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R2021-178 2021-08-23RESOLUTION NO. R2021-178 A Resolution of the City Council of the City of Pearland, Texas, authorizing a contract with Leaf Engineers, for Facility Generator Assessment Services, in the estimated amount of $93,490.00. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS: Section 1. That certain contract for facility generator assessment services, a copy of which is attached hereto as Exhibit "A" and made a part hereof for all purposes, is hereby authorized and approved. Section 2. That the City Manager or his designee is hereby authorized to execute and the City Secretary to attest a contract for design services associated with facility generator assessment services. PASSED, APPROVED and ADOPTED this the 23rd day of August, A.D., 2021. EVIN COLE AYOR ST: STAL ROAN, TRMC, CMC CITY SECRETARY APPROVED AS TO FORM: II 4ai II iiiii\i\N ARRIN M. COKER CITY ATTORNEY CONTRACT FOR PROFESSIONAL SERVICES THIS CONTRACT is entered into upon final execution by and between the City of Pearland ("CITY") and LEAF Engineers ("CONSULTANT"). The CITY engages the CONSULTANT to perform professional services for a project known and described as Generator Assessment Study ("PROJECT"). (Project #FA1702) SECTION I - SERVICES OF THE CONSULTANT The CONSULTANT shall perform the following professional services to CITY standards and in accordance with the degree of care and skill that a professional in Texas would exercise under the same or similar circumstances: A. The CONSULTANT shall provide inspection and assessment of facility generators. See Exhibit A, attached, for a detailed SCOPE OF WORK and PROJECT schedule. The PROJECT schedule shall be submitted in digital and hard copy form in the Microsoft Project for Windows format. B. The CONSULTANT shall prepare and submit a detailed opinion of estimated cost of the PROJECT. C. The CONSULTANT acknowledges that the CITY (through its employee handbook) considers the following to be misconduct that is grounds for termination of a CITY employee: Any fraud, forgery, misappropriation of funds, receiving payment for services not performed or for hours not worked, mishandling or untruthful reporting of money transactions, destruction of assets, embezzlement, accepting materials of value from vendors, or consultants, and/or collecting reimbursement of expenses made for the benefit of the CITY. The CONSULTANT agrees that it will not, directly or indirectly; encourage a CITY employee to engage in such misconduct. D. The CONSULTANT shall submit all final construction documents in both hard copy and electronic format. Plans shall be AutoCAD compatible and all other documents shall be Microsoft Office compatible. The software version used shall be compatible to current CITY standards. Other support documents, for example, structural calculations, drainage reports and geotechnical reports, shall be submitted in hard copy only. All Record Drawings electronic files shall be submitted to the CITY in TIF format. E. The CONSULTANT recognizes that all drawings, special provisions, field survey notes, reports, estimates and any and all other documents or work product generated by the CONSULTANT under the CONTRACT shall be delivered to the CITY upon request, shall become subject to the Open Records Laws of this State. F. The CONSULTANT shall procure and maintain for the duration of this Agreement, insurance against claims for injuries to persons, damages to property, or any errors Design 1 of 7 D2. Revised 04/2019 and omissions relating to the performance of any work by the CONSULTANT, its agents, employees or subcontractors under this Agreement, as follows: (1) Workers' Compensation as required by law. (2) Professional Liability Insurance in an amount not less than $1,000,000 in the aggregate. (3) Comprehensive General Liability and Property Damage Insurance with minimum limits of $1,000,000 for injury or death of any one person, $1,000,000 for each occurrence, and $1,000,000 for each occurrence of damage to or destruction of property. (4) Comprehensive Automobile and Truck Liability Insurance covering owned, hired, and non -owned vehicles, with minimum limits of $1,000,000 for injury or death of any one person, $1,000,000 for each occurrence, and $1,000,000 for property damage. The CONSULTANT shall include the CITY as an additional insured under the policies, with the exception of the Professional Liability Insurance and Workers' Compensation. The CONSULTANT shall agree to waive its Right to Subrogation. Certificates of Insurance and endorsements shall be furnished to the CITY before work commences. Each insurance policy shall be endorsed to state that coverage shall not be suspended, voided, canceled, and/or reduced in coverage or in limits ("Change in Coverage") except with prior written consent of the CITY and only after the CITY has been provided with written notice of such Change in Coverage, such notice to be sent to the CITY either by hand delivery to the City Manager or by certified mail, return receipt requested, and received by the City no fewer than thirty (30) days prior to the effective date of such Change in Coverage. Prior to commencing services under this CONTRACT, CONSULTANT shall furnish CITY with Certificates of Insurance, or formal endorsements as required by this CONTRACT, issued by CONSULTANT'S insurer(s), as evidence that policies providing the required coverage, conditions, and limits required by this CONTRACT are in full force and effect. G. The CONSULTANT shall indemnify and hold the CITY, its officers, agents, and employees, harmless from any claim, loss, damage, suit, and liability of every kind for which CONSULTANT is legally liable, including all expenses of litigation, court costs, and attorney's fees, for injury to or death of any person, for damage to any property, or errors in design, any of which are caused by the negligent act or omission of the CONSULTANT, his officers, employees, agents, or subcontractors under this CONTRACT. H. All parties intend that the CONSULTANT, in performing services pursuant to this CONTRACT, shall act as an independent contractor and shall have control of its own work and the manner in which it is performed. The CONSULTANT is not to be considered an agent or employee of the CITY. Design 2 of 7 D2 Revised 04/2019 SECTION II - PERIOD OF SERVICE This CONTRACT will be binding upon execution and end February 28, 2022. SECTION III - CONSULTANT'S COMPENSATION A. The total compensation for the services performed shall not exceed the total noted in Section B. B. The CITY shall pay the CONSULTANT in installments based upon monthly progress reports and detailed invoices submitted by the CONSULTANT based upon the following: 1. Basic Services (Lump Sum) $91,900.00 2. Additional Services shall require independent and specific authorization and shall be billed as (Not to Exceed): $0.00 3. Bid Phase Services (Hourly Not to Exceed) $0.00 4. Construction Phase Services (Hourly Not to Exceed) $0.00 5. Reimbursable Expenses (Not to Exceed) $1,500.00 C. Total: $93,490 D. The CITY shall make payments to the CONSULTANT within thirty (30) days after receipt and approval of a detailed invoice. Invoices shall be submitted on a monthly basis. E. CONSULTANT shall invoice for work performed during the preceding thirty day period ("Billing Period"). The Billing Period shall run from the 26th day to the 25th day of each consecutive month. Invoices shall be submitted to CITY not more frequently than once every 30 days. CONSULTANT shall be responsible for timely submittal of all invoices and CONSULTANT shall not be entitled to payment for invoices in arrears. All invoices shall reflect most recent single Billing Period only and represent the true, correct and accurate account of work performed during the Billing Period. F. For an agreed contract amount identified as "Lump Sum", Not to Exceed" and "Reimbursable" the CONSULTANT shall not exceed the fixed contractual amount without written authorization in the form of a Contract Amendment. CONSULTANT shall provide 45 days prior notice to the CITY in the event contract fees may exceed the fixed contract amount. CONSULTANT shall be responsible for ensuring that such authorization is complete and executed by all parties performing any work or submitting any invoices for work that exceeds the fixed contract amount under any expense category. Design 3 of 7 D2 Revised 04/2019 G. Allowable Reimbursable Expenses CONSULTANT shall identify and include in the proposal any anticipated Reimbursable Expenses, and shall itemize Reimbursable Expenses by work category. Reimbursable Expenses shall be invoiced AT COST without subsequent markup by the CONSULTANT. All invoices containing a request for Reimbursable Expenses shall include copies of the original expense receipts itemized per the allowable category. Allowable Reimbursable Expenses include: • Hard copy reproductions, copies and/ or binding costs • Postage • Mileage, for travel from Consultant's local office (within a 25 mile radius) to meetings at the City or job -site. Mileage shall be charged at the current IRS rates. • Travel expenses, mileage from local office to State or federal regulatory agency office beyond 100 miles. • Lodging expenses, for destinations beyond 100 miles from the Consultant's local office AND when business hours exceed eight hours within one business day OR requires more than one eight hour day. F.2. Disallowed Expenses Disallowed Expenses include travel expenses for professional expertise traveling into the greater Houston area from Consultant offices outside of the greater Houston area. SECTION IV - THE CITY'S RESPONSIBILITIES A. The CITY shall designate a project manager during the term of this CONTRACT. The project manager has the authority to administer this CONTRACT and shall monitor compliance with all terms and conditions stated herein. All requests for information from or a decision by the CITY on any aspect of the work shall be directed to the project manager. B. The CITY shall review submittals by the CONSULTANT and provide prompt response to questions and rendering of decisions pertaining thereto, to minimize delay in the progress of the CONSULTANT'S work. The CITY will keep the CONSULTANT advised concerning the progress of the CITY'S review of the work. The CONSULTANT agrees that the CITY'S inspection, review, acceptance or approval of CONSULTANT'S work shall not relieve CONSULTANT'S responsibility for errors or omissions of the CONSULTANT or its sub- consultant(s) or in any way affect the CONSULTANT'S status as an independent contractor of the CITY. Design 4 of 7 D2 Revised 04/2019 SECTION V - TERMINATION A. The CITY, at its sole discretion, may terminate this CONTRACT for any reason -- with or without cause -- by delivering written notice to CONSULTANT personally or by certified mail at LEAF Engineers, 11 Greenway Plaza, 22nd Floor, Houston, TX 77046. Immediately after receiving such written notice, the CONSULTANT shall discontinue providing the services under this CONTRACT. B. If this CONTRACT is terminated, CONSULTANT shall deliver to the CITY all drawings, special provisions, field survey notes, reports, estimates and any and all other documents or work product generated by the CONSULTANT under the CONTRACT, entirely or partially completed, together with all unused materials supplied by the CITY on or before the 15`h day following termination of the CONTRACT. C. In the event of such termination, the CONSULTANT shall be paid for services performed prior to receipt of the written notice of termination. The CITY shall make final payment within sixty (60) days after the CONSULTANT has delivered to the CITY a detailed invoice for services rendered and the documents or work product generated by the CONSULTANT under the CONTRACT. D. If the remuneration scheduled under this contract is based upon a fixed fee or definitely ascertainable sum, the portion of such sum payable shall be proportionate to the percentage of services completed by the CONSULTANT based upon the scope of work. E. In the event this CONTRACT is terminated, the CITY shall have the option of completing the work, or entering into a CONTRACT with another party for the completion of the work. F. If the CITY terminates this CONTRACT for cause and/or if the CONSULTANT breaches any provision of this CONTRACT, then the CITY shall have all rights and remedies in law and/or equity against CONSULTANT. Venue for any action or dispute arising out of or relating to this CONTRACT shall be in Brazoria County, Texas. The laws of the State of Texas shall govern the terms of this CONTRACT. The prevailing party in the action shall be entitled to recover its actual damages with interest, attorney's fees, costs and expenses incurred in connection with the dispute and/or action. CONSULTANT and CITY desire an expeditious means to resolve any disputes that may arise between under this CONTRACT. To accomplish this, the parties agree to mediation as follows: If a dispute arises out of or relates to this CONTRACT, or the breach thereof, and if the dispute cannot be settled through negotiation, then the parties agree first to try in good faith, and before pursuing any legal remedies, to settle the dispute by mediation of a third party who will be selected by agreement of the parties. Design 5 of 7 D2 Revised 04/2019 SECTION VI — ENTIRE AGREEMENT This CONTRACT represents the entire agreement between the CITY and the CONSULTANT and supersedes all prior negotiations, representations, or contracts, either written or oral. This CONTRACT may be amended only by written instrument signed by both parties. SECTION VII — COVENANT AGAINST CONTINGENT FEES The CONSULTANT affirms that he has not employed or retained any company or person, other than a bona fide employee working for the CONSULTANT to solicit or secure this CONTRACT, and that he has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage brokerage fee, gift, or any other consideration, contingent upon or resulting from the award or making of the CONTRACT. For breach or violation of this clause, the CITY may terminate this CONTRACT without liability, and in its discretion, may deduct from the CONTRACT price or consideration, or otherwise recover, the full amount of such fee, commission, percentage brokerage fee, gift, or contingent fee that has been paid. SECTION VIII- SUCCESSORS AND ASSIGNS This CONTRACT shall not be assignable except upon the written consent of the parties hereto. 2.C./Y./—an( j DATE July 27, 2020 DATE Design 6 of 7 D2 Revised 04/2019 Exhibit A 11 Greenway Plaza, 22"d Floor Houston, Texas 77046-1104 Phone: 713/940-3300 www.LEAFengineers.com May 3, 2021 via email Mr. Jack Enochs Lt, LEAF RS City Facilities of Pearland Services Manager I Public Works 3501 East Orange Street Pearland, TX 77581 RE: City -Wide Generator Assessment Project Fee Proposal Dear Jack, LEAF Engineers is thankful for the opportunity to provide this fee proposal for the emergency power generator assessments, city wide, in Pearland, Texas. This letter will serve as our scope of work summary and professional fee proposal. Project Scope Description: 1. Emergency Generator Assessment: LEAF Engineers will perform an inspection of each engine -generator set to assess the condition and status including the following item(s): Check engine, radiator, and generator for debris, foreign objects, obstructions, and loose or broken fittings, guards, and components Visual inspection for worn belts, wiring connections, and/or leaking fuel system components Evaluation of clearances, containment, sound barriers, mufflers Inspection of transfer switch and remote annunciators where installed Inspection of oil crankcase and engine block heaters and separate battery charging circuits where present Review of existing maintenance logs, if available 2. LEAF will engage the services of a 3rd party engine -generator service company to provide comprehensive inspection services and summary evaluation report on each generator's condition including the following: Crankcase oil and filter and breather system Air intake system Fuel system Battery and charger Generator connectors and cables Exhaust system Radiator Hoses, belts, clamps, fuel lines AC and DC wiring and Breakers Safety shutdowns Housing Vibration isolation Mr. Jack Enochs City of Pearland Page 2 of 3 - Fluid Leaks Performance results of a 2-hour on -site load bank test O 30 minutes at 25% load O 30 minutes at 50% load O 60 minutes at 80% load 3. Generator Assessment Booklet: LEAF will produce a complete written summary of findings, including recommended corrective actions, and estimated costs and priorities associated with recommendations list for each generator, up to and including replacement if applicable FEES: LEAF Engineers will perform the professional services on the above referenced project for a fee of $91,990 plus reimbursable expenses related to printing and reproduction of documents. Reimbursable expenses will be billed with a 1.0 multiplier (straight pass through without markup) and are not expected to exceed $1,500 for this project. Total maximum not to exceed fee for this project is $93,490 Fee Breakdown: a. Engineering Field Investigation and Summary Report $43,450 b. 3rd Party Generator Technician Inspection Services $16,340 c. 2 Hour Load Bank Testing $32,200 e. Reimbursable Expenses (Not to exceed) $1,500 TOTAL $93,490 Project Schedule: Project Phase Activity Duration Engineering Assessments (37 generator sites) 30 days 3rd Party Technician Inspections/Load Bank Testing 45-60 days Preliminary Report Phase 15 days Final Report Phase 15 days Total 105-120 days Mr. Jack Enochs City of Pearland Page 3 of 3 Please review this document and let me know what questions or comments the city may have regarding the proposal, professional fees, and services to be provided. There will be no additional services without prior written consent and authorization from the City of Pearland. Sincerely, LEAF Engineers Signature, arl Madorsky, P.E., CxAD AP BD+C President cc: Mr. Mike Ghormley, Phil Rutter - PBK Mr. David Templeman — LEAF Engineers CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2021-783490 Date Filed: 07/27/2021 Date Acknowledged: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. LEAF Engineers Houston, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Pearland 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. FA1702 MEPT Design Services - Generator Assessment Study 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check if there is NO Interested Party. only X 6 UNSWORN DECLARATION My name is tACJ , and my date of birth Is ,7—'31\C-nl(' j.( My address is \ \ ��� � 11 07 o f_22,10 ais_, .__SQy'l .-7 L (zip code) of,,, v V...\ (month) W U5* (country) , 20 %t . c\uVrN . (street) I declare under penalty of perjury that the foregoing is true and correct. Executed in --\CA.SY\S County, (city) (state) State of 1Pxn..S . on the 2+day ;4,61I6,4� (year) Signature of authorized agent of cor .lung business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.ceffcl98a House Bill 89 Verification (Person name), the undersigned representative (h-taqfter referred as ' epgentative") of 'i &/G C'f2 (company or business name, hereafter referred to as "Business Entity"), being an adult over the age of eighteen (18) years of age, after being duly sworn by the undersigned notary, do hereby depose and affirm the following: 1. That Representative is authorized to execute this verification on behalf of Business Entity; 2. That Business Entity does not boycott Israel and will not boycott Israel during the term of any contract that will be entered into between Business Entity and the City of Pearland; and 3. That Representative understands that the term "boycott Israel" is defined by Texas Government Code Section 2270.001 to mean refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not iclude an action made for ordinary business purposes. SIGNATURE OF REPRESENTATIVE SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned authority, on this 2L-A- day of 30 kk. , 2024. AUDREY E. BILLINGS °'' ► ';_Notary Public, State„f Texas Comm. Expires 07-11-2023 ''"i;,%\1/4/ Notary ID 128670311 • Notary Public Design 7 of 7 D2 Revised 04/2019 ACC �® lvViR CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/4/2021 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 does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 2618 Broadway St Pearland TX 77581 CONTACT NAME: PHONE(Aic o Ert) 713-209-2841 FAX No): 713-369-1463 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Continental Casualty Company 20443 INSURED PBKAR-2 PBK Architects dba LEAF Engineers 11 Greenway Plaza, Suite 2210 Houston, TX 77046-1104 INSURER B : LM Insurance Corporation 33600 INSURERC: Liberty Insurance Corporation 42404 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 650495826 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF /Y (MM/DDYYY) POLICY EXP (MM/DD/YYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY TB5-Z91-472898-021 4/25/2021 4/25/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (EaENTED occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES X jECOT- X PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ C AUTOMOBILELIABILITY X ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY AS7-Z91-472898-031 4/25/2021 4/25/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE TH7-Z91-472898-051 4/25/2021 4/25/2022 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 1n (Inn $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A WC5-Z91-472898-011 4/25/2021 4/25/2022 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liability Claims Made Form AEH591912035 8/1/2020 8/1/2021 Each Claim Aggregate Deductible Ea Claim $5,000,000 $10,000,000 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation policy includes a B anket waiver of subrogation endorsement that provides this feature only when there is a written contract, agreement or permit between the named insured and the certificate holder that requires such status. CERTIFICATE HOLDER CANCELLATION City of Pearland 2559 Hillhouse Pearland, TX 77584 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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 is added to Section I11— 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG20370413 © Insurance Services Office, Inc., 2012 Page 1 of 1 LM Insurance Co #WC5-Z91-472898-011 4/25/2021-4/25/2022 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. Specific Waiver Name of person or organization x Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium The premium charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium WC 42 03 04 B (Ed. 6-14) 1 of 2 © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. Racf id Date Policy No. Agency Code WC 42 03 04 B (Ed. 6-14) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 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 Policy Effective State Policy No. Insured Insurance Company WC 42 03 04 B (Ed. 6-14) Endorsement No. Premium Countersigned by 2 of 2 © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. LM Insurance Corporation #WC5-Z91-472898-011 4/25/2021-4/25/2022 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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 % of the California workers' compensation premium otherwise due on such remuneration. Schedule [Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of $ ] Person or Organization Job Description Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Issued by Choose an item. For attachment to Policy No. Effective Date Premium $ Issued to WC 04 03 06 R1 Page 1 of 1 Ed. 08/2013 LM Insurance Corporation #WC5-Z91-472898-011 4/25/21-4/25/22 TEXAS WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY MANUAL WC 42 06 01 Original Printing Effective January 1, 1994 TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. In the event of cancellation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number of days advance notice is shown in the Schedule. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 1. Number of days advance notice: (30) 2. Notice will be mailed to: Note: Use this endorsement if Texas is shown in Item 3.A. of the Information Page and the insurer agrees to give to a third party advance notice of cancellation or other material change.