The URL can be used to link to this page

4. 1st Change Order 08/21/2024 GVS COURTq° o: A Kevin Madok, CPA - �o ........ � Clerk of the Circuit Court& Comptroller Monroe County, Florida �z cooN DATE: September 9, 2024 TO: Beth Leto, Airports Business Manager, KWIA FROM: Liz Yongue, Deputy Clerk SUBJECT: August 21, 2024 BOCC Meeting The following item has been executed and added to the record: I4 1st Change Order with G&S Mechanical USA, Inc. in the amount of$127,778.00 for updated design that includes modifications to the OBIA conveyor line to the upgrade to the Outbound Baggage Handling System (BHS) at the Key West International Airport. The Agreement is funded by FDOT Grant Contract GIV31 (50%) and Airport Operating Funds (50%). Should you have any questions please feel free to contact me at(305) 292-3550. cc: County Attorney Finance File KEY WEST MARATHON PLANTATION KEY 500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 Co . EP T O� ORMoNROE . ' CONT'RACT CHANGE ORDER PROJECT TITLE: EYW Outbound Baggage Handling System CHANGE ORDER • INITIATION DA TE:June 25th,2024 • TO CONTRACTOR:G and S Mechanical USA,Inc: CONTRACT DATE: May 15th,2024 The Contract is changed as follows: � .... $2,229 The original(Contract Sum)(Guaranteed Maximum P'rice)..:.., . ::....... ..., Net change b previously authorized Change Orders $0 The(Contract Sum)(Guaranteed Maximum Price)prior to this Change order was..........a...$2,229,320.00 ..127,778,00 .. -The(Contract Sum)(Guar-anteed Maximum Price)will�be(increased) �(decreased) (unchanged)bythis 77 4 127,' 8.0 �� :•thi s. . �Ch ange Order. The new Contract,Sum)_(Guaranteed Maximum Price)including this Change Order is...,..$ ,2,357,098.00 The Contract Time will be(increased)(decreased): (unchanged) Y The date'of Substantial Completion as:of the date of this Change Order is...........---. , .:....• Ma y:23,2025 Detailed description of change order and justification: It was brought to our attention that the approved 100%BHS design will have conflicts with utilities in the N:ew'Terminal; In order to avoid these major conflicts/dashes, G&S has developed an updated design that : includes modifications to the OBI Conveyor Line. Please see attached Project Change.Proposal for more information. This change Order is 5_73%of the original contract price. Not valid until signed by Owner,Architect(if applicable) and Contractor F : 7 2 9/24 ARCHITECT:: � .. : e / , .. .. .. : Date f,. / V:.. , ,,,,,„--- 0 7 2 c/2.0 z.y, '' CONTRACTOR:•: .. . ' ' ••••0 0•00;•10' ,-, d Date Recommended b : ,. 08.05.2024 DIRECTOR OF AIRPORTS Date Approved by: # r. ! : 21/2024 F,,,:.-1Ip lROE COUNTY: Date :' , Mayo r/Cha rman qua �� le,-,-,y C----..--s: - 14) % • �, �•P e tt t,°t;, ��,` IN MADOK,CLERK V-3- "'el'''' <N,PIO NROE COUNTy Ano% Ey ,,,, ...n TEFS,,,,,,ft:SL-5:-;- :7 17 —- 4:' Ar0V7 FO 72 ' gzi ----: k.,7-.4,---,------.-.7-:: ----;:-?....7s, ,''' - ef., ' ",,, 7.Z4--t-'Zie yr-,;--,-L-r40 otA,10 LAW\A_ ---r-''' 4 -1"4., 00) 71 ,,,, ` : ;.:; ..way 1 ASS!vi PED r 0 J. •`., a�1�y.. ' e- /�i��. • v �, as D uty Clerk R Date 8/6/24 x Change Order Attachment per Monroe County Code Section 2-68(b) ~ Change Order was not included in the original contract specifications. Yea( ) No(X ) If Yes, explanation - Change Order was included in the original specifications. Yes ( ) No ( X ) If Yes, explanation of increase inprice: - Change Order exceeds$100,000 or-5%of contract price(whichever is greater).Yes(X) No |f Yes, explanation aoto why itim not subject for a calling for bids: This is a sole source contract ~ Project architect approves the change order. Yes(X) No ) |f no,explanation ofwhy � Change Order is correcting on error or omission in design document. Yes ( ) No ( X ) Should a claim under the applicable professional liability policy be made? Yes No Explain � air�p�rd onvyor [�—rq—ject—dfi—anj�--Proposal OU1 Project: Outbound Baggage Handling System Additions-Key West International Airport . Description: Modifications to OB1A Line Date: June 25,2024 Customer: Tyler Bethel Key West International Airport- Revision: 00 Company: Monroe Count G&S Project: 23EYW1553 Schedule TBD G&S Proj.Mgr. Dustin Crumley Impact: Description of Change It was brought to our attention that the approved 100%6HS design will have conflicts with utilities in the New Terminal. In order to avoid these major conflicts/clashes, G&S has developed an updated design that includes modifications to the OB1A Conveyor Line. Scope of Work This Proposed Change Order involves the following additional scope: • Supply&Install of(1)Additional 00 Degree Power Curve(061A-04) • Supply&Install of(1)Additional G&S General Transport Conveyor(061A-05) • Supply&Install of(1)Additional 45 Degree Power Curve(OB1A-06) • Supply&Install of(1)Additional 45 Degree Merge Conveyor(081A-07) • Supply&Install of an additional 20 feet of Catwalk • Supply&Install of an additional 10 feet of"Top Hat" • Engineering,updates to Mechanical&Electrical Drawings • Additional Controls Hardware&Programming • Provision of NEMA12 Electrical Devices on Conveyors OB1A-04,05,06&07 The Proposed Change Order involves the reduction of the following scope: • Supply&Install of(2)General Transport Conveyors Pricin Item Price PCP001 Price (includes engineering, manufacturing, mechanical $127,778.00 installation,and additional controls) Sales Tax& Bonding Not Included Total Prier: 127,7"7(I. 1 Notes and Exceptions: • Pricing is in US Dollars • Pricing does not include canopy to cover conveyors located outdoors • Pricing does not include sales tax • Bonding is not included June 2S,2024 CERTIFICATE OF INSURANCE ISSUE 24/02/28 M/DD) 4/02/28 BROKER This certificate is issued as a matter of information only and confers Wilson M. Beck Insurance Services(Victoria) Inc. no rights upon the certificate holder.This certificate does not amend, #350 4396 West Saanich Road Victoria BC V8Z 3E9 extend or alter the coverage afforded bythe policies below. COMPANY Federal Insurance Company A INSURED's FULL NAME AND MAILING ADDRESS COMPANY G&S Mechanical USA, Inc. B 3409 West Harry Street, COMPANY Wichita, KS 67213 C COMPANY D COMPANY E COVERAGES 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. TYPE OF INSURANCE CO POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS OF LIABILITY LTR DATE(YY/MM/DD) DATE(YY/MM/DD) (Canadian dollars unless indicated otherwise) COMMERCIAL GENERAL LIABILITY A Policy No.99508397 24/02/28 25/02/28 Per Occurrence 2,000,000 USD Primary Non-Contributory Clause AM Best:A++ Aggregate Limit 2,000,000 USD Occurrence Basis AM Best:002085 NAIC: 20281 Products—Comp/Op Agg 2,000,000 USD Personal Injury Agg 2,000,000 USD Advertising Injury Agg 2,000,000 USD Tenant's Legal Liability 1,000,000 USD Medical Expenses Limit 10,000 USD FBI Y , w 2.29.24 -- DESCRIPTION OF OPERATIONS/LOCATIONS/AUTOMOBILES/SPECIAL ITEMS/ADDITIONAL INSURED Reference:All Operations of the Named Insured as Described in the Policy Declarations. It is hereby understood and agreed that the Certificate Holder is added as Additional Insured to the Commercial General Liability Coverage Policy but only with respect to liability arising out of the Named Insured's sole negligence. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL Monroe Count BOCC SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Y KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 1100 Simonton St., Key West FL 33040 AUTHORIZED REPRESENTATIVE ��9 Client#: 1266945 GSMEC DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 10/02/2023 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jenn Decker NAME: USI Insurance Services LLC PHONE FAX A/C,No,Ext: (A/C,No): 2375 E. Camelback Rd, Suite 250 E-MAIL ADDRESS: jenn.decker@usi.com Phoenix,AZ 85016 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Cas.Co.of America 25674 INSURED INSURER B:Travelers Indemnity Co of America 25666 G &S Mechanical USA Inc. INSURER C 3409 W Harry St INSURER D Wichita, KS 67213 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 42135251 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR , 16tt T DAMAGE RENTED PREMISESS(Ea occurrence $ MED EXP(Any one person) $ DA 1 O PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: A X —_ GENERAL AGGREGATE $ PRO PRODUCTS-COMP/OP AGG $ POLICY JECTPRO- LOC OTHER: $ B AUTOMOBILE LIABILITY X X BA6N396236 10/01/2023 10/01/202 (CEO MaccidentS BINED INGLE LIMIT 1 r 000r 000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A UMBRELLA LIAB N OCCUR EX8N968484 10/01/2023 10/01/2024 EACH OCCURRENCE s5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION X U136J622054 10/01/2023 10/01/202 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Installation 630507OM206 10/01/2023 10/01/202 $350,000 Limit Floater $1,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Installation Floater Coverages: At any installation premises or temporary storage premises: $350,000 At any other not owned, leased, or regularly operated premises: $25,000 Personal property in transit: $350,000 Deductible: $1,000 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe Count BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE �• ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S42135251/M42057460 SACT DESCRIPTIONS (Continued from Page 1) SAGITTA 25.3(2016/03) 2 of 2 #S42135251/M42057460 POLICY NUMBER: BA6N396236 COMMERCIAL AU CO ❑❑I❑EN❑OR❑EMEN❑ C❑AN❑E❑ ❑❑E POLICY❑PLEA❑E REA❑ I❑CARE❑ULLY❑ BU❑INE❑❑ AU❑O E❑ ❑EN❑ION EN❑OR❑EMEN❑ -1 e Edor Eeme EF_-lmodi fie❑i-iu F1 re Cro Ei ded a Eder Ee 9110 -i❑❑ BU❑INE-AU-O CO❑ERAfE ❑ORM ❑ENERAL ❑E]CRIP❑ION O_ CO❑ERA❑E - -s eCdorCeme=broCde=coCerF1c❑❑o❑eCerCcoCerFe -or =y i_ury-dfrnFe or medic❑ e❑-ewe❑deCeribed i Ty o-_e :To3:io❑❑o =i- e❑dorCeme❑ m y be eCeluded or limi-ed by Fo Ecr e Edor Eeme=9 _e C o Eer Fc P Er==d -e Ce co Eer F] f- bro Ede Ei=Ero Ei Ero=do -o- --Ay _e e E:le= co Eer❑ e i e Ecluded or limi-ed by Euc❑- e Edor Eeme=-_e _ollo-i- li s— i ❑Ee Eer❑co Eer- ❑ e de Seri Eio❑o 1y Limi=ib==d e Eclu Cio=m y ❑Ily 9 Ee Ee co Eer❑=e EERe Ed :11 _e :To 3:io❑❑o_=i e dor Eeme==d _e re❑-o-your -olicy c:te Willy 9 de Eermi Ee ri E=EEdu fie Q❑Ld _--i-::Ed i-_o-co Eered A BROA_ DORM NAME-IN URE- __ ❑IRE- AU❑O P_Y_JCAL -AMA_E LO❑❑0E B BLAN_E- AI-IONALINURE UE INCREAE LIMI I P Y_JCAL -AMA-E ❑RAN-'OR❑A❑ION C❑ EMPLOYEE -IRE- AU-0 E❑PENE❑❑INCREA E - LIMI - EMPLOYEE❑A- IN❑URE❑ PER❑ONAL PROPER❑Y E- UPPLEMEN-ARY PAYMEN❑_ INCREAE- AIRBA❑❑ LIMI L NO-ICE AN NO LE__E O ACCI EN OR -- -IRE- AU-0 LIMI-E_ - ORL_-I-E CO LO❑❑ ERA❑E IN EMNI YBA-1 M BLAN❑E_ -AI-ER O_ �:JBRO❑A❑ION -_ -Al-ER 0- _E-UC-IBLE _ ❑LA— N UNIN-ENAONAL ERROR❑OR OMI❑ElON❑ PRO❑ICON❑ A BROA_ ❑ORM NAME-INURE- =i i❑urQ re die❑ A o1y 9 _e eE[e=FFTT- -_e -ollo-i- i- Edded 9 PErEEr❑Z A❑ E ❑o I ErEo❑ or orFT-Fimio❑EuaiTeE= T "iZ hired" A IEEuredEb_EC❑ION II CO❑ERE❑ AU❑O❑ uEder _e _o I-A I❑bred EroCtCio❑coFTT-1Eed LIABILI-Y CO❑ERA❑E: i Eec fio❑II A y or❑ Sib❑you -e-ly EcEuire or -orm dur C EMPLOYEE ❑IRE AU-0 i- _e -olicy Ecriod oEer -sc you mJZIl❑ _ __e -olio-i- i Edded 9 PErEEr= A❑I❑ or more o❑Eer-r❑iEFereQ==d i- :b❑ ❑ Eo I❑A- IEirred❑o_ EC❑ION II CO_- EeELr❑[ely iEEured 9r BuEi°Ce=Aug Co❑erEEb❑ ERE- AU O - LIABILI_YCO❑ERA❑E: Cofer❑ e u❑der =i_ :to3:io❑i- ❑T rded o1y u❑❑ A "emAoyee" oyouur❑i_ "i❑fired" _31e A _e ❑❑=d y ❑Ter you Ec Euire or sjrm _e or o fcr-i= - "_u W 3red or re FTcid a Eder ❑ f=i—o❑or _e esl o _e -olicy :briodf-3c= co❑rEc❑ or EEreeme= i_ - "emAoyee P efer i-e11lier❑ ❑-me❑-i your ❑emni Elio=❑sle ❑er:brmi-= dudbErelEed 9 _e coEduc❑o your bud::] B BLAN_E- AI-IONALINURE- Ee= -_e -ollo-i— i Edded 9 PEr❑-r=c❑i A❑I❑ 2_ -_e -olio-i- reE1Ece❑PErEEi7=b❑i_ B❑❑L Eo I❑A IEuredCb_EC❑ION II CO-ERE- OFer I❑-urF_Fce❑o_ EC❑ION I _ BU-1- AU❑O- LIABILI YCO❑ERA❑E: NE=AU❑OCON I-ION A y EerCofor or-EII—of -_o i-reEuired u❑der b❑ or -fired Aug P❑yfic❑ ❑Em❑ c Cofer- ❑ri❑e❑co�rEc for EEreeme=be=ee❑you EEd F-1-c-❑-e -olio_i- Ere deemed 9 be co E&Eo❑ or or_FT_i=::ib= i EiF-ed ❑=dd ered "EuEci1:7you o e Eecu Eed by you be fore _e "bodily i-ury" or — A y co(ered "_u W you le❑-e f ire "EroEerfy dEmF1c" occur❑ A i- i e=&c❑ re--or borro❑❑❑ d duri= _e -olicy :briod❑9 be ELmed =- ::Idi❑ 2- A y co(ered "_u W 3red or re❑:dd by io❑1 i❑ired i — "i=hired" -or Cored Auk::] your "emdoyee" uEder ❑ co�rEc❑i❑ Li:bili y Cofer❑ emu-oly 9r d❑rnFl-c-C9 3c❑ _ "emdoyee❑7 EEme❑ -i your CA 3 3 -2 ❑❑ -2S _e _rSeler^Ioem::i�y Com-'Sy_lllri-Sre_er_ed❑ PFe -o_E I-elude-co yri -edmSeri7o-I_ irSce -er::ice-0=ice:ls_-i-i--ermiSio COMMERCIAL AU EO You EE ree b m 1 E❑i❑ :11 re Cuired or 2 I or o your co Wired comCulCory i❑iu❑ re i_ y Cuc❑ cou= =1- coCerFc die❑o1y i_ _e eCc=o_❑Ccim ry u b _e mi3mum limi re:bired by -e-o-your co Wired loci 1 Your ❑ilure b com Ay i A IRB com Eul Cory i❑-ur-be re Euireme C- ill co deduc table C y b - Per Co m Pro Eery -o- i=:Iid=d _e coCerF] e Ts❑ rded by A c❑ �- -olicy-bu ❑e -ill o1y be li-ble b � IRB ❑❑ EEme eEe=Ee -ould EEEc bee❑ liEble -_e 911o_i- i- Cdded 9 PCrEr=B3FFF❑clu❑ =d you comAied _i- _e com:bEbry i= Co=o_ EC❑ION III P_Y_ICAL -AMA-E Cur❑-ce re3iiremeFTT_F CO❑ERA❑E: A- I-i-u Eder Q-ood ❑e Cre _o - ::dmi❑ ECcluCio❑3=doe❑_o_ -1y 9 "low' 9 o_e or -ed or Cu-oTiCed i❑urer ouTrde -e more Crrb=i- ❑coCered"_tb" you o-'- 'i- UCiCed ❑fie❑ o Americ=i- Cerri brie❑ I-e due b CcCuCe o-er ❑cCuCe o_"lo - _d Eo❑e-io CCI=Puer b Rico =d C= _e -or i P Cr EEr=%T A❑7b❑ =d A❑Lc=bu Ed CC-e E-tme _o re=6❑ibili S -or Te o Ay: :iir3❑3= o cerTliicElb❑o i❑urF1 ce❑or I "_u9" i ❑co❑cred"1r9" -or Commie❑ -or com Eli❑ re i- y --y -i _e 1-❑ EeEdEe Cofer❑ c u❑der =i :blicy o-o❑brcou❑rie❑rely❑❑9 i❑hr❑=ce❑ b❑ -_e Grb=Cre -o-coCcred u❑der y -Cr- -_ -AI ER 0- E UC IBLE ❑LA❑❑ rEEFy E::Ed -_e bllo-i- i Cdded b PCrE[:-r= -❑ ❑educTE cC -_e Crrb=Eere _o_i❑d:dbZlly i❑I❑bd❑ ble❑o_ EC❑ION III P-Y_ICAL -AMA-E -e -ill -y u b CmEr mum o- ❑FFF❑ -or E1:y CO❑ERA❑E: o_e "lo-1❑ No deducible -or ❑ coEered "_ub" -ill __Ay b L NO-ICE AN- _-NO- LE_-E 0- ACCI-EN-OR ❑=dCm❑-e i-_e ❑=i-re2rred rCzer FFTT- LO❑❑ reQCced❑ -_e bllo i- i Cdded b PCrE[:r= A2=o❑ -_ -IRE_ AU-0 P-Y <CAL -AMA_E LO❑❑0E EC❑ION I_ BU�:TNE❑❑AU❑O CON-I_ION_: UE 'INCREAF- LIMI Your du 9 1_e u-or our DuEoriCedreCreCe FTFF -_e bllo-i-- reQEce❑-e 1— CeECeEee o-PCr= i-e :Tom❑❑::b ce o_ _e ":bcide= or "low' Cr=AFFThFFI,o= O UCe E❑ cFemo_ ❑EC❑ lie o1y ❑:b❑ _e ":bcide= or "low' i_ Zb-❑ -ION III P Y <CAL AMA E CO❑ERA❑E: b: Eo❑e:br❑-e moQ=❑e -.ill -y -or y e❑-cue❑ You -you Ere i::di3du:]= -or to o-uEb i -6 -er d-y b ❑mEEimumo❑ I- A E:Er-cr -you Ere ❑E:[:-r❑-er❑ = CTT-Fs>r y o cide❑ ❑ -c A member -you Ere Climi-ed li-biliy com I- P-Y <CAL -AMA-E ❑RAN-'OR❑A❑ION ==y- E❑PEN ❑-INCREA-E LIMI A- A e:bcurC:b oTicer❑direcbr or i❑&Fl-ce -_e bllo-i-- reElEce❑_e it CeTcEee i PCrC mC-Ler you Cie ❑corCorEdbEor oTcror- Ef A ❑rforRio❑ E❑-e—em o❑ =-=10-Dor EC❑ION III P_Y_ICAL AMA-E CO-ER- -e- A y "emAoyee" Ar❑bri:bd by you 9 1� 3�❑ A E: ice o _e ":bcide=or "lo-' e -ill -y u b — -er d-y b ❑mEEimum o❑ M BLAN_E_ -AI-ER O_ �:JBRO❑A❑ION -❑TTl -or bm::br3y r=❑brsio❑ e❑Eb❑� i= =-_e 911o_i- reQEce❑PCrEEr= A❑71L r r curred by you bee EuEb o__e bA _e- o-❑co CC O Ri 0 Reco❑cry AEi=O-er❑ ❑o U= ered "_t b" o__e Eri�e Cie❑-er Cy Ee❑ o_ -EC❑I ON I_ B U_INE_- AU-0 CON I- PER❑ONAL PROPER❑Y ❑ION❑ -_e bllo-i- i Edded b PITCI-r= A=Co Der- - Cr r O Ri O Reco❑cry AEi= EFe❑CioC=o EC❑ION III P❑Y_ICAL on ❑o U❑ -AMA-ECO-ERA-E: e E1:b y ri=o-recoCery ❑em_y CE❑e Per Cbm ProCbrCy FFF,=y EerCo❑or or_=iSio❑ b _e eCC re Cuired o you by ❑ Cri-e C co❑rEe e -ill -y u b C� br "lo- b ❑e Cri CZ Er❑-ed -d e Eecu Eed -rior b y ":bcide= ECreI -d oTer EerCom EroEerCy -.sc- i:] or "lo-_ :To3ded s _e ":bcide= or "lo -„ Z OE:bd by - "i❑[itred"❑E d CriCe❑ ou- o o:br=ib= co=[dmA=dd by CA 3 3 -2 ❑- -2Z_ __e -rSeler^Islem::i�y Com_=y_lllri-Sre_er_ed❑ PFc 3 oE I-elude-co yri -edmSeri7o-I_ ir=ce -er::ice-0=ice:ls_-i-i--ermi=io TRAVELERS J� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-6J622054-22-14-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING: ONTARIO INTERNATIONAL AIRPORT AUTHORITY (OIAA) 1923 E AVION STREET. ONTARIO, CA 91761 Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 08-16-22 STASSIGN: PAGE 1 OF _TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-6J622054-22-14-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR SWITCHGEAR AND SWITCHBOARD APPARATUS WHICH THE INSURED HAS AGREED MANUFACTURING BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING: ONTARIO INTERNATIONAL AIRPORT AUTHORITY (OIAA) 1923 E AVION STREET. ONTARIO, CA 91761 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 No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 08-16-22 STASSIGN: Page 1 of 1 WORKERS COMPENSATION TRAVELERS Jam' AND EMPLOYERS LIABILITY POLICY ONE TOWER SQUARE HARTFORD CT 06183 ENDORSEMENT WC 99 03 J9 (00) - 001 POLICY NUMBER: UB-6J622054-22-14-G KANSAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Kansas 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. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us, and 1. Such written contract is not a construction contract subject to the Kansas Fairness in Private Construction Contract Act (Kan. Stat. Sections 16-1801 through 16-1807) or the Kansas Fairness in Public Construction Con- tract Act (Kan. Stat. Sections 16-1901 through 16-1908), or any amendments to those laws; or 2. This policy is part of a consolidated or wrap-up insurance program. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING ONTARIO INTERNATIONAL AIRPORT AUTHORITY (OIAA) 1923 E AVION STREET. ONTARIO, CA 91761 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 issuance of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE 08-16-22 STASSIGN Page of 1 ©Copyright 2014 National Council on Compensation Insurance, Inc.All Rights Reserved. TRAVELERS JW WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 42 03 04( B) — 001 POLICY NUMBER: UB-6J622054-22-14-G 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. 1• ❑ Specific Waiver ❑X Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. INCLUDING: ONTARIO INTERNATIONAL AIRPORT AUTHORITY (OIAA) 1923 E AVION STREET. ONTARIO, CA 91761 2. Operations: ALL TEXAS OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.00 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: $SEE SCHEDULE 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 No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 08-16-22 STASSIGN: Page 1 of 1 ©Copyright 2014 National Council on Compensation Insurance, Inc.All Rights Reserved. TRAVELERS JW WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 43 03 05 (00) - 001 POLICY NUMBER: UB-6J622054-22-14-G UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah 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. (This agreement applies only to the extent that 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 Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties. Schedule Designated Person: Designated Organization: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING: ONTARIO INTERNATIONAL AIRPORT AUTHORITY (OIAA) 1923 E AVION STREET. ONTARIO, CA 91761 DATE OF ISSUE: 08-16-22 STASSIGN: PAGE 1 OF