured on this Coverage Part
under a written contract or written agreement,provided such contract or agreement:
(1) is currently in effect or becomes effective during the term of this Coverage Part;and
(2) was executed prior to:
(a) the bodily injury or property damage;or
(b) the offense that caused the personal and advertising injury,
for which such additional insured seeks coverage,
b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer
will not provide such additional insured with:
(1) a higher Emit of insurance than required by such contract or agreement:or
(2) coverage broader than required by such contract or agreement,and in no event broader than that described
by the app'leable paragraph A.through H.below.
Any coverage granted by this endorsement shall apply only to the extent permissible by law.
A. Controlling Interest
Any person or organization with a controlling interest in a Named Insured,but only with respect to such person or
organization's liability for bodily injury,property damage or personal and advertising Injury arising out of:
1. such person or organizalion's financial control of a Named Insured;or
2. premises such person or organization owns, maintains or controls while a Named Insured leases or
occupies such premises;
provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or
demolition operations performed by,on behalf of,or for such additional insured.
B. Co-owner of Insured Premises
A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect
to such co-owner's liability for bodily injury, property damage or personal and advertising Injury as co-owner
of such premises.
C. Lessor of Equipment
Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for
bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named
Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such
bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place
prior to the termination of such lease.
D. Lessor of Land
Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily
Injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use
of such land, provided that the occurrence giving rise to such bodily Injury, property damage or the offense
giving rise to such personal and advertising Injury takes place prior to the termination of such lease. The
CNA74705XX(1-15) Policy No: 7036126854
Page 2 of 17 Endorsement No; 1
The Continental insurance Co. Effective Date: 11/01/2022
Insured Name: PACIFIC INFRASTRUCTURE CORPORATION
Copyright CNA AA Rights Reserved. Indudes copyrighted rnatedal of Insurance Services Office,Inc.,wish its permission.
C/VA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by,on behall of,or for such additional insured.
E. Lessor of Premises
An owner or lessor of premises leased to the Named Insured,or such owner or lessor's real estate manager,but
only with respect to liability for bodily Injury,property damage or personal and advertising Injury arising out of
the ownership, maintenance or use of such part of the premises leased to the Named Insured,and provided that
the occurrence giving rise to such bodily injury or property damage,or the offense giving rise to such personal
and advertising injury, takes place prior to the termination of such lease. The coverage granted by this
paragraph does not apply to structural alterations, new construction or demolition operations performed by, on
behalf of,or for such additional insured.
F. Mortgagee,Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's
liability for bodily Injury, property damage or personal and advertising Injury arising out of the Named
Insured's ownership,maintenance,or use of a premises by a Named Insured.
The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by,on behalf of,or for such additional insured.
G. State or Governmental Agency or Subdivision or Political Subdivisions--Permits
A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but
only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily
Injury,property damage or personal and advertising Injury arising out of:
1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which
this insurance applies:
a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults,street banners,or decorations and similar exposures;or
b. the construction,erection,or removal of elevators;or
c. the ownership,maintenance or use of any elevators covered by this Insurance;or
2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf.
The coverage granted by this paragraph does not apply to:
a. Bodily injury,property damage or personal and advertising injury arising out of operations performed
for the state or governmental agency or subdivision or political subdivision,or
b. Bodily Injury or property damage included within the products-completed operations hazard.
a Vlfith respect to this provision's requirement that additional Insured status must be requested under a written
contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the
Named Insured to add the governmental entity as an additional insured.
r� H. Trade Show Event Lessor
1. With respect to a Named Insured's participation in a trade show event as an exhibitor,presenter or displayer,
any person or organization whom the Named Insured is required to include as an additional insured, but only
with respect to such person or organization's liability for bodily Injury, property damage or personal and
advertising Injury caused by:
CNA74705XX(1-15) Policy No: 7 336126$54
Page 3 of 17 Endorsement No: 1
The Continental Insurance Co. Effective pale: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copydght CNA Ail Rights Resenvd. Indudes copyrighted mater[al of Inwrance SeMcn ORke,Inc.,whh its permission.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
a. the Named Insured's acts or omissions;or
b. the acts or omissions of those acting on the Named Insured's behalf,
in the performance of the Named Insured's ongoing operations at the trade show event premises during the
trade show event.
2. The coverage granted by this paragraph does not apply to bodily Injury or property damage included within
the products-completed operations hazard.
2. ADDITIONAL INSURED-PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSUREDS INSURANCE
The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to
add the following paragraph:
If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non-
contributory relative to an additional insureds own insurance, then this insurance is primary, and the Insurer will not
seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own
insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding
anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess
of any other insurance available to such person or organ zation-
3. BODILY INJURY--EXPANDED DEFINITION
Under DEFINITIONS,the definition of bodily injury is de,eted and replaced by the following:
Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock,
mental anguish or menial injury sustained by that person at any time which results as a consequence of the physical
injury,sickness or disease.
4. BROAD KNOWLEDGE OF OCCURRENCE/NOTICE OF OCCURRENCE
Under CONDITIONS,the condition entitled Duties In The Event of Occurrence,Offense,Claim or Suit is amended
to add the following provisions-
A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence,
offense or claim only when the occurrence,offense or claim is known to a natural person Named Insured,to a
partner, executive officer, manager or member of a Named Insured, or an employee designated by any of the
above to g've such notice.
B. NOTICE OF OCCURRENCE
The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give
the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured's
reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However,
the Named Insured shall give written notice of such occurrence,offense or claim to the Insurer as soon as the
Named Insured Is aware that this insurance may apply to such occurrence,offense or claim.
5. BROAD NAMED INSURED
WHO IS AN INSURED is amended to delete its Paragraph 3.in its entirely and replace it with the following:
3. Pursuant to the limitations described In Paragraph 4. below, any organization In which a Named Insured has
management control,
a. on the effect.ve date of this Coverage Part;or
CNA74705XX(1-15) Policy No: '7036126854
Page 4 of 17 Endorsement No: 1
The Contiaerital Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copydghf CNA AN Rights Reserved. Includes copyrighted mater.ai of Irtmoance services Me.Inc. wish fts permission.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
b, by reason of a Named Insured creating or acquiring the organization during the policy period,
qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary,
contributory,excess,contingent or otherwise,which provides coverage to such organization,or which would have
provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or
narrower than that provided by this insurance.
But this BROAD NAMED INSURED provision does not apply to:
(a) any partnership,limited liability company or joint venture;or
(b) any organization for which coverage is excluded by another endorsement attached to this Coverage Part.
For the purpose of this provision,management control means:
A. owning interests representing more than 50% of the voting, appointment or designation power for the
selection of a majority of the Board of Directors of a corporation;or
B. having the right, pursuant to a written trust agreement, to protect,control the use of, encumber or transfer or
sell property held by a trust.
4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above,this insurance
does not apply to;
a. bodily Injury or property damage that first occurred prior to the date of management control, or that first
occurs after management control ceases;nor
b. personal or advertising injury caused by an offense that first occurred prior to the date of management
control or that first occurs after management control ceases
5. The insurance provided by this Coverage Part applies to Named Insureds when trading under their own names
or under such other trading names or doing-business-as names (dba) as any Named Insured should choose to
employ.
6. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK
A. Under COVERAGES, Coverage A -- Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete exclusions k.and I.and replace them with the following:
This Insurance does not apply to:
k. Damage to Your Product
Property damage to your product arising out of it,or any part of it except when caused by or resulting from
(1) fire;
(2) smoke;
(3) collapse;or
m
(4) explosion.
I. Damage to Your Work
ttl>ll� Property damage to your work arising out of it, or any part of it and included in the products-completed
operations hazard.
This exclusion does not apply:
(1) If the damaged work, or the work out of which the damage arises, was performed on the Named
Insured's behalf by a subcontractor;or
CNA74705XX(1-15) Policy No: 7036126854
Page 5 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
CopyrfghtCNA All Rights Reserved. Includes copydghted maeria of Insurance Servion Office.Inc.,with Rs permission.
c/VA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
(2) If the cause of loss to the damaged work arises as a result of:
(a) fire;
(b) smoke;
(c) collapse;or
(d) explosion.
B. The following paragraph is added to LIMITS OF INSURANCE:
Subject to 5.above,$100.000 is the most the Insurer will pay under Coverage A for the sum of damages arising
out of any one occurrence because of property damage to your product and your work that is caused by fire,
smoke, collapse or explosion and is included within the product-completed operations hazard. This sublimit
does not apply to property damage to your work if the damaged work, or the work out of which the damage
arises,was performed on the Named Insured's behalf by a subcontractor.
C. This Broadened Liability Coverage For Damage To Your Product And Your Worts Provision does not apply if
an endorsement of the same name Is attached to this policy.
7. CONTRACTUAL LIABILITY—RAILROADS
With respect to operations performed within 50 feet of railroad property,the definition of insured contract is replaced
by the following:
Insured Contract means;
a. A contract for a lease of premises. However,that portion of the contract for a lease of premises that indemnifies
any person or organization for damage by fire to premises while rented to a Named Insured or temporarily
occupied by a Named Insured with permission of the owner is not an Insured contract;
b. A sidetrack agreement;
c. Any easement or license agreement;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a
municipality;
9. An elevator maintenance agreement;
f. That part of any other contract or agreement pertaining to the Named Insured's business (including an
indemnification of a municipality in connection with work performed for a municipality) udder which the Named
Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person
or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or
agreement.
Paragraph L does not include that part of any contract or agreement:
(1) That indemnifies an architect,engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders,change orders or drawings and specifications;or
(b) Giving directions or instructions, or falling to give them, If that Is the primary Cause of the injury or
damage;
(2) Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage
arising out of the insured's rendering or failure to render professional services, including those listed in (1)
above and supervisory,inspection,architectural or engineering activities.
a. ELECTRONIC DATA LIABILITY
CNA74706XX(1-15) Policy No: 7036126854
Page 6 of 17 Endorsement No; 1
The COrttinental Insurance Co. Effective Date; 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copyright CNA AO Rights Reser%vd. Indudes copyrighted material of Insurance services Office.Inc. with Its permission.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following:
This insurance does not apply to:
p. Access Or Disclosure 01 Confidential Or Personal Information And Data-related Liability
Damages arising out of:
(1) any access to or disclosure of any person's or organization's confidential or personal information,
including patents, trade secrets, processing methods, customer llsts, financial information, credit card
information,health information or any other type of nonpublic information;or
(2) the loss of, loss of use of. damage to, corruption of, inability to access, or inability to manipulate
electronic data that does not result from physical injury to tangible property.
However, unless Paragraph(1) above applies, this exclusion does not apply to damages because of bodily
Injury.
This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses,
forensic expenses, public relation expenses or any other loss, cost or expense incurred by the Named
Insured or others arising out of that which is described In Paragraph(1)or(2)above.
B. The following paragraph is added to LIMITS OF INSURANCE:
Subject to 5.above, $100,000 is the most the Insurer will pay under Coverage A for all damages arising out of
any one occurrence because of property damage that results from physical injury to tangible property and
arises out of electronic data.
C. The following definition Is added to DEFINITIONS:
Electronic data means Information, facts or programs stored as or on, created or used on, or transmitted to or
from computer software (including systems and applications software), hand or floppy disks, CD-ROMS, tapes,
drives,cells,data processing devices or any other media which are used with electronically controlled equipment.
D. For the purpose of the coverage provided by this ELECTRONIC DATA LIABILITY Provision, the definition of
property damage in DEFINITIONS is replaced by the following:
N
Property damage means:
a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use
shall be deemed to occur at the time of the physical injury that caused it;
b. Loss of use of tangible property that is not physically injured.All such loss of use shall be deemed to occur at
the time of the occurrence that caused it;or
c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate
electronic data, resulting from physical injury to tangible property. All such loss of electronic data shall be
t�
deemed to occur at the time of the occurrence that caused it.
For the purposes of this insurance,electronic data is not tangible property.
_ E- If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the
$100,000 limit provided by this ELECTRONIC DATA UABILITY Provision is part of, and not in addition to, that
higher limit.
S. ESTATES,LEGAL REPRESENTATIVES,AND SPOUSES
C
The estates,heirs, legal representatives and spouses of any natural person Insured shall also be insured under this
policy;provided, however, coverage is afforded to such estates, heirs, legal representatives, and spouses only for
CNA74705XX(1-15) Policy No: 7036126854
Page 7 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured blame:PACIFIC INFRASTRUCTURE CORPORATION
Copyright CNA All Rights Resenvd. Indwin copyrighted material of Insurance Services Office,Inc.,with Ills permission.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks
damages from marital community property, jointly held property or property transferred from such natural person
Insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal
representative, or spouse outside the scope of such person's capacity or status as such, provided however that the
spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership
Named Insureds are Insureds w th respect 10 such spouses'acts, errors or omissions in the conduct of the Named
Insured's business.
10. EXPECTED OR INTENDED INJURY—EXCEPTION FOR REASONABLE FORCE
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following;
This insurance does not apply to,
Expected or Intended Injury
Bodily Injury or property damage expected or intended from the standpoint of the Insured.This exclusion does not
apply to bodily Injury or property damage resulting from the use of reasonable force to protect persons or property.
11. GENERAL AGGREGATE LIMITS OF INSURANCE-PER PROJECT
A. For each construct on protect away from promises the Named Insured owns or rents, a separate Construction
Project General Aggregate Limit,equal to the amount of the General Aggregate Limit shown In the Declarations,
is the most the Insurer w-ll pay for the sum of.
I. All damages under Coverage A,except damages because of bodily Injury or property damage included in
the products-completed operations hazard;and
2. All medical expenses under Coverage C.
that arise from occurrences or accidents wh ch can be attributed so'ely to ongoing operations at that construction
project_ Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the
Construction Project General Aggregate Limit of any other construction project.
B. AII:
1. Damages under Coverage B,regardless of the number of locations or construction projects involved:
2. Damages under Coverage A. caused by occurrences which cannot be attributed solely to ongoing
operations at a single construction project, except damages because of bodily injury or property damage
included in the products-completed operations hazard;and
3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing
operations at a single construction project,
will reduce the General Aggregate Limit shown in the Declarations.
C. The limits shown in the Declarafions for Each Occurrence, for Damage To Premises Rented To You and for
Medical Expense continue to app'y, but will be subject to either the Construction Project General Aggregate Limit
or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be
attributed solely to ongoing operations at a particular construction project.
D. When coverage for liability arising out of the products-completed operations hazard is provided,any payments
for damages because of bodily Injury or property damage included in the products-completed operations
hazard will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations, regardless of
the number of projects involved.
ONA74705XX(1-15) Policy No: 7036126854
Page 8 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
CoRrighl CNA AO Rights Reserved Includes eglyrighted matenal 01 Inswanea S wukes OHka,Inc.,vAth Its perm scion.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
E. It a single construction project away from premises owned by or rented to the Insured has been abandoned and
then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or
timetables,the project will still be deemed to be the same construction project.
F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as
stipulated.
12, IN REM ACTIONS
A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the
Named Insured, will be treated in the same manner as though the action were in personam against the Named
Insured.
13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE
Solely with respect to bodily injury that arises out of a health care incident:
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Insuring Agreement is amended to replace Paragraphs 1.b.(1)and 1.b.(2)with the following:
b. This insurance applies to bodily injury provided that the professional health care services are incidental to
the Named Insured's primary business purpose,and only it:
(1) such bodily Injury is caused by an occurrence that takes place in the coverage territory.
(2) the bodily Injury first occurs during the policy period.All bodily Injury arising from an occurrence wil:
be deemed to have occurred at the time of the first act,error, or omission that is part of the occurrence:
and
S. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Llablllty, the paragraph entitled
Exclusions is amended to:
I. add the following to the Employers Liability exclusion:
This exclusion applies only if the bodily Injury arising from a health care Incident is covered by other
liability insurance available to the Insured (or which would have been available but for exhaustion of its
limits).
If. delete the exclusion entitled Contractual Liability and replace it with the following;
This insurance does not apply to:
IN
Contractual Liability
the Insured's actual or alleged liability under any oral or written contract or agreement, including but not
limited to express warranties or guarantees.
Ili. add the following additional exclusions:
This insurance does not apply to:
e
Discrimination
any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on
an inclMdual's race, creed, color, age, gender, national origin, religion, disability. marital status or sexual
f� orientation.
Dishonesty or Crime
Any actual or alleged dishonest,criminal or malicious act.error or omission.
Medicare/Medicaid Fraud
CNA74705XX(1-15) Policy No: 7036126854
Page 9 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACII'IC INMASTRUCTURE CIDRPURATIUN
Copyd9M CNA All Rights Reserved. Includn copyrighted material of Insurance Services ONke,Inc.,whh Its perm ssion.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
any actual or alleged violation of law with respect to Medicare, Medicaid,Tricare or any similar federal,state
or local governmental program
Services Excluded by Endorsement
Any health care incident far wh�ch coverage is excluded by endorsement.
C. DEFINITIONS is amended to:
I. add the following definitions:
Health care Incident means an act, error or omission by the Named Insured's employees or volunteer
workers in the rendering of:
a. professional health care services on behalf of the Named Insured or
b. Good Samaritan services rendered In an emergency and for which no payment is demanded or received.
Professional health care services means any health care services or the related furnishing of food,
beverages, med cal supplies or appliances by the following providers in their capacity as such but solely to
the extent they are duly licensed as required:
a. Physician;
b. Nurse;
c. Nurse practitioner;
d. Emergency medical technician;
e. Paramedic;
1. Dentist;
g. Physical therapist;
In. Psychologist;
I. Speech therapist:
I. Other a'lied health professional;or
Professional health care services does not include any services rendered in connection with human clinical
trials or product testing.
U. deiete the definition of occurrence and replace it with the following:
Occurrence means a health care incident. All acts,errors or omissions that are logically connected by any
common fact,circumstance, situation,transaction, event, advice or decision will be considered to constitute a
single occurrence;
Ili. amend the definition of Insured to:
a. add the following:
the Named Insured's employees are Insureds with respect to:
(1) bodily Injury to a co-employee while in the course of the co-employee's employment by the
Named Insured or while performing duties related to the conduct of the Named Insured's
business;and
CNA74705XX(1-15) Policy No: 7036126854
Page 10 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTUE CORPORATION
Copyright CNA Ar Rights Reserved. Indudes copyrighted material a4 Insurance Services Oflfce,Inc..with Its permission
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
(2) bodily Injury to a volunteer worker while performing duties related to the conduct of the
Named Insured's business;
when such bodily Injury arises out of a health care Incident.
the Named Insured's volunteer workers are Insureds with respect to:
(1) bodily injury to a co-volunteer worker while performing duties related to the conduct of the
Named Insured's business;and
(2) bodily injury to an employee while in the course of the employee's employment by the Named
Insured or while performing duties related to the conduct of the Named Insured's business;
when such bodily Injury arises out of a health care Incident.
b. delete Subparagraphs(a),(b),(c)and(d)of Paragraph 2.a.(1)of WHO IS AN INSURED.
D. The Other Insurance condition is amended to delete Paragraph b.(1) In its entirety and replace it with the
following:
Otherinsurance
b. Excess Insurance
(1) To the extent this insurance app ies, it is excess over any other insurance, self insurance or risk transfer
instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased
specifically by the Named Insured to be excess of th;s coverage.
14. JOINT VENTURES J PARTNERSHIP 1 LIMITED LIABILITY COMPANIES
WHO IS AN INSURED is amended to delete its last paragraph and replace it with the following:
No person or organization is an Insured with respect to the conduct of any current or past partnership,joint venture or
limited liability company that is not shown as a Named Insured in the Declarations,except that if the Named Insured
was a joint venturer, partner, or member of a limited liability company and such joint venture, partnership or limited
liability company terminated prior to or during the policy period,such Named Insured is an Insured with respect to
its interest in such joint venture,partnership or limited liability company but only to the extent that:
a. any offense giving rise to personal and advertising injury occurred prior to such termination date, and the
personal and advertising Injury arising out of such offense first occurred after such termination date;
b. the bodily injury or property damage first occurred after such termination date;and
c. there is no other valid and collectible insurance purchased specifically to insure the partnership,joint venture or
limited liability company;and
If the joint venture, partnership or limited liability company is or was insured under a consolidated (wrap-up)
insurance program,then such insurance will always be considered valid and collectible for the purpose of paragraph
c.above. But this provision will not serve to exclude bodily Injury, property damage or personal and advertising
Injury that would otherwise be covered under the Contractors General Liability Extension Endorsement provision
entitled WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS.
;Q Please see that provision for the definition of consolidated(wrap-up)insurance program.
15. LEGAL LIABILITY — DAMAGE TO PREMISES 1 ALIENATED PREMISES 1 PROPERTY IN THE NAMED
INSUREDS CARE,CUSTODY OR CONTROL
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete exclusion j.Damage to Property in Hs entirety and replace it with the following:
This Insurance does not apply to:
CNA74705XX(1-15) Policy No: 7036126854
Page 11 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 1IJ01/2022
Insured Name:eAClric INFRASTRUCTURE CORPORATION
Copyright CNA AR Rigim Reserved. locivdes oopyrigmw mm6ai of Insurance Services office,Inc.,whh its permission.
CN� CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
j. Damage to Property
Property damage to:
(1) Property the Named Insured owns, rents.or occupies, including any costs or expenses incurred by you,
or any other person, organization or entity, for repair, replacement, enhancement, restoration or
maintenance of such property for any reason, including prevention of injury to a person or damage to
anther's property;
(2) Premises the Named Insured sells, gives away or abandons, if the property damage arises out of any
part of those premises;
(3) Property loaned to the Named Insured;
(4) Personal property in the care,custody or contro!of the Insured;
(5) That particular part of real property on which the Named Insured or any contractors or subcontractors
working directly or indirectly on the Named Insured's behal' are performing operations, if the property
damage arises out of those operations;or
(6) That particular part of any property that must be restored, repaired or replaced because your work was
incorrectly performed on it.
Paragraphs(1),(3)and(4)of this exclusion do not apply to property damage(other than damage by fire)to
premises rented to the Named Insured or temporarily occupied by the Named Insured with the permission of
the owner, nor to the contents of premises rented to the Named Insured for a period o1 7 or fewer
consecutive days.A separate limit of insurance applies to Damage To Premises Rented To You as described
In LIMITS OF INSURANCE.
Paragraph(2)of this exclusion does not apply if the premises are your work.
Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack
agreement.
Paragraph (6) of this exclusion does not apply to property damage included in the products-completed
operations hazard.
Paragraphs(3)and(4)of this exclusion do not apply to property damage to:
I. tools,or equipment the Named Insured borrows from others,nor
ii. other personal property of others in the Named Insured's care,custody or control while being used in the
Named Insured's operations away from any Named Insured's premises.
However,the coverage granted by this exception to Paragraphs(3)and(4)does not apply to:
a. property at a job site awaiting or during such property's installation,fabrication, or erection;
b. properly that is mobile equipment leased by an Insured;
c. property that is an auto,aircraft or watercraft;
d. property in transit;or
e. any portion of property damage for which the Insured has available other valid and collectible
insurance,or would have such insurance but for exhaustion of its limits,or but for application of one of its
exclusions.
A separate limit of insurance and deductible apply to such property of others. See LIMITS OF INSURANCE
as amended below.
CNA74706XX(1-15) Policy No: 7036126854
Page 12 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
cq)yrighc CNA A111 Rights resod. induda capyfighted mataaai of traurarr_o SavIces Ottke.Inc„w;th Us parm-nion.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
S. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions Is amended to delete Its last paragraph and replace it with the following:
Exclusions c. through in. do not apply to damage by fire to premises while rented to a Named Insured or
temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of
premises rented to a Named Insured for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE.
C. The following paragraph is added to LIMITS OF INSURANCE:
Subject to 5.above. $25,000 is the most the Insurer will pay under Coverage A for damages arising out of any
one occurrence because of the sum of all property damage to borrowed tools or equipment, and to other
personal property of others in the Named Insured's care, custody or control, while being used in the Named
Insured's operations away from any Named Insumd's premises. The Insurer's obligation to pay such property
damage does not apply until the amount of such property damage exceeds$1,000,The Insurer has the right but
not the duty to pay any portion of this$1,000 in order to effect settlement. If the Insurer exercises that right,the
Named Insured will prompry reimburse the Insurer for any such amount.
D. Paragraph 6.,Damage To Premises Rented To You Limit,of LIMITS OF INSURANCE is deleted and replaced by
the following.
6. Subject to Paragraph 5.above, (the Each Occurrence Limit),the Damage To Premises Rented To You Limit
is the most the Insurer will pay under Coverage A for damages because of property damage to any one
premises while rented to the Named Insured or temporarily occupied by the Named Insured with the
permission of the owner, including contents of such premises rented to the Named Insured for a period of 7
or fewer consecutive days.The Damage To Premises Rented To You Limit is the greater of:
a. $500,000;or
b. The Damage To Premises Rented To You Limit shown in the Declarations.
E. Paragraph 4.b.(1)(a)(II)of the Other Insurance Condition Is deleted and replaced by the following:
(fi) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by
the Named Insured with the permission of the owner; or for personal property of others in the Named
Insured's care,custody or control;
16. LIQUOR LIABILITY
Under COVERAGES, Coverage A -- Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entided Liquor Liability.
This LIQUOR LIABILITY provision does not apply to any person or organization who otherwise qualifies as an
additional insured on this Coverage Part.
17. MEDICAL PAYMENTS
A. LIMITS OF INSURANCE is amended to delete Paragraph 7.(the Medical Expense Limit) and replace it with the
following:
7. Subject to Paragraph S. above (the Each Occurrence Limit), the Medical Expense Limit is the most the
Insurer will pay under Coverage C—Medical Payments for all medical expenses because of bodily injury
sustained by any one person.The Medical Expense Limit is the greater of:
(1) $15,000 unless a different amount is shown here: $N,NNN,NNN,NNN; or
(2) the amount shown in the Declarations for Medical Expense Limit.
CNA74705XX(1-15) Policy No: 7036126854
Page 13 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACICIC INFRASTRUCTURE CORPURATION
CopyNht CNA All Rights Resen*d. Indudes copyrighted mamrial of Insurance Se vloea Ofte.Inc.,with Ns permission.
CNA CNA PARAMOUNT
Contractors` General Liability Extension Endorsement
B. Under COVERAGES, the Insuring Agreement of Coverage C — Medical Payments is amended to replace
Paragraph 1.a.(3)(b)with the following:
(b) The expenses are incurred and reported to the Insurer within three years of the date of the accident;and
18. NON-OWNED AIRCRAFT
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended as follows:
The exclusion entitled Aircraft,Auto or Watercraft is amended to add the following:
This exclus on does not apply to an aircraft not owned by any Named Insured,provided that.
I. the pilot in command hods a currently effective certificate issued by the duly constituted authority of the United
States of America or Canada,designating that person as a commercial or airline transport pilot;
2, the aircraft Is rented with a trained, paid crew to the Named Insured;and
3. the aircraft is not being used to carry persons or property for a charge.
19. NON-OWNED WATERCRAFT
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete subparagraph (2) of the exclusion ermlled Aircraft, Auto or Watercraft, and
replace it with the following.
This exclus-on does not apply to,
(2) a watercraft that is not owned by any Named Insured,provided the watercraft is:
(a) less than 75 feet tong;and
(b) not being used to carry persons or property for a charge.
20. PERSONAL AND ADVERTISING INJURY--DISCRIMINATION OR HUMILIATION
A. Under DEFINITIONS,the definition of personal and advertising Injury is amended to add the following tort:
Discrimination or humiliation that results in injury to the feelings or reputation of a natural person.
B. Under COVERAGES, Coverage B — Personal and Advertising Injury Liability, the paragraph entitled
Exclusions is amended to:
1. delete the Exclusion entitled Knowing Violation Of Rights Of Another and replace it with the following:
This Insurance does not apply to:
Knowing Violation of Rights of Another
Personal and advertising Injury caused by or at the direction of the Insured with the knowledge that the act
would violate the rights of another and would inflict Personal and advertising injury.This exclusion shall not
apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but
only if such discrimination or humiliation is not done intentionally by or at the direction of:
(a) the Named Insured;or
(b) any executive off leer, director, stockholder, partner, member or manager (if the Named Insured Is a
limited liability company)of the Named Insured.
2. add the following exclusions:
GNA74705XX(1-15) Policy No: 7036126854
Page 14 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copyright CNA AA Rights Rasarvad. Includes copyrighted mateftl of Insurance Services Offfca,Inc.,wish its permission_
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
This insurance does not apply to:
Employment Related Discrimination
Discrimination or humiliation directly or Indirectly related to the employment, prospective employment, past
employment or termination of employment of any person by any Insured.
Premises Related Discrimination
discrimination or humiliation arising out of the sale, rental, lease or sub-lease or prospective sale, rental,
lease or sub-lease of any room,dwelling or premises by or at the direction of any Insured.
Notwithstanding tha above, there is no coverage for fines or penalties levied or imposed by a governmental entity
because of discrimination.
The coverage provided by this PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION
Provision does not apply to any person or organization whose status as an Insured derives solely from
Provision 1.ADDITIONAL INSURED of this endorsement;or
attachment of an additional insured endorsement to this Coverage Part.
This PERSONAL AND ADVERTISING INJURY—DISCRIMINATION OR HUMILIATION Provision does not apply to
any person or organization who otherwise qualifies as an additional insured on this Coverage Part.
21. PERSONAL AND ADVERTISING INJURY-CONTRACTUAL LIABILITY
A. Under COVERAGES, Coverage B --Personal and Advertising Injury Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entitled Contractual Liability.
B. Solely for the purpose of the coverage provided by this PERSONAL AND ADVERTISING INJURY -
CONTRACTUAL LIABILITY provision, the following changes are made to the section entitled
SUPPLEMENTARY PAYMENTS—COVERAGES A AND B:
I. Paragraph 2.d.is replaced by the following:
d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit
are such that no conflict appears to exist between the interests of the Insured and the Interests of the
indemnitee;
2. The first unnumbered paragraph beneath Paragraph 2.f.(2)(b)is deleted and replaced by the following:
So long as the above conditions are met, attorneys fees incurred by the Insurer in the defense of that
indemnitee,necessary litigation expenses incurred by the Insurer,and necessary litigation expenses incurred
by the indemnitee at the Insurer's request will be paid as defense costs.Such payments will not be deemed
to be damages for personal and advertising Injury and will not reduce the limits of insurance.
C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply if
Coverage B—Personal and Advertising Injury Liability is excluded by another endorsement attached to this
Coverage Part.
This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply to any
person or organization who otherwise qualifies as an additional insured on this Coverage Part.
22. PROPERTY DAMAGE—ELEVATORS
i A. Under COVERAGES, Coverage A -- Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs(3), (4) and(6)of
the Damage to Property Exclusion do not apply to property damage that results from the use of elevators.
CNA74706XX(1-15) Policy No: 7036126854
Page 15 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance SeMoes Otllce,Inc.,with its perm salon.
CNA CNA PARAMOUNT
Contractors` General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Other Insurance conditions is amended to add the following paragraph:
This insurance is excess over any of the other insurance whether primary, excess, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevators.
23. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows:
A. Paragraph 1.b.is amended to delete the$250 limit shown for the cost of bail bonds and replace it with a$5,000.
limit;and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a
$1,000. limit.
24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named Insured unintentionally fai's to disclose all existing hazards at the inception date of the Named
Insured's Coverage Part,the Insurer will not deny coverage under this Coverage Part because of such failure.
25. WAIVER OF SUBROGATION-BLANKET
Under CONDITIONS,the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to
add the following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of:
1. the Named Insured's ongoing operations;or
2. your work included in the products-completed operations hazard.
However,this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in
a written contract or written agreement,and only if such contract or agreement:
1. is in effect or becomes effective during the term of this Coverage Part;and
2. was executed prior to the bodily Injury, property damage or personal and advertising injury giving rise to the
claim.
26. WRAP-UP EXTENSION:OCIP,CCIP,OR CONSOLIDATED(WRAP-UP)INSURANCE PROGRAMS
Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any
construction project In the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up)
Insurance program by applicable state statute or regulation.
If the endorsement EXCLUSION —CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary
endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance
Programs(C.C.I.P.)is attached,then the following changes apply:
A. The following wording is added to the above-referenced endorsement:
With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was
involved,this exclusion does not apply to those sums the Named Insured become legally obligated to pay as
damages because of:
1. Bodily injury,property damage,or personal or advertising injury that occurs during the Named Insured's
ongoing operations at the project, or during such operations of anyone acting on the Named Insured's
behalf;nor
CNA74705XX(1-16) Policy No: 7036126854
Page 16 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Q)pydgM CNA A9 Rights R"wv*d. Indudes eopyrightvd rnaWal of Insurance SeMms 0fte,Inc.,with ifs permission.
CNA CNA PARAMOUNT
Contractors' Genera! Liability Extension Endorsement
2. Bodily Injury or property damage included within the products-completed operations hazard that arises
out of those portions of the project that are not residential structures.
B. Condition 4.Other Insurance is amended to add the following subparagraph 4.b.(1xc):
This insurance Is excess over:
(c) Any of the other insurance whether primary,excess,contingent or any other basis that is insurance available
to the Named Insured as a result of the Named Insured being a participant in a consolidated (wrap-up)
Insurance program, but only as respects the Named Insured's involvement in that consolidated (wrap-up)
Insurance program.
C. DEFINITIONS is amended to add the following definitions:
Consolidated(wrap-up) Insurance program means a construction, erection or demolition project for which the
prime contractorlproject manager or owner of the construction project has secured general liability insurance
covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled
Insurance Program(O.C.I.P.)or Contractor Controlled Insurance Program(C.C.I.P.).
Residential structure means any structure where 30%or more of the square foot area is used or is intended to
be used for human residency,including but not limited to:
1. single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit
developments;and
2. the common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs,
detached garages,guest houses or any similar structures).
However,when there Is no Individual ownership of units, residential structure does not include milftary housing,
collegaluniversity housing or dormitories, long term care facilities, hotels or motels. Residential structure a°so
does not include hospitals or prisons.
This WRAP-UP EXTENSION:OCIP, CCIP, OR CONSOLIDATED(WRAP-UP)INSURANCE PROGRAMS Provision
does not apply to any person or organization who otherwise qualities as an additional insured on this Coverage Part.
All other terms and conditions of the Policy remain unchanged.
This endorsement,which forms a art of and is for attachment to the Policy issued b the designated Insurers,takes effect
� P cY� Y 9
sv on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
tJ
Q
a
CNA74705XX(1-15) Policy No: 7036126854
Page 17 of 17 Endorsement No: 1
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC: INFRASTRUCTURE CORPORATION
Copydght CNA Ag Rights Resenvd. Includes copyrighted material of Insurance Sorvloec Office.Inc.,wish Its permission.
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by
written contract to add as an additional insured on this coverage part,but only with respect to liability for bodily
Injury,property damage or personal and advertising Injury caused in whole or in part by your acts or omissions,or
the acts or omissions of those acting on your behalf:
A. to the performance of your ongoing operations subject to su&written contract;or
B. in the performance of your work subject to such written contract,but only with respect to bodily Injury or
property damage included in the products-completed operations hazard,and only if:
1. the written contract requires you to provide the additional insured such coverage;and
2. this coverage part provides such coverage.
II. But if the written contract requires:
A. additional insured coverage under the 11-85 edition, 10-93 edition,or 10-01 edition of CG2010,or under the 10-
01 edition of CG2037;or
B. add'tionat insured coverage with"arising out or language;or
C. additional insured coverage to the greatest extent permissible by law;
then paragraph I.above is deleted in its entirety and replaced by the following:
WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by
written contract to add as an additional Insured on this coverage part,but only with respect to liability for bodily
Injury,property damage or personal and advertising injury arising out of your work that is subject to such written
contract.
III. Subject always to the terms and conditions of this policy,including the limits of insurance,the Insurer will not provide
such additional insured with:
A. coverage broader than required by the written contract;or
B. a higher limit of insurance than required by the written contract.
W. The insurance granted by this endorsement to the additional insured does not apply to bodily injury.property
damage,or personal and advertising injury arising out of:
A. the rendering of,or the failure to render,any professional architectural,engineering,or surveying services,
Including:
Q
1. the preparing,approving,or failing to prepare or approve maps,shop drawings,opinions,reports,surveys,
field orders,change orders or drawings and specifications:and
is
2. supervisory,inspectlon,architectural or engineering activities;or
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entifled Other Insurance is amended 10
add the following,which supersedes any provision to the contrary in this Condition or elsewhere In this coverage
part:
CNA75079XX(10-16) Policy No. 7036126854
Page 1 of 2 Endorsement No: 2
The Continental Insurance Co. Effective Date. 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copyt%W CNA Ar Rights Resem-ad. Indvdos copyrighted mawlal or Insurance Services Ofte,Inc.,with Its permission.
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
Primary and Noncontributory Insurance
With respect to other insurance available to the additional insured under which the additional insured is a named
insured,this insurance is primary to and will not seek contribution from such other insurance, provided that a written
contract requires the insurance provided by this policy to be:
1. primary and non-contributing with other insurance available to the additional insured;or
2. primary and to not seek contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional Insured,
VI. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence,Offense,Claim or Suit is amended with the addition of
the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim,or any occurrence or offense which may result in a claim;
2. send the Insurer copies of all legal papers received,and otherwise cooperate with the Insurer in the investigation,
defense,or settlement of the claim;and
3. make available any other insurance,and tender the defense and indemnity of any claim to any other insurer or
self-insurer,whose policy or program applies to a loss that the Insurer oovers under this coverage part.However,
if the written contract requires this insurance to be primary and non-contributory,this paragraph 3.does not
apply to insurance on which the additional insured is a named Insured.
The Insurer has no duty to defend or indemnity an additional insured under this endorsement until the Insurer receives
written notice of a claim from the additional insured.
VII. Solely with respect to the insurance granted by this endorsement,the section entitled DEFINITIONS Is amended to
add the following definition:
Written contract means a written contract or written agreement that requires you to make a person or organization an
additional Insured on this coverage part,provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy;and
B. was executed prior to:
1. the bodily injury or property damage;or
2. the offense that caused the personal and advertising injury;
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,lakes effect
on the effective date of said Policy at the hour stated in said Policy,unless another effective date is shown below,and
expires concurrently with said Poli
CNA75079XX(10-16) Policy No: 7036126854
Page 2 of 2 Endorsement No: 2
The Continental Insurance Co. Effective Date: 11/01/2022
Insured Name:PACIFIC INFRASTRUCTURE CORPORATION
Copyright CNA Art Rights Reserved. Indudes copyrighted matenaf of Insurance Services Office,Inc.,with its permission_
CNA Business Auto Policy
Policy Endorsement
CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I. LIABILITY COVERAGE
A. Who Is An Insured
The following is added to Section II. Paragraph A.1., Who Is An Insured:
1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the
date of inception of this Coverage Form; provided that,
b. The insurance afforded by this provision A.1. does not apply to any such entity that is an
Insured under any other liability "policy" providing auto coverage.
2. Any organization you newly acquire or form, other than a limited liability company, partnership or
joint venture, and over which you maintain majority ownership interest.
The insurance afforded by this provision A_2.:
a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy
period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier.
b. Does not apply to:
11) Bodily Injury or property damage caused by an accident that occurred before you acquired or
formed the organization; or
12) Any such organization that is an Insured under any other liability "policy" providing auto
coverage.
3. Any person or organization that you are required by a written contract to name as an additional
insured is an insured but only with respect to their legal liability for acts or omissions of a person,
who qualifies as an insured under SECTION II — WHO IS AN INSURED and for whom Liability
Coverage is afforded under this policy. If required by written contract,this insurance will be primary
and non-contributory to insurance on which the additional insured is a Named Insured.
4. An employee of yours is an Insured while operating an auto hired or rented under a contract or
agreement in that employee's name, with your permission, while performing duties related to the
conduct of your business.
"Policy", as used in this provision A. Who Is An Insured, includes those policies that were in force on
the inception date of this Coverage Form but:
1. Which are no longer in force; or
2. Whose limits have been exhausted.
B. Bail Bonds and Loss of Earnings
Section 11, Paragraphs A.2. (2) and A.2. (4)are revised as follows-
1. In s-(2), the limit for the cost of bail bonds is changed from $2,000 to $6,000; and
2. In a.141.the limit for the loss of earnings is changed from $250 to $500 a day.
Form No:CNA83359XX(04-2012) Policy No:SUA 7036134100
Endorsement Effective Date: Endorsement Expiration Date! Policy Effective Date: 11101!2022.
Endorsement No: 10;Page: 1 of 4 Policy Page: 53 of 85
Underwriting Company: Transportation Insurance Company, IS N Franklin St,ChIcsgo.I-60606
91 Copyright CNA A I Rights Reserved. Includes copyrighted material of the
Insurance Services Office,Inc.,used with its permission.
CNA Business Auto Policy
Policy Endorsement
C. Fallow Employee
Section 11, Paragraph B.5 does not apply.
Such coverage as is afforded by this provision C. Is excess over any other collectible insurance.
Il. PHYSICAL DAMAGE COVERAGE
A. Glass Breakage - Hitting A Bird Or Animal - Falling Objects Or Missiles
The following is added to Section III, Paragraph A.3.:
With respect to any covered auto, any deductible shown in the Declarations will not apply to glass
breakage if such glass is repaired, in a manner acceptable to us, rather than replaced.
B. transportation Expenses
Section ill, Paragraph A.4.a. is revised, with respect to transportation expense incurred by you, to
provide:
a. $60 per day, in lieu of $20; subject to
b. $1,800 maximum, in lieu of $600.
C. Lose of Use Expenses
Section III, Paragraph A.4.b. is revised, with respect to loss of use expenses incurred by you, to
provide:
a. $1,000 maximum, In lieu of $600.
D. Hired "Autos"
The following is added to Section III. Paragraph A.:
5. Hired "Autos"
If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired
Autos, then Physical Damage coverage is extended to:
a. Any covered auto you lease, hire, rent or borrow without a driver; and
b. Any covered auto hired or rented by your employee without a driver, under a contract in that
individual employee's name, with your permission, while performing duties related to the
conduct of your business.
c. The most we will pay for any one accident or loss is the actual cash value, cost of repair, cost
of replacement or $75,000, whichever is less, minus a $500 deductible for each covered auto.
No deductible applies to lose caused by fire or lightning.
d. The physical damage coverage as is provided by this provision is equal to the physical damage
coverage(s) provided on your owned autos.
e. Such physical damage coverage for hired autos will:
(1) Include loss of use, provided it is the consequence of an accident for which the Named
Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing
or rental concern.
(2) Such coverage as is provided by this provision will be subject to a limit of $750 per
accident.
E. Alrbag Coverage
The following is added to Section III, Paragraph B.3.:
The accidental discharge of an airbag shall not be considered mechanical breakdown.
Form No:CNA53359XX 104=2012i Policy No:SUA 7036134100
Endorsement Effective Date: Endorsement Expiratio-i Date: Policy Effective Date: 11101!2022
Endorsement No; 10;Page:2 of 4 Policy Page 54 of 85
Underwriting Company:Transportation Insurance Company, 161 N Franklin Sr.Ch"cago, IL 60606
"Copyright CNA A I Rights Reserved. Includes copyrighted materiat of the
Insurer.ce Services Office, Inc.,used with its permission.
CAA Business Auto Policy
Policy Endorsement
F. Electronic Equipment
Section III, Paragraphs 8.4.c and 8.4.d. are deleted and replaced by the following:
c. Physical Damage Coverage on a covered auto also applies to loss to any permanently installed
electronic equipment including its antennas and other accessories
d. A $100 per occurrence deductible applies to the coverage provided by this provision.
G. Diminution In Value
The following is added to Section III, Paragraph B.6.:
Subject to the fallowing, the diminution in value exclusion does not apply to:
a. Any covered auto of the private passenger type you lease, hire, rent or borrow, without a driver
for a period of 30 days or less, while performing duties related to the conduct of your business;
and
b. Any covered auto of the private passenger type hired or rented by your employee without a
driver for a period of 30 days or less, under a contract in that individual employee's name, with
your permission, while performing duties related to the conduct of your business.
c. Such coverage as is provided by this provision is limited to a diminution In value loss arising
directly out of accidental damage and not as a result of the failure to make repairs; faulty or
incomplete maintenance or repairs; or the installation of substandard parts.
d. The most we will pay for loss to a covered auto in any one accident is the lesser of:
11) $5,000; or
12) 20% of the auto's actual cash value (ACV).
Ill. Drive Other Car Coverage - Executive Officers
The following is added to Sections it and III;
1. Any auto you don't own, hire or borrow is a covered auto for Liability Coverage while being used by,
and for Physical Damage Coverage while in the care, custody or control of, any of your "executive
officers", except:
a. An auto owned by that "executive officer" or a member of that person's household: or
b. An auto used by that "executive officer" while working in a business of selling, servicing, repairing
or parking autos.
Such Liability and/or Physical Damage Coverage as is afforded by this provision.
11) Equal to the greatest of those coverages afforded any covered auto; and
12) Excess over any other collectible insurance.
2. For purposes of this provision, "executive officer" means a person holding any of the officer positions
created by your charter, constitution, by-laws or any other similar governing document, and, while a
resident of the same household, includes that person's spouse.
Such "executive officers" are Insureds while using a covered auto described in this provision.
IV. BUSINESS AUTO CONDITIONS
A. Duties In The Event Of Accident, Claim, Suit Or Loss
The following is added to Section IV, Paragraph A.2.a.:
Form No.CNA6335OXX(04-2012) Policy No:SUA 7036134100
Endorsement Effective Date: Endorsement Expiration Date- Policy Effective Date: 11/01!2022
Endorsement No: 10;Page: 3 of 4 Policy Page: 55 of 85
' Underwriting Company: Transportation Insurance Company, 151 N Franklin St,Chicago, IL 60606
Copyr ght CNA All Rights Reserved. Includes copyrighted material of the
Insurance Services Office, Inc.,used with Its permission.
CNA Business Auto Policy
Policy Endorsement
14) Your employees may know of an accident or loss. This will not mean that you have such
knowledge, unless such accident or loss is known to you or if you are not an individual, to any
of your executive officers or partners or your insurance manager.
The following is added to Section IV, Paragraph A.2.b.:
16) Your employees may know of documents received concerning a claim or suit. This will not mean
that you have such knowledge, unless receipt of such documents is known to you or if you are
not an individual, to any of your executive officers or partners or your insurance manager.
B. Transfer Of Rights Of Recovery Against Others To Us
The following is added to Section IV, Paragraph A.S. Transfer Of Rights Of Recovery Against Others To
Us:
We waive any right of recovery we may have, because of payments we make for injury or damage,
against any person or organization for whom or which you are required by written contract or
agreement to obtain this waiver from us.
This injury or damage must arise out of your activities under a contract with that person or
organization.
You must agree to that requirement prior to an accident or loss.
C. Concealment, Misrepresentation or Fraud
The following is added to Section IV, Paragraph B.2.:
Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not
prejudice you with respect to the coverage afforded provided such failure or omission is not intentional.
D. Otherinsurance
The following is added to Section IV, Paragraph B.S.:
Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy
shall be on a primary non-contributory basis. This provision is applicable only when required by a
written contract.
That written contract must have been entered into prior to Accident or Less.
E. Policy Period, Coverage Territory
Section IV, Paragraph B. 7.15).(a). is revised to provide:
a. 45 days of coverage in lieu of 30 days.
V. DEFINITIONS
Section V. paragraph C. is deleted and replaced by the following:
Bodily injury means bodily injury, sickness or disease sustained by a person, including mental anguish,
mental injury or death resulting from any of these.
Form No:CNA63359XX(04 2012) Policy No:SUA 7036134100
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 11f01!2022
Endorsement No; 10;Pape:4 of 4 Policy Page: 66 of 86
Underwriting Company: Transportation Insurance Company. 161 N Franklin St.Chicago, 1, 60606
o Copyright CNA All Rights Reserved. Includes copyrighted material of the
Insurance Sery ces Office, Inc.,used with Its permission.
ENDORSEMENT AGREEMENT BROKER COPY
STATE
WAIVER OF SUBROGATION REP 31
BLANKET BASIS 9287193-22
RENEWAL
sc
HOME OFFICE 0-26-16-23
SAN FRANCISCO EFFECTIVE NOVEMBER 1, 2022 AT 12.01 A.M. PAGE 1 OF 1
ALLEFFECTIVE DATESARE AND EXPIRING NOVEMBER 1, 2023 AT 12.01 A.M.
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
PACIFIC INFRASTRUCTURE CORPORATION
435 BOULDER CT STE 200
PLEASANTON, CA 94566
WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE
LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL
NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR
ORGANIZATION NAMED IN THE SCHEDULE.
THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU
PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU
TO OBTAIN THIS AGREEMENT FROM US.
THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE
2.00% OF THE TOTAL POLICY PREMIUM.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
ANY PERSON OR ORGANIZATION BLANKET WAIVER OF
FOR WHOM THE NAMED INSURED SUBROGATION
HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS
WAIVER
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING} ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER. WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SANNFRFRANCISCO: NOVEMBER 2, 2022
2572
AUTHORIZED REPRESENT/IVE PRESIDENT AND CEO
SCIF FORM 10217 SREV.7-2014I OLD DP 217
CITY OF UKIAH BUSINESS LICENSE-
GENERAL l
ID NO 23-000174
ISSUED TO ISSUED BY
Mark Jorgenson City of Ukiah
Pacific Infrastructure 300 Seminary Avenue
435 Boulder Ct. Ukiah,CA 95482
Pleasanton.CA 94566
(707)463-6215 phone
(707)463-6204 fax
efrausto@cityofuklah.com
-_--------------------------------------------------------------------------------------------------------------
c
CITY OF UKIAH BUSINESS
LICENSE-GENERAL City o/Ukiah
ISSUED TO ISSUED BY
Mark Jorgenson Ginny Michel
Pacific Infrastructure
435 Boulder Cl. Ukiah,CA
Pleasanton,CA 94566
ISSUED ON: 06127/2023
VALID FROM: 06/27/2023
EXPIRES: 12/31/2023
ID NO: 23-000174
This license is Non-Transferable
Elizabeth Frausto This license issued in compliance with City Of
Approved By Ukiah and subject to the provisions thereof.
2 -- --------------------------------------------------------------------------------------------------------------
CITY OF UKIAH
MARKJORGENSON
PACIFIC INFRASTRUCTURE
435 BOULDER CT.
PLEASANTON,CA 94566
CITY OF UKIAH BUSINESS LICENSE-GENERAL
ID NO: 23-000174
EXPIRES: 12131/2023
This license is Non-Transferable
This license issued in compliance with the City Of Ukiah and subject to the
provisions thereof.
Page V1
MYGOV.US License Printed on 06/27/2023 at 8,00 AM By Eli2abeth Frausto