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HomeMy WebLinkAboutA9052 - UNIVERSAL CONSTRUCTION AND ENGINEERING DBA UNIVERSAL CONSTRUCTION ENGINEERINGstateFerm STATEFARM~ A . POBox2368 Bloomington IL 61702-2368 71A 12 000685 0093 CITY OF PALM SPRINGS A DATE OF NOTICE: JUN 10 2025 CODE: r~ ~ 3200 E TAHQUITZ CANYON WAY PALM SPRING S CA 92262 -6959 NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP , LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. I ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Fire and Casualty Company NAMED INSURED : UNIVERSAL CONSTRUCTION AND ~ ENGINEERING !il 77725 ENFIELD LN i PALM DESERT CA 92211-0468 ,::- POLICY NO: 615 9634·A25·55E YR /MAKE/MODEL: 2010 FREIGHTLNR DMP MULT VIN /CAMPER: 1 FUJGBDV2ALAN6339 AGENT NAME : TRAVIS FOSTER INS AGENCY INC AGENT PHONE : (530)242-1411 2BD4-FA96A COVERAGE: Bl AND PD LIABILITY $1 Mil $500 DED. COMP. $500 DED . COLL ENDORSEMENT NO: 6028BU POLICY EFFECTIVE i;j POLICY MESSAGES: This polk:y shown above supersedes policy# 6159634 -55 D. i The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance MAY 16 2025 UNTIL TER MI NATED 1 provided and subject to all policy prov1s1ons . The additional insured will be given 20 days notice If the polley is terminated. Until such notice ; is provided, It shall be presumed that the required renewa l premiums have i,een paid. The additional insu red must noti fy us within 10 days ot ~ any change of interest or ownership coming to t heir attention. Failure to do so will render this policy null and void. N ... FAT RECE\VED JUN 1 7 7.07.5 f 1HE C\l'l CLERK Off\CE 0 UNITBRO-01 JL PEZ ACORN CERTIFICATE OF LIABILITY INSURANCE o10/2ATE l /2024 10/25/2024 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate doe_ s not conifer _rights to the certificate holder in lieu of such endarsement(s). _ PRODUCER ACT Jessica Lopez Commercial The Brokerage PHONE FAX The Brokerage, an Alera Group Company RECEIVED I"' He,ERA): (949)287 -5677 (AIC, No): 201 SW Acacia $t, Suite 200 MDREss:jlopez@thebrokerageins.com Newport Beach, CA 92660 I, U C T J O 2024 INSURER(3) AFFORDING COVERAGE NAIL If INSURER A: PALOMAR SPECIALTY INSURANCE COMPANY 20338 INSURED INSURER B: Everest Premier Insurance Company 16045 Universal General & EngineeG ERCE OF THE CITY CLERK 73-700 Dinah Shore Dr., Suite 307 INSURER D: Palm Desert, CA 92211 INSURER E ... INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILM TYPE OF INSURANCE gDDL SUER POLICY NUMBER POLICY EFF POLICY IBM, A X COMMERCIAL GENEML UABR EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X CPGLP-00000309 10/26/2024 10126/2025 PREMISES RENTED(Ea occi,mence) S 50,000 MED EXP (Any one person) $ PERSONAL S ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMpIT. APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X JECT LOG PRODUCTS - COMPIOP AGG 3 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ee accident) S ANY AUTO BODILY INJURY (Per person) S OU��N�E� ONLY SCHEDULE OWNED SAUTOS CHEDULED BODILY INJURY (Per aoxcelem) S q AIIITOS ONLY AUTNOS ONL1 PA0P¢Rde^t) AMAGE $ S UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS B WORKERS ND EMPLOY X ERH RSELIABIIl1TY STATUTE ANY PROPRIETOR/PARTNERIEXECUTIVE Y N 7800025283241 2/15/2024 2/15/2025 1,000,000 A pF�FlCERMEEMggER E%CLUDED? NIA E.L. EACH ACCIDENT $ IaraMatary in NNI E L. DISEASE - EA EMPLOYEE S i,D0000p DESCRIPTION OF OPERATIONS bek,w 1,000,000 E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Scbeside, may be attached if more space is required) RE: All operations performed by the Named Insured during the current policy period. glai LCity of Palm Springs is included as Additional Insured as respects General Liability per attached endorsement. City of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AV RIZED REPRESENTATIVE ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD / 1 ACORO' AGENCY CUSTOMER ID: UNITBRO-01 LOC #: 1 ADDITIONAL REMARKS SCHEDULE The ACORD name and logo are registered marks of ACORD JLOPEZ Page 1 of 7 POLICY NUMBER: CPGLP-00000309 COMMERCIAL GENERAL LIABILITY CG 20 3712 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with —respect —to —liability —for —"bodily injury" —or -- "property damage" caused, in whole or in part, by If coverage provided to the additional insured is "Your work" at the location designated and required by a contract or agreement, the most we described in the Schedule of this endorsement will pay on behalf of the additional insured is the performed for that additional insured and included amount of insurance: in the "products -completed operations hazard". 1. Required by the contract or agreement; or However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: CPGLP-00000309 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ zations Locations Of Covered Operations any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on our policy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your -__-_behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, --maintenance or -repairs) to be -performed -by -or-- — on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 CONTRACT ABSTRACT Agreement; Performance & Payment Bonds; Insurance Contract Company Name: Company Contact: Summary of Services: Contract Price: Funding Source: Contract Term: Universal Construction and Engineering Cathy Cooke CP 21-33, Airport Misc. Stormwater Concrete Improvements $39,610.00 Airport funds To be determined by the Notice to Proceed Contract Administration Lead Department: Contract Administrator: Development Services – Engineering Division Joel Montalvo/Francisco Jaime Contract Approvals Approval Date: Agreement Number: TBD TBD Contract Compliance Exhibits: Signatures: Insurance: Bonds: Attached Attached Attached Attached Contract Prepared By: Engineering Division Submitted on: 02/08/2022 By: Vonda Teed DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FE DocuSign Envelope ID: 79D8D2A2-4CD3-41C4-8BCF-3AA0706239FEA90522/9/2022 UNIVCON-07 DNIELSEN ntoRO' CERTIFICATE OF LIABILITY INSURANCERECSIVED DAT13012DIYYYYI 130/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UF�eTogG7 ¢ICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFFCCSSkkCC11ED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEE8?E ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. U Ce O the City Clerk IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # 0767776 WarACT Diane Nielsen PRO No, Ext: 760) 360-4700 4742 1 Fes, No: 760 200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive RECEIVED Suite 201 M6., diane.nielsen@hubintemadonal.com Palm Desert, CA 92211 FEB 0 12023 INSURE S AFFORDING COVERAGE NAICX INSURER A: Scottsdale Insurance Company 41297 INSURED Universal Construction and EGOM,94he City Clerk DBA: Universal Construction Engineering 77725 Enfield Lane, Ste 210 INSURER a: Everest Premier Insurance Company 16045 INSURERC: INSURER D: Palm Desert, CA 92211 INSURER E: INSURER F : rcerrorA VM MI MOOR RFVICInN1 NI IMRFR- v THIS IS TOCERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL ManPOUCYNUMBER SUB POUCYEFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 CLAIMSWADE FX OCCUR X X RBS0183094 1/1/2023 1/1/2024 DAMAGEORENTED 100,000 MED EXP ono 5,000 PERSONAL & ADV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY�j �LOC GENERAL AGGREGATE 2,000,00O PRODUCTS - COMP/OP AGO S 2,000,000 OTHER'. AUTOMOBILE LIABILITYCONMI. lent) SINGLE LMn $ BODILY INJURY Perperson) S ANY AUTO BODILY INJURY Per accident AUOS ONLY AUQSULED WNW CNEDULED AUTOS ONLY AUTOB OrJLV d%PE AMAGE A UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE XLS1224056 1/1/2023 1/1/2024 EACH OCCURRENCE 51000,000 X AGGREGATE S 5,000,000 DED I I RETENTIONS B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y❑ pFFICERIMEMgW EXCLUDED? IMandNory in NH) H yes aesvLe under DES CRIPTIONOFOPERATIONSbelow NIA X 7600022063231 1N/2023 1/1/20241,000,000 TH- 1,000,000 S MIT rDISEASE- 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addmonal Remarks Schedule, may be attached Ifmom space Is required) Job -Desert Highland Park, 480 Tramview Rd., Palm Springs, CA City of Palm Springs, its officials, employees and agents am named as additional insured per attached. Insurance is primary & non-contributory. Waiver of Subrogation applies to General Liability & Workers Compensation per attached. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium. City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTUTUHH_O(')RV(E/D REPRESENTATIVE � — ACORD 25 (2016/03) v TBBa-zuTD PAwr1LJ A.vr<r�lcsll Ivn. e1n nynu reserveu. The ACORD name and logo are registered marks of ACORD 1.1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - 1' 1 ; ►I 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 01/01/2023 Policy No. 7600022063231 Insured: Universal Construction and Engineering Insurance Company: Everest Premier Insurance Company Countersigned By: -199a by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's Catifornia Workers' Compensation Insurance Forms Manual -1999. Endorsement No. 001 Premium $ INCL. POLICY NUMBER RBS0183084 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -(FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. i3�7:I�1O�? Name of Person or Organization: Per Certificate - As required by written contract Any person or organization to which you are obligated by virtue of a written contract to provide insurance such as is afforded by this policy, but only with respect to (1) occurrences taking place after such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period, or occurrences resulting from the conduct of your business during the policy period. A person or organization that qualifies as an "insured" under the above paragraph of this Endorsement shall be an additional insured solely with respect to such additional insured's liability for 'bodily injury," property damage" or "personal and advertising injury" caused in whole or in part by your acts or omissions in the performance of "your work" for the additional insured on or at "commercial construction projects." For the purposes of this Endorsement, "commercial construction projects" are defined as buildings or structures constructed for commercial use and also includes apartments, hotels, homes for the aged, dormitories or barracks. However, "commercial construction projects" shall not include any building or structure which contains individual owner occupied units or dwellings. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising outof "yourwork" for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ Policy #RBS0183084 COMP.1ERCIAL GENERAL LIABILITY CG20330413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. However, the insurance afforded to such This exclusion applies even if the claims against additional insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law; in the supervision, hiring, employment, training or and monitoring of others by that insured, If the 2. Will not be broader than that which you are "occurrence" which caused the "bodily injury" or required by the contract or agreement to "property damage", or the offense which caused provide for such additional insured. the "personal and advertising injury', involved the rendering of or the failure to render any A person's or organization's status as an professional architectural, engineering or additional insured under this endorsement ends surveying services. when your operations for that additional insured are completed. CG 20 33 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of 'your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 33 0413 Policy #RBS0183084 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy #RBS0183084 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization to which you are obligated by virtue of a written contract to provide insurance such as is afforded by this policy, but only with respect to (1) occurrences taking place after such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period, or occurrences resulting from the conduct of your business during the policy period. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ ,ek File: 11923540 (CA PV) Customer: UNIVERSAL CONSTRUCTION & ENGIN rr�� Notice Requested by: Customer #: 947755 / �� oS Sunbelt Rentals, Inc. Job Name: P.S. VISITOR CENTER 1275 West Mound Street Job# / PO#: 1 - P.S. VISITOR CEN / VISITOR CENTER Columbus, OH 43223 800-508-4756 Cert #: 9314 8898 8030 0068 4711 73 APN #: PRELIMINARY NOTICE This is not a lien. This is not a reflection on the integrity of any contractor or subcontractor, but the notice prescribed in California Civil Code Sections.8102, 8200, et seq., 9300, et seq. TO OWNER OR REPUTED O)XrNER(S)/PUBLIC ENTITY CITY OF PALM SPRINGS PO BOX 2743 PALM SPRINGS, CA 9226: DIRECT CONTRACTOR UNIVERSAL CONSTRUCTION & ENGIN SUITE 210 PALM DESERT, CA92211 760-200-3100 TO LENDER/SURE Advised No Lender , Bond/Loan # The following is a general description of the labor, service, equipment or materials furnished or to be furnished: Various Construction Equipment Rentals Estimated Price: $3,076.56 The name of the person who furnished that labor, service, equipment or materials is: _ Sunbelt Rentals, Inc_ 1275 West Mound Street Columbus, OH 43223 800-508-4756 Date labor, service, equipment or materials first furnished: 5/17/2023 The name of the person who contracted for purchase of that labor, service, equipment or material is: UNIVERSAL CONSTRUCTION & ENGIN 77725 ENFIELD LN, SUITE 210 PALM DESERT, CA 92211 The description of the jobsite is: P.S. VISITOR CENTER #1 - P.S. VISITOR CEN 2901 N PALM CANYON DR, PALM SPRINGS, CA 92262 NOTICE TO PROPERTY OWNER EVEN THOUGH YOU HAVE PAID YOUR CONTRACTOR IN FULL, if the person or firm that has given you this notice is not paid in fullfor labor, service, equipment, or material provided or to be provided to your construction project, a lien may be placed on your property. Foreclosure of the lien may lead to loss of all or part of your property. You may wish to protect yourself against this by (1) requiring your contractor to provide a signed release by the person -or firm that has given you this notice before making payment to your contractor, or (2) any other method that is appropriate under the circumstances. This notice is required by law to be served by the undersigned as a statement of your legal rights. This notice is not intended to reflect upon the financial condition of the contractor or the person employed by you on the construction project. If you record a notice of cessation or completion of your construction project, you must within 10 days after recording, send a copy of the notice of completion to your contractor and the person or Linn that has given you this notice. The notice must be sent by registered or certified mail. Failure to send the notice will extend-thedeadline to record a'claim of lien. You are not required !9 send the notice if yea are a residential. homeowner of a - - dwelling containing four or fewer units. Dated: 6/14/2023 By: �� ) Laura Pavey / CRF Solutions Authorized Agent For: Sunbelt Rentals, Inc. PROOF OF NOTICE DECLARATION 1 declare that 1 served a copy of the above Preliminary Notice, and any related documents, by (as required by law) first-class, certified or registered mail, postage prepaid, addressed to the above named parties, at the addresses listed above, on 6/14/2023. 1 declare under penalty of perjury that the foregoing is true and correct. Executed at Simi Valley, CA on 6/14/2023. By: Laura Pavey / Lien Administrator SUNBELTo RECEIVED RENTALS 111111111111111111111111 JUN202023 Construction Notice Department City Hell PO Box 1389, Simi Valley, CA 93062 9314 8898 8030 0068 4711 73 Reception Desk Address Service Requested 6/14/2023 SBR999 11923540 CITY OF PALM SPRINGS PO BOX 2743 PALM SPRINGS, CA 92263-2743 IMPORTANT NOTICE PLEASE READ CAREFULLY Enclosed you will find a notice that is being sent to you on behalf' of Sunbelt Rentals, Inc. in regards to the construction project known as P.S. VISITOR CENTER and located at 2901 N PALM CANYON DR , PALM SPRINGS, CA 92262. PO # VISITOR CENTER.. The name the person or company who contracted for the furnishing of equipment is 947755, UNIVERSAL CONSTRUCTION & ENGIN. It is important to note this notice and the amount listed is sent in order to comply with certain state requirements that may exist and should not reflect in any way on the integrity or credit standing of any of the known interested parties associated with this job. If an amount is reflected on this notice, it is the total invoiced amount for all invoiced services as of the date of this notice, however the amount reflected may not be due at this time depending on payment terms. The notice is merely a letter informing the owner of the property and/or general contractor that Sunbelt Rentals, Inc. has supplied or will supply services, equipment and/or materials. Failure to ensure that their vendor is paid may result in a lien being placed on your property and you're paying twice for the materials and/or services provided to you by the vendor listed this notice. If you have paid or are about to pay your contractor, ask them for a Release of Lien to ensure their vendor is paid at lienrelease@sunbeltrentals.com We have attempted to verify the proiect's information prior to sending this notice. If there is a payment bond related to the improvements or documents relating to the work of improvement being ordered by a lessee/tenant, this is a formal request by Sunbelt Rentals, Inc. for a copy of said documents. If any of the information contained in this notice is incorrect, or you are not associated with this job, please contact us immediately at Notices@SunbeltRentals.com If you require information regarding contractor payment status, please contact Sunbelt Rentals, Inc. at 800-508-4756 ext. 4435.