HomeMy WebLinkAboutCC Resolution 13588 (Code Enforcement Services)RESOLUTION NO. 13588
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT FOR
PROFESSIONAL CODE ENFORCEMENT SERVICES WITH CSG
CONSULTANTS, INC, (CSG) TO PROVIDE PROFESSIONAL CODE
ENFORCEMENT STAFFING SERVICES TO FILL A VACANCY DURING THE
RECRUITMENT PROCESS
(Term of Agreement: up to I year, with a total budget amount not to exceed
$70,000)
WHEREAS, the City of San Rafael has determined that interim code enforcement
services are needed to provide support to the Code Enforcement Division of the Community
Development Department during recruitment for recently vacated Code Enforcement Officer I
position within the Division; and
WHEREAS, at the City's request, CSG Consultant, Inc. (Consultant) has submitted a
Proposal Supplement -- On Call Code Enforcement .Services, dated Jzcly 29, 2013,
including a list of anticipated activities/tasks and the hourly rate for performance of these
services, and said proposal is attached to the Agreement for Professional Services; and
WHEREAS, the costs associated with the Consultant's interim professional Code
Enforcement services would be paid for from the salary savings from vacant position within the
Code Enforcement Division.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of San
Rafael does hereby authorize the City Manager to execute, on behalf of the City, an Agreement
for Professional Code Enforcement Services with CSG Consultants, Inc. in the form attached
herewith.
1, Esther C. Beirne, Clerk of the City of San Rafael, hereby certify that the foregoing Resolution
was duly and regularly introduced and adopted at a regular meeting of the City Council of the
City of San Rafael, held on Monday, the 19th of August, 2013, by the following vote, to wit:
AWES: Councilmembers: Colin, Connolly, Heller, McCullough & Mayor Phillips
NOES: C'ounciImembers: None
ABSENT: Councilmembers: None
Esther C. 13eirrte, City Clerk
Exhibit A Agreetnent for Code E.nforcernent Services for Professional Code Enforcement Staffing
SerN ices bete een City of San Rafael and CSG Consultants, Inc. with attached Proposal
Supplement - On Cull Code L)ifi.)rceinent :Services. dated.Jzt/y 9, 2013.
PROFESSIONAL SERVICES AGREEMENT/CONTRACT
COMPLETION CHECKLIST AND ROUTING SLIP
Below is the process for getting your professional services agreements/contracts finalized and
executed. Please attach this "Completion Checklist and Routing Slip" to the front of your
contract as you circulate it for review and signatures. Please use this form for all professional
services agreements/contracts (not just those requiring City Council approval).
This process should occur in the order presented below.
Step
Responsible
Description
Department
I
City Attorney
Review, revise, and comment on draft
agreement.
Contracting Department
Forward final agreement to contractor for
their signature. Obtain at least two signed
originals from contractor.
3
Contracting Department
Agendize contractor -signed agreement for
Council approval, if Council approval
necessary (as defined by City Attorney/City
Ordinance*).
4
City Attorney
Review and approve form of agreement
bonds, and insurance certificates and
endorsements.
5
City Manager Mayor /or
Agreement executed by Council authorized
Department Head
official.
6
City Clerk
City Clerk attests signatures, retains original
agreement and forwards copies to the
-------
contracting department—
'To be completed by Contracting Department:
I
Completion
Date
-V"O
,14"
Project Manager: Raffi Bolovan, Communitv Development Department`
Project Name: Code Enforcement Contract Services for Code Enforcement Staffitiv- of
Vacancy
Agendized for City Council Meeting of (if necessary): 8,119,13)
If you have questions on this process, please contact the City Attorney's Office at 485-3080.
* Council approval is required if contract is over $20,000 on a ciimulatii,e basis.
AGREEMENT FOR
PROFESSIONAL CODE ENFORCEMENT STAFFING SERVICES
This Agreement is made and entered into this 19fl' day of August, 2013 by and between the
CITY OF SAN RAFAEI. (hereinafter "CITY"), and CSG Consultants, Inc. (hereinafter
"CONTRACTOR').
RECITALS
WHEREAS, due to a vacancy in the Code Enforcement Division and given the current
workload of staff and the pace of code enforcement complaints, the CITY has determined that
professional code enforcement services are needed to supplement existing staffing during the
timeframe necessary to complete recruitments for a vacant position within the Code Enforcement
Division.
AGREEMENT
NOW, THEREFORE, the parties hereby agree as follows:
1. PROJECT COORDINATION.
A. CITY. The City Manager shall be the representative of the CITY for all purposes
under this Agreement. The Planning Manager is hereby designated the PROJECT MANAGER for
the CITY, and said PROJECT MANAGER shall supervise all aspects of the progress and execution
of this Agreement.
B. CONTRACTOR. CONTRACTOR shall assign a single PROJECT DIRECTOR
to have overall responsibility for the progress and execution of this Agreement for
CONTRACTOR. Robert Cushing is hereby designated as the PROJECT DIRECTOR for
CONTRACTOR. Should circumstances or conditions subsequent to the execution of this
Agreement require a substitute PROJECT DIRECTOR for any reason, the PROJECTDIRECTOR
designee shall be subject to the prior written approval of the PROJECT MANAGER,
2. DUTIES OF CONTRACTOR.
CONTRACTOR shall perform the duties andior provide services as described in Exhibit
"A" attached hereto and incorporated herein as well as other duties as assigned by Project Manager
necessary to provide professional code enforcement services to the CITY.
It is expected that CONTRACTOR will provide one consistent code enforcement officer to
serve for the duration of the time needed for an average of 15-20 hours a week. '4Uork in excess of a
total of 20 hours a week shall require prior authorization of the Project Manager;
Version "-15-11
I
3. DUTIES OF CITY.
CITY shall pay the compensation as provided in Paragraph 4, and perform the duties as
follows:
a) Provide work space for CONTRACTOR, b) provide general direction and support to
CONTRACTOR; c) provide legal assistance to develop administrative enforcement cases;
and d) provide Police Department escort or backup if needed and necessary.
4. COMPENSATION.
For the full performance of the services described herein by CONTRACTOR, CITY shall
pay CONTRACTOR for the hours of work at the hourly rates, and for the authorized expenses, as
specified in Exhibit "A", in a total amount not to exceed $140,000.
Payment will be made monthly upon receipt by PROJECT MANAGER of itemized
invoices submitted by CONTRACTOR.
5. TERM OF AGREEMENT.
The term of this Agreement shall be for 1 year, commencing on September 1, 2013 and
ending on August 30, 2014. Upon mutual agreement of the parties, and subject to the approval of
the City Manager, the term of this Agreement may be extended for an additional period of 1 year, if
the total budget authorized by this agreement has not been exceeded and the City decides to
continue using contract services to fill the vacancy.
6. TERMINATION.
A. Discretionary. Either party may terminate this Agreement without cause upon
thirty (30) days written notice mailed or personally delivered to the other party.
B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days
written notice mailed or personally delivered to the other party, and the notified party's failure to
cure or correct the cause of the termination, to the reasonable satisfaction of the party, giving such
notice, within such fifteen (15) day time period.
C. Effect of Termination. Upon receipt of notice of termination, neither party shall
incur additional obligations under any provision of this Agreement without the prior written consent
of the other.
D. Return of Documents. Upon termination, any and all CITY documents or
materials provided to CONTRACTOR and any and all of CONTRACTOR's documents and
materials prepared for or relating to the performance of its duties under this Agreement. shall be
delivered to CITY as soon as possible, but not later than thirty (30) days after termination.
7.OT;I;:RSIIIP OF I)OC't;MENTS.
The written documents and materials prepared by the CONTRACTOR in connection with
the performance of its duties under this Agreement, shall be the sole property of CITY. CITY may
use said property for any purpose, including projects not contemplated by this Agreement.
8. INSPECTION AND AUDIT.
Upon reasonable notice, CONTRACTOR shall make available to CITY, or its agent, for
inspection and audit, all documents and materials maintained by CONTRACTOR in connection
with its performance of its duties under this Agreement. CONTRACTOR shall fully cooperate
with CITY or its agent in any such audit or inspection.
9. ASSIGNABILITY.
The parties agree that they shall not assign or transfer any interest in this Agreement nor the
performance of any of their respective obligations hereunder, without the prior written consent of
the other party, and any attempt to so assign this Agreement or any rights, duties or obligations
arising hereunder shall be void and of no effect.
10. INSURANCE.
A. During the term of this Agreement, CONTRACTOR shall maintain, at no expense
to CITY, the following insurance policies:
1. A commercial general liability insurance policy in the minimum amount of
one million ($1,000,000) dollars per occurrence for death, bodily injury, personal injury, or property
damage.
2. An automobile liability insurance policy, for owned, non -owned, and hired
vehicles, in the minimum amount of one million ($1,000,000) dollars per occurrence.
3. If any licensed professional performs any of the services required to be
performed under this Agreement, a professional liability insurance policy in the minimum amount
of one million $1,000,000) dollars to cover any claims arising out of the CONTRACTOR's
performance of services under this Agreement.
B. The insurance coverage required of the CONTRACTOR in Subparagraph A above,
shall also meet the following requirements:
I. Except for professional liability insurance, the insurance policies shall be
endorsed for contractual liability and personal injury.
2. Except for professional liability insurance. the insurance policies shall
provide in their text or shall be specifically endorsed to name the CITY, its officers, agents,
employees, and volunteers, as additionally named insureds under the policies, and to provide that
the insurance shall be primary with respect to any insurance or coverage maintained by CITY and
shall not call upon CITY's insurance or coverage for any contribution.
I
3. CONTRACTOR shall provide to City's Project Manager, (a) Certificates of
Insurance evidencing the insurance coverage required herein, and (b) text from the insurance
policies or the endorsements as specified in Subparagraph B(2).
4. The insurance policies shall provide that the insurance carrier shall not
cancel, terminate or otherwise modify the terms and conditions of said insurance policies except
upon ten (10) days written notice to City's Project Manager.
5. If the insurance is written on a Claims Made Form, then, following
termination of this Agreement, said insurance coverage shall survive for a period of not less than
five years.
6. The insurance policies shall provide for a retroactive date of placement
coinciding with the effective date of this Agreement.
7. The insurance shall be approved as to form and sufficiency by PROJECT
MANAGER and the City Attorney.
C. If it employs any person, CONTRACTOR shall maintain worker's compensation
and employer's liability insurance, as required by the State Labor Code and other applicable laws
and regulations, and as necessary to protect both CONTRACTOR and CITY against all liability
for injuries to CONTRACTOR's officers and employees.
D. Any deductibles or self-insured retentions in CONTRACTOR's insurance policies
must be declared to and approved by the City's Risk Manager and the City Attorney. At CITY's
option, the deductibles or self-insured retentions with respect to CITY shall be reduced or
eliminated to CITY's satisfaction, or CONTRACTOR shall procure a bond guaranteeing payment
of losses and related investigations, claims administration, attorney's fees and defense expenses.
11. INDEMNIFICATION.
A. Except as provided in Subparagraph B., CONTRACTOR shall indemnify,
release, defend and hold harmless CITY, its officers, and employees, against any claim, demand,
suit, judgment, loss, liability or expense of any kind, including attorney's fees, arising out of or
resulting in any way, in whole or in part, from any acts or omissions, intentional or negligent, of
CONTRACTOR or CONTRACTOR's officers, agents and employees in the performance of'
their duties and obligations under this Agreement.
B. Where the services to be provided by CONTRACTOR under this Agreement are
design professional services to be performed by a design professional as that term is defined
under Civil Code Section 2782.8, CONTRACTOR shall, to the fullest extent permitted by law,
indemnify, release, defend and hold harmless CITY, its officers. and employees. against any
claim, demand, suit, judgment, loss, liability or expense of any kind, including attorney's fees,
that arises out of, pertains to, or relates to the negligence, recklessness, or Nvillful misconduct of
CONTRACTOR in the: performance of its duties and obligations under this Agreement.
12. NONDISCRIMINATION.
CONTRACTOR shall not discriminate, in any way, against any person on the basis of age,
sex, race, color, religion, ancestry, national origin or disability in connection with or related to the
performance of its duties and obligations under this Agreement.
13. COMPLIANCE WITH ALL LAWS.
CONTRACTOR shall observe and comply with all applicable federal, state and local laws,
ordinances, codes and regulations, in the performance of its duties and obligations under this
Agreement. CONTRACTOR shall perform all services under this Agreement in accordance with
these laws, ordinances, codes and regulations. CONTRACTOR shall release, defend, indemnify
and hold harmless CITY, its officers, agents and employees from any and all damages, liabilities,
penalties, fines and all other consequences from any noncompliance or violation of any laws,
ordinances, codes or regulations.
14. NO THIRD PARTY BENEFICIARIES.
CITY and CONTRACTOR do not intend, by any provision of this Agreement, to create in
any third party, any benefit or right owed by one party, under the terms and conditions of this
Agreement, to the other party.
15. NOTICES.
All notices and other communications required or permitted to be given under this
Agreement, including any notice of change of address, shall be in writing and given by personal
delivery, or deposited with the United States Postal Service, postage prepaid, addressed to the
parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or
if mailed, upon the date of deposit with the United States Postal Service. Notice shall be given as
follows:
TO CITY: Raffi Boloyan, Project Manager
Community Development Department
City of San Rafael
1400 Fifth Ave. (P,O. Box 151560)
San Rafael, CA 94915-1560
TO CONTRACTOR: Robert Cushing, ("ode Enforcement Manager
(Project Director)
CSG Consultants. Inc
1700 South A1nphlett Blvd, 3r" Floor
San Mateo, CA 04402
16. INDEPENDENT CONTRACTOR.
For the purposes, and for the duration, of this Agreement, CONTRACTOR, its officers,
agents and employees shall act in the capacity of an Independent Contractor, and not as employees
of the CITY. CONTRACTOR and CITY expressly intend and agree that the status of
CONTRACTOR, its officers, agents and employees be that of an Independent Contractor and not
that of an employee of CITY.
17. ENTIRE AGREEMENT -- AMENDMENTS.
A. The terms and conditions of this Agreement, all exhibits attached, and all documents
expressly incorporated by reference, represent the entire Agreement of the parties with respect to the
subject matter of this Agreement.
B. This written Agreement shall supersede any and all prior agreements, oral or written,
regarding the subject matter between the CONTRACTOR and the CITY.
C. No other agreement, promise or statement, written or oral, relating to the subject
matter of this Agreement, shall be valid or binding, except by way of a written amendment to this
Agreement.
D. The terms and conditions of this Agreement shall not be altered or modified except
by a written amendment to this Agreement signed by the CONTRACTOR and the CITY.
E. If any conflicts arise between the terms and conditions of this Agreement, and the
terms and conditions of the attached exhibits or the documents expressly incorporated by reference,
the terms and conditions of this Agreement shall control.
18. SET-OFF AGAINST DEBTS.
CONTRACTOR agrees that CITY may deduct from any payment due to
CONTRACTOR under this Agreement, any monies which CONTRACTOR owes CITY under
any ordinance, agreement, contract or resolution for any unpaid taxes, fees, licenses, assessments,
unpaid checks or other amounts.
19. WAIVERS.
The waiver by either party of any breach or violation of any term. covenant or condition of
this Agreement. or of any ordinance, law or regulation, shall not be deemed to be a Nkaiver of any
other term, covenant, condition, ordinance. law or regulation. or of any subsequent breach or
violation of the sante or other term, covenant, condition, ordinance, law or regulation. The
subsequent acceptance by either party of any fee, performance. or other consideration which may
become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding
breach or violation by the other party of any ten -n. condition, covenant of this Agreement or any
applicable law, ordinance or regulation.
M
24. COSTS AND ATTORNEY'S FEES.
The prevailing party in any action brought to enforce the terms and conditions of this
Agreement, or arising out of the perfonnance of this Agreement, may recover its reasonable costs
(including claims administration) and attorney's fees expended in connection with such action.
21. CITY BUSINESS LICENSE % OTHER TAXES.
CONTRACTOR shall obtain and maintain during the duration of this Agreement, a CITY
business license as required by the San Rafael Municipal Code. CONTRACTOR shall pay any
and all state and federal taxes and any other applicable taxes. CITY shall not be required to pay for
any work performed under this Agreement, until CONTRACTOR has provided CITY with a
completed Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and
Certification).
22, APPLICABLE LAW.
The laws of the State of California shall govern this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month
and year first above written.
CITY OF SAN RAFAEL
NANCY MACKLE. City`':Manager
ATTEST:
ESTHER C. BEIRNE, City Clerk -
APPROVED AS TO FORkI:
-3
ROBERT F. EPSTEi City 'A -ttorney
CONTRACTOR
By: A:rc
Name:.._. `i
Title:
Exhibit A: Proposal Supplement - On Call Code Enforcement Services. July 29, 2013
July 29, 2013
City of San Rafael
1400 Fifth Avenue
P.0 Box 151560
San Rafael, CA 94915-1560
Attn: Mr. Raffi Boloyan, Planning Manager
Re: Proposal Supplement — On -Call Code Enforcement Services
At the City's request and as a supplement to our services and fee schedule described in our July 19, 2013
proposal for massage ordinance enforcement, CSG proposes to provide an additional Code Enforcement
Officer for general code enforcement duties throughout the City of San Rafael, or in specific program or
geographic areas as assigned by the city, for up to five days per week for up to one year. CSG also agrees
to extend the contact for this additional officer on a year -by -year basis. The rate for this additional
officer will be $85 per hour. Upon approval, CSG will meet with City staff to review qualifications for
Code Enforcement Officers from our employee pool to ensure that the City is provided with a journey
level officer with the skills necessary to perform the work in San Rafael. This letter also serves to amend
an erroneous date on CSG's original proposal cover letter which indicates July 19, 2012 rather than July
19, 2013. Please accept our apologies for any confusion this may have caused.
CSG is pleased to provide this proposal for an additional staffing resource, and looks forward to
extending our code enforcement services to the City.
Sincerely,
Cyrus Kianpour, P.E., P.L.S.
President, CSG Consultants, Inc.
1'00 Suuth Amph4,.It Bou'evard 3' F€t or; ti,ar "43ee o, A 144432
Phone: 659 522-250f), Fax: 2599
,� �F, ia�r.co,*t; CJs r r:a at .v:vw rs€;wPb itP.Ct;n;
P, 1,0112;100,
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attech ACORD 101, Additional Remarks Schadule, If mors space Is required)
All operations of the Named Insured.
Certificate Holder, its agents, employees & 'volunteers are Additional Insured per attached endorsement.
CERTIFICATE HOLDER
Community development Department
City of San Rafael
1400 5th Avenue
San Ratae.L, CA 94915-:.560
I
ACORD 25 (2010/05)
jabezean
35088926
USA
CANCELLATION
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
+.9s 1588-2010 ACORD CORPORATION. All rights reserved.
rhe ACORD name and logo are registered marks of ACORD
AcoKv CERTIFICATE OF LIABILITY
INSURANCE I
DATE (MMIDDNYYY)
08/05/2013
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 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 0726293 1-415-546-9300
CONTACT Don Tarantino
NAME!
Arthur J. Gallagher & Co.
PHONE - -- ---- ----- - � - - - -- -- -- lFAx ------ -- - -- - -- -- -` ---
F�t1 415-536-8617 iAIC No ): 415-536-8627
��.
Insurance Brokers of California, Inc., License #0726293
One Market Plaza, Spear Tower
EMAIL o
ADDRESS: don-tarantino@ajg.Com
L
Suite 200
---- -- -- -- ---- -- — - - - -- - -
San Francisco, CA 94105
- ____ ____-_. INSURERj5IAFFORDING COVERAGE_ _ NAIC-#
INSURER A: TRAVELERS PROP CAS CO OF AMER 25674
INSURED
INSURERS : TWIN CITY FIRS INS CO CO 29459
CSG Consultants Inc.
------------- - - ---- --- ----- -- - - -
INSURER C._ARCH INS CO 11150
Precision Inspection - CSG
- — -
1700 S. Amphlett Blvd 3rd Floor
INSURERD:
San Mateo, CA 94402
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 35088926
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.
1NSR - - - ADDL SuaR - -- - - --- - --- - --
LTR TYPE OF INSURANCE 1n I POLICY NUMBER
POLICY EFF PEXP _-- ---- ---- -------------------_.---
IMM/ODIYYYYI OL
LIMITS
A
GENERAL LIABILITY X 680294HOSSO-TIL-12
12/04/12 12/04/13 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL. LIABILITY
DAMAGE TO RENTED "000'000
-PREMISES occurrenceL__ $__ _ _
- ] CLAIMS -MADE l XJ OCCUR
MED EXP (Arty une Person) $ 10,000
PERSONAL & ADV INJURY $ 1, 000,000
_
GENERALAGGREGATE $2, 000, 000
E LIMI I APPLIES PER.
GEN'L AGGREGATE
PRODUCTS - COMP/OP AGO $ 2, 000, 000
_
PRO- X I
POLICY LOC
I _ ---- --_-- --_-- . -$ --- -- --- ---
A
I
AUTOMOBILE LIABILITY
X
BA -461M7612-12
12/04/12 12/04/13 COMBINEDSINGLELIMIT
LEa accklentj $ 1, 000, 000_
X ANY AUTO
i
BODILY INJURY (Per person) $
_ _
I ALL OWNED SCHEDULED
AU10S _
I
BODILY -------------
BODILY INJURY (Per accident) $
XX i
HIRED AUTOS I_--�AUTOS
NON OWNED
!
PROPERTY DAMAGE $
_Ler eeuderd-------------____----__-----
$
A X UMBRELLALIAB X;
OCCUR
! COP294M1060-12
12/04/12 12/04/13 EACHOCCURRENCE $ 5,000,000
EXCESS LIAB
------
CLAIMS MADE'
i
AGGREGATE
r--lowing--------I
$ 5 000, 000
--- -----------
I UN$
� i
I
iFollowing Form
f$
WOIDERSICOMPENSATlO
B N I ; X 157WEEP4360-01
1 12/04/12 12/04/13
X WCSTl�li 1 iOEi.
,
AND EMPLOYERS'LIABILITY
ANY PROPRIE IORIPAR INE R/EXLCUTIVE YIN!
I
I__--,_IS�iY
( E EACH
.�
1, 000, 000
OFFICERVEMSER EXCLUDED? N i A
j {
(Mandatory In NH) L7E.L.I
L ACCIDENT"
I E t DISEASE EA EMPLOYE
$
-"- -- -" -
$- 1, 000, 000
It yes describe under F
�- --- -------- -- -
1, 000, 000
DESCRIPTION OF OPERATIONS hebw
E L DISEASE POLICY LIMIT
$
C !Prof Liability j AEP 004731501
4 12/04/14 12/04/13ILimitt 3Mil/3Mi
;Retention 50,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attech ACORD 101, Additional Remarks Schadule, If mors space Is required)
All operations of the Named Insured.
Certificate Holder, its agents, employees & 'volunteers are Additional Insured per attached endorsement.
CERTIFICATE HOLDER
Community development Department
City of San Rafael
1400 5th Avenue
San Ratae.L, CA 94915-:.560
I
ACORD 25 (2010/05)
jabezean
35088926
USA
CANCELLATION
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
+.9s 1588-2010 ACORD CORPORATION. All rights reserved.
rhe ACORD name and logo are registered marks of ACORD
rr.
u
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 680-294MO850-TIL-12 ISSUE DATE: 10-25-12
f}
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
(ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
NAME OF PERSON(S) OR ORGANIZATION(S):
PER SCHEDULE ON FILE WITH AGENT
EM
PROJECT/LOCATION OF COVERED OPERATIONS:
PROVISIONS
A. The following is added to WHO IS AN INSURED
(Section II):
The person or organization shown in the Sched-
ule above is an additional insured on this Cover-
age Part, but only with respect to liability for "bod-
ily injury", "property damage" or "personal injury"
caused, in whole or in part, by your acts or omis-
sions or the acts or omissions of those acting on
your behalf:
a. In the performance of your ongoing opera-
tions;
b. In connection with premises owned by or
rented to you; or
c. In connection with "your work" and included
within the "products -completed operations
hazard".
Such person or organization does not qualify as
an additional insured for "bodily injury' "property
damage" or "personal injury" for which that per-
son or organization has assumed liability in a con-
tract or agreement.
The insurance provided to such additional insured
is limited as follows:
d. This insurance does not apply to the render-
ing of or failure to render any "professional
services".
e. The limits of insurance afforded to the addi-
tional insured shall be the limits which you
agreed in that "contract or agreement requir-
ing insurance" to provide for that additional
insured, or the limits shown in the Declara-
tions for this Coverage Part, whichever are
less. i'his endorsement does not increase the
limits of insurance stated in the LIMITS OF
INSURANCE (Section III) for this Coverage
Part
B. The following is added to Paragraph a. of 4.
Other insurance in COMMERCIAL GENERAL
LIABILITY CONDITIONS (Section IV):
However, J you specifically agree in a "contract or
agreement requiring insurance" that, for the addi-
tional insured shown in the Schedule, the insur-
ance provided to that additional insured under this
CG 03 82 09 07 kD 200' The rtavecers C.ocnaries, tr,r Page I of 2
Includes the copyrighted material ;.if Insurance Services i;ffice, Inc-, with its permission
1"?"A.118002
COMMERCIAL GENERAL LIABILITY
Coverage Part must apply on a primary basis, or
a primary and non-contributory basis, this insur-
ance is primary to other insurance that is avail-
able to such additional insured which covers such
additional insured as a named insured, and we
will not share with the other insurance, provided
that:
(1) The "bodily injury" or "property damage" for
which coverage is sought occurs; and
(2) The "personal injury" for which coverage is
sought arises out of an offense committed;
after you have entered into that "contract or
agreement requiring insurance" for such addi-
tional insured. But this insurance still is excess
over valid and collectible other insurance,
whether primary, excess, contingent or on any
other basis, that is available to the additional in-
sured when the additional insured is also an addi-
tional insured under any other insurance.
C. The following is added to Paragraph 8. Transfer
Of Rights Of Recovery Against Others To Us
in COMMERCIAL GENERAL LIABILITY CON-
IXTIONS (Section IV):
We waive any rights of recovery we may have
against the additional insured shown in the
Schedule above because of payments we make
for "bodily injury", "property damage" or "personal
Page 2 of 2
injury" arising out of "your work" on or for the pro-
ject, or at the location, shown in the Schedule
above, performed by you, or on your behalf, un-
der a "contract or agreement requiring insurance"
with that additional insured. We waive these
rights only where you have agreed to do so as
part of the "contract or agreement requiring insur-
ance" with that additional insured entered into by
you before, and in effect when, the "bodily injury"
or "property damage" occurs, or the "personal in-
jury" offense is committed.
D. The following definition is added to DEFINITIONS
(Section V):
"Contract or agreement requiring insurance"
means that part of any contract or agreement un-
der which you are required to include the person
or organization shown in the Schedule as an ad-
ditional insured on this Coverage Part, provided
that the "bodily injury" and "property damage" oc-
curs, and the "personal injury" is caused by an of-
fense committed:
a. After you have entered into that contract or
agreement;
b. While that part of the contract or agreement is
in effect; and
c. Before the end of the policy period.
(41 ;;0; P*he I ravelets Ccr»par;es, Inc. CG 03 82 05 07
%noudes the copyrighted irateriai of Insurance Services t tftce Inc , Faith its Gzrr:issron
L-A
P32,WWh1W
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
OTHER INSURANCE - ADDITIONAL INSUREDS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROVISIONS
COMMERCIAL GENERAL LIABILITY CONDITIONS
(Section IV), ParaUtaph 4. (Citiver lmurarnce), Its
amended as follows:
1. The following Is added to Paragraph a. Primary
Insurance:
However, If you specifically agree In & written con-
Iract or written agreement that the insurance pro-
vided to an additional Insured under this
Coverage Part must apply on a primary basis, or
a pilmary and non-contrIbutory basis, this Insur-
anco Is primary to other insurance Iftat Is avall-
able to such additional Insured which covers such
additional Insured as a named Insured, and we
will not share with that other Insurance, provided
that:
a. The "bodfly Injury" or "property damage" for
which coverage Is sought occurs; rind
-G 00 3704 05 St P-,JcA
b, The "personal Injury" or "advertising Injury* for
which coverage Is Wight arises out of an of•
fensu committed
aubsequent to the signing and execution of that
contract or agruernunt by you,
2. Tho first Ciubparaqriph (2) of Paragraph b. Ex-
cass Insurance regarding any other primary in-
sutrance available to you In delated.
3. The toltowing Is added to Paragraph h. Excoen
Insurance, as an addIllonal subparagraph tinder
Subparagraph (1):
That is available to the Insured when the Insured
Is added as an additional Insured under any other
policy, Including any umbrella or excess policy,
P
0
ri
0
0
u>
rt
.r
a
w
r�
in
N
0
0
Ln
ri
49
ash
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WORKERS'COMPENSATION BROAD! -ENDORSEMENT
EXTENDED i i
P licy Number: 57 WE EP4360 Endorsement Number:
Effectiv Date: 12/04/12 Effective hour is the same as stated on the Information Page of the policy.
Nam d Insured and Address: CSG CONSULTANTS INC
1700 S AMPHLETT BLVD 3RD FL
SAN MATEO, CA 94402
Section I of this endorsement expands coverage provided under WC 00 00 00.
Section 11 of this endorsement provides additional coverage usually only provided by endorsement.
Section III of this endorsement is a Schedule of Covered States.
You may use the index to locate these coverage features quickly:
SECTION 1
PARTS ONE and TWO
01 We Will Also Pay
PART -THREE
02 How This insurance Works
PART - SIX
03 Transfer of Your Rights and Duties
04 Liberalization
SECTION 0
VOLUNTARY COMPENSATION INSURANCE
05 Voluntary Compensation Insurance
A. How This Insurance Applies
B. We Will Pay
C. Exclusions
D. Before We Pay
E. Recovery From Others
F, Employers' Liability Insurance
EMPLOYERS'LIABILITY STOP GAP
ENDORSEMENT
06 Employers' Llablilty Stop Gap
Coverage
A. Stop trap Coverage Limited to
Montana, North Dakota, Ohio,
Washington, West Virginia and
Wyoming
Form WC Iii 03 03 8 Printed in U.S.A. (Ed. 8100)
Pr+oce"Dat : 10/09/12
2000, The Hartford
Paye 1 of 6
Policy E*rstton Date: 12/04/13
0
PAM
SUBJ
PAM
2
B. Part One Does Not Apply
3
2
C. Application of Coverage
3
2
D. Additional Exclusions
3
2
E. West Virginia
3
2
EXTENDED OPTIONS
4
2
01
Employers' LiablIity Insurance
4
2
02
Unintentional Failure to Disclose
4
2
Hazards
2
03
Waiver of Our Right to Recover from
4
2
Others
04
Foreign Voluntary Compensation
4
2
A. How This Reimbursement Applies
4
2
B. We Will Reimburse
4
3
C. Exclusions
4
3
D. Before We Pay
5
3
E. Recovery From Others
5
3
F. Reimbursement For Actual Loss
5
3
Sustained
3
G. Repatriation
5
H. Endemic Disease
5
3
05
Longshore and Harbor Workers'
5
Compensation Act Coverage
3
Endorsement
SECTION 10
6
01
Schedule of Covered States
6
2000, The Hartford
Paye 1 of 6
Policy E*rstton Date: 12/04/13
0
p.. �nno�son,
SECTION I
PARTS ONE and TWO
1. WE WILL ALSO PAY
D. W WIN Also Pay of Part One (WORKERS'
COMPENSATION INSURANCE); and
E. We Will Also Pay of Peat Two (EMPLOYERS'
LIABILITY INSURANCE) is replaced by the
following:
We Will Also Pay
We will also pay these costs, in addition to
other amounts payable under this insurance,
as part of any claim, proceeding, or suit we
defend:
1. reasonable expenses incurred at our
request, INCLUDING loss of earnings;
2. premiums for bonds to release
attachments and for appeal bonds In bond
amounts up to the limit of our liability
under this Insurance;
3. litigation costs taxed against you;
4. Interest on a judgment as required by law
until we offer the amount due under this
law; and
5. expenses we incur.
PARTTHREE
2. Now This Insurance Applies
Paragraph 4. of A. How This Insurant Appli s
of Part 3 (Other States Insurance) Is replaced by
the following:
4. If you have work on the effective date of this
policy in any state not listed in Item 3.A. of the
Information Page, coverage will not be
afforded for that state unless we are notified
within sixty days.
PART SIX
3. Transfer Of Your Rights and Duties
C. Transfer Of Your Rights and Duties of Part 6
(Conditions) Is replaced by the following:
Your rights or duties under this policy may not
be transferred without our written consent.
ff you die and we receive notice within sixty
days after your death, we will cover your legal
representative as insured.
4. LlMralizaflon
It we adopt a change in this form that would
broaden the coverage of this form without extra
charge, the broader coverage will apply to this
policy, it will apply when the change becomes
effective in your state.
SECTION 11
VOLUNTARY COMPENSATION AND EMPLOYERS'
LIABILITY COVERAGE
S. Voluntary Compensation Insurance
A. H w This Insurance Applies
This insurance applies to bodily injury by
accident or bodily injury by disease. Bodily
Injury Includes resulting death.
1. The bodily Injury must be sustained by any
officer or employee not subject to the
workers' compensation law of any state
shown In Item 3.A. of the Information
Page,
2. The bodily injury must arise out of and in
the course of employment or Incidental to
work In a state shown in Item 3.A. of the
Information Page.
Form WC 99 03 93 B Printed in U.S.A. (Ed. 91t1U)
3. The bodily Injury must occur in the United
States of America, its territories or
possessions, or Canada, and may occur
elsewhere H the employee Is a United
States or Canadian citizen, or otherwise
legal resident, and legally employed, in the
United States or Canada and temporarily
away from those places.
4. Bodily injury by accident must occur
during the policy period.
5. Bodily injury by disease' must be caused
or aggravated by the conditions of the
Page 2 t$
officer's or employee's employment. The
officer's or employee's last day of last
exposure to the conditions causing or
aggravating such bodily injury by disease
Form WC 99 03 03 8 Printed In ti.S.A (Ed. 8100)
If the persons entitled to the benefits of this
Insurance make a recovery from others, they
must reimburse us for the benefits we paid
them.
F. Employers' Liability Insurance
Part Two (Employers' Liability Insurance)
applies to bodily Injury covered by this
endorsement as though the State of
Employment was shown in Item 3.A. of the
Information Page.
This provision 5. does not apply in New Jersey or
Wisconsin.
EMPLOYERS' LIABILI7Y STOP CTAP COVERAGE
6. Employers' Liability Stop Gap Coverag
A. This coverage only applies In Montana, North
Dakota, Ohio, Washington, West Virginia and
Wyoming.
B. Part One (Workers' Compensation Insurance)
does not apply to work in states shown in
Paragraph A above.
C. Part Two (Employers' Liability Insurance)
applies In the states, shown in Paragraph A.,
as though they were shown in Item 3.A. of the
Information Page.
D. Part Two, Section C. Exclusions is changed
by adding these exclusions.
This insurance does not covor,
5. bodily injury intentionally caused or
aggravated by you or in Ohio bodily injury
resulting from an act which is determined
by an Ohio court of law to have been
committed by you with the belief than an
Injury is substantially certain to occur.
However, the cost of defending such
claims or suits in Ohio is covered.
13. bodily Injury sustained by any member of
the flying crew of any aircraft.
14. any claim for bodily injury with respect to
which you are deprived of any defense or
defenses or are otherwise subject to
penalty because of default In premium
under the provisions of the workers'
compensation law or laws of a state
shown in Paragraph A-
E. This Insurance appites to damages for which
you are liable under West Virginia Code Annot.
$23-4-2,
Page 8 of 6
must occur during the policy period.
B. W Wig Pay
We will pay an amount equal to the benefits
that would be required of you as If you and
your employees were subject to the workers'
compensation law of any state shown in Item
3A, of the Information Page. We will pay
UD
11
those amounts to the persons who would be
M
entitled to them under the law.
0
C. Exclusion
�+
This insurance does not cover:
0
a
1. any obligation imposed by workers'
compensation or occupational disease law
or any similar law.
w
2. bodily Injury Intentionally caused or
aggravated by you.
ry
0
3. officers or employees who have elected
in
not to be subject to the state workers'
+�
compensation law.
4. partners or sole proprietors not covered
!
under the Standard Sole Proprietors,
Partners, Officers and Others Coverage
Endorsement.
D. Before We Pay
gam.
Before we pay benefits to the persons entitled
'®
to them, they must:
--
1. Release you and us, in writing, of all
responsibility for the Injury or death.
2. Transfer to us their right to recover from
t�
others who may be responsible for the
i�
Injury or death.
3. Cooperate with us and do everything
necessary to enable us to enforce the right
to recover from others.
mom
If the persons entitled to the benefits of this
X=
insurance fall to do those things, our duty to
pay ends at once. If they claim damages from
you or from us for the injury or death, our duty
to pay ends at once.
E. Recovery From O#ws
It we make a recovery from others, we will
mama
keep an amount equal to our expenses of
=1
recovery and the benefits we paid. We will
;tom
pay the balance to the parsons entitled to It.
Form WC 99 03 03 8 Printed In ti.S.A (Ed. 8100)
If the persons entitled to the benefits of this
Insurance make a recovery from others, they
must reimburse us for the benefits we paid
them.
F. Employers' Liability Insurance
Part Two (Employers' Liability Insurance)
applies to bodily Injury covered by this
endorsement as though the State of
Employment was shown in Item 3.A. of the
Information Page.
This provision 5. does not apply in New Jersey or
Wisconsin.
EMPLOYERS' LIABILI7Y STOP CTAP COVERAGE
6. Employers' Liability Stop Gap Coverag
A. This coverage only applies In Montana, North
Dakota, Ohio, Washington, West Virginia and
Wyoming.
B. Part One (Workers' Compensation Insurance)
does not apply to work in states shown in
Paragraph A above.
C. Part Two (Employers' Liability Insurance)
applies In the states, shown in Paragraph A.,
as though they were shown in Item 3.A. of the
Information Page.
D. Part Two, Section C. Exclusions is changed
by adding these exclusions.
This insurance does not covor,
5. bodily injury intentionally caused or
aggravated by you or in Ohio bodily injury
resulting from an act which is determined
by an Ohio court of law to have been
committed by you with the belief than an
Injury is substantially certain to occur.
However, the cost of defending such
claims or suits in Ohio is covered.
13. bodily Injury sustained by any member of
the flying crew of any aircraft.
14. any claim for bodily injury with respect to
which you are deprived of any defense or
defenses or are otherwise subject to
penalty because of default In premium
under the provisions of the workers'
compensation law or laws of a state
shown in Paragraph A-
E. This Insurance appites to damages for which
you are liable under West Virginia Code Annot.
$23-4-2,
Page 8 of 6
i,.aaw�sarz
EXTENDED OPTIONS
1. Empf yers' Liability insurance 4.
Item 3.8. of the information Paye is replaced by
the following:
B. Employers' Liability Insurance:
1. Part Two of the policy applies to work in
each state listed in Item 3.A.
The Limits of Liability under Part Two are
the higher of:
Bodily Injury
by Accident $500,000 Each Accident
Bodily Injury
by Disease $600,000 Polley Limit
Bodily Injury
by Disease $500,000 Each Employee
OR
2. The amount shown in the Information
Page.
This provision 1 of EXTENDED OPTIONS does not
apply In New York because the Limits Of Our
Llability are unlimited.
In this provision the limits are changed from
$5011,000 to $1,000,000 In Califomis.
2. UnInt ntlonal Failure to Disclose Hazards
If you unintentionally should fail to disclose all
existing hazards at the inception date of your
policy, we shall not deny coverage under this
policy because of such failure.
3. Waiver of Our Right To Recover From Others
A. 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
any person or organization for whom you
perform work under a written contract that
requires you to obtain this agreement from us.
This agreement shall not operate directly or
Indirectly to benefit anyone not named In the
agreement.
B. This provision 3. does not apply in the states
of Pennsylvania and Utah.
Form WC 99 03 03 0 Printed In U.S.A. (Ed. 81Ci0)
Foreign Voluntary Compensation and
Employers' Liabiiity Reimbursement
A. Now This Reimbursement Applies
This reimbursement provision applies to bodily
injury by accident or bodily injury by disease.
Bodily injury includes resulting death.
1. The bodily Injury must be sustained by an
officer or employee.
2. The bodily injury must occur in the course
of employment necessary or Incidental to
work in a country not listed in Exclusion
C.1. of this provision.
3. Bodily Injury by accident must occur
during the policy period.
4. Bodily injury by disease must be caused
or aggravated by the conditions of your
employment. The officer or employee's
last exposure to those conditions of your
employment must occur during the policy
period.
B. We Will Reimburse
We will reimburse you for all amounts paid by
you whether such amounts are:
1. voluntary payments for the benefits that
would be required of you M you and your
officers or employees were subject to any
workers' compensation law of the state of
hire of the Individual employee.
2. sums to which Part Two (Employers'
Liability Insurance) would apply if the
Country of Employment were shown In
Item 3.A, of the Information Page.
C. Exclusions
This Insurance does not cover:
1. any occurrences in the United States,
Canada, and any country or jurisdiction
which is the subject of trade or economic
sanctions Imposed by the laws or
regulations of the United States of
America in effect as of the Inception date
of this policy,
2, any obligation Imposed by a workers'
compensation or occupational disease
law, or similar law.
3, bodily Injury intentionally caused or
aggravated by you.
Paye 4 of 6
4. liability for any consequence, whether
direct or Indirect, of war, Invasion, act of
Foreign enemy, hostilities (whether war be
declared or not), civil war, rebellion,
revolution, insurrection or military or
usurped power. No endorsement now or
subsequently attached to this policy shall
be construed as overriding or waiving this
limitation unless specific reference is
made thereto.
of America necessarily Incurred as a direct
result of bodily Injury.
Our reimbursement shall be limited as follows:
i. to the amount by which such expenses
exceed the normal cost of returning the
officer or employee If in good health, or
2. In the event of death, to the amount by
which such expenses exceed the normal
cost of returning the officer or employee if
alive and in good health.
In no event shall our reimbursement exceed
the bodily Injury by accident limit shown In
{tem 3.8, of the Information Page as respects
any one such officer or employee whether
dead or alive.
H. Endemic Disease
The word "disease" Includes any endemic
diseases.
The coverage applies as It endemic diseases
were Included in the provisions of the workers'
compensation law.
S. Longshore and Harbor Workers' Compensati n
Act Coverage
General Section C. Workers' Con4 wnaatf n
Law is replaced by the following:
C. Workers' Compensation Law
Workers' Compensation Law means the
workers or workers" compensation law and
occupational disease law of each state or
territory named In Item 3.A of the Information
Page and the Longshore and Harbor Workers°
Compensation Act (33 USC Sections 9011-
950). ft Includes any amendments to those
laws that are in effect during the policy period.
ft does not Include any other federal workers
or workers' compensation law, other federal
occupational disease law or the provisions of
any law that provide nonoccupational disability
benefits.
Part Two (Employers' Liability Insurance), C.
Exclusions, exclusion 8, does not apply to
work subject to the Longshore and Harbor
Workers' Compensation Act.
This coverage does not apply to work subject
to the Defense Bass Act, the fluter
Continental Shelf Lands Act, or the
Nonappropria led Fund Instrumentalities Act.
Form WC 99 03 03 s Printed fn U.S.A. (Ed. &OO) P&O 6 1 8
D. setons We Pray
Before we reimburse you for the benefits to the
persons entitled to them, you must have them:
1. release you and us, In writing, of all
responsibility for the Injury or death,
0
2. transfer to us their right to recover from
others who may be responsible for their
Injury or death,
3. cooperate with us and do everything
necessary to enable us to enforce the right
N
to recover from others.
0
in
If the persons entitled to the benefits paid fail
If
to do these things, our duty to reimburse ends
at once. if they claim damages from us for the
Injury or death, our duty to reimburse ends at
amp
once.
E. Recovery From Othera
am
If we make a recovery from others, we will
am
keep an amount equal to our expenses of
Mft
recovery and the benefits we reimbursed. We
an
will pay the balance to the persons entitled to
�
ft. If persons entitled to the benefits make a
recovery from others, they must repay us for
�
the amounts that we have reimbursed you.
11115111
F. N Imbursement for Actual Loss Sustained
lift
This endorsement provides only for
reimbursement for the loss you actually
am
sustain. In order for you to recover loss or
expenses under this reimbursement you must:
1. actually sustain and pay the loss or
expense In money after trial, or
2. secure our consent for the payment of the
loss or expense.
OWN
Our reimbursement includes the additional
expenses of repatriation to the United States
Samr
M
of America necessarily Incurred as a direct
result of bodily Injury.
Our reimbursement shall be limited as follows:
i. to the amount by which such expenses
exceed the normal cost of returning the
officer or employee If in good health, or
2. In the event of death, to the amount by
which such expenses exceed the normal
cost of returning the officer or employee if
alive and in good health.
In no event shall our reimbursement exceed
the bodily Injury by accident limit shown In
{tem 3.8, of the Information Page as respects
any one such officer or employee whether
dead or alive.
H. Endemic Disease
The word "disease" Includes any endemic
diseases.
The coverage applies as It endemic diseases
were Included in the provisions of the workers'
compensation law.
S. Longshore and Harbor Workers' Compensati n
Act Coverage
General Section C. Workers' Con4 wnaatf n
Law is replaced by the following:
C. Workers' Compensation Law
Workers' Compensation Law means the
workers or workers" compensation law and
occupational disease law of each state or
territory named In Item 3.A of the Information
Page and the Longshore and Harbor Workers°
Compensation Act (33 USC Sections 9011-
950). ft Includes any amendments to those
laws that are in effect during the policy period.
ft does not Include any other federal workers
or workers' compensation law, other federal
occupational disease law or the provisions of
any law that provide nonoccupational disability
benefits.
Part Two (Employers' Liability Insurance), C.
Exclusions, exclusion 8, does not apply to
work subject to the Longshore and Harbor
Workers' Compensation Act.
This coverage does not apply to work subject
to the Defense Bass Act, the fluter
Continental Shelf Lands Act, or the
Nonappropria led Fund Instrumentalities Act.
Form WC 99 03 03 s Printed fn U.S.A. (Ed. &OO) P&O 6 1 8
SECTION Iii
1. SCHEDULE OF COVERED STATES B. If a state, shown in Item 3.A. of the Information
A. This endorsement only applies In the states Page, approves this endorsement after the
listed in this Schedule of Covered States. effective date of this policy, this endorsement
will apply to this policy. The coverage will
apply in the new state on the effective date of
the state approval.
C. Schedule of Covered States:
CA
Countersigned by
Authorized Representative
F rats WC 99 03 03 B Printed In U1 S.A. (Ed. 8100) Page 6 of 6
Qu b.lo
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC
B. EMPLOYEE HIRED AUTO EQUIPMENT — INCREASED LIMIT
C. EMPLOYEES AS INSURED 1. WAIVER OF DEDUCTIBLE — GLASS
D. SUPPLEMENTARY PAYMENTS — INCREASED
LIMITS
E. TRAILERS — INCREASED LOAD CAPACITY
F. HIRED AUTO PHYSICAL DAMAGE
G. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES -- INCREASED LIMITI
A. BLANKET ADDITIONAL INSURED
The following is added to Paragraph A.1., Who is
An Insured, of SECTION 11 — LIABILITY COV-
ERAGE:
Any person or organization who is required under
a written contract or agreement between you and
that person or organization, that is signed and
executed by you before the "bodily injury" or
"property damage" occurs and that is in effect
during the policy period, to be named as an addi-
tional insured is an "insured" for Liability Cover-
age, but only for darnages to which this insurance
applies and only to the extent that person or or-
ganization qualifies as an "insured" under the
Who Is An insured provision contained in Section
II.
B. EMPLOYEE HIRED AUTO
1, The togowing is added to Paragraph AA..
Who Is An insured, of SECTION 11 — LI-
ABiLITY COVERAGE:
J. PERSONAL EFFECTS
K. AIRBAGS
L. AUTO LOAN LEASE GAP
M. BLANKET WAIVER OF SUBROGATION
perforating duties related to the conduct of
your business.
2. The following replaces Paragraph b. in 8.5.,
Other Insurance, of SECTION IV -- BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered "autos" you own:
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
that individual "employee's" name,
with your permission, while perform-
ing duties related to the conduct of
your business,
However, any "auto" that is leased, hired,
rented or borrowed with a diver is not a
covered "auto".
C. EMPLOYEES AS INSURED
An "employee" of yours is an "insured" white
operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is
under a contract or agreement in that "ern- An Insured, of SECTION 11 — LIABILITY COV-
ployee's" name, with your permission, while ERAGE:
CA T4 20 07 10 2Qt D The Travelers ?nsfeiwwy Company Al+ tights eserved Page 1 of 3
l,scluue� cdpyr:ghtei watenal of insurance Serki es Office, Inc with its Permission
COMMERCIAL AUTO
Any "employee" of yours is an "insured" while us-
ing a covered "auto" you don't own, hire or borrow
in your business or your personal affairs.
D. SUPPLEMENTARY PAYMENTS -- INCREASED
LIMITS
1. The following replaces Paragraph A.2.a.(2) of
SECTION 11— LIABILITY COVERAGE:
(2) Up to $3,000 for cost of bail bonds (in-
cluding bonds for related traffic law viola-
tions) required because of an "accident"
we cover. We do not have to furnish
these bonds.
2. The following replaces Paragraph A.2.a.(4) of
SECTION Il — LIABILITY COVERAGE:
(4) All reasonable expenses incurred by the
"insured" at our request, including actual
loss of earnings up to $500 a day be-
cause of time off from work.
E. TRAILERS — INCREASED LOAD CAPACITY
The following replaces Paragraph CA. of SEC-
TION I -- COVERED AUTOS:
1. "Trailers" with a load capacity of 3,000
pounds or less designed primarily for travel
on public roads
F. HIRED AUTO PHYSICAL DAMAGE
The following Is added to Paragraph AA., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Hired Auto Physical Damage Coverage
If hired "autos" are covered "autos" for Liability
Coverage but not covered "autos" for Physical
Damage Coverage, and this policy also provides
Physical Damage Coverage for an owned "auto",
then the Physical Damage Coverage is extended
to "autos" that you hire, rent or borrow subject to
the following:
(1) The most we will pay for 'loss" in any one
"accident" to a hired, rented or borrowed
"auto" is the lesser of:
(a) $50,000;
(b) The actual cash value of the damaged or
stolen property as of the time of the
"loss' or
(c) The cost of repairing of replacing the
darriaged or stolen properly will) other
properly of like kind and quality.
(2) An adjustment for depreciation and physical
condition will be made in determining actual
cash value In the event of a totai `loss",
Page 2 of 3
(3) If a repair or replacement results in better
than like kind or quality, we will not pay for the
amount of betterment.
(4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
covered "auto".
(5) This Coverage Extension does not apply to:
(a) Any "auto" that is hired, rented or bor-
rowed with a driver; or
(b) Any "auto" that is hired, rented or bor-
rowed from your "employee".
G. PHYSICAL DAMAGE -- TRANSPORTATION
EXPENSES -- INCREASED LIMIT
The following replaces the first sentence in Para-
graph A.4.a., Transportation Expenses, of
SECTION III — PHYSICAL DAMAGE COVER-
AGE:
We will pay up to $50 per day to a maximum of
$1,500 for temporary transportation expense in-
curred by you because of the total theft of a cov-
ered "auto" of the private passenger type.
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT — INCREASED LIMIT
Paragraph C.2., Limit Of Insurance, of SEC-
TION III — PHYSICAL DAMAGE COVERAGE is
deleted.
1. WAIVER OF DEDUCTIBLE — GLASS
The following is added to Paragraph D., Deducti-
ble, of SECTION III _ PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered "auto" will apply to
glass damage if the glass is repaired rather than
replaced.
J. PERSONAL EFFECTS
The following is added to Paragraph A.4., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Personal Effects Coverage
We will pay up to $400 for "loss" to wearing ap-
parel and other personal effects which are:
(1) Owned by an "insured'; and
(2) In or or; your covered "auto".
This coverage only applies in the event of a total
theft of your covered "auto".
No deductibles apply to Personal Effects cover-
age.
2010 The Travefers IndenInAy Company Ali nghts reserved, CA T4 20 07 10
Includes copyrighted natermi of Irnsurance Services Office, Inc w4h ka oerm±ssion.
y;; 144C
K. AIRBAGS
The following is added to Paragraph B.3., Exclu-
sions, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to "loss" to one or
more airbags in a covered "auto" you own that in-
flate due to a cause other than a cause of"loss"
set forth in Paragraphs AA.b. and A.1.c., but
only:
a. If that "auto' is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one "loss".
L. AUTO LOAN LEASE GAP
The following is added to Paragraph AA., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Auto Loan Lease Gap Coverage for Private
Passenger Type Vehicles
In the event of a total "loss" to a covered "auto' of
the private passenger type shown in the Schedule
or Declarations for which Physical Damage Cov-
erage is provided, we will pay any unpaid amount
due on the lease or loan for such covered "auto"
less the following:
(1) The amount paid under the Physical Damage
Coverage Section of the policy for that "auto";
and
CA T4 20 07 10
COMMERCIAL AUTO
(2) Any:
(a) Overdue lease or loan payments at the
time of the "loss'
(b) Financial penalties imposed under a
lease for excessive use, abnormal wear
and tear or high mileage;
(c) Security deposits not returned by the les-
sor;
(d) Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or
lease; and
(e) Carry-over balances from previous loans
orleases.
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.S., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — BUSINESS AUTO CONDI-
TIONS:
S. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any person or organization to the ex-
tent required of you by a written contract exe-
cuted prior to any "accident" or "loss", pro-
vided that the "accident" or "loss" arises out of
the operations contemplated by such con-
tract. The waiver applies only to the person or
organization designated in such contract.
? LQt'� The rraveters (ndefrnity Cwnpany AD rights reserved. Page 3 of 3
Pnciurfes coryr+anted rnatera of tnsurance Services Offrre, Inc with its permirssfan
a
SUPPLEMENT TO CERTIFICATE OF INSURANCE
NAME OF INSURED: CSG Consultants Inc.
Precision inspection - CSG
Additional Descriotion of OoerationsiRemarks from Paoe 1:
Additional Information:
i
i
l
SUPP (OS/f14}
DATE
08/05/2013