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Proposal - Ocean Springs - Qualifications
Compan Address Represe Phone:'- c4a Qmu(& RE VEST FOR QUALIFICATIONS SUMMARY (Use additional pages if needed) Mission Statement: _ Statement_of-Values: A \CA Cza -�- (M IFORNIA -- - Work-- Work Schedule (Use additional pages or an alternate format if needed) Provide a proposed detailed schedule of work that identifies the aspects of the work required. The proposed schedule should address issues such as daily, weekly maintenance times," water clarity, algae removal, odors, and types of chemicals used."Also include weekly/monthly strategies to maintain the pool and water features to a high standard. Proposed weekly schedule of work:>C�n�l��-tT� �G, QuusrG, EQUIPMENT TO BE USED (Use additional pages or an alternate format if needed) List equipment to be used on this project and include any specialized equipment used for water feature maintenance, do you have a preventative maintenance program, and 'how often equipment maintenance is performed. Equipment List: A Al 00KNP, CERTIFICATION OF PROPOSER'S EXPERIENCE AND QUALIFICATIONS The undersigned Proposer certifies that he is, at the time of proposing, and shall be, throughout the period of the Contract, licensed under the provisions of Chapter 9, Division 3, of the Business and Professions Code of the'State of California, to do the type of work contemplated in the Contract Documents. Proposer shall further certify that it is skilled and regularly engaged in the general class and type of work called for in the Contract Documents. The Proposer represents that it is competent, knowledgeable, and has special skills on the nature, extent, and inherent conditions of the work to be performed. Proposer further acknowledges that there are certain peculiar and inherent conditions existent in the maintenance of the facilities, which may create, during the water feature maintenance contract, unusual or peculiar unsafe conditions hazardous to persons and property. Proposer expressly acknowledges that it is aware of such peculiar risks and that it has the skill and experience to foresee and to adopt protective measures to adequately, and safely, perform the work with respect to such hazards. The Proposer shall list below three (3) contracts completed in the last seven (7) years of similar size and complexity that indicate the Proposer's experience in water feature maintenance. The projects must be similar in scope of work (i.e. commercial and/or municipal). Please indicate on additional paper if a quality control program was implemented, and managed, as part of the work efforts, and if written proof of the quality control program can be provided to the City of La Quinta prior to the award of proposal for this previous assignment. A. Project Name: - Owner:�\.��� Contract Amount: $ ���Ji��. Contract Time:?)��__) Calendar Days Owner's Representative ( -Owner's Telephone No: 16C)°F--l6LA- --\\\ Duration of Contract: yD Years from .,l_ lb to Prevailing Wage: _Yes Y\ No ta Q"fra —:ALWOaNIA— B. Project Name: Owner: Contract Amount: $�.� r _ Contract Time: CalendarDays Owner's Rep resentative:lDi-z,&(-,Ski-Cowner's Telephone Duration of Contract: \C)— Years from _ A\C' _ to Prevailing Wage: _Yes X No A C. Project Name: Owner: Contract Amount: $��`��,_ Contract Time:Calendar Days Owner's Representative: Wa CNVn Owner's Telephone No:�9'-1Lc�"111v1 Duration of Contract: Years from (Qn1LA to�� Prevailing Wage: _Yes X No Signed this day of , 2020. Name of Proposer Contractor's License No. �. ��►a air' .rc t n -j� -ea1 / a(pan Address of Proposer License Expiration Date �J Y:� DIR Number (Prevailing Wage) Ni\10�- DIR Classification Cell Pone Expiration Date Email address' Office Phone *Have you or your sub -contractors been debarred: Yes ❑ No If yes, provide additional information on a separate sheet of paper. --iAuFORNIA CERTIFICATIONS List any certifications that apply to this project held by your company and/or staff, and how many staff members have those certifications. Certification: Certification: %c Certification: L m�jlCfu� Certification: i Certification: � 'a Certification: Certification: Certification: Certification: Certification: Certification: Additional Comments: CHEMICALS List any and all chemicals to be used for this project, and their purpose. Additional Comments: taQ"fra C V ItORN1A PROPOSED PERSONNEL Provide a list of proposed personnel to be assigned specifically for this project, include any details as to what would make your staff more qualified than anyone else. Include the size of the assigned Supervisor's and Foreman's territory and other Munis, Businesses, and H OA's. Occupatio n/Title:'1('CIIC�S Occup at ion/ Tit I e: -t Occupatio n/Title:_��(1 Occupation/Title: • - WR �0i1-M-S I 017LM Occupation/Title: Occupation/Title: Occupation/Title: Occupation/Title: Occupation/Title: Occupation/Title: Additional Comments: - x"M WORM,% �- NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY PROPOSER AND SUBMITTED WITH PROPOSAL State of California ) - )ss. County ofirer,ic� -Airm ina7 P-cxA(190?- -Z- being first duly sworn, deposes and says that kq/she is Tjf-5�powl; r of - ; e in6 the party making the foregoing proposal that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that the proposer has not directly or indirectly induced or solicited any other proposer to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any proposer or anyone else to put in a sham proposal, or that anyone shall refrain from proposing; that the proposer has not in any manner, directly or indirectly sought by agreement, communication, or conference with anyone to fix the proposal price of the proposer or any other proposer, or to fix any overhead, profit, or cost element of the proposal price, or of that of any other proposer, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the proposal are true; and, further, that the proposer has not, directly or indirectly, submitted his or her proposal price of any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, proposal depository, or to any member of agent thereof to effectuate_a collusive -or sham proposal. Signature aMy KARINA ARRIETA Notary Public - California /9- %� /J �� �� / V 6Z i Riverside County 15Commission b 2279133 Name of Proposer Comm. Expires Feb 28, 2023 "-pp &�) Title 4. Z-0 Z G Date Exhibit A Page 5 - Request for Qualification Summary Company Name: Ocean Spring Tech Inc. Address: 12526 Palm Drive Suite A Desert Hot Springs Ca 92240 Representative: Armando Rodriguez Phone: 760-329-8933 Email: oceansprinps@hotmail.com Mission Statement: Ocean Springs Tech aspires to provide superior swimming pool maintenance, service, and repairs to our residential and commercial customers. Providing leading edge swimming pool solutions and outdoor living enhancement to the Coachella Valley, the High Desert, and surrounding areas. Statement of Values: Ocean Springs Tech is known as the leader in customer service and satisfaction within the pool remodeling, water management and maintenance industry. Our experience includes management of full technical crew and repair team, water management, major and minor repairs, plumbing and electrical repairs. Page 6 - Work Schedule: Ocean Springs Tech will disinfect and clean One Lap Pool and One Wadding Pool at the Fritz Burns Park three days a week. In addition, all equipment will be inspected on each scheduled visit to assure it is in proper working condition. The following procedures will be done at every scheduled visit ➢ Vacuuming the Lap Pool and the Wadding Pool three times a week. ➢ Brush down walls and bottom of pools as necessary. ➢ Backwash the pools three times a week. ➢ Clean filter pump as necessary. ➢ Remove all leaves and foreign objects from the pool skimmer baskets. ➢ Skim leaves and other foreign objects from the surface and bottom of the pools. ➢ Scrub waterline tiles with soap and brush to remove oils. Dirt, and scum at a minimum of once per week and /or whenever necessary to prevent build-up of oils dirt and scum from the pools. ➢ Maintain water chemistry by using a test kit to ensure compliance with health and water quality standards established by the Riverside County Health Department. ➢ The chemical readings for the pool include: Free Chlorine & PH (each visit) combined chlorine, Alkalinity, Calcium, Conditioner, and Phosphate levels. ➢ Monitor the pools for proper water levels. ➢ Maintain and complete the chemical log sheet on each service visit. ➢ Maintain chemical rooms clean of debris and free of unsafe issues. ➢ Report any safety and/ or issues other than equipment problems such as: loose handrails, bad flow meters, water leaks, failing timers etc. Ocean Springs Tech will disinfect and clean The Splashpad seven days a week. In addition, all equipment will be inspected on each scheduled visit to assure it is in proper working condition. ➢ Clear the Splashpad of any trash such as paper, cans, bottles, broken glass, and other debris that may be unsafe surrounding the water feature. ➢ Maintain the Splashpad clear of leaves, branches, algae, or any other slippery build up. ➢ Maintain water chemistry by using a test kit to ensure compliance with health and water quality standards established by the Riverside County Health Department. ➢ The chemical readings for the Splashpad include: Free Chlorine & PH (each visit) combined chlorine, Alkalinity, Calcium, Conditioner, and Phosphate levels. ➢ Monitor the Splashpad for proper water levels. ➢ Maintain and complete the chemical log sheet on each service visit. ➢ Maintain chemical rooms clean of debris and free of unsafe issues. ➢ Report any safety and/ or issues other than equipment problems such as: loose nozzles, broken drain covers, bad flow meters, water leaks, failing timers etc. Preventative Maintenance Programs Sand Filter Frequency Schedule: It is recommended to change out the sand media and do a sand filter evaluation every 2 years for Pool facilities with a high body load. (Cost of this service not included in this proposal) ➢ Backwash Filters — Once a week ➢ Inspect and adjust all pressure gauges, vents & butterfly valves — Monthly ➢ Check and adjust torque for all tank caps bolts — Monthly ➢ Backwash entire system — Bi -Annually ➢ Remove and inspect top end cap and pressure plate assembly — Bi -Annually ➢ Remove and inspect Tubular elements — Bi -Annually ➢ Inspect bottom of filter tank for media build-up — Bi -Annually ➢ Clean sight glass tube — Bi -Annually ➢ Set Backwash flow rate — Bi -Annually ➢ Remove mesh screen assembly from the internal air relief tubing — Bi -Annually Heater Maintenance Frequency Schedule It is recommended to perform a heater disooting annually. (Cost of this service not included in this proposal) ➢ Remove any debris —As needed ➢ Review & maintain flame condition and ensure quality combustion — Bi -Weekly ➢ Replace heater combustion air filter — Monthly ➢ Heater Disassembly to facilitate inspections and cleaning of burners and gas manifolds - Annually ➢ Upper Cabinet cleaning, including disassembly and cleaning—Annually ➢ Test and set manifold pressure — Bi -Annually ➢ Test and set combustion air cabinet pressure — Annually ➢ Confirm proper vent draft — Bi -Annually ➢ Lubricate Booster pump bearing assembly —Annually ➢ Complete chemical evaluation — Annually Page 7 — Equipment to be used ➢ Porter vacuum ➢ Large vacuum head ➢ Small vacuum head ➢ 50ft & 25 ft vacuum hose and connector ➢ One 16-32 ft pole & Extender ➢ Regular pool net ➢ Fine pool net/ Pole ➢ Tile pads with hand pole ➢ 25-50 ft Garden hose ➢- 25-50 ft Electric -extension cord- - ➢ Complete water test kit ➢ Two brushes — one metal & one nylon (or combined) ➢ Measuring cup for the chemicals ➢ Broom and dustpan to sweep chemical room U Page 11- Chemicals and their Purpose ➢ Chlorine (Sodium Hypochlorite) — Sanitation Product ➢ Acid (Muriatic Acid) -Used to adjust pH levels ➢ Neutralizer (Sodium Sulfate) — Reduces chlorine levels ➢ Soda Ash (Sodium Carbonate) — Additive used to rise pH and Alkalinity levels ➢ Alkalinity (Sodium Bicarbonate) — Rises Alkalinity levels in the pool ➢ CYA (conditioner) — Chemical used to Protects chlorine from UV rays from the sun ➢ Thrid-chlore (Algaecure) — Effective Algicide ➢ Thri-chlore tablets - Removes Calcium scale and inhibits the formation on new scale. ➢ Di-chlore (Granular)—Sanitation Product ➢ Blue Soap (Body oil Remover) — Body Oil Remover ➢ Red/ Brown soap — Remove calcium build up ➢ Bio-Dex Tile Cleaner — Pool Tile Cleaner ➢ QT Defoamer — Prevents and eliminates foam Page 13 - Additional Services ➢ Water Management ➢ Plumbing Repairs ➢ Electrical Repairs ➢ Major and Minor repairs on equipment ➢ Water feature and fountain maintenance and repairs ➢ New Pool Construction ➢ Pool Remodeling ➢ Decking -➢-Sand/Glass Blasting ➢ Chlorine/ Acid Wash OC EASP R-02 CERTIFICATE OF LIABILITY INSURANCE DAT°/YYYY) 5/129/22912020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 CONTACT NAME;. San Ramon, CA - HUB International Insurance Services Inc. PHONE tet) (8a0j 366-7050 I FArc, Nn}: 825} 905-5584 2300 Clayton Rd - • Concord, CA 94520 E-MAIL ADDRESS; INSURED Independent Pool & Spa Service Association PO Box 1617 Rocklin, CA 95677 —INSURER(S) AFFORDING COVERAGE _ _NAIC N NSURERA:Evanston Insurance Company _ 35378 NSURER B NSURER C.; INSURER E INSURER F. 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. ISRiADDLSUBR POLICY EFF POLICY EXP �(>u$n. TR + TYPE OF INSURANCE yyyn-, . POLICY NUMBER LIMITS CLAIMS -MADE A ` X J COMMERCIAL GENERAL LIABILITY 11,000,0' 1 I CLAIMS -MADE X OCCURRPG1100001-16 4/1/2020 4/1/2021 X X EACH OCCURRENCE_ _ $ _ DAMAGE TO RENTED _PR EMISESP-s o; _ 200,0 MFA EXP(Any one person)....—_.�...� 5,0 $_ _ PERF*W A_VV INJURY l'3,000,01 7,000,01 GENT AGGREGATE LIMIT APPLIES PER: I GEhIERAI_AGGREGATE A PRO- x'1 POLICY Li FRO - !LOC r_�_ _ ..._ ~PR4-S-CCOAjP1 PAGE ._ 3,000,0I i OTHER $ WORKERS COMPENSATION AUTOMOBILE LIABILITY PER GTH- AND EMPLOYERS' LIABILITY y i N COMBINED SINGLE L1M1T -jEa accidenll_ _ _ T .... - . . 'ANY PROPRIETOR/PARTNER/EXECUTIVEr-�l OFFICER/MEMBER EXCLUDED? LJ (Mandatory in NH) ANY AUTO E.L.EACH ACCIDENT _ E.L. DISEASE - EA EMPLOYEE BODILY INJURY (Per person)_ If yes, describe under DESCRIPTION OF OPERATIONS below — OWNED SCHEDULED AUTOS ONLY AUTOS F -L DISEASE -POLICY LIMIT j" BODILY INJURY (Per ! [ I _ NCD AUTOS ONLY AUTOS ONLY eracR.idnDAMAGE •_,�_� $ �� DESCRIPTION OF OPERATIONS ! LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Swimming Pool Service, Repair and Remodeling Member: Armando Rodriguez of Ocean Springs Tech, Inc. Certificate holder is listed as additional insured per form MEGL 2215 Primary and no contributory perform attached. Waiver of subrogation applies. R City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD — — UMBRELLA LIAB ! OCCUR I EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE I AGGREGATE $_ _ DED HL T EN1 ION $ WORKERS COMPENSATION PER GTH- AND EMPLOYERS' LIABILITY y i N T .... - . . 'ANY PROPRIETOR/PARTNER/EXECUTIVEr-�l OFFICER/MEMBER EXCLUDED? LJ (Mandatory in NH) N/A E.L.EACH ACCIDENT _ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below F -L DISEASE -POLICY LIMIT ! [ DESCRIPTION OF OPERATIONS ! LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Swimming Pool Service, Repair and Remodeling Member: Armando Rodriguez of Ocean Springs Tech, Inc. Certificate holder is listed as additional insured per form MEGL 2215 Primary and no contributory perform attached. Waiver of subrogation applies. R City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OCEASPR-02 G CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/14/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # 0757776 - - --- ----- --- - j co A ACT Rocky Stein -- -- - -- N HUB International Insurance Services Inc. RONEExl 877 825 268FAX 1 951 1-2572 2300 Clayton Rd i . )-..(_–_- 23 --- -.- _ – — �_ C,Nq):{ ) Concord, CA 94520 E-MAlL CaI.CPU Hubinternational.com _ ApDgESs: -----Q - - _-,JNSUREF3(S)gFFOPING_CQVEMGE I NAICII INSURERA:Nationwide Mutual Insurance Company .... :23787 INSURED Ocean Springs Tech, Inc. P.O. Box 234 Desert Hot Springs, CA 92240 nnVPPAnPR r r-0TlVlr'ATC kI11RARF=F7- INSURER B: Nautilus Insurance Company. _ 17370 INSURERC:I.nsurance Comrty, paof the West _- — 17847_ NNgURF�$E1_- - — - IHSt1R£R E -- INSURER F: f o1-tllelnkl Id I I RAn mo I 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. INSRTYPE OF INSURANCE 'ADDLi.SUBRi POLICY NUMBER f POLICY EFF MMIDDiYYYY)I POLICY EXP LIMITS _ I COMMERCIAL GENERAL LIABILITY _ _ CLAIMS -MADE u OCCUR EACH QCCU E $ _ DAMAGE TO RENTED $ IdED F'P-{-My-Me p=54nJ - —I -- _PERSONAL &AAV L& UR_Y $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a LOC - $ $ _ -- G_El1ERA_LAGGR_EGA7E PRODUCTS -COMPIOPAGG_ OTHER: P $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED j I SCHEDULED AUTOS ONLY AUTOS I ACP3087672992 4/1/2020 4/1/2021 f COMBINED SINGLE LIMIT •BODILY INJURY (Perperson� $ 1,000,000 $ BODILY INJURY_ Per acciden " $ X HIRED f X NON -OWNED AUTOS ONLY _ . , AUTOS ONLYI i III PR4PSIt AMAGI; .,(F'e'w -_ B X UMBRELLA LIAB X OCCUR __ EACH OCCURRENCE '4,000,000 AGGREGATE EXCESS LIAR CLAIMS -MADE AN084002 4/1/2020 4/1/2021 — DED I X I RETENTION$ 10,000 !Prod/Comp Ops _ 1 4,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN FIC LUDED? ER/MEMBER EXCN� Wi, ndatory in NH) +-- I If describe under gD IPTION OF OPERATIONS below N / A X WPL503357104 4/1/2020 4/1/2021 XI PEROTH- ; 1,000,000 E -L, EACH ACCIDENT $ 1,000,000 EL DISEASE-_EAEMPLOYEF $ E.L DISEASE - POLICY LIMIT ! 1,000,000 DESCRIPTION OF OPERATIONS / LOCA1IONS; VEIIICLI;S (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Waiver of Subrogation with regard to Workers Compensation applies in favor of Clty of La Quints when required by written contract per the attached endorsement form WC990634 (Ed. 8-00). City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CA OPERATIONS 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 Effective04/01/2020 Policy No. WPL 5033571 04 Endorsement No. Insured OCEAN SPRINGS TECH INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CA OPERATIONS 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 Effective04/01/2020 Policy No. WPL 5033571 04 Endorsement No. Insured OCEAN SPRINGS TECH INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED References La Quinta Resort & Oub 49-499 Eisenhower Drive La Quinta Ca 92253 Contact: Max Schroeder Phone: 760-564-4111 Max.schroederC@waldorfastoria.com Santa Rosa Cove 49-991 Eisenhower Drive La Quinta Ca 92253 Contact: Dave Scott Phone: 760-777-7621 Dave.scott_@aIbertmgt.com Silver Sands Racquet Club 74155 Country Club Drive Palm Decert Ca 92.260 Contact: Douglas Quinn quedc)ctor@hotmall.com Sands RV & Golf Resort 16400 Bubbling Wells Road Desert Hot Springs Ca 92240 Contact: Scott Matas Phone: 760-251-1030 Smatas@suncommunities.com