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HomeMy WebLinkAboutCAG2022-434 - Original - Univar Solutions USA Inc. - Water Treatment Chemical Supply - 11/15/2022Ap p r o v a l Originator:Department: Date Sent:Date Required: Authorized to Sign: Director or Designee Date of Council Approval: Grant? Yes No Type: Re v i e w / Si g n a t u r e s / R o u t i n g Comments: Date Routed to the City Clerk’s Office: Ag r e e m e n t I n f o r m a t i o n Vendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Basis for Selection of Contractor: Termination Date: Local Business? Yes No* Business License Verification: Yes In-Process Exempt (KCC 5.01.045) If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Notice required prior to disclosure? Yes No Contract Number: Agreement Routing Form For Approvals, Signatures and Records Management This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms. Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20 Budget Account Number: Budget? Yes No Dir Asst: Sup/Mgr: Dir/Dep: rev. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY (Optional) * Memo to Mayor must be attached GOODS & SERVICES AGREEMENT - 1 ($20,000 or Less, incl. WSST) GOODS & SERVICES AGREEMENT between the City of Kent and Univar Solutions USA Inc. THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Univar Solutions USA Inc. organized under the laws of the State of Washington, located and doing business at 8201 S. 212th Street, Kent, WA 98032, Phone: (253) 872-5000, Contact: Jennifer Perras (hereinafter the "Vendor"). AGREEMENT I.DESCRIPTION OF WORK. The Vendor shall provide the following goods and materials and/or perform the following services for the City: The Vendor shall supply the City of Kent Water Department with water treatment chemicals (bid item #8) according to the bid proposal submitted October 18, 2022, which is attached as Exhibit A and incorporated by this reference. The Vendor acknowledges and understands that it is not the City’s exclusive provider of these goods, materials, or services and that the City maintains its unqualified right to obtain these goods, materials, and services through other sources. II.TIME OF COMPLETION. Upon the effective date of this Agreement, the Vendor shall complete the work and provide all goods, materials, and services by December 31, 2023. III.COMPENSATION. The City shall pay the Vendor an amount not to exceed Three Thousand, Six Hundred Sixty Dollars ($3,660), including applicable Washington State Sales Tax, for the goods, materials, and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: Compensation of up to $3,660 is based on an estimate of annual need. Actual need may vary as follows: Item #8: Zero to 1,200 Gallons Therefore, actual compensation will be between $0 and $3,660 and be based on the exact quantity of chemicals ordered by the City. Card Payment Program. The Vendor may elect to participate in automated credit card payments provided for by the City and its financial institution. This Program is provided as an alternative to payment GOODS & SERVICES AGREEMENT - 2 ($20,000 or Less, including WSST) by check and is available for the convenience of the Vendor. If the Vendor voluntarily participates in this Program, the Vendor will be solely responsible for any fees imposed by financial institutions or credit card companies. The Vendor shall not charge those fees back to the City. If the City objects to all or any portion of an invoice, it shall notify the Vendor and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. A. Defective or Unauthorized Work. The City reserves its right to withhold payment from the Vendor for any defective or unauthorized goods, materials or services. If the Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services from other sources, and the Vendor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Agreement price specified above. The City further reserves its right to deduct these additional costs incurred to complete this Agreement with other sources, from any and all amounts due or to become due the Vendor. B. Final Payment: Waiver of Claims. VENDOR’S ACCEPTANCE OF FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Vendor has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Vendor maintains and pays for its own place of business from which the Vendor’s services under this Agreement will be performed. C. The Vendor has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained the Vendor’s services, or the Vendor is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Vendor is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Vendor has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by the Vendor’s business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Vendor maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. VI. CHANGES. The City may issue a written amendment for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines, for any reason, that an amendment is necessary, the Vendor must submit a written amendment request to the GOODS & SERVICES AGREEMENT - 3 ($20,000 or Less, including WSST) person listed in the notice provision section of this Agreement, Section XV(D), within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Vendor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the amended work upon receiving either a written amendment from the City or an oral order from the City before actually receiving the written amendment. If the Vendor fails to require an amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the adjustment as provided in subsections A through E of Section VIII, Claims, below. The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. An amendment that is accepted by the Vendor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. VII. FORCE MAJEURE. Neither party shall be liable to the other for breach due to delay or failure in performance resulting from acts of God, acts of war or of the public enemy, riots, pandemic, fire, flood, or other natural disaster or acts of government (“force majeure event”). Performance that is prevented or delayed due to a force majeure event shall not result in liability to the delayed party. Both parties represent to the other that at the time of signing this Agreement, they are able to perform as required and their performance will not be prevented, hindered, or delayed by the current COVID-19 pandemic, any existing state or national declarations of emergency, or any current social distancing restrictions or personal protective equipment requirements that may be required under federal, state, or local law in response to the current pandemic. If any future performance is prevented or delayed by a force majeure event, the party whose performance is prevented or delayed shall promptly notify the other party of the existence and nature of the force majeure event causing the prevention or delay in performance. Any excuse from liability shall be effective only to the extent and duration of the force majeure event causing the prevention or delay in performance and, provided, that the party prevented or delayed has not caused such event to occur and continues to use diligent, good faith efforts to avoid the effects of such event and to perform the obligation. Notwithstanding other provisions of this section, the Vendor shall not be entitled to, and the City shall not be liable for, the payment of any part of the contract price during a force majeure event, or any costs, losses, expenses, damages, or delay costs incurred by the Vendor due to a force majeure event. Performance that is more costly due to a force majeure event is not included within the scope of this Force Majeure provision. If a force majeure event occurs, the City may direct the Vendor to restart any work or performance that may have ceased, to change the work, or to take other action to secure the work or the project site during the force majeure event. The cost to restart, change, or secure the work or project site arising from a direction by the City under this clause will be dealt with as a change order, except to the extent that the loss or damage has been caused or exacerbated by the failure of the Vendor to fulfill its obligations under this Agreement. Except as expressly contemplated by this section, all other costs will be borne by the Vendor. VIII. CLAIMS. If the Vendor disagrees with anything required by an amendment, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Vendor may file a claim as provided in this section. The Vendor shall give written notice to the City of all claims within fourteen (14) calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts or events giving rise to the claim, whichever occurs first. Any claim for damages, additional payment for any reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively deemed GOODS & SERVICES AGREEMENT - 4 ($20,000 or Less, including WSST) to have been waived by the Vendor unless a timely written claim is made in strict accordance with the applicable provisions of this Agreement. At a minimum, a Vendor's written claim shall include the information set forth in subsections A, items 1 through 5 below. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. A. Notice of Claim. Provide a signed written notice of claim that provides the following information: 1. The date of the Vendor's claim; 2. The nature and circumstances that caused the claim; 3. The provisions in this Agreement that support the claim; 4. The estimated dollar cost, if any, of the claimed work and how that estimate was determined; and 5. An analysis of the progress schedule showing the schedule change or disruption if the Vendor is asserting a schedule change or disruption. B. Records. The Vendor shall keep complete records of extra costs and time incurred as a result of the asserted events giving rise to the claim. The City shall have access to any of the Vendor's records needed for evaluating the protest. The City will evaluate all claims, provided the procedures in this section are followed. If the City determines that a claim is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. C. Vendor's Duty to Complete Protested Work. In spite of any claim, the Vendor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. D. Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Vendor also waives any additional entitlement and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section, the Vendor completely waives any claims for protested work and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). IX. LIMITATION OF ACTIONS. VENDOR MUST, IN ANY EVENT, FILE ANY LAWSUIT ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATE THE CONTRACT WORK IS COMPLETE OR VENDOR’S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. X. WARRANTY. The Vendor warrants that it will faithfully and satisfactorily perform all work provided under this Agreement in accordance with the provisions of this Agreement. In addition to any other warranty provided for at law or herein, this Agreement is additionally subject to all warranty provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington. The Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, and will perform in accordance with their specifications and the Vendor’s representations to City. The Vendor shall promptly correct all defects in workmanship and materials: (1) when the Vendor knows or should have known of the defect, or (2) upon the Vendor’s receipt of notification from the City of the existence or discovery of the defect. In the event any part of the goods are repaired, only original replacement parts shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for GOODS & SERVICES AGREEMENT - 5 ($20,000 or Less, including WSST) that portion of the work shall extend for an additional year beyond the original warranty period applicable to the overall work. The Vendor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. XI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. The Vendor shall execute the attached City of Kent Non-Discrimination Policy Declaration and comply with City Administrative Policy 1.2. XII. INDEMNIFICATION. The Vendor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Vendor's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of the Vendor's work when completed shall not be grounds to avoid any of these covenants of indemnification. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event the Vendor refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Vendor’s part, then the Vendor shall pay all the City’s costs for defense, including all reasonable expert witness fees and reasonable attorneys’ fees, plus the City’s legal costs and fees incurred because there was a wrongful refusal on the Vendor’s part. The provisions of this section shall survive the expiration or termination of this Agreement. XIII. INSURANCE. The Vendor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. XIV. WORK PERFORMED AT VENDOR'S RISK. The Vendor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at the Vendor's own risk, and the Vendor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XV. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. GOODS & SERVICES AGREEMENT - 6 ($20,000 or Less, including WSST) C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties’ performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section XII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and the Vendor. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Vendor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to the Vendor's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Vendor acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Vendor agrees to cooperate fully with the City in satisfying the City’s duties and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. VENDOR: By Print Name Its Mrrnicinal Comme al Manaoer DATE: Novemher 2, 2022 CITY OF KENT: By: Digitallysigned by David A. Brock D a v i d A. B roc k ff:fl;",ilii l;l':*;i=11?Jlli::ff#'" Dat€: 2022.i 1.1 5 05:21 I 2 {800' Print Name:David A. Brock, P.E. Deputy Di rector OperationsIts: DATE: IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered betow. All acts consistent with the authority of this Agreement and prior to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. P :\Admln\Contracts\Dani GOODS & SERVICES AGREEMENT - 7 ($20,000 or Less, including WSST) NOTICES TO BE SENT TO: VENDOR: Jennifer Perras Univar Solutions USA, Inc. 8201 S. 212th Street Kent, WA 98032 (253) 872-5000 (telephone) (253) 572-5O4I (facsimile) NOTICES TO BE SENT TO: CITY OF KENT: Chad Bieren, P.E. City of Kent 220 Fourth Avenue South Kent, WA 98032 (253) Bs6-5500 (telephone) (253) 856-6500 (facsimile) ATTEST: Kent City Clerk EEO COMPLIANCE DOCUMENTS - 1 of 5 DECLARATION CITY OF KENT NON-DISCRIMINATION POLICY The City of Kent (City) is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors, consultants, vendors, and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City’s equal employment opportunity policies. The City of Kent and its contractors are subject to and will comply with the following: • Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of race, color, national origin); • 49 C.F.R. Part 21 (entitled Non-discrimination In Federally-Assisted Programs Of The Department Of Transportation-Effectuation Of Title VI Of The Civil Rights Act Of 1964); • 28 C.F.R. section 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of the Civil Rights Act of 1964). • Ch. 49.60 RCW (Washington Law Against Discrimination) The preceding statutory and regulatory cites hereinafter are referred to as “the Acts and Regulations”. The following statements specifically identify the requirements the City deems necessary for any contractor, subcontractor, or supplier on this specific Agreement to adhere to. An affirmation of all of the following is required for this Agreement to be valid and binding. If any contractor, subcontractor, or supplier willfully misrepresents themselves with regard to the directives outlined below, it will be considered a breach of contract and it will be at the City’s sole determination regarding suspension or termination for all or part of the Agreement. The statements are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement I, the prime contractor, will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. During the performance of this contract, the contractor, for itself, its assignees, and successors in interest (hereinafter referred to as the "contractor") agrees as follows: EEO COMPLIANCE DOCUMENTS - 2 of 5 A. Compliance with Regulations: The contractor, subcontractor, consultant, vendor, and supplier (hereinafter “Contractor”) will comply with all Acts and the Regulations relative to non-discrimination, including those applicable to Federally- assisted programs of the U.S. Department of Transportation, State-assisted programs through the Washington State Department of Transportation, and generally under Washington’s Law Against Discrimination, Ch. 49.60 RCW, as they may be amended from time to time, which are herein incorporated by reference and made a part of this contract. B. Non-discrimination: The contractor, with regard to the work performed by it during the contract, will not discriminate on the grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials and leases of equipment. The contractor will not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations, including employment practices when the contract covers any activity, project, or program set forth in Appendix B of 49 CFR Part 21. C. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations, either by competitive bidding, or negotiation made by the contractor for work to be performed under a subcontract, including procurements of materials, or leases of equipment, each potential subcontractor or supplier will be notified by the contractor of the contractor's obligations under this contract and the Acts and the Regulations relative to non-discrimination on the grounds of race, color, or national origin. D. Information and Reports: The contractor will provide all information and reports required by the Acts and Regulations and directives issued pursuant thereto and will permit access to its books, records, accounts, other sources of information, and its facilities as may be determined applicable to contractor’s contract by the City or the Washington State Department of Transportation to be pertinent to ascertain compliance with such Acts and Regulations and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish the information, the contractor will so certify to the City or the Washington State Department of Transportation, as appropriate, and will set forth what efforts it has made to obtain the information. E. Sanctions for Noncompliance: In the event of a contractor's noncompliance with the non-discrimination provisions of this contract, the City will impose such contract sanctions as it or the Washington State Department of Transportation may determine to be appropriate, including, but not limited to: a. withholding payments to the contractor under the contract until the contractor complies; and/or b. cancelling, terminating, or suspending a contract, in whole or in part. F. Incorporation of Provisions: The contractor will include the provisions of paragraphs (A) through (F) above in every subcontract, including procurements of materials and leases of equipment, unless exempt by the Acts and Regulations and directives issued pursuant thereto. The contractor will take action with respect to any subcontract or procurement as the City or the Washington State Department of Transportation may direct as a means of enforcing such provisions including sanctions for noncompliance. Provided, that if the contractor becomes involved in, or is threatened with litigation by a subcontractor, or supplier because of such EEO COMPLIANCE DOCUMENTS - 3 of 5 direction, the contractor may request the City to enter into any litigation to protect the interests of the City. In addition, the contractor may request the United States to enter into the litigation to protect the interests of the United States. 6. During the performance of this contract, the contractor, for itself, its assignees, and successors in interest agrees to comply with the following non-discrimination statutes and authorities; including but not limited to: Pertinent Non-Discrimination Authorities: i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of race, color, national origin); and 49 CFR Part 21. ii. The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. § 4601), (prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal-aid programs and projects); iii. Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 et seq.), (prohibits discrimination on the basis of sex); iv. Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits discrimination on the basis of disability); and 49 CFR Part 27; v. The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits discrimination on the basis of age); vi. Airport and Airway Improvement Act of 1982, (49 USC § 471, Section 47123), as amended, (prohibits discrimination based on race, creed, color, national origin, or sex); vii. The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of the terms "programs or activities" to include all of the programs or activities of the Federal-aid recipients, sub-recipients and contractors, whether such programs or activities are Federally funded or not); viii. Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the operation of public entities, public and private transportation systems, places of public accommodation, and certain testing entities (42 U.S.C. §§ 12131-12189) as implemented by Department of Transportation regulations at 49 C.F.R. parts 37 and 38; ix. The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. § 47123) (prohibits discrimination on the basis of race, color, national origin, and sex); x. Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations, which ensures Non-discrimination against minority populations by discouraging programs, policies, and activities with disproportionately high and adverse human health or environmental effects on minority and low-income populations; xi. Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency guidance, national origin discrimination includes discrimination because of Limited English proficiency (LEP). To ensure compliance with Title VI, you must take reasonable steps to ensure that LEP persons have meaningful access to your programs (70 Fed. Reg. at 74087 to 74100); xii. Title IX of the Education Amendments of 1972, as amended, which prohibits you from discriminating because of sex in education programs or activities (20 U.S.C. 1681 et seq). xiii. Washington Law Against Discrimination (Ch. 49.60 RCW) 8. The submission of the final invoice for this contract will constitute a reaffirmation that the preceding statements were complied with during the course of the contract's performance. By signing below, I agree to fulfill the five requirements referenced above. By: Jennifer M. Perras For: Univar Solutions USA Inc. Title: Municipal Specialist Date: 11 /14/2022 EEO COMPLIANCE DOCUMENTS - 4 of 5 EEO COMPLIANCE DOCUMENTS - 5 of 5 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: October 20, 2022 SUBJECT: INCLUSIVE CONTRACTING SUPERSEDES: January 1, 1998 APPROVED BY Dana Ralph, Mayor POLICY: Equal employment opportunity and non-discrimination in contracting requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants, and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Further, all contractors, subcontractors, consultants, suppliers, grantees, or subgrantees of the City, regardless of the value of the Agreement, are required to sign the City’s Non-Discrimination Policy Declaration, prior to commencing performance. Any contractor, subcontractor, consultant or supplier who willfully disregards the City’s nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to coordinate with the City’s Title VI coordinator, and perform the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City’s equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EXHIBIT A WATER TREATMENT CHEMICAL SUPPLY FOR 2023 PROPOSAL FORM The undersigned hereby proposes to provide all equipment, labor, materials and supplies to perform the service as specified In this contract (see Special Provisions 1.3 & 1.6) for the following fees: Bidder's Name: Univar Solutions USA Inc. Item Estimated Description Bid Unit Total Annual Unit Prices Usage 6 1,200 12 1/2% Sodium Hypochlorite in $3.05 $ 3,660.00 GALS* 100 to 400 Gal. Deliveries BULK GAL. FOB Garrison Well Total s 3,660.00 *Estimated annual need Is 1,200 Gals. Actual need may vary. Univar Solutions USA Inc. Company Submitting Proposal Auth rized Signature Note: Contractor must submit a Rrm proposal for the contract term(s). EXHIBIT B INSURANCE REQUIREMENTS FOR SERVICE CONTRACTS Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Contractor shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. The City shall be named as an insured under the Contractor’s Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 3. Workers’ Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate and a $2,000,000 products-completed operations aggregate limit. EXHIBIT B (continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Contractor’s insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor’s insurance and shall not contribute with it. 2. The Contractor’s insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor’s Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer’s liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Contractor. Ho l d e r I d e n t i f i e r : 77 7 7 7 7 7 7 0 7 0 7 0 7 0 0 0 7 7 7 6 3 6 1 6 0 6 5 5 5 3 3 3 0 7 7 2 6 1 7 4 4 6 3 0 4 5 5 7 7 0 74 4 2 0 2 7 7 7 2 5 0 7 3 0 0 0 7 3 6 4 0 5 7 7 1 4 6 3 2 1 1 2 0 7 7 2 4 0 5 1 1 3 0 6 7 0 1 1 2 0 75 6 2 0 5 1 3 3 6 2 7 4 5 1 2 0 7 5 6 6 6 3 7 5 3 6 0 3 6 7 7 4 0 7 1 4 0 0 1 3 1 5 0 6 3 2 3 1 2 0 71 4 4 0 1 7 5 7 2 2 7 4 1 3 0 0 7 7 7 2 7 2 5 2 0 2 5 7 7 3 1 1 0 7 7 7 7 7 7 7 0 7 0 0 0 7 0 7 0 0 7 66 6 6 6 6 6 6 0 6 0 6 0 6 0 0 0 6 2 6 0 6 4 6 6 2 0 4 4 4 6 2 0 0 6 2 2 2 0 0 4 2 4 0 0 4 2 0 2 0 0 62 2 2 0 0 6 2 4 2 2 4 0 0 0 2 0 6 2 2 2 0 2 6 0 4 2 2 6 0 0 2 2 0 6 2 2 0 2 0 6 2 6 2 0 4 2 2 2 0 0 62 0 2 0 2 6 2 6 0 2 6 0 0 0 0 0 6 2 0 0 0 2 4 0 4 0 2 6 2 0 2 0 0 6 2 2 2 2 0 4 2 4 0 2 4 2 2 0 0 0 62 2 0 0 0 6 0 6 2 2 0 0 4 2 2 0 6 6 6 4 6 0 6 2 2 4 0 6 6 4 4 4 0 6 6 6 6 6 6 6 0 6 0 0 0 6 0 6 0 0 6 Ce r t i f i c a t e N o : 57 0 0 9 3 3 7 0 4 1 7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/31/2022 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). 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. PRODUCER Aon Risk Services Central, Inc. Philadelphia PA Office 100 North 18th Street 15th Floor Philadelphia PA 19103 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 22667ACE American Insurance CompanyINSURER A: 20702ACE Fire Underwriters Insurance Co.INSURER B: 43575Indemnity Insurance Co of North AmericaINSURER C: 27960Illinois Union Insurance CompanyINSURER D: INSURER E: INSURER F: FAX (A/C. No.):800-363-0105 CONTACT NAME: Univar Solutions, Inc 3075 Highland Parkway Suite 200 Downers Grove IL 60515 USA COVERAGES CERTIFICATE NUMBER:570093370417 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $3,000,000 $3,000,000 Excluded $3,000,000 $3,000,000 $3,000,000 A 06/01/2022 06/01/2023 SIR applies per policy terms & conditions XSLG47304775 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $5,000,000A06/01/2022 06/01/2023 Commercial Auto COMBINED SINGLE LIMIT (Ea accident) ISA H10699058 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $4,000,000 $4,000,000 06/01/2022 SIR applies per policy terms & conditions UMBRELLA LIABD 06/01/2023XCEG27380566009 RETENTIONX X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- ER PER STATUTEC06/01/2022 06/01/2023 AOS WLRC70303048A 06/01/2022 06/01/2023 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN MA WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WLRC70303085 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Delivery of Water treatment chemicals, Location: All ship to locations in the Bid. City of Kent is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. The Insured is self-insured for physical damage to their vehicles. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Kent Attn: Sean Bauer 220 4th Ave. S. Kent WA 98032 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570093370417 570093370417 Aon Risk Services Central, Inc. 570000014538 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # Univar Solutions, Inc TYPE OF INSURANCE POLICY NUMBER LIMITS AUTOMOBILE LIABILITY A MMT H10699125 06/01/2022 06/01/2023 WORKERS COMPENSATION B SCFC70302962 06/01/2022 06/01/2023 A WCUC70303000 06/01/2022 06/01/2023 Combined Single Limi $5,000,000 Truckers Liability WI Excess WC--CA OH OR,WA N/A N/A ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) SIR applies per policy terms & conditions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SIGNA URES Named Insured Univar Solutions Inc. Endorsement Number 3 Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G47304775 o6/01/2022 To o6/ol/2023 Issued By (Name of Insurance Company) ACE American Insurance Company THE ONLY COMPANY APPLICABLE TO THIS POLICY IS THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS. By signing and delivering the policy to you, we state that it is a valid contract. INDEMNITY INSURA E COMPA OF NORTH A RICA (A stock company) BA NIMS STA INSURA E COMPA (A stock company) ACE A RICA INSURA E COMPA (A stock company) ACE PROPERTY A CASUA TY INSURA E COMPA (A stock company) INSURA E COMPA OF NORTH A RICA (A stock company) PACIFIC EMPLOYERS INSURA E COMPA (A stock company) ACE FIRE UNDERWRITERS INSURA E COMPA (A stock company) WESTCHESTER FIRE INSURA E COMPA (A stock company) 436 Walnut Street, P.O. Box i000, Philadelphia, Pennsylvania 191o6-3703 JULIET SCHWEIDEL, Secretary JOHN J. LUPICA, President Authorized Representative CC-1K11j (03/21) Page 1 of 1 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS Named Insured Endorsement Number Univar Solutions Inc. 46 Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G47304775 06/01/2022 to 06/01/2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY Schedule Organization Additional Insured Endorsement Any additional insured with whom you have agreed to provide such non- contributory insurance, pursuant to and as required under a written contract executed prior to the date of loss. (If no information is filled in, the schedule shall read: `All persons or entities added as additional insureds through an endorsement with the term `Additional Insured" in the title) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IVA: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a loss we cover under this policy, this insurance will apply to such loss and is primary (subject to satisfaction of the "retained limit"), meaning that we will not seek contribution from the other insurance available to the Additional Insured. Your "retained limit' still applies to such loss, and we will only pay the Additional Insured for the "ultimate net loss" in excess of the "retained limit' shown in the Declarations of this policy. Authorized Representative XS-20288a (05/14) ©Chubb. 2016. All rights reserved. Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured Endorsement Number Univar Solutions Inc. 67 Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G47304775 06/01 /2022 to 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. Authorized Agent XS-6W34 (09/95) Ptd. in U.S.A. Page 1 of 1 ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT Named Insured Endorsement Number Univar Solutions Inc. 22 Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G47304775 06/01 /2022 to 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY The following is added to Section 11.2 — Who Is An Insured: e. Any person or organization that you are required to include as an additional insured under this policy because of a written contract that: 1) Is in effect during this policy period; and 2) Was executed prior to the "occurrence" of the "bodily injury" or "property damage"; and 3) Qualifies as an "insured contract" as defined in this policy. Any such person or organization is an additional insured only for "bodily injury" and "property damage" resulting from: a. "your work" that you do for that additional insured pursuant to such contract; or b. "your product" distributed or sold to that additional insured pursuant to such contract; and such person is only an additional insured for "occurrences" taking place during the period of time required by such contract or until the end of the policy period, whichever is sooner. However: i) The insurance afforded to such additional insured only applies to the extent permitted by law; and ii) If coverage provided to the additional insured is required by a ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contract: x. The insurance provided by this endorsement shall be limited to the Limits of Insurance required by the written contract; and y. This endorsement shall not increase the Limits of Insurance stated in the Declarations under Item 3. Limits of Insurance pertaining to the coverage provided herein. Any coverage provided by this endorsement to an additional insured shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless the written contract specifically requires that this insurance apply on a primary or non-contributory basis. XS-21234b (08/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 In accordance with the terms and conditions of the policy and as more fully explained in the policy, as soon as practicable, each additional insured must give us prompt notice of any "occurrence" which may result in a ladm, forward all legal papers to us, cooperate in the defense of any actions, and otherwise comply with all of the policy's terms and conditions. Authorized Representative XS-21234b (08/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Named Insured Endorsement Number Univar Solutions Inc. 4 Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G47304775 06/01 /2022 to 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization: Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance And Retained Limit: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Authorized Representative XS-6W25b (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 NOTICE TO OTHERS ENDORSEMENT - SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Named Insured Unlvar Solutions Inc. Endorsement Number 16 Policy Symbol Policy Number Policy Period Effective Date of Endorsement I SA �H10699058 06/01 /2022 To 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel this Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D. We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. Authorized Representative ALL-32686 (01/11) Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured Unlvar Solutions Inc. Endorsement Number 26 Policy Symbol Policy Number Policy Period Effective Date of Endorsement I SA �H10699058 06/01 /2022 To 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM AUTO DEALERS COVERAGE FORM We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE. SCHEDULE Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. Authorized Representative DA-13115a (06/14) Page 1 of 1 POLICY NUMBER: ISA H10699058 Endorsement Number: 42 COMMERCIAL AUTO CA23051013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WRONG DELIVERY OF LIQUID PRODUCTS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Covered Autos Liability Coverage is changed by adding Delivery is considered completed even if further service or the following exclusion: maintenance work, or correction, repair or replacement is This insurance does not apply to: required because of wrong delivery. "Bodily injury" or "property damage" resulting from the delivery of any liquid into the wrong receptacle or to the wrong address, or from the delivery of one liquid for another, if the "bodily injury" or "property damage" occurs after delivery has been completed. CA 23 05 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 SIGNA URES Named Insured Univar Solutions Inc. Endorsement Number 3 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA H1o699058 o6/01/2022 To o6/ol/2023 Issued By (Name of Insurance Company) ACE American Insurance Company THE ONLY COMPANY APPLICABLE TO THIS POLICY IS THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS. By signing and delivering the policy to you, we state that it is a valid contract. INDEMNITY INSURA E COMPA OF NORTH A RICA (A stock company) BA NIMS STA INSURA E COMPA (A stock company) ACE A RICA INSURA E COMPA (A stock company) ACE PROPERTY A CASUA TY INSURA E COMPA (A stock company) INSURA E COMPA OF NORTH A RICA (A stock company) PACIFIC EMPLOYERS INSURA E COMPA (A stock company) ACE FIRE UNDERWRITERS INSURA E COMPA (A stock company) WESTCHESTER FIRE INSURA E COMPA (A stock company) 436 Walnut Street, P.O. Box i000, Philadelphia, Pennsylvania 191o6-3703 JULIET SCHWEIDEL, Secretary JOHN J. LUPICA, President Authorized Representative CC-1K11j (03/21) Page 1 of 1 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS Named Insured Unlvar Solutions Inc. Endorsement Number 14 Policy Symbol Policy Number Policy Period Effective Date of Endorsement I SA �H10699058 06/01 /2022 TO 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM Schedule Organization Additional Insured Endorsement Any additional insured with whom you have agreed to provide such non- contributory insurance, pursuant to and as required under a written contract executed prior to the date of loss. (If no information is filled in, the schedule shall read: `All persons or entities added as additional insureds through an endorsement with the term `Additional Insured" in the title) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to the Other Insurance Condition under General Conditions: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a loss we cover under this policy, this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. Authorized Representative DA-21886b (06/14) Page 1 of 1 POLICY NUMBER: ISA H10699058 Endorsement Number: 41 COMMERCIAL AUTO CA99481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. Covered Autos Liability Coverage is changed as follows: 1. Paragraph a. of the Pollution Exclusion applies only to liability assumed under a contract or agreement. 2. With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply. B. Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: 2. Any claim or "suit" by or on behalf of a (1) The "pollutants" or any property in which governmental authority for damages because of the "pollutants" are contained are upset, testing for, monitoring, cleaning up, removing, overturned or damaged as a result of the containing, treating, detoxifying or neutralizing, maintenance or use of a covered "auto"; or in any way responding to or assessing the and effects of "pollutants". (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. CA 99 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 ADDITIONAL INSURED — DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Unlvar Solutions Inc. Endorsement Number 4 Policy Symbol Policy Number Policy Period Effective Date of Endorsement I SA H 10699058 06/01 /2022 To 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A. For a covered "auto," Who Is Insured is amended to include as an "insured," the persons or organizations named in this endorsement. However, these persons or organizations are an "insured" only for "bodily injury" or "property damage" resulting from acts or omissions of: 1. You. 2. Any of your "employees" or agents. 3. Any person operating a covered "auto" with permission from you, any of your "employees" or agents. B. The persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative DA-91.174c (03/16) Page 1 of 1 POLICY NUMBER: ISA H10699058 1 Endorsement Number: 39 COMMERCIAL AUTO CA 20 01 11 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the Policy effective on the inception date of the Policy unless another date is indicated below. Named Insured: Univar Solutions Inc. Endorsement Effective Date: SCHEDULE Insurance Company: ACE American Insurance Company Policy Number: ISA H10699058 Effective Date: 06/01/2022 Expiration Date: 06/01/2023 Named Insured: Univar Solutions Inc. Address: 3075 Highland Parkway Suite #200 Downers Grove IL 60515 Additional Insured (Lessor): Any Lessor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. Address: Designation Or Description Of "Leased Autos": All autos leased by you Coverages Limit Of Insurance Or Deductible Covered Autos Liability $ 5,000,000 Each "Accident' CA 20 01 11 20 © Insurance Services Office, Inc., 2019 Page 1 of 2 Comprehensive $ Excluded Deductible For Each Covered "Leased Auto" Collision $ Excluded Deductible For Each Covered "Leased Auto" Specified Causes Of Loss $Excluded Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. 1. If we cancel the Policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the Policy, we will mail notice to the lessor. Page 2 of 2 © Insurance Services Office, Inc., 2019 CA 20 01 11 20 POLICY NUMBER: MMT H10699125 Endorsement Number: 41 COMMERCIAL AUTO CA23051013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WRONG DELIVERY OF LIQUID PRODUCTS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Covered Autos Liability Coverage is changed by adding Delivery is considered completed even if further service or the following exclusion: maintenance work, or correction, repair or replacement is This insurance does not apply to: required because of wrong delivery. "Bodily injury" or "property damage" resulting from the delivery of any liquid into the wrong receptacle or to the wrong address, or from the delivery of one liquid for another, if the "bodily injury" or "property damage" occurs after delivery has been completed. CA 23 05 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured Unlvar Solutions Inc. Endorsement Number 29 Policy Symbol Policy Number Policy Period Effective Date of Endorsement M MT H 10699125 06/01 /2022 To 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM AUTO DEALERS COVERAGE FORM We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE. SCHEDULE Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. Authorized Representative DA-13115a (06/14) Page 1 of 1 POLICY NUMBER: MMT H10699125 Endorsement Number: 39 COMMERCIAL AUTO CA99481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. Covered Autos Liability Coverage is changed as follows: 1. Paragraph a. of the Pollution Exclusion applies only to liability assumed under a contract or agreement. 2. With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply. B. Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: 2. Any claim or "suit" by or on behalf of a (1) The "pollutants" or any property in which governmental authority for damages because of the "pollutants" are contained are upset, testing for, monitoring, cleaning up, removing, overturned or damaged as a result of the containing, treating, detoxifying or neutralizing, maintenance or use of a covered "auto"; or in any way responding to or assessing the and effects of "pollutants". (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. CA 99 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS Named Insured Unlvar Solutions Inc. Endorsement Number 12 Policy Symbol Policy Number Policy Period Effective Date of Endorsement M MT H 10699125 06/01 /2022 TO 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM Schedule Organization Additional Insured Endorsement Any additional insured with whom you have agreed to provide such noncontributory insurance, pursuant to and as required under a written contract executed prior to the date of loss. (If no information is filled in, the schedule shall read: `All persons or entities added as additional insureds through an endorsement with the term `Additional Insured" in the title) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to the Other Insurance Condition under General Conditions: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a loss we cover under this policy, this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. Authorized Representative DA-21886b (06/14) Page 1 of 1 SIGNA URES Named Insured Univar Solutions Inc. Endorsement Number 2 Policy Symbol Policy Number Policy Period Effective Date of Endorsement MMT IH1o699125 o6/01/2022 To o6/ol/2023 Issued By (Name of Insurance Company) ACE American Insurance Company THE ONLY COMPANY APPLICABLE TO THIS POLICY IS THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS. By signing and delivering the policy to you, we state that it is a valid contract. INDEMNITY INSURA E COMPA OF NORTH A RICA (A stock company) BA NIMS STA INSURA E COMPA (A stock company) ACE A RICA INSURA E COMPA (A stock company) ACE PROPERTY A CASUA TY INSURA E COMPA (A stock company) INSURA E COMPA OF NORTH A RICA (A stock company) PACIFIC EMPLOYERS INSURA E COMPA (A stock company) ACE FIRE UNDERWRITERS INSURA E COMPA (A stock company) WESTCHESTER FIRE INSURA E COMPA (A stock company) 436 Walnut Street, P.O. Box 1000, Philadelphia, Pennsylvania 191o6-3703 JULIET SCHWEIDEL, Secretary JOHN J. LUPICA, President Authorized Representative CC-1K11j (03/21) Page 1 of 1 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE Named Insured Unlvar Solutions Inc. Endorsement Number 14 Policy Symbol Policy Number Policy Period Effective Date of Endorsement M MT H 10699125 06/01 /2022 To 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32687 (05/11) Page 1 of 2 All other terms and conditions of the Policy remain unchanged. Authorized Representative ALL-32687 (05/11) Page 2 of 2 POLICY NUMBER: MMT H10699125 Endorsement Number: 7 FORM MCS-90 OMB No.: 2126-0008 Expiration: 05/31/2024 USDOT Number: Date Received: Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire. For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division. A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590. `s United States Department of Transportation �W Federal Motor Carrier Safety Administration Endorsement for Motor Carrier Policies of Insurance for Public Liability under Sections 29 and 30 of the Motor Carrier Act of 1980 FORM MCS-90 Issued to Univar Solutions Inc. of IL (Motor Carrier name) Dated at Wilmington. DE 19803 Amending Policy Number: MMT H10699125 (Motor Carrier state or province) on this 23rd day of June 20 22 . Effective Date: 06/01/2022 Name of Insurance Company: ACE American Insurance Company Countersigned by: 5:�GFl�,N J. L J P I 'Av �"r,s"di "•I (authorized company representative) The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one): This insurance is primary and the company shall not be liable for amounts in excess of $ 5,000,000 for each accident. QThis insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the underlying limit of $ each accident. Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA, to verify that the policy is in force as of a particular date. The telephone number to call is: 215 - 640 - 4555. Cancellation of this endorsement may be effected by the company or the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA's registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC). Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs. (continued on next page) FORM MCS-90 Page 1 of 3 Rev 6/3/2021 MC1622y (06-21) Wolters Kluwer I Uniform Forms FORM MCS-90 OMB No.: 2126-0008 Expiration: 05/31/2024 DEFINITIONS AS USED IN THIS ENDORSEMENT Accident includes continuous or repeated exposure to conditions or which results in bodily injury, property damage, or environmental damage which the insured neither expected nor intended. Motor Vehicle means a land vehicle, machine, truck, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway for transporting property, or any combination thereof. Bodily Injury means injury to the body, sickness, or disease to any person, including death resulting from any of these. Property Damage means damage to or loss of use of tangible property. The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA). In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, maintenance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere. Such insurance as is afforded, for public liability, does not apply to injury to or death of the insured's employees while engaged in the course of their employment, or property transported by the insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, this endorsement, or any other endorsement thereon, Environmental Restoration means restitution for the loss, damage, or destruction of natural resources arising out of the accidental discharge, dispersal, release or escape into or upon the land, atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate damage to human health, the natural environment, fish, shellfish, and wildlife. Public Liability means liability for bodily injury, property damage, and environmental restoration. or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, irrespective of the financial condition, insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which the endorsement is attached shall remain in full force and effect as binding between the insured and the company. The insured agrees to reimburse the company for any payment made by the company on account of any accident, claim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement. It is further understood and agreed that, upon failure of the company to pay any final judgment recovered against the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment. The limits of the company's liability for the amounts prescribed in this endorsement apply separately to each accident and any payment under the policy because of anyone accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident. (continued on next page) FORM MCS-90 Page 2 of 3 MCI622y (06-21) FORM M -90 OM No.:2126-0008 Expiration:05/31/2024 SCHEDULE OF LIMITS - PUBLIC LIABILITY Type of carriage Commodity transported January 1, 1985 (1) For -hire (in interstate or foreign commerce, with a Property (nonhazardous) $750,000 gross vehicle weight rating of 10,001 or more pounds). (2) For -hire and Private (in interstate, foreign, or Hazardous substances, as defined in 49 CFR 171.81 $5,000,000 intrastate commerce, with a gross vehicle weight rating transported in cargo tanks, portable tanks, or of 10,001 or more pounds). hopper -type vehicles with capacities in excess of 3,500 water gallons; or in bulk Division 1.1, 1.2, and 1.3 materials, Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; in bulk Division 2.1 or 2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403. (3) For -hire and Private (in interstate or foreign Oil listed in 49 CFR 172.101; hazardous waste, $1,000,000 commerce, in any quantity; or in intrastate commerce, hazardous materials, and hazardous substances in bulk only; with a gross vehicle weight rating of defined in 49 CFR 171.8 and listed in 49 CFR 10,001 or more pounds). 172.101, but not mentioned in (2) above or (4) below. (4) For -hire and Private (In interstate or foreign Any quantity of Division 1.1, 1.2, or 1.3 material; any $5,000,000 commerce, with a gross vehicle weight rating of less quantity of a Division 2.3, Hazard Zone A, or Division than 10,001 pounds). 6.1, Packing Group I, Hazard Zone A material; or highway route controlled quantities of a Class 7 material as defined in 49 CFR 173.403. `The schedule of limits shown does not provide coverage. The limits shown in the schedule are for information purposes only FORM MCS-90 Page 3 of 3 MC1622y (06-21) ADDITIONAL INSURED — DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Unlvar Solutions Inc. Endorsement Number 3 Policy Symbol Policy Number Policy Period Effective Date of Endorsement M MT H 10699125 06/01 /2022 To 06/01 /2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A. For a covered "auto," Who Is Insured is amended to include as an "insured," the persons or organizations named in this endorsement. However, these persons or organizations are an "insured" only for "bodily injury" or "property damage" resulting from acts or omissions of: 1. You. 2. Any of your "employees" or agents. 3. Any person operating a covered "auto" with permission from you, any of your "employees" or agents. B. The persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative DA-91.174c (03/16) Page 1 of 1 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Named Insured Endorsement Number Univar Solutions Inc. 7 Policy Symbol Policy Number Policy Period Effective Date of Endorsement WCU C70303000 06/01/2022 to 06/01/2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D. We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This endorsement is not applicable in the states of AZ, FL, TX, ID, and NM. Authorized Representative WC 99 05 21 (01/11) Page 1 of 1 POLICY NUMBER: U C70303000 SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the employer named in Item 1 of the Information Page. The words "we", "us", 'bur" and the "Company" refer to the company providing this insurance as indicated on the Information Page. In consideration of the payment of the premium as herein provided, and of their respective agreements as herein set forth, the insurance company named on the Information Page made a part hereof and the party or parties named on the Information Page made a part hereof do hereby agree as follows: GENERAL SECTION A. Self -Insurance Your acceptance of this policy indicates that you are now and will remain until the end of the policy period a duly qualified self -insurer in each state named in Item 3 of the Information Page. You will do whatever is required, including provision of sufficient funds and compliance with any legally required self -insured registration or similar requirements, to maintain your status as a qualified self -insurer with respect to any Loss covered by this policy. If Your Retention or your self -insurer status at any time becomes invalid, suspended, unenforceable or uncollectible for any reason, we will be liable only to the extent we would have been had Your Retention remained in full effect and only to the extent we would be liable if you were a qualified self -insured. The Insured named in Item 1 of the Information Page shall give us written notice as soon as practicable of any change in the operating status of any of your self -insurer registrations in any state. If you begin work after the effective date of this policy in any state not named in Item 3 of the Information Page, or are not a qualified self -insured for such work, this insurance will apply as though that state were named in Item 3 of the Information Page, or as though you were qualified in that state, but only if you notify us in writing within ninety (90) days from the date you begin such work. B. The Policy This policy includes at its effective date the Information Page and all the endorsements or schedules listed in Item 8 of the Information Page. The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. C. Who Is Insured You are insured if: 1. you are an employer named in Item 1 of the Information Page; 2. the employer named in Item 1 of the Information Page is a partnership or joint venture, and you are a partner in that partnership or a member of that joint venture, but you are an insured only in your capacity as an employer of employees in the partnership or joint venture; you are a subsidiary, a division or an affiliated company now existing or as may hereafter be constituted, of an employer named in Item 1 of the Information Page, provided at least a 51% majority interest is owned or controlled by an employer named in Item 1 of the Information Page; or 4. you are a business entity over which an employer named in Item 1 of the Information Page has day-to-day management control. D. Workers Compensation Law Workers compensation law means the: 1. Workers compensation law and occupational disease law of each state or territory named in Item 3 of the Information Page; 2. Workers compensation law of a state not listed in Item 3 of the Information Page provided: CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 1 of 11 a. the injured employee was working within the scope of his employment, at your direction; and b. the injured employee was regularly employed in a state listed in Item 3 of the Information Page; and C. the work in the other state was incidental to work in a state listed in Item 3 of the Information Page; and d. the work in the other state was temporary and transitory. 3. Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901 - 944); 4. Non -Appropriated Funds Instrumentalities Act (5 U.S.C. Sections 8171 et seq.); and the provisions of the Longshore and Harbor Workers Compensation Act that apply to that law; 5. Outer Continental Shelf Lands Act (43 U.S.C. Section 1331 et seq.); 6. Longshore and Harbor Workers Compensation Act (33 U.S.C. Sections 901 et seq.); 7. Any amendments to these laws that are in effect during the policy period. Workers compensation law does not include the provisions of any law that provide non -occupational disability benefits. E. State State means any state of the United States of America and the District of Columbia. F. Covered Employees Unless expressly stated in Part Three, Voluntary Compensation, this policy only indemnifies you for Loss relating to Covered Employees. Covered Employees means those employees who are hired by you and are subject to the workers compensation law of a state listed in Item 3 of the Information Page. EXCESS INSURANCE PROVISIONS OUR LIMIT OF INDEMNITY AND YOUR RETENTION A. Our Limit of Indemnity Our Limit of Indemnity under this policy shall be only for the Ultimate Net Loss in excess of Your Retention, as stated in Item 6 of the Information Page, and then only for an amount not exceeding Our Limit of Indemnity stated in Item 5 of the Information Page; provided that Your Retention and Our Limit of Indemnity shall apply to: 1. bodily injury by accident, including death resulting therefrom sustained by one or more employees in each accident; or 2. bodily injury by disease, including death resulting therefrom, sustained by each employee. Ultimate Net Loss means the amount of Loss, including Loss incurred as part of the Voluntary Compensation Coverage provided hereunder, minus Your Retention. B. Your Retention Your Retention means the amount shown in Item 6 of the Information Page, which is the amount that you must pay before this insurance applies. PART ONE - WORKERS COMPENSATION INSURANCE A. How This Insurance Applies Subject to Our Limit of Indemnity set out in Item 5 and Your Retention set out in Item 6 of the Information Page, this Workers Compensation Insurance applies to Loss paid by you as required by the workers compensation law for bodily injury by accident or bodily injury by disease, and including resulting death, provided: 1. the bodily injury by accident must occur during the policy period; and CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 2 of 11 2. the bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. Loss 1. Loss means the amount actually paid by you for benefits under the workers compensation law in effect at the date the accident or disease exposure occurs. Loss includes: a. the amount paid by you in settlement of claims for benefits under the workers compensation law; b. the amount paid by you in satisfaction of awards or judgments for benefits under the workers compensation law. 2. Loss does not include: a. court costs, interest, fines or penalties assessed against you or your claims administrator; b. salaries of employees and office expenses, or penalties or assessments against you, incurred in investigation, adjustment and litigation; C. fees paid to the organization handling your claims and performing other insurance services for you; d. taxes paid by you or other expenses incurred in qualifying for and maintaining your self -insurer's status; or e. allocated loss adjustment expenses which means costs associated with investigation, adjustment or legal expenses directly and definitely chargeable to a specific workers compensation claim. C. Exclusions Part One - Workers Compensation Insurance does not cover: 1. Loss arising out of operations or Loss related to employees for which you have rejected any workers compensation law; 2. Loss insured by a standard Workers Compensation & Employers Liability Insurance Policy; 3. Loss payable under the workers compensation law of any state which is not shown in Item 3 of the Information Page, if you are protected from the loss by any other insurance; or 4. any assessment made upon self -insurers, whether imposed by statute, regulation or otherwise. D. Defense We have no duty to investigate, handle, settle or defend any claim, suit or proceeding against you. However we have the right and shall be given the opportunity by you to associate with you in the defense, investigation, handling, settlement or defense of any claim, suit or proceeding which appears reasonably likely to involve us. In such an association, you shall promptly cooperate with us in all aspects of investigation, handling, settlement or defense. E. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law; 5. you violate or fail to comply with any workers compensation law; or 6. of the unreasonable delay or refusal to make payments of compensation by you or on your behalf, including the legal fees associated with defending resulting claims or suits. If we make any payments on your behalf in excess of the benefits regularly provided by the workers compensation law, you will reimburse us promptly. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 3 of 11 F. Statutory Provision Terms of this insurance that conflict with the workers compensation law regarding excess workers compensation insurance are changed by this statement to conform to that law. PART TWO - EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies Subject to Our Limit of Indemnity set out in Item 5 and Your Retention set out in Item 6 of the Information Page, this Employers Liability Insurance applies to loss paid by you for bodily injury by accident or bodily injury by disease, and including resulting death, provided that: 1. the bodily injury must arise out of and in the course of the injured employee's employment by you; 2. the injured employee must be normally employed in a state listed in Item 3 of the Information Page, and the employment, must be necessary or incidental to your work in a state or territory listed in Item 3 of the Information Page, or as otherwise defined in this policy; 3. the bodily injury by accident must occur during the policy period; and 4. the bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or bodily injury by disease must be brought in the United States of America. B. Loss 1. Loss means the amount actually paid by you for damages imposed upon you by law. Loss includes: a. the amount paid by you in settlement of claims for legal damages; b. the amount paid by you in satisfaction of awards or judgments for damages; 2. Loss does not include: a. court costs, interest upon awards and judgments, punitive damages or fines; b salaries of employees and office expenses, or penalties or assessments against you, incurred in investigation, adjustment and litigation; C. fees paid to the organization handling your claims and performing other insurance services for you; d. taxes paid by you or other expenses incurred in qualifying for and maintaining your self -insured status; or e. allocated loss adjustment expenses which include costs associated with investigation, adjustment or legal expenses directly and definitely chargeable to a specific workers compensation claim. C. Federal Acts Coverage This Employers Liability Insurance also applies to Loss paid by you because of damages imposed upon you by the following Federal Acts: 1. The Jones Act (46 U.S.C. Section 688); 2. The Federal Employers Liability Act (45 U.S.C. Sections 51 et seq.); and 3. The Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.). CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 4 of 11 D. Stop Gap Insurance If, it is determined by the State Workers Compensation board or any other regulatory authority that any employee of yours, who is reported and declared under the workers compensation law(s) of the state of North Dakota, Ohio, Washington and Wyoming, sustains bodily injury by accident or bodily injury by disease in the course of his/her employment by you, but is not entitled to receive (or elects not to accept) the benefits provided by the aforementioned law, then this policy shall cover you for Loss arising from such bodily injury by accident or bodily injury by disease in excess of Your Retention as stated in Item 6 of the Information Page. This Stop Gap Insurance shall not apply to: 1. any premium assessment, penalty, fine or other obligation imposed by any workers compensation law; 2. bodily injury, disease or death suffered or caused by any person knowingly employed by you in violation of any law as to age, or under the age of 14 years, regardless of such law; 3. any claim for bodily injury, disease or death with respect to which you are deprived of any defense or defenses or are otherwise subject to penalty because of default in premium payment under, or any other failure to comply with, the provisions of the workers compensation law or laws of the states named above. Our Limit of Indemnity for Stop Gap Insurance is stated in Item 5 of the Information Page. E. Exclusions Part Two — Employers Liability Insurance does not cover: 1. liability assumed under a contract; 2. bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 3. any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 4. bodily injury caused intentionally or aggravated by you; 5. damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 6. fines or penalties:; 7. damages arising out of operations for which you have violated or failed to comply with any workers compensation law; 8. damages arising out of operations for which you have rejected any workers compensation law; or 9. damages arising out of operations for which you are covered under a standard Workers Compensation & Employers Liability Insurance Policy. F. Defense We have no duty to investigate, handle, settle or defend any claim, suit or proceeding against you. However, we have the right and shall be given the opportunity by you to associate with you in the defense, investigation or settlement of any claim, suit or proceeding which appears reasonably likely to involve us. In such an association, you shall promptly cooperate with us in all aspects of defense, investigation or settlement. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 5 of 11 PART THREE — VOLUNTARY COMPENSATION INSURANCE A. How This Insurance Applies In addition to the other coverages provided herein, subject to Our Limit of Indemnity set out in Item 5, and Your Retention set out in Item 6 of the Information Page, this policy also provides coverage for your employees who are not subject to the workers compensation laws or occupational disease law, or any similar law of any state, but who were hired in and are normally employed in the United States, its territories or possessions. This Voluntary Compensation coverage applies to bodily injury subject to the following terms and conditions: 1. the bodily injury must be sustained by an employee included in the group of employees described in the Voluntary Compensation Schedule Endorsement (the "Schedule"); 2. the bodily injury must arise out of and in the course of employment necessary or incidental to work in a state listed in the Schedule; 3. the bodily injury must occur in the United States of America, its territories or possessions or Canada, or the country or countries designated in the Schedule ("Designated Countries") or while being transported to or from the United States of America, its territories or possessions, or Canada if the employee is a United States or Canadian citizen away from those places and the employment must be necessary or incidental to work in a Designated Country, subject to the extraterritorial coverage provisions of the applicable state law; 4. bodily injury by accident must occur during the policy period; and 5. bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Indemnify Under this Voluntary Compensation coverage, we will indemnify you, subject to Our Limit of Indemnity set out in Item 5 and Your Retention as set out in Item 6 of the Information Page: 1. an amount equal to the benefits that would be required of you if you and your employees described in the Schedule were subject to the workers compensation laws of the states of employment listed in Item 3 of the Information Page; and 2. an amount equal to the benefits for bodily injury or death arising out of a disease endemic to a Designated Country or a location therein, which benefits would be payable if such endemic disease were a covered occupational disease in the state of employment of the diseased employee. We will indemnify you for those amounts paid by you to the persons who would be entitled to them under the law of the employee's state of employment, as such state is indicated in your records. We will also indemnify you, subject to Our Limit of Indemnity set out in Item 5 and Your Retention as set out in Item 6 of the Information Page expenses as reasonably may be incurred over and above normal transportation costs for repatriation of employees suffering from covered bodily injury or diseases (including the bodies of fatally injured employees) from a Designated Country to a destination in the United States of America or Canada provided that such injuries make repatriation necessary in the opinion of competent medical authorities. C. Exclusions Part Three - Voluntary Compensation Insurance does not cover: 1. any obligation imposed by a workers compensation or occupational disease law, or any similar law; or 2. bodily injury intentionally caused or aggravated by you. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 6 of 11 D. Before We Indemnify Before we indemnify you for benefits paid to the persons entitled to them as Voluntary Compensation coverage, 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 others who may be responsible for the injury or death; and 3. cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits of this insurance fail to do those things, our duty to indemnify ends at once. If they claim damages from you or from us for the injury or death, our duty to indemnify ends at once. E. Employers Liability Insurance Part Two - Employers Liability Insurance applies, subject to Our Limit of Indemnity set out in Item 5, Part Two, and Your Retention set out in Item 6 of the Information Page, to bodily injury covered by this Voluntary Compensation Section as though the State of employment listed in the Schedule were shown in Item 3. of the Information Page. PART FOUR — CLAIMS A. Your Claims Reporting Duties 1. In the event of an accident or disease that appears reasonably likely to involve coverage under this policy, and/or in the event of any claim reserved for 50% or more of Your Retention stated in Item 6 of the Information Page, you or someone on your behalf shall give written notice as soon as practicable, but not more than ninety (90) days, after such notice has been received by the Risk Management Department, or other equivalent department, of your organization. 2. Immediate written notice shall be given to us when any accident to one or more employees results in any of the following: a. a fatality; b. amputation of a major extremity; C. any serious head injury (including skull fracture or loss of sight of either or both eyes); d. any injury to the spinal cord; e. any severe burn case; or f. any claim arising under Part Two, Employer's Liability. You shall give notice, with full particulars, of any claim made because of any injury listed in a) through f) above. 3. Failure to provide notice of a reportable claim as defined herein, within the parameters set out above, may result in the denial of coverage. All notices to us must contain particulars sufficient to identify you and also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the injured party or parties and of available witnesses. If, after you give us notice as described herein, suit or other proceeding is instituted against you to enforce a claim, you shall, when requested by us, forward to us every demand, notice, summons, or other process or true copies thereof, received by you or your representatives, together with copies of reports of investigations made by you with respect to such claim, suit or proceeding. B. Your Claims Handling Duties It is your responsibility to investigate, settle, defend and appeal any claim, suit or other proceeding made against you. However, you must not make any voluntary settlement involving loss to us without our written consent. If you do not appeal an award or judgment which exceeds Your Retention, we have the right to take an appeal at our own cost and expense and shall be liable for costs, disbursements and interest related to the appeal. If we elect to appeal, our liability on such an award or judgment shall not exceed Our Limit of Indemnity as stated in Item 5 of the Information Page plus the cost and expense of such appeal. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 7 of 11 C. Claim Audits We have the right to examine and audit your claims handling and reserving procedures, practices and records while this policy is in force and for three years after the final settlement of all claims. Also you will provide us any claim information which we may request. PART FIVE — PREMIUM A. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. B. Deposit Premium At the beginning of the policy period you must pay us the Deposit Premium shown in Item 7 of the Information Page. At the end of the policy period: 1. you will owe us the amount by which the final premium is greater than the Deposit Premium; or 2. we will owe you the amount by which the Deposit Premium is greater than the final premium. However, we shall retain not less than the policy Minimum Premium as stated in Item 7 of the Information Page. C. Final Premium 1. The Deposit Premium shown in Item 7 of the Information Page is an estimate. We will determine the final premium, subject to the Minimum Premium, after this policy ends by using the actual, not the estimated, premium basis which includes payroll and, if applicable, all other remuneration paid or payable during the policy period for the services of: a. all your officers and employees engaged in work covered by this policy; and b. all other persons engaged in work that could make us liable under Part One - Workers Compensation Insurance of this policy. We will determine the final payroll and remuneration based upon (i) the manuals and rules of the National Council on Compensation Insurance, Inc. in the states where such manuals and rules apply to workers compensation and in the states where private workers compensation insurance may not be sold, and (ii) the manuals and rules of other licensed rating organizations for workers compensation insurance in the states where such manuals and rules apply to workers compensation. If you are unable to furnish us with payroll records for these persons, we may use the contract price for their services and materials as the premium basis. Paragraph 1.b) will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. 2. If this policy is cancelled, final premium will be determined in the following way: a. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the Minimum Premium shown in Item 7 of the Information Page; b. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short rate cancellation table and procedure. Final Premium will not be less than the short rate share of the Minimum Premium shown in Item 7 of the Information Page. D. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 8 of 11 E. Audit. You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. If you fail to cooperate with us in an audit, we may estimate your exposure and utilize that estimate in calculating your final premium. PART SIX- CONDITIONS A. Acceptance By acceptance of this policy, you agree that the statements on the Information Page are your agreements and representations, that this policy is issued in reliance upon the truth of such representations, and that this policy embodies all agreements existing between you and us or any of our agents relating to this insurance. B. Action Against Us There will be no right of action against us under this insurance unless you have complied with all the terms of this policy. C. Bankruptcy or Insolvency Your bankruptcy or insolvency will not relieve us from the payment of any claim covered by this policy; however, in no event shall our obligation to pay be increased or expanded as a result of your bankruptcy or insolvency so as to apply to Your Retention, or otherwise. D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. If we cancel because of non-payment of premium, we must mail or deliver to you not less than ten (10) days advance written notice stating when the cancellation is to take effect. If we cancel for any other reason, we must mail or deliver to you not less than sixty days (60) advance written notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 2 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy is change by this statement to comply with that law. E. In Rem Any accident otherwise covered by this policy in an action "In Rem" shall, in all respects, be treated in the same manner as though the action resulting therefrom were "In Persona" against you. F. Inspection We have the right, but are not obligated to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with law, regulations, codes or standards. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 9 of 11 G. Omnibus Reconciliation Act - Government Access Clause We will make available this policy and all documents needed to confirm the premium paid by you if the Secretary of Health and Human Services or the Comptroller General of the United States find that the policy is a contractor described in Section 1861 of the Social Security Act, 42 U.S.C. Section 1395, or any amendment to it, and they or you ask for our documents. If the Secretary of Health and Human Services or the Comptroller General asks for access to our documents, we will immediately notify you and make these documents available to you, unless prohibited by law. The right to access will be determined by the above statute, or any amendment to it, or any rules or regulations established under it. H. O her Insurance If the Insured carries other valid insurance, reinsurance or indemnity with any other insurer covering a loss covered by this policy (other than insurance that is purchased to apply in excess of the sum of Your Retention and the Limit of Indemnity hereunder), we shall not be liable for a greater proportion of such loss than the applicable Limit of Indemnity of all valid and collectible insurance, reinsurance or indemnity against such loss. If the Insured carries other insurance with us covering a loss within the limit covered by this policy, the insured must elect which policy shall apply and we shall be liable under the policy so elected and shall not be liable under any other policy. I. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. Any amount recovered as a result of such proceedings, together with all expenses necessary to the recovery of any such amount, shall be apportioned as follows: 1. if there is insurance coverage in excess of Our Limit of Indemnity, that insurer shall first be reimbursed to the extent of its actual payment; 2. we shall then be reimbursed to the extent of our actual payment and then we will pay the balance, if any, to you. The expenses of all proceedings necessary to the recovery of any such amount shall be apportioned between you and us in the ratio of their respective recoveries as finally settled. If there should be no recovery in proceedings instituted solely on our initiative, the expenses thereof shall be borne by us. In the event of any payment under this policy for a Loss for which you have waived the right of recovery in a written contract entered into prior to the Loss, we hereby agree to also waive our right of recovery but only with respect to such Loss. J. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to give or receive notice of cancellation, accept indemnity, receive return premium or request changes in this policy. K. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. L. Unintentional Errors and O ssions Your failure or omission to disclose all hazards existing as of the inception date of the policy shall not prejudice you with respect to the coverage afforded by this policy provided such failure or omission is not intentional and you did not know about such hazards prior to the commencement of the policy period. CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 10 of 11 M. Loss Payments We shall pay any Loss for which we may be liable under this policy in the following manner: 1. As respects Part One - Workers Compensation Insurance, payment shall first be made by you in accordance with the provisions of the workers compensation law, and we shall reimburse you for such Loss periodically, at intervals of not less than three months, upon receipt from you of proper proofs of payment. 2. As respects Part Two — Employers' Liability Insurance, if damages are paid by you, we shall make payment to you within thirty (30) days after we receive proper proofs of your payment of Loss covered under Part Two - Employers' Liability IN WITNESS WHEREOF, the Company has caused this policy to be signed by its President and Secretary, and, where required by law, its Information Page to be countersigned by one of its duly authorized representatives. UL�1-- REBECCA L. COLLINS, Secretary 9XJOHN J. LUPICA, President CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 11 of 11 ALTERNATE EMPLOYERS ENDORSEMENT Named Insured Endorsement Number Univar Solutions Inc. 1 Policy Symbol Policy Number Policy Period Effective Date of Endorsement WCU C70303000 06/01/2022 to 06/01/2023 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: SPECIFIC EXCESS WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY This endorsement applies only with respect to bodily injury to your employees while in the course of special or temporary employment by the alternate employer in the state named in Item 2 of the Schedule. Part One (Workers Compensation Insurance) and Part Two (Employer Liability Insurance) will apply as though the alternate employer is insured. If an entry is shown in Item 3 of the Schedule the insurance afforded by this endorsement applies only to work you perform under the contract or at the project named in the Schedule. Under Part One (Workers Compensation Insurance) we will reimburse the alternate employer for the benefits required by the workers compensation law. The insurance afforded by this endorsement is not intended to satisfy the alternate employer's duty to secure its obligations under the workers compensation law. We will not file evidence of this insurance on behalf of the alternate employer with any government agency. We will not ask any other insurer of the alternate employer to share with us a loss covered by this endorsement. Premium will be charged for your employees while in the course of special or temporary employment by the alternate employer. The policy may be canceled according to its terms without sending notice to the alternate employer. Part Four (Claims) applies to you and the alternate employer. The alternate employer will recognize our right to defend under Parts One and Two and our right to inspect under Part Six. This endorsement is not applicable in FL, ME, NY, and NH. Schedule 1. Alternate Employer If Any Address Does not apply to Alaska, or to any employee lease contract/arrangement 2. State of Special or Temporary Employment any state shown in Item 3 of the Information Page 3. Contract or Project Authorized Representative WC 99 04 40 (07/06) ©Chubb. 2016. All rights reserved. Page 1 of 1 M. Loss Payments We shall pay any Loss for which we may be liable under this policy in the following manner: 1. As respects Part One - Workers Compensation Insurance, payment shall first be made by you in accordance with the provisions of the workers compensation law, and we shall reimburse you for such Loss periodically, at intervals of not less than three months, upon receipt from you of proper proofs of payment. 2. As respects Part Two — Employers' Liability Insurance, if damages are paid by you, we shall make payment to you within thirty (30) days after we receive proper proofs of your payment of Loss covered under Part Two - Employers' Liability IN WITNESS WHEREOF, the Company has caused this policy to be signed by its President and Secretary, and, where required by law, its Information Page to be countersigned by one of its duly authorized representatives. UL�1-- REBECCA L. COLLINS, Secretary 9XJOHN J. LUPICA, President CKE-1167M (01/15) ©ACE AMERICAN INSURANCE COMPANY Page 11 of 11 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNIVAR SOLUTIONS INC. 3075 HIGHLAND PARKWAY SUITE #200 Policy Number DOWNERS GROVE IL 60515 Symbol: WLR Number: C70303085 Policy Period Effective Date of Endorsement 06-01-2022 TO 06-01-2023 06-01-2022 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. ALTERNATE EMPLOYER ENDORSEMENT This endorsement applies only with respect to bodily injury to your employees while in the course of special or temporary employment by the alternate employer in the state named in Item 2 of the Schedule. Part One (Workers Compensation Insurance) and Part Two (Employers Liability Insurance) will apply as though the alternate employer is insured. If an entry is shown in Item 3 of the Schedule the insurance afforded by this endorsement applies only to work you perform under the contract or at the project named in the Schedule. Under Part One (Workers Compensation Insurance) we will reimburse the alternate employer for the benefits required by the workers compensation law if we are not permitted to pay the benefits directly to the persons entitled to them. The insurance afforded by this endorsement is not intended to satisfy the alternate employer's duty to secure its obligations under the workers compensation law. We will not file evidence of this insurance on behalf of the alternate employer with any government agency. We will not ask any other insurer of the alternate employer to share with us a loss covered by this endorsement. Premium will be charged for your employees while in the course of special or temporary employment by the alternate employer. The policy may be canceled according to its terms without sending notice to the alternate employer. Part Four (Your Duties If Injury Occurs) applies to you and the alternate employer. The alternate employer will recognize our right to defend under Parts One and Two and our right to inspect under Part Six. 1. Alternate Employer IF ANY Schedule Address DOES NOT APPLY TO ANY EMPLOYEE LEASE CONTRACT/ARRANGEMENT 2. State of Special or Temporary Employment ANY STATE SHOWN IN ITEM 3A OF THE INFORMATION PAGE 3. Contract or Proiect This endorsement is not applicable in the states of AK, HI, MI, OK and TX. Authorized Representative WC 00 03 01A (Ed. 2-89) © Copyright 1984, 1988 National Council on Compensation Insurance, Inc. All Rights Reserved. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNIVAR SOLUTIONS INC. 3075 HIGHLAND PARKWAY SUITE #200 Policy Number DOWNERS GROVE IL 60515 Symbol: WLR Number: C70303085 Policy Period Effective Date of Endorsement 06-01-2022 TO 06-01-2023 06-01-2022 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We ave the right to recover our payments from anyone liable for an injury covered by this policy. We ill 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 ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the ssddiri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Agent WC 00 03 13 (11/05) © Copyright 1983-2017 National Council on Compensation Insurance, Inc. All Rights Reserved. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNIVAR SOLUTIONS INC. 3075 HIGHLAND PARKWAY SUITE #200 Policy Number DOWNERS GROVE IL 60515 Symbol: WLR Number: C70303085 Policy Period Effective Date of Endorsement 06-01-2022 TO 06-01-2023 06-01-2022 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the "Schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with the information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. E. We may arrange with your representative to send such notice in the event of any such cancellation. F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical address of the persons or organizations listed in the Schedule. G. This endorsement does not apply in the event that you cancel the Policy. SCHEDULE Name of Certificate Holder E-Mail Address Physical Address MARIN MUNICIPAL WATER DISTRICT DGRAHAM@MARINWATER.ORG 220 NELLEN AVENUE CORTE MADERA, CA 94925 All other terms and conditions of this Policy remain unchanged. This endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM, TX and WI. 5:5�� Authorized Representative WC 99 03 71 (01/11) Page 1 of 1 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNIVAR SOLUTIONS INC. 3075 HIGHLAND PARKWAY SUITE #200 Policy Number DOWNERS GROVE IL 60515 Symbol: WLR Number: C70303085 Policy Period Effective Date of Endorsement 06-01-2022 TO 06-01-2023 06-01-2022 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. NOTICE TO OTHERS ENDORSEMENT — SCHEDULE A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. This endorsement must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. WC 99 03 70A (08/12) Page 1 of 2