OWNER-CONTROLLED INSURANCE PROGRAM

Transcription

1 PART 1 GENERAL OWNER-CONTROLLED INSURANCE PROGRAM 1.01 INTRODUCTION A. The Water Authority has implemented an Owner-Controlled Insurance Program for its Emergency Storage Project. In an OCIP, the construction owner furnishes most of the Workers' Compensation, General Liability, and Professional Liability insurance associated with construction and construction management of the project. Insurance furnished under an OCIP covers the Water Authority, the Contractor, and its subcontractors of all tiers (with some exceptions). As detailed below, the Contractor still provides some insurance coverage in an OCIP. B. The Contractor s work will be covered by the Water Authority s OCIP. Contractors are required to exclude the cost of the insurance to be provided by the Water Authority as described herein under its OCIP from the cost, which is compensable to the Contractor, by the Water Authority DEFINITIONS A. The following definitions shall be used for this Attachment: 1. Claims Claims asserted against the insurance coverage herein described. 2. Insured Parties Enrolled Contractor, its subcontractors, the Water Authority, its contractors excluding parties listed in items 5 & 6 of these definitions and are enrolled in the OCIP rendering services at the work site, as defined by the policies of insurance described in Sections 1.04, 1.05, and 1.06 below, with a contract for work or services for the work. 3. OCIP Administrator The Insurance Broker retained by the Water Authority for Workers Compensation, General Liability and Professional Liability. 4. ESP The Emergency Storage Project, including but not limited to the work to be performed under this Contract. 5. Subconsultant A subcontractor of any tier except: vendors, suppliers (including manufacturers who furnish materials or equipment), fabricators, material dealers, truckers, and others who merely transport, pick up, deliver or carry materials, personnel, parts, or equipment, or other items or persons to or from the work site or sites incidental to the work, or those engaged solely in the loading, unloading, stocking, testing, or hauling of equipment. 6. Uninsured Parties A person, partnership, corporation, or other business entity performing work under the Contract for whom OCIP insurance coverage is not provided. 7. OCIP Field Administrator Individual responsible for all OCIP Field Administrative Functions. 1

2 1.03 INSURANCE PROVIDED BY THE WATER AUTHORITY A. Prior to commencement of the work, the Water Authority will obtain the insurance coverages described in Sections 1.04, and 1.05, for the duration of the Contract for the insured parties. B. With respect to the Contractor and its subcontractors and except as provided in 1.06B, the insurance set forth in Sections 1.04 and 1.05, will cover only that work performed at the work site. C. The Water Authority assumes no obligations to provide insurance other than that evidenced by the policies referred to in Sections 1.04 and The Water Authority, however, reserves the right to furnish insurance coverage of various types and limits provided that such coverage will not be less than that specified below. The Water Authority will notify the Contractor of any changes in the policy. The costs of such insurance will be borne by the Water Authority. D. The Water Authority does not warrant or represent that the OCIP coverages constitute an insurance portfolio that adequately addresses the risk faced by the Contractor or its subcontractors. The Contractor and its subcontractors shall satisfy themselves as to the existence, extent, and adequacy of the OCIP coverages prior to the commencement of work under the Contract. G. The OCIP coverages referred to above are set forth in full in the respective policy forms, and the foregoing descriptions of such policies are not intended to be complete, or to alter or amend any provision of the actual policies. In the event of an actual conflict between the foregoing descriptions of policies with such instruments, the provisions of the insurance policies shall govern. F. The Contractor is responsible for review and knowledge of the policy forms. The policies are available through the Risk Management Department of the Water Authority WORKERS' COMPENSATION INSURANCE A. Workers' Compensation insurance in statutory limits of the workers' compensation laws of the State of California, with Coverage B Employer's Liability, to limits of not less than one million dollars ($1,000,000) each accident, one million dollars ($1,000,000) each employee for bodily injury by disease, and one million ($1,000,000) policy limit for bodily injury by disease covering operations of the insured parties at the work site. Coverage under the Broad Form All States extension is also included. This insurance is primary for all occurrences at the work site LIABILITY INSURANCE A. Liability insurance (excluding Automobile) under a Commercial General Liability insurance policy and covering the insured parties in connection with the performance of the work at the work site, including hazards of operations (including explosion, collapse, and underground coverage), elevators, independent Contractors, employees as additional insureds, completed operations with a ten (10) year extended discovery period after substantial completion of the work, contractual liability coverage (for contracts related to the work), personal injury liability coverage, and excess Employer's Liability coverage for claims arising out of the work hereunder, for personal injury, bodily injury, and property damage, in policies of insurance such that the total available limits to all insureds combined will not be less than one hundred million dollars ($100,000,000) combined single limits for each occurrence and aggregates, as applicable. 2

3 1. Notwithstanding the actual policy deductibles per occurrence, the Contractor shall be liable for a deductible for each occurrence, to the extent losses payable are attributable to its acts or omissions or the acts or omissions of its subcontractors, uninsured parties, or any other entity or person for whom it may be responsible. The Contractor's deductible shall encompass the costs of investigation and defense, including court costs and attorneys' fees. The deductible is $15,000 per incident. 2. Any deductible amount will be invoiced to the Contractor by separate billing. If not paid within thirty (30) days of notice, the amount will be deducted from the next periodic payment. Any payment of a deductible amount per occurrence by the Contractor shall not be compensable to Contractor by the Water Authority. 3. Each claim without regard to the amount claimed shall be reported to the insurance company who will adjust the claim on behalf of the insureds. Failure to report a claim promptly may jeopardize any coverage owed by the insurer. B. Professional Liability/Errors and Omissions Insurance coverage will be provided with a limit of twenty million dollars ($20,000,000) per claim and in the aggregate. The policy will provide blanket coverage for all subcontractors who are providing professional services and who have a direct contract with the Contractor. The policy will provide a five (5) year extended discovery period beginning at the date of completion of the project. Contractor s pollution legal liability coverage is included in the policy. 1. Notwithstanding the actual policy deductibles per claim, the Contractor shall be liable for a deductible not to exceed Fifteen thousand dollars ($15,000) for each claim, to the extent losses payable are attributable to its acts or omissions or the acts or omissions of its subcontractors, uninsured parties, or any other entity or person for whom it may be responsible 2. Any deductible amount will be invoiced to the Contractor by separate billing. If not paid within thirty (30) days of notice, the amount will be deducted from the next periodic payment. Any payment of a deductible amount per occurrence by the Contractor shall not be compensable to Contractor by the Water Authority. 3. Each claim without regard to the amount claimed shall be reported to the insurance company who will adjust the claim on behalf of the insureds. Failure to report a claim promptly may jeopardize any coverage owed by the insurer. C. The insurance provided under the OCIP will not extend coverage for products liability to any insured party or uninsured party. However, Products/Completed Operations liability arising from manufacturing or assembly of items manufactured or assembled at the work site as required by the Contract is covered NO WAIVER OF CONTRACT OBLIGATIONS A. Nothing contained herein or in any document referenced herein shall relieve, limit, or be construed to relieve or limit the Contractor, its subcontractors, or uninsured parties of responsibility or obligations otherwise imposed by this Contract. The OCIP shall not be construed as limiting, among other things: 1. The extent to which the Contractor may be held legally responsible for damages to persons or property. 3

4 2. The Contractor's indemnity obligations under the Contract. The intent of the OCIP is simply to ensure that the Contractor has been provided the insurance coverage indicated up to the limits and with the Contractor's deductibles herein indicated NAMED INSUREDS AND INFORMATION TO BE PROVIDED BY CONTRACTOR AFTER CONTRACT AWARD A. Except for Workers Compensation and Employers Liability, the Named Insured on the Water Authority-provided OCIP policies will include the Water Authority, its Board of Directors, officers, agents, employees, and contractors rendering services at the work site, the Contractor and its subcontractors, and such other persons or interests as the Water Authority may specifically designate. B. Within fifteen (15) calendar days from the award of the Contract, the Contractor shall complete and return to the Engineer the OCIP Insurance Enrollment Form, and provide such other information as the Engineer or OCIP insurance carriers deem necessary. Each subcontractor shall complete the OCIP Insurance Enrollment Form and return such forms to the Contractor for submission with, and attachment to, its form. C. Each subcontractor shall complete the OCIP Insurance Enrollment Form and return such documents to the Contractor for submission to the Engineer not less than two weeks prior to the date they are scheduled to commence work at the work site. Failure to submit the information within the time required may delay the subcontractor's ability to commence work on the work site, and may result in waiver of OCIP coverage. D. The Contractor shall ensure that each subcontractor on the work site for whom OCIP coverage is provided has received confirmation of such coverage from the OCIP Administrator prior to commencement of the subcontractor's work. E. Within fifteen (15) calendar days from the award of the Contract, the Contractor shall submit to the Engineer its Injury and Illness Prevention Plan, Code of Safe Work Practices, Hazard Communication Program, Emergency Action and Fire Protection Plan, and Employee Substance Abuse Program. F. The Water Authority will review the documents submitted by the Contractor pursuant to this paragraph within fifteen (15) days of their submittal. Any deficiencies noted shall be corrected by the Contractor within five (5) days of its receipt of the returned documents. G. Failure to complete and return the documents identified in this Attachment within the time provided may delay the Water Authority s issuance of the Notice to Proceed. 4

5 1.08 THE WATER AUTHORITY S RIGHT TO AUDIT A. The Contractor hereby warrants to the Water Authority the accuracy of the information provided on the OCIP Insurance Enrollment Form, and agrees that the Water Authority, its officers, agents, insurance carriers, and the OCIP Administrator may audit the records of the Contractor and its subcontractors to confirm the accuracy of information provided, including, but not limited to, the accuracy of all estimated payrolls, and to ascertain any effect on insurance resulting from changes in the work. The audit will be held during the Contractor's normal business hours at the office of the Contractor or at another mutually agreeable location. B. The Water Authority shall be entitled to credits in OCIP insurance premiums that may accrue as a result of the audit. C. The Contractor shall maintain or cause to be maintained sufficient records as may be necessary to audit its compliance and its subcontractors' compliance with the requirements of the OCIP ASSIGNMENT A. The Contractor and each of its subcontractors hereby assign to the Water Authority all return premiums, premium refunds, dividends, and other monies due or to become due in connection with the insurance provided by the Water Authority. The Contractor and its subcontractors shall execute such other further documentation as may be required by the Water Authority to effectuate this assignment OCIP CLAIMS A. The Contractor, its subcontractors, and uninsured parties shall assist the Water Authority, its agents, and the OCIP Administrator and provide the utmost cooperation in the adjustment of claims arising out of the operations conducted under, or in connection with, the work and shall cooperate with the Water Authority s insurance carriers in claims and demands that arise out of the work and that the insurance carriers are called upon to adjust or resist ALTERNATIVE INSURANCE A. In the event the Water Authority is unable to furnish, or after commencement of work elects not to furnish or to continue to furnish the insurance coverage herein described, and upon 30 days written notice from the Water Authority, the following shall be required: 1. The Contractor shall secure and maintain all or as much of the insurance herein described as the Water Authority designates. The Water Authority will thereafter no longer be obligated to furnish such insurance. 2. All insurance secured by the Contractor or its subcontractors pursuant to this article shall be in policies subject to the prior written approval of the Water Authority as to form, content, limits of liability, cost, and issuing company. 5

6 PART 2 CONSULTANT OBLIGATIONS/RESPONSIBILITIES 2.01 CONTRACTOR-PROVIDED INSURANCE NECESSARY FOR THE WORK, BUT OUTSIDE THE OCIP (LIMITS ARE ESTABLISHED ON PROJECT SPECIFIC BASIS) A. General 1. The Contractor shall, for the duration of the Contract, provide and maintain insurance and shall require each subcontractor to provide and maintain insurance of the type and in the limits as set forth below. Except as otherwise provided in Section 2.01C, this insurance is intended to cover employee injury, personal injury, bodily injury, property damage liability and professional liability/errors and omission for work performed away from the work site. Such insurance shall name the parties required to secure same as insureds and shall be in a form and through issuing companies authorized to do business in the state of California and maintaining an agent for process within the state. Such insurance company shall maintain a current A.M. Best Rating classification of A - or better, and a financial size of ten million dollars ($10,000,000) to twenty four million dollars ($24,000,000) (Class V) or better, unless alternative insurance accepted in writing by the Water Authority. Such insurance shall contain a defense of suits provision and shall provide the following coverage: a. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached, or any endorsement or certificate now or hereafter attached hereto, it is agreed that the Water Authority, its officers, agents, and employees (and such other persons or interests as the Water Authority may specifically designate) are additional insureds hereunder, and that coverage is provided for all operations, uses, occupation, acts, and activities of the insured under the Contract, and under amendments, modifications, extensions, or renewals of said Contract, regardless of whether liability is attributable to the insured or a combination of the insured and the additional insured. b. The policy to which this endorsement is attached shall not be canceled or reduced in coverage until after the Water Authority has been given thirty (30) days prior written notice by registered mail addressed to the San Diego County Water Water Authority, 4677 Overland Avenue, San Diego, California 92123, Attention: Mr. Robert Homer, Risk Manager. c. The coverage provided by the policy to which this endorsement is attached is primary coverage and other insurance, if any, carried by the Water Authority is excess coverage. d. In the event of one of the named insureds incurring liability to any other of the named insureds, this policy shall provide protection for each named insured against whom claim is or may be made, including claims by other named insureds in the same manner as if separate policies had been issued to each named insured. Nothing contained herein shall operate to increase the company's limit of liability. e. Notice of occurrences or claims under the policy shall be made to the person designated by the Water Authority. 2. The insurance may be provided in policy or policies, primary and excess, including an umbrella or catastrophe form. As and when the Water Authority may direct, copies of the actual insurance policies or renewals or replacements thereof shall be submitted to the OCIP Administrator in form and content acceptable to the OCIP Administrator. Liability covered 6

7 shall be as stated below, unless, prior to commencement of work, written approval is granted by the OCIP Administrator for variance from such limits. B. Workers' Compensation Insurance: Workers' Compensation insurance with statutory limits of the workers' compensation laws of the State of California, with Coverage B Employers Liability to limits of not less than one million dollars ($1,000,000) each accident, one million dollars ($1,000,000). Each employee for bodily injury by disease, and one million dollars ($1,000,000) policy limit for bodily injury by disease. C. Automobile Liability Insurance: Automobile Liability insurance covering all owned, non-owned and hired automobiles, trucks, and trailers of the respective parties required to provide and maintain this insurance. Such insurance shall provide coverage not less than that of the Standard Comprehensive Automobile Liability policy in limits not less than, as respects the Contractor XXX million dollars ($XXXXXXX) combined single limit for each occurrence for bodily injury and property damage. As respects the subcontractors the limits are XXX million dollars ($XXXXXX). Such insurance shall cover occurrences both at and away from the work site. D. Aircraft Liability: If aircraft is used by the Contractor, its subcontractors, or anyone else on their behalf, the Contractor or its subcontractor shall maintain or cause the operator of the aircraft to maintain aircraft public liability insurance insuring passengers and the general public against personal injury, bodily injury, or property damage arising from aircraft owned, used, operated or hired in connection with the work by the Contractor, subcontractor, or anyone else in limits of not less than XXX million dollars ($XXXXX) combined single limit for each occurrence, for each aircraft. E. General Liability: General Liability insurance (including products liability for any product manufactured, assembled, or otherwise worked upon away from the Work site) under forms providing coverage not less than that of a Standard Commercial General Liability insurance policy (Occurrence Form) for operations of the party required to furnish same, including hazards of operations (including explosion, collapse, and underground coverage), elevators, independent Contractors, products and completed operations, for claims arising out of the work hereunder for personal injury, bodily injury, and property damage in policy or policies of insurance such that the total available limits combined shall not be less than XXX million dollars ($XXXXX) for each occurrence. As respects the subcontractors, the limits are XXXX dollars ($XXXX). F. Professional Liability/Errors and Omissions: Coverage for negligent acts, errors or omissions of a professional nature in the amount of XXX million dollars ($XXXXXX) per claim and aggregate. A deductible or retention may be utilized, subject to approval by the Water Authority. G. Before the execution of the Agreement by the Water Authority, the Contractor shall have provided the Water Authority with satisfactory certification by qualified representative of the Insurer(s) using Certificates of Insurance and endorsements on the forms provided herein that the Contractor s insurance complies with all provisions in this section. The certificates need only reference current annual policies, but shall be replaced at renewal to comply with the requirement of maintaining coverage for 24 months following the date of filing of the Notice of Completion. 7

8 2.02 CONTRACTOR RESPONSIBILITY FOR UNINSURED PARTIES A. The Contractor or its subcontractors shall maintain, or require their respective vendors, suppliers, material dealers, truckers, and others who merely transport, pick up, deliver, or carry materials, personnel, parts, or equipment, or other items or persons to or from the Work site to maintain the following insurance: 1. Workers' Compensation insurance with statutory limits of the workers' compensation laws of the State of California with Coverage B Employer's Liability, to limits of not less than one million dollars ($1,000,000), covering operations of the party required to furnish equipment, supplies, or material in connection with the work at the Work site. 2. Automobile Liability insurance covering all owned, non-owned and hired automobiles, trucks and trailers of the respective parties required to provide and maintain this insurance. Such insurance shall provide coverage not less than that of the Standard Comprehensive Automobile Liability policy in limits of not less than five hundred thousand dollars ($500,000) combined single limit for each occurrence for bodily injury and property damage. 3. General Liability insurance for all operations (including products liability for any product manufactured, assembled, or otherwise worked upon away from the Work site) in a form providing coverage not less than that of a Standard Commercial General Liability insurance policy (Occurrence Form) for operations of the party required to furnish same, including hazards of operations (including explosion, collapse, and underground coverage), elevators, independent Contractors, products, and completed operations, with contractual liability coverage (for contracts related to the work) for claims arising out of the work for personal injury, bodily injury, and property damage in policies of insurance such that the total available limits combined shall not be less than five hundred thousand dollars ($500,000) for each occurrence. B. The Water Authority reserves the right to add or subtract coverages required by the Contractor. If such additions or deletions are made, an equitable adjustment to the Contract amount shall be made by extra work order. C. The Contractor shall verify its subcontractors' compliance with the foregoing requirements and cause their certificates of insurance to be provided to the Water Authority CONTRACTOR OBLIGATIONS A. The Contractor and each of its subcontractors shall: 1. Provide enrollment information as required by the Water Authority. Furnish to the Water Authority or its designee, or the insurance carriers all information and documentation that the OCIP Administrator may require from time to time in connection with the issuance of policies under this Contract, in such form and substance as the OCIP Administrator may prescribe. 2. Furnish to the OCIP Administrator or the insurance carriers monthly payroll reports on the form provided by OCIP Administrator or insurance carrier and payroll records as required. 8

9 3. Segregate their respective reports relating to the work for which OCIP coverage is herein provided from their records relating to other work for which such coverage is not provided. 4. Promptly comply with the recommendations of the OCIP insurance carriers as submitted through the Engineer. B. The Contractor shall not violate or knowingly permit to be violated any conditions of the policies of insurance provided by the Water Authority under the terms of the Contract and shall at all times satisfy the requirements of the insurance companies issuing them. C. The Contractor shall assure that all OCIP requirements imposed upon and to be performed by the Contractor shall likewise be imposed upon, assumed, and performed by each of its subcontractors and uninsured parties with whom it or its subcontractors have a contractual relationship. D. The Contractor shall furnish each bidding and negotiating subcontractor, vendor, supplier, material dealer, or other person or business entity that may provide goods or services in connection with the work a copy of this Attachment describing the insurance requirements for the Contractor and its subcontractors shall require each to impose the same requirement in their subcontracting and procurement procedures. E. If the Contractor or any of its subcontractors should fail to comply with the requirements of this Attachment the Water Authority may withhold payments due to the Contractor or suspend the work until such time as the Contractor and its subcontractors have performed such obligations to the reasonable satisfaction of the Engineer NOTICES, COSTS, AND LOSSES A. Certificate of insurance shall provide for at least thirty (30) days prior written notice to the Water Authority of any cancellation, intent not to renew, or reduction in the policies coverage, except in the application of the aggregate limit provisions, (unless cancellation is for nonpayment of premium, in which case ten (10) days notice will suffice) or material reduction, and shall delete from any certificate the words endeavor to and but failure to do so shall impose no obligation or liability of any kind upon the issuer, its agents or representatives from the obligation to notify the certificate holder (Water Authority) of such cancellation non-renewal or reduction. Upon Water Authority request, Contractor (or subcontractors) shall provide the Water Authority with a certified copy of any policy of insurance by part 2. Vendors, suppliers, material dealers and others who merely transport, pick up, deliver or carry materials, parts or equipment or any other items or persons to or from the Project site and those who furnish material worked to a special design but perform no operations at the Project Site shall not be required to furnish a certificate(s) or other evidence of insurance to the Water Authority. B. The Contractor and its subcontractors shall not be permitted on the work site for the performance of work until appropriate certificates of insurance are issued by the OCIP Administrator. Prior to the date on which the Contractor or any subcontractor commences performance of its part of the work, the Contractor shall cause to be furnished to the OCIP Administrator certificates of insurance for insurance required to be maintained by the Contractor and its subcontractors as provided herein. 9

10 C. The Water Authority will pay the cost of the premiums for the insurance described above as being provided by the Water Authority, and the Water Authority will receive and pay, as the case may be, all adjustments in such costs, whether by way of dividends or otherwise. The Contractor shall execute such instruments of assignment as may be necessary to permit the Water Authority s receipt of such adjustments and shall cause all subcontractors covered by such insurance to do the same. D. The cost of losses sustained because of clauses that specify the Contractor deductible amounts in any of the insurance policies furnished by the Water Authority shall be paid by the Contractor. If the Water Authority-provided OCIP policies described in Section1.05 have deductible amounts greater than the Contractor-deductible amounts, such excess amounts will be paid by the Water Authority provided that the Contractor shall be responsible for losses greater than OCIP policy limits. G. Payments by the insurer for all losses covered under the All Risk Builder's Risk policy as specified in Section 1.06 will be made to the Water Authority. The Water Authority will make monies from the Builder's Risk policy available to the Contractor for rebuilding work damaged by covered perils SUBROGATION AND WAIVER A. The Contractor shall require all policies of insurance that are related to the work and that are secured and maintained by the Contractor and its subcontractors to include clauses providing that each underwriter and carrier shall waive all of their respective rights of recovery, under subrogation or otherwise, against the Water Authority, its Board of Directors, officers, agents, employees, and Contractors rendering services at the work site, the Contractor, its subcontractors, other project contractors, and their subcontractors regardless of tier. B. The Contractor waives all rights of recovery against its subcontractors, the Water Authority, its Board of Directors, officers, agents, employees, and Contractors rendering services at the work site, other project contractors, and their subcontractors regardless of tier that the Contractor may have or acquire because of deductible clauses in or inadequacy of limits of policies of insurance that are in any way related to the work and that are secured and maintained by the Contractor. C. The Contractor shall require its subcontractors to waive the rights of recovery in the same manner (as waived in the preceding paragraph by the Contractor) against the Water Authority, its Board of Directors, officers, agents, employees, and Contractors rendering services at the Work site, the Contractor, other project contractors, and their subcontractors regardless of tier OCIP INSURANCE MANUAL A. OCIP Administrator will provide an OCIP Insurance Manual that will describe procedures relevant to the OCIP. The Contractor and its subcontractors are required to comply with the procedures therein described. 10

11 San Diego County Water Authority Emergency Storage Project Insurance Enrollment Form San Diego County Water Authority Emergency Storage Project Owner Controlled Insurance Program Enrollment Transmittal Date: From: Contractor Name No of Pages: Contact Name/Phone Number To: Debbie Palmer San Diego County Water Authority - ESP c/o Marsh Risk & Insurance Services 4275 Executive Square, Suite 600 La Jolla, CA cc: Robert Homer, Risk Manager 4677 Overland Avenue San Diego, Ca Re: Water Authority's ESP Spec # Fax: (858) Fax: (858) Attached are the following enrollment forms: ο Form 1 Insurance Enrollment ο Form 2 Notice of Subcontract Award ο Certificate of Insurance - For Off-site coverages Please process enrollment and forward coverage information and verification to: Contractor Contact Name Address Fax # You may fax this information to initiate the enrollment process. However, enrollment will not be complete untilall original enrollment forms are received. ESP Spec # Project Name Name of Contractor (If your organization has a subsidiary who will perform work on this project, the subsidiary must enroll.) 11

12 San Diego County Water Authority Emergency Storage Project Insurance Enrollment Form Address Prime Sub of Prime 2 nd Tier Sub Fax Federal Employer s ID# People at your company to contact for: Enrollment Phone No. Payroll Phone No. Safety/Loss Control Phone No. Claims Phone No. Location of Payroll Records Contract Information Contract No. Contract Value (Total dollar amount of work you will perform.) Estimated Start Date From whom contracted Estimated Completion Date Current Workers Compensation Insurance Information Regular Workers Compensation insurance company Experience Modifier Effective Date Policy Period From To CA Bureau ID Number Agent (Name/Phone #) Current General Liability Insurance Information Regular General Liability insurance company Policy Number Agent Policy Period From Basis for Premium To (Name/Phone #) 12

13 San Diego County Water Authority Emergency Storage Project Insurance Enrollment Form Current Umbrella and/or Excess Liability Insurance Information Umbrella/Excess Liability insurance company Policy Number Agent (Name/Phone #) Policy Period From Basis for Premium To Rate For work to be performed under this contract only Attach additional forms if necessary Job Classification WC Classification Code Estimated Payroll Please complete and submit the following forms with this enrollment form: ο Form 2 Notice of Subcontract Award, if applicable Signed by: Date: Title Refer any questions to: Marsh Risk & insurance Services Lisa Casella Telephone: (858) or Kathy McKenna Telephone: (858)

14 Date San Diego County Water Authority - ESP c/o Marsh Risk & Insurance Services 4275 Executive Square, Suite 600 La Jolla, CA Re: Notice of Subcontract Award and Request for Insurance Water Authority's ESP - OCIP Spec # We have awarded the following contract: Contract No. Subconsultant Address Representative Date of Contract Type of Work Estimated Contract Amount Telephone Probable Starting Date Please send OCIP Contractor Information Manual and enrolment forms to process our subcontractor s enrollment. Sincerely, Name/Title Company Name Return to: SDCWA- ESP c/o Marsh Risk & Insurance Services 4275 Executive Square Suite 600 La Jolla, CA Fax: (858)

15 San Diego County Water Authority Emergency Storage Project Owner Controlled Insurance Program (OCIP) Professional Liability Insurance Application (Claims Made Basis) Applicant Instructions: 1. Please type or print in ink. 2. Answer all questions; leave no blank spaces. 3. If space provided is insufficient to answer any question fully, attach separate sheet. 4. This application must be signed and dated by an Owner, Partner or Officer. This is important. NOTE: In applying for coverage, the applicant agrees that in the event of covered losses, he will be required to be defended by the Company s appointed attorneys and that the deductible shall apply to loss and include (whether or not loss payment is made) adjusting expenses, investigation costs, and legal fees. If, however, the Applicant elects to handle a claim without in any way involving the Company s attorney, then no coverage for such claim is afforded the Applicant under the Policy. 1. Name and/or designation of Project: San Diego County Water Authority-Emergency Storage Project 2. Describe the nature of Project: (use separate sheet, if necessary) 3. Duration the professional services on this Project: Design phase: from To Construction phase: from to 4. Total estimated Project billing: $ 5. Indicate the percentage of the total estimated Project billings derived from the following services: Architecture: % Land Surveying: % Civil Engineering: % Landscape Architecture: % Electrical Engineering: % Other: (please list) % Soils Engineering: % % Construction Management: % % Mechanical Engineering: % TOTAL: (must equal) 100 % 6. With regard to this Project, will you or one of your subcontractors perform services in the following areas: (if Yes, please check and provide full details on a separate sheet.) Boundary Tunnels Roads Surveys of subsurface conditions Bridges surveys Ground Testing Dams 7. Name of Firm s Prime Professional Liability Insurance Insurance coverage: Company name: Limit of liability: Deductible: Effective date: Expiration date: 15

16 8. Complete the following regarding any subcontractors rendering service in connection with this project: Name of Firm & Address Type of Service Will they enter the project site? 9. Has any insurer during the past ten years cancelled or refused to renew any insurance issued to any Person or Firm comprising your firm? Yes No If Yes, explain: 10. Has any claim, suit or demand for arbitration been made during the past ten years against any Person or Firm comprising your firm? Yes No If Yes, explain: 11. Do the Principals of your firm have knowledge of any error, omission or any other circumstance that is, or could be, a basis for a claim under the proposed policy? Yes No If Yes, explain: 12. With regard to this project, does your firm or any of your subcontractors or any Partner, Officer, Subsidiary or otherwise related Entity engaged in actual construction, manufacturing, fabrication or real estate development? Yes No If Yes, explain: 13. With regard to this Project, does your firm or any of your subcontractors or any partner, Officer, Employees Subsidiary or otherwise related Entity maintain an ownership interest? Yes No If Yes, please indicate name, relationship and percentages of ownership interest: Dated this of, 20. Signature of Director/Partner/Principal: Title: 16