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HomeMy WebLinkAboutHPS Mechanical Inc; 2024-12-12; PWM25-3626UTILDocusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 12th December PWM25-3626UTIL CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT KNOTS LIFT STATION PUMP REPLACEMENTS; CONT. NO. 3840-10 This contract is made on the ______ day of ___________ _, 2024 ("Contract"), by the City of Carlsbad, California, a municipal corporation ("City") and HPS Mechanical Inc., a California corporation whose principal place of business is 9260 Trade Place Suite #101, San Diego, CA 92126 ("Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, as contained in the Standard Specifications for Public Works Construction "Greenbook," latest edition and including all errata; Part 1 General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor's proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by Daniel Zimny (City Project Manager). PAYMENT. The City shall withhold retention as required by Public Contract Code Section 9203. PREVAILING WAGE RATES. Any construction, alteration, demolition, repair, and maintenance work, including work performed during design and preconstruction such as inspection and land surveying work, cumulatively exceeding $1,000 and performed under this Contract constitute "public works" under California Labor Code Section 1720 et seq., and are subject to state prevailing wage laws. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Sections 1770, 1773 and 1773.1 of the California Labor Code . Consistent with the requirement of Section 1773.2 of the California Labor code, a current copy of applicable wage rates may be obtained via the internet at: www.dir.ca.gov/dlsr/. Contractor shall not pay less than the said specified prevailing rates of wages to all such workers employed by him or her in the execution of the Contract. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which requires keeping accurate payroll records, verifying and KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 1 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Labor Code Section 1776. DIR REGISTRATION. California Labor Code Section 1725.5 requires the Contractor and any subcontractor or subconsultant performing any public work under this Contract to be currently registered with the California Department of Industrial Relations ('DIR'), as specified in Labor Code Section 1725.5. Labor Code Section 1771.1 provides that a contractor or subcontractor/subconsultant shall not be qualified to engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Labor Code section 1725.5. Prior to the performance of public work by any subcontractor or subconsultant under this Contract, Contractor must furnish the City with the subcontractor or subconsultant's current DIR registration number. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATION. Contractor's vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board {CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov / our-work/programs/ a dva nced-clea n-fleets. CALIFORNIA AIR RESOURCES BOARD (CARB) IN-USE OFF-ROAD DIESEL FUELED FLEETS REGULATION. Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. More information about the requirements and Contractor's required certification is provided in Exhibit D. CONSTRUCTION MANAGEMENT SOFTWARE. Procore Project Management and Collaboration System. This project may utilize the Owner's Procore (www.procore.com) online project management and document control platform. The intent of utilizing Procore is to reduce cost and schedule risk, improve quality and safety, and maintain a healthy team dynamic by improving information flow, reducing non- productive activities, reducing rework and decreasing turnaround times. The Contractor is required to create a free web-based Proco re user account(s) and utilize web-based training/ tutorials (as needed) to become familiar with the system. Unless the Engineer approves otherwise, the Contractor shall process all project documents through Procore because this platform will be used to submit, track, distribute and collaborate on project. If unfamiliar or not otherwise trained with Procore, Contractor and applicable team members shall complete a free training certification course located at http://learn.procore.com/procore-certification-subcontractor. The Contractor is responsible for attaining their own Procore support, as needed, either through the online training or reaching out to the Procore support team. It will be the responsibility ofthe Contractor to regularly check Procore and review updated documents as they are added. There will be no cost to the Contractor for use of Proco re. It is recommended that the Contractor provide mobile access for Windows, iOS located at https://apps.apple.com/us/app/procore-construction-management/id374930542 or Android devices located at https://play.google.com/store/apps/details?id=com.procore.activities with the Procore App installed to at least one on-site individual to provide real-time access to current posted drawings, specifications, RFls, submittals, schedules, change orders, project documents, as well as any deficient observations or punch list items. Providing mobile access will improve communication, efficiency, and productivity for all parties. The use of Procore for project management does not relieve the contractor of any other requirements as may be specified in the contract documents. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 2 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this Contract and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five (5) years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract Signature: ' • -... '--- bidding. ~~ Print Name: ~ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. Property damage insurance in an amount of not less than ........ $2,000,000 Automobile Liability Insurance in the amount of $2,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non-scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that 30 days written notice shall be given to the City prior to such cancellation. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 3 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. INDEMNITY. Contractor agrees to defend (with counsel approved by the City), indemnify, and hold harmless the City and its officers, elected and appointed officials, employees and volunteers from and against all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys' fees for litigation, arbitration, or other dispute resolution method. THIRD PARTY RIGHTS. Nothing in this Agreement should be construed to give any rights or benefits to any party other than the City and Contractor. JURISDICTION AND VENUE. This Agreement shall be interpreted in accordance with the laws of the State of California. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out ofthis Contract is San Diego County, California. Start Work: Contractor agrees to start within five (5) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within one hundred (100) working days after receipt of Notice to Proceed. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 4 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B CONTRACTOR'S INFORMATION. HPS Mechanical Inc. (name of Contractor) 793014 3/31/2025 (Contractor's license number and exp. date) A, B, C-4, C16, C20, C34, C36,C42,C-2,Cl0,C43,C46 (license classifications) 1000001107 6/30/2026 (DIR registration number and exp. date) PWM25-3626UTIL 9260 Trade Place Suite #101 (street address) San Diego, CA 92126 (city/state/zip) 858-537-5110 (telephone no.) alma@hpsmechanical.com (e-mail address) AUTHORITY. The individuals executing this Contract and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Contract. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 [signatures on following page] Page 5 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B CONTRACTOR HPS MECHANICAL INC., a California corporation By ~~ (sign ~---- Les DenHerder, Executive Chairman (print name, title) By: ~- Scott DenHerder, President (print name, title) PWM25-3626UTIL CITY OF CARLSBAD, a municipal corporation of the State of California By: Amanda L. Flesse, Utilities Director, as authorized by the City Manager ATTEST: SHERRY FREISINGER, City Clerk By: Deputy City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !i.e. corporation, Contract must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: _bt_._lAA,_~_t.-VYU __ °'-____ _ Assistant City Attorney KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 6 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B CALIFORNIA ACKNOWLEDGMENT CIVIL CODE§ 1189 @:o 8 g:0:9:9:§:0::rnoo {DJ g-g:o § g 9:g:00Q080:a~, "8( E j 2 B l3 B B C B 5 9 0:0:01 3 J E D D E E ):8 9:0:B 6 E E B B B 6 0 0:0:1 1:0,e 00:00:0:0:0 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of -~K=e~r~"~---------- On 11/27/2024 before me, __ A_lm_a_L_. _M_a_rt_i_n_ez~•~N_ot_a_ry~P_u_b_li_c ____ ~ Date Here Insert Name and Title of the Officer personally appeared ___ L_e_s_D_e_n_H_e_rd_e_r_a_n_d_S_c_o_tt_D_e_n_H_e_rd_e_r _________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ~············i a AI.MAL.MAlmNEZ : Notary Public • CaHfornla • I Kern County s: Comm1mon I 2472095 -j O O O !vz:m;·;:n:,es,:CJ1020;J I Place Notary Seal and/or Stamp Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ____________________________ _ Document Date: ______________________ Number of Pages: ____ _ Signer(s) Other Than Named Above: ______________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ____________ _ □ Corporate Officer -Title(s): ______ _ □ Corporate Officer -Title(s): ______ _ □ Partner -□ Limited □ General □ Partner -□ Limited □ General □ Individual □ Attorney in Fact □ Individual □ Attorney in Fact □ Trustee □ Guardian or Conservator □ Trustee □ Guardian or Conservator □ Other: □ Other: Signer is Representing: _________ _ Signer is Representing: _________ _ o:s:o:o:s:0:sa1a 1:a111 sss E a:o:s:a 1 1 c:8 s:o:s:o:s:ou:B:o®ffi6 cc 8 fl cc 3 BOB □@oo co cc c □cc ca c@wreee1aa. -1 e&efEAt2P1tP133@0DQ ©2019 National Notary Association Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion oft he work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Type of Work Business Name and Address DIR Registration No. License No., %of to be & Expiration Date Classification Total Subcontracted & Expiration Contract Date None Total% Subcontracted: =0..c.:%'-------- The Contractor must perform no less than 50% of the work with its own forces. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 7 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL EXHIBIT B Project: Knots Lift Station Location: 502 Knots Lane, Carlsbad, CA 92008 Bidder: HPS Mechanical Inc. Replace pumps no. 1 and 2 at the Knots Sewer Lift Station and all associated piping, supports, foundations and appurtenances between the isolation valves. JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION Provide and install all material, labor as per sheets noted Chlorination, air test, flushing, disinfecting of new installation Remove and replace small pumps, including all piping and appurtenances replaced between the isolation valves Expansion joints, check valve, spools, gauge assembly Labor & Materials Bond *Includes taxes, fees, expenses and all other costs. Bypass not required Long lead time item valvematic check valve 7-9 weeks ARO Excludes: BIM, CWA, PLA, PSA, Permits, Inspection, surveying, hazard materials or soil, night work, holidays, weekends, saw cutting, back patch, haul offs of any disposal offsite and fees, any demo (or) removals of existing and appurtenance, any dewatering or ground water, hoe ramming-hard digging, swale reducer, TOTAL* PRICE $59,630 KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 8 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B BOND NO. 9436688 PREMIUM: $366.00 EXHIBIT C LABOR AND MATERIALS BOND PWM25-3626UTIL WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to HPS Mechanical Inc. (hereinafter designated as the "Principal"), a Contract for: KNOTS LIFT STATION PUMP REPLACEMENTS CONTRACT NO. 3840-10 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, HPS MECHANICAL INC., as Principal, (hereinafter designated as the "Contractor"), and FIDELITY AND DEPOSIT COMPANY OF MARYLAND as Surety, are held firmly bound unto the City of Carlsbad in the sum of fifty nine thousand six hundred thirty dollars ($59,630), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 9 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL This labor and materials bond may be approved as to form by the City Attorney for the City in counterpart, and the counterparts shall all constitute a single, original instrument. SIGNED AND SEALED, this 27TH day of _N_O_V_E_M_B_E_R ______ _, 2024. FIDELITY AND DEPOSIT COMPANY OF MARYLAND H __ PS_M_E_C_H_A_N_IC_A_L_,_IN_C_. ____ (SEAL) ___________ (SEAL) (Surety) - -s"'·on DENHERDER, PRESIDENT {SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON City Attorney By: Assistant City Attorney KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 10 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D. Murray. Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Wes BRADFORD, Elizabeth AGUINAGA, Johannah GRIFFITH, Lorinda HOFFMANN, Julie SANDERS, Lori MCQUILLIAMS all of Bakersfield, California, its true and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By-Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF :MARYLAND, this 12th day ofJuly, A.D. 2023 . By: Robert D. Murray Vice President By: Dawn E. Brown Secretary State of Maryland County of Baltimore .. ... -..... , ~__.. ... ..,,'t '-"'~ '1~s,r~~~liJ,~'1v1~c~~ _l(c. SEAL Jf ~ SEAL -SEAL'" 1:! \~ (f/ ., 'I/\~ -!I! "' 'I' -......_41,i;_., "'% ... , ..,...., .. ...,-9 ...,,,,.,.,... .._,,....,.. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND On this 12th day of July, A.O. 2023, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, Robert D. Murray, Vice President and Dawn E. Brown, Secretary of the Companies, to me personally known to be the individuals and officers described_in a~d who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she 1s the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Iva Bethea Notary Public My Commission Expires September 30, 2023 Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 U:iEiE J ih A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of _..,_K=e=r.,__,n'-------------- On 11/27/2024 before me, __ A_lm_a'-----L_. -'-"-M""'a'-'--rt=in-'--'e=z:..,_, _;__N,;....:oc...:.ta=ry~P-'u=b:...:.li:...:.c ____ ~ Date Here Insert Name and Title of the Officer personally appeared ___ J_o_h_a_n_n_a_h_G_r_iffi_1t_h_a_n_d_S_c_o_tt_D_e_n_H_e_r_d_e_r __________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. i············1 • Al.MAL. MARTINEZ : Nota,y Public • California I i Kern County CQmmtssion # 2472095 -~ 0 0 0 !Y5:";·;:;:,es:CJ1;_2og I Place Notary Seal and/or Stamp Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature __,,~--=-----~--------)--1-,,,.,-~------ Signature of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Payment & Performance Bonds Document Date: _____________________ Number of Pages: ___ _ Signer(s) Other Than Named Above: _______________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ Signer's Name: □ Corporate Officer -Title(s): ______ _ □ Corporate Officer -Title(s): ______ _ □ Partner -□ Limited □ General □ Partner -□ Limited □ General □ Individual □ Attorney in Fact □ Individual □ Attorney in Fact □ Trustee □ Guardian or Conservator □ Trustee □ Guardian or Conservator □ Other: □ Other: Signer is Representing: _________ _ Signer is Representing: _________ _ ©2019 National Notary Association Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL EXHIBIT D In-Use Off-Road Diesel-Fueled Fleet Regulation Requirements CARB implemented amendments to the In-Use Off-Road Diesel Fueled Fleets Regulations that apply broadly to all self-propelled off-road diesel vehicles 25 horsepower or greater and other forms of equipment used in California. More information about the requirements can be found at https ://ww2.a rb.ca .gov/ ou r-work/progra ms/use-road-diesel-fue led-fleets-regulation Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. The City is a "Public Works Awarding Body," as that term is defined under Title 13 California Code of Regulations Section 2449(c)(46). Accordingly, the Contractor must submit, with their pre-award contract documents, valid Certificates of Reported Compliance (CRC) for the Contractor's fleet, and for the fleets of any listed subcontractors (including any applicable leased equipment or vehicles). Failure to provide a valid CRC, will limit the city's ability to proceed with awarding this Contract. Contractor has an on-going obligation for term of this Agreement to provide copies of Contractor's, as well as all listed subcontractors, most recent CRC issued by CARB. Throughout the Project, and for three (3) years thereafter, Contractor shall make available for inspection and copying any and all documents or information associated with Contractor's and subcontractors' fleet including, without limitation, CRC, fuel/refueling records, maintenance records, emissions records, and any other information the Contractor is required to produce, keep or maintain pursuant to the Regulation upon two (2) calendar days' notice from the City. KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 11 City Attorney Approved 6/5/24 Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PWM25-3626UTIL EXHIBIT D (CONT.) IN-USE OFF-ROAD DIESEL-FUELED FLEET REGULATION CERTIFICATION Contractor hereby acknowledges that they have reviewed the CARB' s policies, rules and regulations and are familiar with the requirements of In-Use Off-Road Diesel-Fueled Fleet Regulation. Contractor hereby certifies, subject to the penalty of perjury, that the option checked below relating to the Contractor's fleet, and/or that of their subcontractor(s) ("Fleet") is true and correct: IXl The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. D The Fleet is exempt from the Regulation under Section 2449.l{f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. □ Contractor and/or their subcontractor is unable to procure R99 or Rl00 renewable diesel fuel as defined in the Regulation pursuant to Section 2449.l(f)(3). Contractor shall keep detailed records describing the normal refueling methods, their attempts to procure renewable diesel fuel and proof that shows they were not able to procure renewable diesel (i.e., third party correspondence or vendor bids). □ The Fleet is exempt from the requirements of the Regulation pursuant to Section 2449(i)(4) because this Project has been deemed an "emergency", as that term is defined in Section 2449(c)(18). Contractor shall only operate the exempted vehicles in the emergency situation and records of the exempted vehicles must be maintained, pursuant to Section 2449(i)(4). □ The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached to this certification. Name: Les DenHerder Title: Executive Chairman Date: November 25, 2024 KNOTS LIFT STATION PUMP REPLACEMENTS CONT. NO. 3840-10 Page 12 City Attorney Approved 6/5/24 Do c u s i g n E n v e l o p e I D : D 1 E 7 B 9 7 1 - B 6 B F - 4 5 C 2 - 8 E E E - 0 B 8 1 C B E 5 F D 2 B Califi rnia En"ironmenral 1 rotl' ti n gene · Air Resources Board January 1, 2024 CERTIFICATE OF REPORTED COMPLIANCE OFF-ROAD DIESEL VEHICLE REGULATION Is issued to HPS MECHANICAL INC ft ].c.:tt _,. Certlftoat.e expire• Z/28/2025 PWM25-3626UTIL Exhibit "E" Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B MARRON SHEET NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RD DEL ~AK£ CALAV£RA FAifAOA y A VE f_AGOON BAT!QUITOS -------- lfo PKWY ALGA k " t "I--- ,--.._, 0, VV£NHAIN VICINITY MAP NOTTO SCALE INDEX OF SHEETS DRAWING NO. G-1 C-1 C-2 C-3 C-4 C-5 S-1 S-2 S-3 S-4 S-5 S-6 S-7 S-8 E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 E-10 L-1 L-2 L-3 L-4 TITLE TITLE SHEET CIVIL NOTES CIVIL SITE PLAN PIPING PLAN PIPING SECTIONS CIVIL DETAILS STRUCTURAL NOTES PLANS, SECTIONS, DETAILS ELEVS., SECTS., DETAILS FOUNDATION+ DECK PLAN SECTIONS I SECTIONS II STAIRWAY DETAILS HANDRAIL DETAILS ELECTRICAL SYMBOLS AND ABBREVIATIONS ELECTRICAL SITE PLAN POWER AND LIGHTING -PLAN SIGNAL PLAN SINGLE LINE DIAGRAM AND DETAILS MAIN CONTROL PANEL (MCP) DETAIL CONTROL DIAGRAM -No.1 CONTROL DIAGRAM -No.2 CONTROL DIAGRAM -No.3 SCHEDULES IRRIGATION SPECIFICATIONS IRRIGATION PLAN PLANTING SPECIFICATIONS PLANTING PLAN CONSTRUCTION PLANS FOR KNOTS LANE LIFT ST A TION -,;. c:-;-I I I , __ , \✓A_l_t?-- k C.J ·, CARLSBAD MUNICIPAL WATER DISTRICT CARLSBAD, CALIFORNIA JUNE 1998 \ \ \ \ SITE~fi 1 RUDDER AV£ '\ 2 R££V£ RD. \\ J KNOTS LN. \\ '~ ' \ 11 l \ BA 77QU/TOS LAGOON LOCATION MAP NOTTO SCALE BOARD OF DIRECTORS CLAUDE A. "BUD" LEWIS-PRESIDENT RAMONA FINNILA-VICE PRESIDENT ANN J. KULCHIN-DIRECTOR MA TT HALL-DIRECTOR JULIE NYGAARD-DIRECTOR RAYMOND R. PATCHETT -EXECUTIVE MANAGER ROBERT J. GREANEY-GENERAL MANAGER WILLIAM E. PLUMMER-DISTRICT ENGINEER LEGEND r z'J'f ~ SPOT £L£VA 770N -56 -CONTOUR -s6-ORIGINAL CONTOUR ~ DIR£C770N OF FLOW 4" A.G. PAVEMENT/ 6" A.8. e22222u zzzz1 SOUNDWALL REDWOOD HEADER ---6" PVC S£WER FORCE MAIN (CL 125) ---+llv.s'-- 01) WATER SERV1C£ BACKFLOW PREVENTER ---10" PVC SEWER MAIN "iZ --~ _ THRUST BLOCK ------0-SEWER ACCESS HOLE CITY OF CARLSBAD REFERENCE DRAWINGS IN5f't:CT0tt: APPROl,£O RECORD ORA WINGS l"l',SIGNrn: owe No. 357-5 DWG No. 357-4 DWG No. 337-98 owe No. 357-5A OWG No. 357-4A DISTRICT APPROVED CHANGES POINSET77A SHORES AREA A-4 IMPROVEMENT Pl,',NS POINSETTIA SHORES AR£A A-J IMPROVEMENT PLANS POINS£TT!A SHORES AREA MASS GRADING PLANS POINSET77A SHORES AR£A A-4 GRADING PLANS POINSETTIA SHORES AREA A-3 GRADING PLANS BENCHMARK ----+~Ap=p-'-',-o"-'v"=-=-·J _1 Dote AGENCY: .......... NOR77-I COUNTY VE:R77CAL CONTROL DA TA ,ffo-9 DESIGNA770N: .. O.C. 0147 --ff. -FLOW LINE OF SWAL£1 ---.~ PROPER TY LINE _jL-EXIST. SLOPE EOG£ OF £XIST. PA V£f.(£NT ---s-£XIST. SEWER MAIN ---(i_-EXIST. STR£ET CENTE(?LINE R/W-£XIST. RIGHT-OF-WA r' LINE ®--o-£XIST. WATER M£TER --w-EXIST. WA TER LINE ---EXIST. SEWER FORCE MAIN <l G £X/ST. DRIVEWAY £X/ST. CURB & GurrtR C-1 CARLSBAD MUNICIPAL W, TER DISTRICT ~~t 28 1 ENGINEERING DEPARTMENT ~eets KNOTS LAN£ LIFT STA TION TITLE SHEET ----~ NOL TE and ASSOCIATES CPS/LJ DRA' ... N: l)escrip lion 1 ff<oRl? PR,91(1/1,/t; DESCRIP770N: .. STANDARD DISC SET FLUSH IN E. COR. ON N. Ef9\ears / Planners / &neyora LJ 5460 KEAP.NY VILL,\. 1(1),,irnl'l'I': :10~. SAN DiEGD. CA. 92123 (,~rn) Z71:l--\l:j\),: llATf : [N-:;INt.C.1'1 01-W"JRK 08/07/98 .JQr-l N\J· ~ARI. P. s~1•MNEN F!.C.E. 26J91 (r XP. J-31-00) DAlf SD0410ps ABU TMENT OF E. BR. --------+-··--------+-----1ELEVA T!ON: ...... 50.558 M.S.I. _____ -----+-----f -----lLOCA770N: ........ APPROX. 300' S. OF S. ENTRY TO CARLSBAD t--+-----STAT£ PARK 40' E. OF CL OF N. BOUND CARLSBAD BL vi) ON PONTO BR. No. A 78B2 Dr wn.: LJ Checked· CMWD 97+-402 OWG NO. 357-58 I I I 1 ~i s ~ • ~ i I I I !! ~ j • i i PWM25-3626UTIL Exhibit "E" Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B PROCEDURES FOR PROCESSING SHOP ORA IMNGS. SUBMITTALS. CHANCE ORDERS. AND REQUESTS FOR INFORMA TION 1. SHOP DRAWINGS, SUBMITTALS, AND CHANGE ORDERS SHALL BE PROCESSED IN ACCORDANCE WITH SECTION 2 AND 3 OF THE STANDARD SPECIF/CATIONS FOR PUBLIC WORKS CONSTRUCTION, 1991 £D/TION. 2. THE AGENCY IS CARLSBAD MUNICIPAL WA lFR DISTRICT. 3. TH£ ENGINEER IS THE DISTRICT ENGINEER FOR CARLSBAD MUNICIPAL WAlFR DISTRICT OR HIS APPROVED REPRESENTATIVE AT {160) 438-3361. NO CHANGES TO TH£ PLANS OR SPECIF/CATIONS SHALL BE MADE WITHOUT APPROVAL OF THE ENGINEER. -f.. TH£ £NGIN££R OF WORK IS NOL 7F AND ASSOC/A lFS AT (619) 218-9392. 5. THE PROJECT INSPECTOR IS TH£ ENGINEERS REPRESENTATIVE FOi? INSPECTION, AND ADMINISTRATION. TH£ PROJ£CT INSP£CTOR IS ASS/GN£D BY TH£ CITY OF CARLSBADS ENGINEERING INSPECTION SECTION AT {760) 438-3891. 6. WHEN SUBMITlFD FOR THE ENGINEERS R£VIEW, SHOP DRAltfNGS SHALL BEAR TH£ CONTRACTOR'S CERTIFICATION THAT HE HAS REVIEWFD, CHECKED AND APPROVED THE SHOP DRAWINGS AND THAT THEY ARE IN CONFORMANCE WITH THE REQUIREMENTS OF THE CONTRACT DOCUMENTS. TH£ CONTRACTOR SHALL SUBSCRIBE TO AND SHALL PLACE THE FOLLOWING CERT/FICA TION ON ALL SUBMITTALS: "I HEREBY CERTIFY THAT THE EQUIPMENT AND MATERIAL SHOWN AND MARKED IN THIS SUBMITTAL IS THAT PROPOSED TO BE INCORPORATED INTO THIS PROJECT, IS IN COMPLIANC£ WITH TH£ CONTRACT DOCUMENTS, CAN 8£ INSTALLED IN THE ALLOCATED SPAC£S, AND IS SUBMITT£D FOR APPROVAL BY:______________ TITLE: ____________ _ DATE: __________ COMPANY NAME: __________ _ 1. THE CONTRACTOR SHALL PROVIDE AND KEEP UP-TO-DATE A COMPLETE "AS-BUILT" RECORD SET OF BLUEL/NE PRINTS, WHICH SffALL BE CORRECTED IN RED DAILY AND SHOW EVERY CHANGE FROM THE ORIGINAL ORA WINGS AND SP£C/FICA TIONS AND TH£ EXACT "AS-8U/L r" LOCATIONS, SIZES AND KINDS OF EQUIPMENT, UNDERGROUND PIPING, VALVES, AND ALL OTHER WORK NOT VISIBLE AT SURFACE GRADE. THIS S£T OF DRAWINGS SHALL BE KEPT ON THE JOB S/lF AND SHALL BE USED ONLY AS A RECORD SET AND SHALL BE DELIVERED TO THE PROJECT INSPECTOR UPON COMPL£TION OF THE WORK. THE PROJECT INSPECTOR WILL SUBMIT THESE TO THE ENGINEER OF WORK TO PR£PARE FINAL AS-BUil T DRAWINGS. 8. A PRE-CONSTRUCTION CONFERENCE SHALL BE HELD AT THE LOCA T/ON, DA TE, AND TIM£ DES/GNA TED BY TH£ PROJECT INSPECTOR. THE MEETING SHALL BE ATTENDED BY THE INSPECTOR, THE ENGINEER OF WORK AND THE CONTRACTOR AND HIS SUPERINTENDENT AND ANY REPRESENTATIVES OF REGULA TORY AGENCIES. 9. PROJECT MEETINGS SHALL BE ATTENDED BY THE ATTENDEES NAMED ABOI-£ THE ENGINEER OF WORK WILL RECORD MINUTES FOR EACH MEETING AND Will FURNISH COPIES TO THE CONTRACTOR WITHIN FlVE WORKING DA Y.S' THEREAFTER. IF THE CONTRACTOR DOES NOT SUBMIT WRITTEN OBJECTION TO THE CONlFNTS OF SUCH MINUlFS WITHIN SEVEN DA Y.S' AFTER PRESENTATION TO HIM, IT SHALL BE UNDERSTOOD AND AGREED THAT THE CONTRACTOR ACCEPTS THE MINUlFS AS THE TRUE AND COMPLElF RECORD OF THE MEETING. THE DA lFS, TIMES AND LOCATIONS FOR THE VARIOUS MEETINGS SHALL BE AGREED UPON AT THE PRE-CONSTRUCTION CONFERENCE. 10. REQUESTS FOR INFORMA llON, SUBMITTALS, AND REQUESTS FOR CHANGE ORDERS SHALL BE SUBMITTED TD THE PROJECT INSPECTOR. THE PROJECT INSPECTOR WILL COORDINATE THE RESPONSE THROUGH THE APPROPRIATE INDIVIDUALS BACK TO THE CONTRACTOR. 11. START-UP AND TESTING PROCEDURES THE FIELD START-UP AND TESTING FOR THE LIFT STATION SHALL BE DONE IN THE FOLLOWING THREE PHASES: 1. PRE-OPERATIONAL CHECK OUT 2. A TWO-DAY START-UP AND TESTING PERIOD WITH MANUFACTURERS PRESENT, AND :J. A FULL THIRTY CALENDAR OA Y OPERA TIONAL TEST THE CONTRACTOR SHALL PROVIDE START-UP AND TESTING PROCEDURES FOR ALL THREE TESTS FOR APPROVAL TO TH£ £NG/NEER TIW-WE£KS PRIOR TO EACH TESTING PHASE. ALL COSTS ASSOC/A TED WITH THE TESTING PHASES SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR. THE PRE-OPERATIONAL CHECK OUT SHALL BE COMPLETED BY THE FOLLOWING EQUIPMENT MANUFACTURERS: FLOW METER, PUMP, CHECK VAL VE. GENERA TOR, PUMP CONTROL PANE:LS. MAIN CONTROL AND BUBBLER CONTROL PANELS. THE CHECK OUT SHALL BE THOROUGH AND EXTENSIVE. EACH MANUFACTURER SHALL THEN PROVIDE A CERTIFICATION VERIFYING THAT THEIR RESPECTIVE PIECE(S) OF EQUIPMENT HAS BEEN INSTALLED PER THEIR RECOMMENDATIONS AND IS READY TO BE POWERED UP OR STARTED UP. EACH MANUFACTURERS CERT/FICA TION SHALL BE APPROVED BY THE ENGINEER PRIOR TO THE TWO-DAY START-UP AND TESTING PERIOD. THE TWO-DAY START-UP AND TESTING PERIOD SHALL BE PERFORMED IN THE PRESENCE OF All THE MANUFACTURERS USTED IN THE PRE-OPERATIONAL CHECK OUT PERIOD. THIS TEST SHALL BE PERFORMED USING POTABLE WAlFR. THE CONTRACTOR SHALL CONSTRUCT A MANIFOLD TO CIRCULATE WATER FROM A CONNECTION POINT IN THE LIFT STATION DRY PIT OR OUTSIDE OF TliE STRUCTURE TO THE WETWEZ.L. AFTER AOJlJSTMENTS, R£PAIR, OR REPLACEMENT OF EQUIPMENT IS MADE TO CONFORM TO THE CONTRACT REQUIREMENTS, THE TEST CAN BEGIN. ONCE THE TEST BEGINS. ALL EQUIPMENT IN CONJUNCT/ON WITH ALL OTHER EQUIPMENT MUST OPERA TE TROUBLE FREE OR THE TEST SHALL 8E REPEA TEO. WHEN THE CONTRACT OOCUMENTS 00 NOT SPECIFY TOLERANCES, TEST RESULTS SHALL COMPLY W/Tli TOLERANCES ESTABLISHED BY R£COGNIZED INDUSTRY PRACTICES SUCH AS THE HYDRAULIC INSTITUTE STANDARDS. TH£ TOO-DAY OPERATIONAL TEST RESULTS SHALL BE APPROVED BY THE £NC/NEER PRIOR TO THE FULL THIRTY-DA Y OPERATIONAL TEST. THE FULL THIRTY-DAY OPERATIONAL TEST SHALL BE PERFORMED (!SING POTABLE WATER. THE FULL OPERATIONAL TEST SHALL INCLUDE NORMAL LIFT STATION OPERA TING CONDITIONS INCLUDING Fl.UC TUA TIONS IN THE WETM:LL LEVELS. THE CONTRACTOR MAY C/RCULA TE WA T£R FROM THE END OF THE LIFT STATION FORCE MAIN BACK TO THE GRAV/TY SYSlFM THAT CONNECTS TO THE LIFT STA l/ON OR PROVIDE POTABLE WATER AT THEIR EXPENSE. TliE MINIMUM NUMBER OF STARTS IN A TWENTY-FOUR HOUR PERIOD SHALL NOT BE LESS TliAN 18 NOR SHALL THE TOTAL RUN HOURS BE LESS THAN 2 PER DAY. AFTER A SUCCESSFUL. TROUBLE FREE CONSECUTIVE THIRTY DAY PERIOD HAS BEEN PERFORMED, ACCEPTANCE PROCEDURES WILL BEGIN. THE FIRST S TEP IN THE ACCEPTANCE PROCEDURES WILL BE A NOTICE OF COMPLETION ISSUED BY THE DISTRICT ENGINEER OF THE CARLSBAD MUNICIPAL WATER DISTRICT (DEFINED AS ENGINEER). AFTER THE NOTICE OF COMPLETION HAS BEEN ISSUED, BUILDING PERMITS FOR HOUSES TRIBUTARY TO THE LIFT STATION MAY BE ISSUED AND RAW SEWAGE MAY ENTER INTO TH£ LIFT STATION WETM:LL AND BE PUMPED PROVIDED THAT A MINIMUM OF 6,000 GALLONS OF SEWAGE IS A VAILABLE TO BE PUMPED THROUGH THE LIFT STA/ON OR A MAXIMUM WcTWELL/FORCE MAIN DETENTION TIME OF LESS TliAN 6 HOURS IS OBTAINABLE. THE WARRANTY PERIOD FOR ALL EQUIPM£NT, EXCEPT FOR LANOSCAP/NG, WILL BEGIN ON THE DA 7F OF THE NOTICE OF COMPLETION. TliE DA TE OF TliE NOTICE OF COMPLETION WILL ALSO DEFINE THE DA TE IN WHICH TliE CARLSBAD MUNICIPAL WATER DISTRICT WILL B£ RESPONSIBLE FOR UTILITY BILLINGS. ALL TRAINING SHALL BE COMPLETED AND OPERATIONS AND MAINTENANCE MANUALS SHALL BE RECEIVED/COMPLElFD BY THE DA TE OF TliE N071CE OF COMPLETION. TliE PUNCH LIST OF llFMS FOR THE CONTRACTOR MUST BE 90:K COMPLETE WITH NO OUTSTANDING ISSUES PRIOR TO TH£ DA TE OF THE NOTICE OF COMPLETION. Tl-f£ 90:K COMPLETION OF TliE PUNCH LIST ITEMS IS ALSO WILL BE THE DEFlN/710/V OF "SUBSTANTIALLY COMPLETE" AS IT RELATES TO TENTATIVE MAP OR ANY OTHER COND/7/0NS OF APPROVAL. FINAL ACCEPrANCE IS DEFINED AS THE DATE THAT NO PUNCH LIST ITEMS REMAIN. NO OPERATIONAL PROBLEMS CONTINUE, AND ALL SYSTEM COMPONENTS ARE DEEMED COMPLETE BY THE ENC/NEER. I SPECIAL NOTES DESIGN AND EQUIPMENT DA TA SOE'R NOTES I) SEWER MAIN AND APPURTENANCES SHALL BE CONSTRUClFD IN ACCORDANCE WITl-f THE "CARLSBAD MUNICIPAL WATER DISTRICT'S S£W£R SYSTEM -DESIGN CRITERIA, STANDARD ORA WINGS AND SPECIF/CATIONS~ AND THE STANDARD SPECIF/CATIONS. MARCH 1997, AND THE STANDARD SPEC/FlCA TIONS FOR PUBLIC WORKS CONSTRUCTION, LA lFST EDITION (GREEN BOOK). 2) THE CONTRACTOR SHALL OBTAIN AN EXCAVATION PERM/ T FROM THE DIVISION OF INDUSTRIAL SAFETY BEFORE ANY EXCA VA 170N AND SHALL ADHERE TO ALL PROVISIONS OF THE STA 7F CONSTRUCTION SAFETY ORDERS. 3) BEFORE ANY CONNECTION TO THE DISTRICT'S EXISTING SYSTEM, A PERMIT SHALL BE OBTAINED FROM THE DISTRICT. IT MUST BE SIGNED AND APPROVED BY TH£ DISTRIC T'S ENGINEER AND SUPER/NlFNDENT. 4) BEFORE CONSTRUCTION BEGINS IN ANY PUBLIC RIGHT OF WAY, A CITY RIGHT OF WAY PERMIT SHALL BE REQUIRED. 5) THE CONTRACTOR SHALL NOllFY THE CITY OF CARLSBAD ENGINEERING INSPECTION 48 HOURS PRIOR TO THE BEGINNING OF CONSTRUCllON. (TELEPHONE NO. [760] 438-3891). SQtE'R FORCE MAIN NOTES I) AT 45 DEGREE BEND USE THRUST BLOCK WITH A MINIMUM OF 10 SQUARE FEET AGAINST UNDISTURB£D SOIL. 2) ALL FITTINGS AND BENDS SHALL BE DOUBLE WRAPPED WITH EIGHT MIL POLYETHYLENE ENCASEMENT. TAPE ALL SEAMS TO PROVIDE A WATER TIGHT SEAL. 3) THE BEDDING IN TH£ PIPE ZONE SHALL BE SAND PER SSPWC {GREEN BOOK) 306-1.2.1. PIPE ZONE SHALL EXTEND 12• ABOVE THE PIPE AND 6" BELOW THE PIPE. CROSS REFERENCE SYSTEM 1. A SECTION CUT ON DRAWING Ml IS IDENTIFIED AS FOLLOWS -~~--DIRECTION OF VIEW---~--jll'!'I-SECTION LETlFR 11 ______ _......,..,...,A..,... M--2 ORA WING WHERE SECTION IS SHOWN 2. ON DRAWING M2 TH£ SECTION IS IDENTIFlED AS FOLLOWS ..;_Sc,_;;;__;C_TJ,_ON,,........,..... _______ ~A~-SECllON LETTER SCALE: I "=3' M=i DRAWING WHERE SECTION OR/GINA TED 3. DETAILS ARE CROSS REFERENCED IN A SIMILAR MANNER TO THAT OF SECTIONS EXCEPT DETAILS ARE ASSIGNED NUMBERS RATHER THAN LETlFRS OETAIL e=DETAIL NUMBER N ;::;~O:.T.;.Ti;..O;;.:::S_CA_L_E __________ ---11-_'--I IND/CA lFS DETAIL IS ON SAM£ SHEET C/111, ABBREV/A TIONS EXIST. EXISTING P. V. C. POL YVINYLCHLORIDE A.C. ASPHAL TIC CONCRElF A.B. AGGREGATE BASE /.£. INVERT ELEVATION I[ FLOWLINE f CENTERLINE If PROPERTY LINE FLG. FLANGED D.I.P. DUCllLE IRON PIPE MIN. MINIMUM FG FINISHED GROUND FS FlNISHED SURFACE EP EDGE OF PAVEMENT TC TOP OF CURB (56.6) EXISTING ELEVA TION CMIW CARLSBAD MUNICIPAL WATER DISTRICT DWG DRAWING DET DETAIL SST STAINLESS STEEL TB THRUST BLOCK P.O.C. POINT OF CONNECTION LETTER IND/CA TES SHEET TYPE G -GENERAL C -CIVIL S -STRUCTURAL E -ELECTRICAL L -LANDSCAPE r:-1'":0!l~ED: N lllr.. NOL TE and ASSOCIATES c,,,,;:/S/LJ APPROvf"D RECORD ORA WINGS 1. CONTRACTOR IS RESPONSIBLE TO NOTIFY THE ENGINEER OF WORK WHENEVER THESE PLANS SEEM UNCLEAR. THIS NOTIFICATION SHALL BE MADE IN ADVANCE OF CONSTRUCTION TO ALLOW THE ENGINEER OF WORK ADEQUATE llM£ TO RESPOND. 2. THE ENGINEER OF WORK IS NOT RESPONSIBLE FOR SUPERVISING GRADING OPERATIONS OR GRADING WORK DONE. THE CONTRACTOR IS SOLELY RESPONSIBLE. THE LETTER FROM TH£ G£0TECHNICAL £NG/NEER IS INCORPORATED INTO AND MADE A PART OF THIS PLAN. 3. DEVIATIONS IN THE EXISTING ELEVATIONS SHOWN HEREON MAY EXIST AT THE TIME OF CONSTRUC770N. CONTRACTOR SHALL VERIFY EXISTING ELEVATIONS OF THE GROUND AT THE SITE, AND NOTIFY TH£ ENGINEER OF WORK OF ANY DISCREPANCIES SUFFlCIENTL YIN ADVANCE OF GRADING WORK TO ALLOW FOR MODIFlCA TION OF THESE PLANS. 4. NO BLASTING SHALL 8E DONE UNTIL PERMISSION IS OBTAINED FROM Tl-IE GOVERNING PUBLIC AGENCY. THE CONTRACTOR IS ALSO REQUIRED TO NOTIFY THE ENGINEER OF WORK PRIOR TO PERFORMING ANY ROCK REMOVAL OP£RA T!ONS. 5. TH£ CONTRACTOR SHALL BE RESPONSIBLE FOR MAINTAINING APPROPRIATE EROSION CONTROL FACILITIES THOUGHOUT TH£ DEVELOPMENT OF THE PROJ£CT. 6. N£/TH£R TH£ OWNER, NOR THE £NG/N£ER OF WORK WILL £NFORCE SAFETY MEASURES OR REGULATIONS TH£ CONTRACTOR SHALL DESIGN, CONSTRUCT AND MAINTAIN ALL SAFETY DEVICES. INCLUDING SHORING. AND SHALL BE SOLEL Y RESPONSIBLE FOR CONFORMING TO ALL LOCAL, S TA TE, AND FEDERAL SAFE TY AND HEAL TH STANDARDS, LA 1-1-S AND REGULA T!ONS 7. THE CONTRACTOR HAS SOLE ANO COMPLElF RESPONSIBILITY FOR JOBS/TE CONDITIONS DURING THE COURSE OF CONSTRUCTlON OF THIS PROJECT, INCLUDING SAFETY OF ALL PERSONS AND PROPERTY, AND THAT THIS REQUIREMENT SHALL APPLY CONTINUOUSLY AND NOT BE LIMITED TO NORMAL WORKING HOURS; AND THAT THE CONTRACTOR SHALL DEFEND, INDEMNIFY AND HOLD THE ENGINEER HARMLESS FROM ANY AND ALL LIABILITY, REAL OR ALLEGED, IN CONNECTION WITH THE PERFORMANCE OF THE WORK ON THIS PROJECT, EXCEPTING LIABILITY ARISING FROM THE SOLE NEGLIGENCE OF THE ENGINEER, AND HEAL TH STANDARDS, LA 11(5' AND REGULA llONS. 8. LOCATIONS AND ELEVA llON OF IMPROVEMENTS TO BE MET BY WORK PROPOSED ON THES£ PLANS SHALL B£ CONFIRMED BY Fl£LD MEASUREMENTS PRIOR TO CONSTRUCTION OF NEW WORK. 9, BEFORE EXCAVATING FOR THIS CONTRACT. THE CONTRACTOR SHALL VERIFY THE HORIZONTAL AND VERTICAL LOCATION OF UNDERGROUND UTILITIES. TO THE BEST OF OUR KNOWLEDGE, THERE ARE NO OTHER EXISTING UTILITIES EXCEPT AS SHOWN ON THESE PLANS. 10. THE GENERAL CONTRACTOR IS REQUIRED TO KEEP AND MAINTAIN A SIGNED SET OF THESE PLANS ONS/TE AT ALL TIMES FOR USE BY THE ENGINEER OF WORK, SOILS ENGINEER, AND THE CITY INSPECTORS. THE GENERAL CONTRACTOR SUPERINTENDENT IS REQUIRED TO UPDATE SAID PLANS WITH AS-BUil T INFORMATION OF A DAILY BASIS AS WORK PROGRESSES. SAID PLANS SHALL BE GIVEN TO THE ENGINEER OF WORK A T THE COMPLETION FO THE PROJECT AND CERT/FlED BY THE SUPER/NlFNDENT AS ACCURATE AND COMPLETE. 11. CONSTRUCT PA VINC, /RR/GA TION, AND LANDSCAPE AFlFR SOUND WALL IS CONSTRUClFD UTILITY CONTACTS THE CONTRACTOR SHALL VERIFY THE EX/SlFNCE AND LOCATION OF ALL UTILITIES BEFORE COMMENCING WORK. AT LEAST TWO (2) WORKING DA Y.S' PRIOR TO EXCAVATION, NOTICE OF THE PROPOSED WORK SHALL BE GIVEN TO: UNDERGROUND SERVICE ALERT 1-800-422-41.JJ PROPOSED WORK WHALL BE COORDINATED WITH THE FOLLOW/NC UTILITIES: SAN DIEGO GAS &-ELECTRIC CAROL CHAPO PACIFIC BELL JANINE ANDERBURG (760) 480-765.J (160) 489-3103 DISTRICT APPROVED CHANG£S INFLUENT WASTEWATER FLOW NUMBER OF EDUS FLOW PER EDU A VERA GE DAILY Fl.OW P£AKING FACTOR PEAK FLOW SEWAGE PUMPS TYPE NUMBER MOTOR SIZE SPEED RA TING POINT EMERGENCY GENERA TOR TYPE SIZE FUEL CONSUMPTION SUMP PUMP TYPE NUMBER MOTOR SIZE SPEED RA TING POINT SUPPLY FAN TYPE MOTOR SIZE MOTOR RATING CAPACITY EXHAUST FAN TYPE MOTOR SIZE MOTOR RATING CAPACITY BENCHMARK Descrri:-!fo,,.___ _ l'ppro ved__ Dote AGENCY.· .......... NORTH COUNTY VERTICAL CONTROL DATA 1,m k'f (CJ,fll l?f'.'91f'.'l,[/.£_. _________ -+----l-'"'-·-"30c.c·,_,997 DESIGNA TION: .. O.C. 0147 I---+-----------------+--·. DESCR/PTION: .. STANDARD DISC SET FLUSH IN E. COR. ON N. ABUTMENT OF E. BR. a.. Erg'leers / Planners / SIJ'Veyora LJ ~(1\1 KllARNY \'ILU. RD.,SIJITI :J.115, t,AN tllECiJ, CA 0~12:J (~IQ) Z7!l-~ [;A fE.: EN<SNErn OF WORK 08/01 /98 . 4-t/~ (~,,,~........ 28}!§_ u,:,tnd r nqineer: WILLIAM £. PLUMMER HCE //, 212 -99 ()a te ----+-----<ELEVAnON: ...... 50.558 M.S.I . 1---+----------------t----t----lLOCATION: ........ APPROX JOO' S. OF S. ENTRY TO CARLSBAD I---+--------··--·· ---····--· jje'"NO ----,,c,cae,--;,cc. ,ca,,"',o"""""'--,'""·'7,-s,as,.,~91 --s("°e,;;--,. -c., -sc.,,cc-o;;;co),--------,,,,:.;;,s--S0041 Ops Ni: (,1/.'•,; iNA /!ON f .XF-'INf-s· .)-.51-0Y. STA TE PARK 40' E. OF CL OF N. BOUND CARLSBAD BL VD ON PONTO BR. No. A18B2 712 220 GPD 109 GPM 3.25 355 GPM NON-CLOG CENTRIFUGAL, IMMERSIBLE MOTOR 2 PLUS I SPARE IN GENERA TOR BUILDING 10 HP 1800 RPM 355 GPM AT 44 FEET TOH DIESEL FUELED 20 KW 2.0 GPH AT FULL LOAD SUBMERSIBLE EFFLUENT PUMP 1 1/3 HP 1550 RPM 15 GPM AT 30 FEET TOH FORWARD CURVED CENTRIFUGAL 1/4 HP 120 VOLT, SINGLE PHASE 800 CFM AT 1/4" 5. P. BACKWARD INCLINED CENTRIFUGAL 1/4 HP 120 VOLT, SINGLE PHASE 800 CFM AT 1/8" S. P. C-1 CARLSBAD MUNICIPAL WA 7 '""R DISTRICT Sheet 2 Drwn _. LJ Checkeo'.· ENGINE£RINC O£PAR1 W'E:NT KNOTS LANE LIFT STATION Cl~L NOTE~" 28 Sheets t;;; Y~ 2, 176 B-20-tJB W/LUAM £. PLUMMER HCE Dote /?/ {,/.','/fr'A i/{)f,,j f->.f'lh',L S .J-.Sf -0'. CMWD 97-4 '2 DWG NO. .J; 7-58 PWM25-3626UTIL Exhibit "E" Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B -§l li -2 -C, ~ .... C, fil -~ COORDINATE DA TA POINT NORTHING EASTING DESCRIPTION (]) 7818.980 8961.761 CENTER Or ACCESS HOLE 0 7772.057 8979.033 10• SEilER AT INSIDE WALL Or WET ilELL 0 7774.014 8984.351 6" rORCE MAIN AT INSIDE WALL OF PUMP ROOM 0 7810.293 8970.997 6" rORCE MAIN CENTER OF 45· ELBOW 0 7829.980 8980.091 6" FORCE MAIN AT P. 0. C. (PROPERTY LINE) 0 7718.944 9002.867 MCC BUILDING FOOTING 0 7700.809 9009.567 MCC BUILDING FOOTING @ 7755.438 8978.756 LIFT STATION FOOTING 0 7765.110 9005.031 LIFT STATION FOOTING @ --·-7826.234 8981.469 POC 10• GRAVITY SEWER .. ,. . ··- (1 i) 7809.898 8937087 END 10" GRAVITY SEWER IJ.,;O(J • j j'jg • ::=:::,...;:::. ::. :::;:::s::::;:::s=-~--=-::;;c::.-S-{:~$.~=c,:;;~:::::'::::S::S~"'::::c-.,a;, N.::::NECT TO m1t1 I I i I \ \ / ..... ...-· \ \ \ \ <~ \ ' • ,.,_, (SEE SHEET L-2) • MIN. A. C. Pl/MT. 6" MIN. A.8. SCARIFY AND RECOMPACT 6" MIN. NATIVE SUBGRAD£ TO 95% '----------~RELATIVE COMPACTION TYPICAL PAVEMENT SECTION NOT TO SCALE N 2072'.30" W N .... NOL TE and ASSOCIATES 8"gileera / Plamera / &rveyora 5469 l!EAill,'{ VJLlJ. JID,,SIJm ~(,-~At-I P]li,'011, C#, W~l2:-l (!llA) 2't8-9!11l2 i:'N!;INC~i-? OF WOOi<'. c.-.RL P. SEPPONE:N l'i:.C.E.. 26~1 (E.XP, ·.j-~jt . .:·oor"·-· om DfSIGNED, CPS/l.J rJRAWN LJ DATE 10/01/99 I---··-JOEl N(): / ' \ \ \ APPROVED RECORD ORA WINGS ,/4/~ -r,,.(ififi;,« • .,. ..... ~ 28176_ Distnct tn9meer: 'LL M E. PLUMMER RCt RCGISTl?A TION FXPIRFS .f-.51-02. • \ \ \ '· \ \ \ GRAPHIC SCALE o' 5' 10· 15• 20· SCALE.· 1 •= 5' BACKFLOW PR. CMW OWG W-20 STA. 9+52.71 KNOTS LANE; /.£. 24.93 INSTALL REDWOOD 4"x 4"x B' POST (w/ 6" EXPOSED ABOl-f" TRE:NCH BACKFILL); CAP 10• SEM"R MAIN fy 2012'45• W GB6% 1 • 'A TER METER P Moo owe w-3 0--"-:--■■l---t--+~ ------+---· , t: DISTRICT APPROVED CHANGES BENCHMARK Description Apf)roved Date AGENCY: .......... NORTH COUNTY VERTICAL CONTROL DA TA t.<rl-----.== ... ----..===-~--------+-c;c-'';-'-;=i 7 RECOTlfJ Pli'NWll{t; /(}•/-DESIGNA llQN; .. 0. C. 014 -------------1-----t----1DESCRIPTION: .. STANDARD DISC SET FLUSH IN£. COR. ON N. ABUTMENT OF£. BR. -------+-----+----l ELEVATION: ...... 50.55B M. S.I. I \\ ~ ~ Ci 3' 1-l::'---- .' / i /l /: / ·' / .' I , ., I / / / / ( /.,. ! / I ' / , / ""' /. ! STA. 10+00 KNOTS LANE CONNECT TO 8" GRAVITY SEWER SEE DWG. No. 357-5, SHEET No. 12 (0✓) (IE 25.85) T .STA. 10+00 KNOTS L_ANE CONNECT TO 6" SEWER FORCE MAIN (IE 43.33) ' -------,---=r--~ ~ <c>i C) ~ I ~L----~~--~-~ VJ I C-2 CARLSBAD MUNICIPAL WATER DISTRICT Sheet 3A £NG/NEERING DEPARTMENT /Ji:-;tn"ct tngineer: KNOTS LANE LIFT STA TION Cll4l SI TE PLAN 28176 WILLIAM E. PLUMMER RC£ Date ,"'.'fO,':JF.'A T:ON EXPIRES 3-31---02. 28 Sheets I/-Y0~9'J -----------1----+-----l LOCATION: ........ APPROX. 300' S. OF S. ENTRY TO CARLSBAD {)rwn .. LJ CMWD 97-402 DWC NO. 357-5B Date t----+----------STA TE PARK 40' £. OF CL OF N. BOUND CARLSBAD BL .V ON PONTO BR. No. A7882 Checked: PWM25-3626UTIL Exhibit "E" Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B B C-4 - ~ i3 -c:, c:, -c:, ,._ ~ &J - :;,,: A C-4 ,---------------~ ' £6) ----t------1"-- (f]r' I i"-9 L. .. _ .. ,. - - - - -__J . ,,. FLOOR Pl.AN SCALE; f/2"=1 ' 0 ~ DRY Plr SUSMERSIBLE PUMP AND MOrOR, TYP. OF 2 0 6"x 4• 0.1.P. FLO PUMP SUC710N ECCENTRIC REDUCER, TYP. OF 2 Q) 6" FLO. PLUG VAL VE WITH HANDWHEEL OPERA TOR, TYP. OF 2 0 5• srYLE 31 V!CrAUL!C COUPLING, ryp, OF 2 @ 6" FLG. D.f.P. SPOOL © 0 ® @ @ @ @ @ @ @ @ 6" 0.1.P. WITH WALL COLLAR, FLO x PE 6" FLG. x FLARED D.I.P. SHORr RADIUS go· ELBOW, TYP. OF 2 3/4" THREADED TAP ANO PRESSURE GAUGE ASSEMBLY, SEE DETAIL@ 6" FLO. x GROOVED ENO O.f.P. SPOOL, TYP. OF 2 6" FLO. DJ.P. 90" BEND, TYP. OF 2 4• FLO. CHECK VAL 1£, SPRING LOADED, TYP. OF 2 PUMP FOUNDATION, SEE DETAIL@ WAU MOUNTED SINK AND FAUCET TYP. OF 4, 2" ABS UTILITY SINK DRAIN PIPE, ROUTE TD SUMP AT MIN. 2% SLOPE 2" SCHEDULE 80 PVC SUMP PUMP DISCHARGE PIPE fO"x 20• DOUBLE DEFLEC710N SUPPLY AIR REGISTER N~ NOL TE and ASSOCIATES Er9leere J Plamen / &rveyora 5-te~ IWRNY VDU BD.,sum; 3Qi), SAN D!roo, Cl. 92I~ (ll11l') 2'i'8-talt2 Er..GIN~:l.R Of WffiK: C.-.ML P. SE'PPONEN R.C.E.. 2~~1 (Ei<P. 3--31-005 om @- OE~GNE:D;- CPS/LJ ORA'M'l: LJ DATE: 08/19/98 --~ .. --,·--·'--------, JOB NG: I SD0410 p '-----I - r--··---~-"-· ------7 I I I I I ,,,..-;-.:'-r~~-:,,--,;::,,;-7,r--,----.-,rr:,,-"""T~-T-T _T_T ___________ 7 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I ,&-----j"---'~L---.1...---1_...1..._.u...~.:;....~c.....,._,.C.L°"""'~-~-~-~-~--I --------,i--------,ll__ ---------1 10"x 10" PUMP ROOM SUPPLY AIR DUCT PUMP ROOM EXHAUST AIR FAN w/ ROOF CURB UN/FLOW CLAMP-ON ULTRASONIC FLOWMETER J'x 5' PUMP REMOVAL HATCH. ALUMINUM CHECKER PLATE, SPRING ASSISTED, L ___________ _ HINGED COVER wm RECESSED LOCK/NO HASP, BILCO, OUR-RED. NYSTROM, OR EQUAL J '-6"x 7'-6" ACCESS HATCH, ALUMINUM CHECKER PLATE, SPRING ASSISTED, HINGED COVER wm RECESSED LOCKING HASP. 8/LCO, OUR-RED, NYSTROM, OR EQUAL PUMP ROOM SUPPLY AIR FAN w/ ROOF CURB 2• CHECK VAL ~ TYP. OF 2 PIPE WALL BRACKET, 6 • FL G. 0.1. P. SPOOL SUMP PUUP TYP. OF 2, SEE DETAIL@ w/ WALL COLLAR, TYP. OF 2 4" FLG. PLUG VAL VE WTH HANDWHEEL OPERA TOR, TYP OF 2 10"x 10" EXHAUST DUCT 4• FLO. D.I.P. 90• BENO, TYP. OF 4 4" STYLE J1 V!CTAULIC COUPLING, TYP. OF 2 6" 0.1.P. x P. V.C. TRANSITION COUPLING I I I I I I I I I I I I I I L_ 11 I I I I I I-- - - -----\IL_ --- ------1 I I 111 I II--- - - ----II L_ ---------1 11 111 I II--- - - - - --I I L _ -- -------1 11 111 I 11----------11L ____ ·--·· ·-· --· ----I 11 111 I I~ ----------\IL----------1 11 11 I I l f----------'LI I 11 I 11 I 11 I 11 I ,---------11 I I I I I f @ r -7 I I -----+--I I I I II 11 ROOF PLAN SCALE: 1/2•-t' 5• x 4• FLO. 0.1.P. RmUaNG TEE 6" x 4• FLO. 0.1.P. REDUCING ELBOW PIPE SUPPORT PER DETAIL@ L _________________ J 4• FLO x GROOVED END 0.1.P. SPOOL, TYP. OF 2 HOSE BIBB AND RACK PER DETAIL 9 r• COPPER PLANT WA lER LIN£, 1• Pi,t;' INTERIOR, EXPOSED ACC£SSHOLE FRAM£ AND COVER PER CMOO OHG. S-4 HANDRAIL (PER STRUCTURAL PLANS) 2• BALL VAL 1.£ C-3 CARLSBAD MUNICIPAL WATER DISTRICT APPROVED RECORD ORA WINGS .d~; £,_ ~•-.::.:1 28176 I/· .?'2-99 District Fnqineer_· 'Q. ifM £ PLUMMER RCE Dote REGIS TRA TION EXPIRES 3-31-02. DISTRICT APPROVED CHANCES BENCHMARK Description Appr oved Do/<1 AGENCY: .......... NORTH COUNTY VERTICAL CONTROL DA TA PRl//,/IIN't; f -30·9 OESIGNA 710N: .. O.C. 0147 1---+------------------+----1------1DESCRIP710N: .. STANDARD DISC SET Fl.USH IN£ COR. ON N. ABUTMENT OF E. BR. -~------+-----+-----lELEVA TION: ...... SO. 558 M.S.la LOCATION: ........ APPROX. 300' S. OF S. ENTRY TO CARLSBAD ------+-------+--___, STA TE PARK 40' E. OF Cl OF N. BOUND CARLSBAD SL VO ON PONTO BR. No. A78B2 Drwn.: LJ Cf/eck0d: £NG/NEERING DEPARTMENT KNOTS LANE LIFT STATION PIPING PLAN CMmJ 97-402 owe No. 357-58 28 Sheets l ! j PWM25-3626UTIL Exhibit "E" REPLACE PUMPS NO. 1 AND 2 AND ALL PIPING, SUPPORTS, FOUNDATIONS, AND APPURTENANCES LOCATED BETWEEN ISOLATION VALVES. Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B ~ c:, lei c:, ~ 11 11 11 11 NOTE: ALL PUMP PIPING, PUMPS ANO APPURTENANCES SHALL BE MOUNTED A T EO/JAL ELEVA TIONS. IF PUMP BASES ARE POURED SEPER A TEL Y FROM FLOOR, USE EPOXY BE7WEEN THE FLOOR ANO BASES, ALSO EPOXY REBAR INTO EXISTING FLOOR FOR VERTICAL REBAR. @-,----, I ' I ......, \ ' ' I I I I 0 0 10 HP ORY PIT SUBAIERSl8L£ MOTOf?, TYP. OF 2 6"x 4• 0.1.P. Fl.G PUMP SUC/lON ECCENTRIC REDUCER, TYP. OF 2 6" FLG. PLUG VAL VE WITH HANDWHEEL OPERA TOR, TYP. OF 2 , - - - - - - - - - - - - - - - - - - - - - - - - - - - --1, -71 El 51.7 0 0 6" STYLE 31 VICTAULIC COUPLING, TYP. OF 2 ' 3 II r -······ \ EL 43.00 / - - - ~ I I I ~ ,__--, I t------~ I ~ f-f \ ! WASH-DOWN TROUGH TO SUM. -12• -<j •3• MIN. FLOOR _2X p ,.___ 1 • SUMP ~ SECT10N NOT TO SCALE I I I I I (s)._ I -' ':,"\ . ' ~ ·v S£CT10N SCALE 1/2"-1' FLOAT START HIGH HIGH WA 7ER ALARM (FLOAT) LAG STA1!:( HIGH WA ALARM (BUBBLER) CORE ANO FILL w/ ORY-PACK GROUT ------------ L EL 49.!50 ~'------, ----,,---w· '-8·"'---Hl-1-2• TEE ~,.__ "' (OPEN O TOP "' ~r::,c:2·"' 2J:::_ ~t) EL~!._47.~.±._4 ~1=~~ ' 8 L rl 4-, -.I INSTALL PLASflC LINER ON WALLS ANO CEILING ABOVE ELEVA TION 22 0 1 '-----;l 7'-----, c_ @ @ 0 @ 0 @ @ @ @ ® @ @ © @ @ ® @ @ @ @ @ @ @ @ @ ® 0 @ © ® ® ® @ @ @ @ @ 42 6" FLG. 0.1.P. SPOOL, TYP. OF 3 6" 0.1.P. IIATH WALL COLLAR 6" FLC. x FLARED D.I.P. SH08T RADIUS 90" ELBOW, TYP. OF 2 3/4" THREADED TAP AND PRESSURE GAUGE, TYP. OF 4, SEE DETAIL@ 6" FLC. x GROOVED £NO D.I.P. SPOOL, TYP. OF 2 6" FLC. 0.1.P. 90" BENO, TYP. OF 2 4" FLG. CHECK VAL l£ SPRING LOADED, TYP. OF 2 PUMP FOUNDATION, SEE DETAIL @ WALL MOUNTED SINK AND FAUCET 2" ABS UTILITY SINK DRAIN PIPE, ROUTE TO SUMP AT MIN, 2:lf SLOPE 2" SCHEDULE 80 PVC SUMP PUMP DISCHARGE PIP£ tO"x 20" DOUBLE DEFLECTION SUPPLY AIR REGISTER ,o·x 10· PUMP ROOM SUPPLY AIR DUCT PUMP ROOM EXHAUST AIR FAN w/ ROOF CURB CLAMP-ON ULTRASONIC FLOWMETER J'x S' ACCESS HATCH, ALUMINUM CHECKER PLATE, SPRING ASSISTED, HINGED COVER WflJI RECESSED LOCKING HASP 3 '-6"x 7'-6" PUMP REMOVAL HATCH, ALUMINUM CHECKER PLATE, SPRING A9SIST£0, HINGED COVER W!TJ-1 RECESSED LOCKING HASP, BILCO, OUR-RED, NYSTROM, OR EOUAL PUMP ROOM SUPPLY AIR FAN w/ ROOF CURB 2" CHECK VAL 11£; TYP. OF 2 WALL BRACKET, TYP. OF 2, SE£ DETAIL @ 6" FLG. 0.1.P. SPOOL w/ WALL COLLAR, TYP. OF 2 SUMP PUMP 4" FLC. PLUG VAL VE IIAl'H HANDWHEEL OPERA TOR, TYP OF 2 1o·x 10· EXHAUST DUCT 4" FLG. 0.1.P. go· BENO, T'fP. OF 4 4" STYLE 31 VICTAULIC COUPLING, TYP. OF 2 6" SMITH BLAIR 441 (0.1.P. x P. V.C.) ll?ANSITION COUPLING, OR EQUAL 6" x 4• FLC. D.I.P. REDUCING TE£ 6" x 4• FLG. O.lP. REDUCING ELBOW PIPE SUPPORT PER DETAIL@ 4• FLG x GROOVED END SPOOL, TYP. OF 2 CHECK VAL l-f"" FLANGE SUPPORT PER DETAIL @ HOSE 8188 AND RACK PER DET.@ 1" PI-C PLANT WATER LIN£ ACCESSHOLE FRAME ANO COl-f""R PER CMWO Dlf/tJ. S-4, TYP. OF 2 HANDRAIL (PER STRUC7URAL PLANS) 2" BALL VAL l-f"" EL 24.90 ~ El 24. 70 -.......~f:======-=I ----+ + ---\ J I.E. 24.50 -,..... • ..., ,= ~ J r@ ,-... 'CO' LEAD START EL 24.50 LAC STOP El 22.70 LEAD STOP \ El 22.50 , ••• \\ LOW LEVEL ALARM ~ (BUBBLER) EL 22.30 FLOAT STOP LOW LOW LEVEL ALARM (FLOAT} El 22.10 EL 18.30 DESjGtilcrJ: N~ NOL TE and ASSOCIATES CPS/LJ DR,11,~: Ef9leera / Plamera / S.rveyors LJ M69 .KIW(Nl VIW. Kl:l.,:swn; :,:15, tlAN DlOOU, CA. ~3 (61V) ;?18-9302 DA.IT, ENGlr-lEER Of WORK, 08/19/98 J.'.l8 NO: (txF" . .J••3J .. oo~ --OAn' S00410 CAFIL P_ SCPPONEN fl.C.E. 2&:-!91 t APPROVED RECORD ORA WINGS ~.-, t ... ~-· ,_,_ 28176 Dis lricl Engineer: iWLLiAM E. PLUMMER RC£ RE:CISTRA noN EXPIRES .r-.n-02. /f-,10-99 ' Dale l@-.r--'-___._-, SECT10N 2% SLOPE TO DRAIN SCALE 1/2"=f' DISTRICT APPROVED CHANCES BENCHMARK Description Approved Dote AGENCY: .......... NORTH COUNTY 14':RTICAL CONTROL DATA l-7>-+-c~=~=~~~---------11---'~----=-I f-L.!.¥"'-"'"'-"'----"'"-"""-""'<.._---------ll-----f--'9'--·1,.,,_tJ'---9-'-'-lDESIGNATION: .. O.C. 0147 t--+-------------------,f------f----tDESCRIPTION: .. STANOARO DISC SET FLUSH IN E. COR. ON N. ABUTMENT OF E. BR. 1----1-----------------1f------f------fCL£VA'llON: ...... 50.55B M.S.I. -+-·-·-·--+------lLOCATION: ........ APPROX. 300' S. OF S. ENTRY TO CARLSBAD -,---------------+-----+----1 STA TE PARK 40' E. OF Cl OF N. BOUND CARLSBAD BLVD ON PONTO BR. No. A7BB2 ,r,, . _:,.:.-;, · ... e'fl'. ,.·'!;~r , ' . c.:,{_:·.\-~--~;_;./:~~·i-::.·.'''' CARLSBAD MUNICIPAL WA TER DISTRICT ENGINEERING DEPARTMENT KNOTS LANE LIFT STATION PIPING SECTIONS Rn;;s mA 770N EXPIRES .3-31-02 Drwn •• • LJ CMIW 97-402 Checked: DWC NO. 357-58 28 Sheets I ij • i i i', i PWM25-3626UTIL Exhibit "E" Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B - ~ (j --- ~ ---a -'I> Cl 51 :;,;: 1/4" NIPPLE f PIP£ ASHCROFT MODEL 1279AS GAUGE OR EQUAL 1/4" NPT NIPPLE ASHCROFT MODEL 101SB OIAPHRAM SEAL OR EQUAL 1/2" NIPPLE 1/2" x 1/4" CAST !11:--,--t..,.---BRONZE REDUCING TE£ L---1/2" NIPPLE 1/4" BUSHING FOR TEST GAUGE CONNECTION JAMESBURY MODEL 1100TT 1/2" BALL VALi-£" .--OR EQUAL ·• • • 1/2" NIPPLE-..i NOTE: 1) GAUGES f°OR SUCTION UNES SHALL BE SIZED FOR 2) 0-5 PSI GAUGES FOR DISCHARGE LINES SHALL B£ SIZED FOR 0-40 pl!ll PR£SSUR£ GAUC£ ASS£MBL Y 36" U-BOL T, 316 SST GRINNELL, FIG. 137 OR EQUAL .......--6" PIP£ _.....-1/4" NEOPRENE PAD WELD£D SST 316 WALL BRACKET ~ ff---GRINN£LL FIG. 199; BRACKET No. 4 OR EQUAL (SEE NOTES 1 &: 2) 3/4" DIA. X 6" SST 316 ANCHOR L!;;;;;;;;;;;:;0-t-----BOLT 4• £UB£DMENT IN CONC. (TYP. 2) NOTE: 1) PAINT BRACKET SAM£ AS PIP£ 2) BRACKET/ U-BOL T.· STEEL, HOT DIP GAL VAN/ZED J} ANCHOR BOLTS: WEDGE ANCHORS. (316 SST) I" X 10" TYPE 18-8 STAINLESS ~-STEEL STUDS W/NUTS (TYP OF 4} BORE 1 1 /4 • HOLES A MINIMUM LEI/FL BAS£ PLATE DRYPACK GROUT I" 'THICK MINIMUM (TYP) OF 6" INTO EX/SrlNG CONCRETE ---i-Jl--------6i...Ji'...._---, PAD AND ANCHOR STUDS W'TH EPOXY (SEE SPECS} ROUGHEN CONCRETE SURFACE l<l---li,,..._ 2-µ. r7£ PROVfDE EPOXY BETWEEN FLOOR, ____ AND PUMP FOUNDA TION BARS (f.JP.} 5/8" SELF -DRILLING CONCRETE v·----------~~-ANCHORS w/ 5/8" BOLTS. EXTEND TO I' CLEAR AT TOP SPACE AT 12" MAX SPACE PUMP FOUNOA TlON @ NOT TO SCALE 2"x 4" REDWOOD OR PRESSURE TREA TED HEADERBOARD EDGE OF PA VEAIENT SHOWN ON PLANS AC 2-BD GALV CHECK VAL VE FLANGE 1/4" FINISH GRADE PAVfNG 2"x 4" llt?OO STAKES I I 6' MAX . I PA VE:M£NT H£AOERBOARD NOT TO SCALE 1-LA YER OF EXTENSION JOINT AND F1LLER. WALL BRACKET SUPPORT (liJ NOTE: NOT TO SCALE 4" x 4" x 3/8" PIPE SADDLE ~1--2• Tl-iR£AD£D STZ. PIPE 1/4" STEEL PLATE MATERIAL UNLESS O'THERWISE NOTED. J/8" 6 X 6 X 1/4 PLATE CHECK VAL~ SUPPORT 1/2" x 6" 316 SST HIL Tl BOLTS (TYP OF 4) 8" x 8" x J/8" STL PLATE ROLIGHEN CONCRETE SURF.·~A'._'.'.C.~'£:::~=t==l~~==~1• NON-SHRINK GROUT (TYP} PIPE SUPPORT N~ =-e!;,~?~!~TES !:1469 KIAIUff \llll..i. m,:ium: ).)6. SAN DIIQQ, l;A, 9i::12:S (tilt) 2'8-fflt ENGINEER □F WORK: C,t,RL P, SEPPONEN Fl:.C.E", 111:.,91 (.:)(JI_ 3-:'!1-□□) OAtt DCSIONED: CPS/LJ DliAY,tl: LJ D.t"TE: 08/19/98 J08 ND: SD04/0p,, 4 X 4 X J/8 n'PE 316 SS ADHESII-£" ANCHOR, 4• LONG, WITH LEVEUNG NUT, NUT AND LOCKWASHER, TYP. 4 £ACH LEG NON-SHRINK GROUT, 1" APPROVED RECORD DRAWINGS ..M)~,,,.:,,. b ~-~::--.. ...,, ,... 28176 Distrid lngineer: W!lI'AM £. PLUMMER RCE REGISTRA nON EXPIRES 3-31-02, ,, ... »==t---PIPE SUPPORTS J' ON CENTER tt FOR EXTERIOR MOUNTING SE£ DET. ® FOR INTERIOR MOUNTING SEE DET. EB ---WATER SUPPLY TO HOSE 8188 PER CIWL OR MECHANICAL DRAWINGS EX XPOSED PIPE SHALL BE CEJLING OR WALL ' ' ' • 0 NOTES: 1/2" DIA. HOLE TYP. OF 4 0 3/8" DIA.x 3-1/2" LONG STAINLESS STE£L CONC. EXPANSION ANCHORS, HIL Tl KB II OR EQUAL, (TYP. OF 4) I. HOSE RACK SHALL BE OF ALL WELDED CONSTRUCTION. MATERIAL 8 GAGE STEEL PLATE, HOT DIP GAL VANIZm AFTER CONSTRUCTION 2. ALL FASTENERS AND MOUNTING HARDWARE SHALL BE 316 STAINLESS STEEL HOS£ BIBB AND RACK 3/8" OIA.x J-1/2" LONG STAINLESS STEEL CONC. EXPANSION ANCHORS, HIL Tl KB II OR EQUAL, (TYP. OF 4} NON-M£TALLIC ADJUSTABLE' PIPE CLAMP .,__ STAINLESS STEEL •z• FlTTING L=r-"T"'.;,---.::::-,....ri;:=.J UN/STRUT P-104SSS OR EQUAL Plit' CHANNEL FRAMING PIPE SUPPORT, LENG'TH TO SUIT SIZE AND NUMBER OF PIPES TO BE SUPPORTED STAINLESS STEEL PIPE CLAMP-~- UN/STRUT P-1100SS OR EQUAL STAINLESS STE£L FRAMING SUPPORT UN/STRUT P-IOOOSS OR EQUAL, LENGTl-i TO SUIT SIZE AND NUMBER OF PIPES TO BE SUPPORTED • • .. ~"f----.J/B"x J" 316 STAINLESS STEEL HIL Tl KB II, OR EQUAL . ' FLUSH MOUNT CHANNEL PIP£ SUPPORT FOR PIP£ SIZ£ 4" AND SMALLER (I) FLUSH MOUNT PVC CHANNEL PIPE SUPPORTED DISTRICT APPROvFD CHANGES BENCHMARK Approved Date AGENCY: .......... NORTH COLINTY VERTICAL CONTROL DA TA l--n.-t.-==-,-.,=:-:-;-;;~~~~-----t-~--t;9~-"'J.?"". "'19 DESIIJNA TION: .. 0. C. 0147 1---+---------------+-----+----· D£SCRIPTION.· .. STANDARD DISC SET FLUSH IN £ COR. ON N. ABUTMENT OF £ BR. >---+-----------------+-----+---i ELEVATION.-...... 50.558 M.S.I . //-.'?" -9fl LOCA r70N: ........ APPROX. JOO' S. OF S. ENTl?Y TO CARLSBAD Date STATE PARK 40' £. OF CL OF N. BOUND l---+----------------;------·-··-+-----1 CARLSBAD BL 1-D ON PONTO BR. No. A78B2 C-5 CARLSBAD MUNICIPAL WATER DISTRICT Sheet 6 ENGINEERING OEPAR"TMENT KNOTS LANE LIFT STA T!ON CIVIL DETAILS 28 Sheets AV'~-. (' '12. _ ™-, ..... .. 2B176 .z~za~1g Dfstrict Engineer,· WILLIAM £. PLUMMER RC£ Date REGISTTfATIO!V EXPlf?ES J-J7-0 _ Drwn.: LJ Checked: CMWD 97-402 owe NO . .J57-5B PWM25-3626UTIL Exhibit "F" Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 5 N-pump, Premium Efficiency Motor (IE3) 5 N-pump, Premium Efficiency Motor (IE3) 5.1 Product description Usage Denomination A submersible pump for efficient pumping of clean water, surface water, and wastewater containing solids or long-fibered material. The pump is designed for sustained high efficiency. For abrasive media, Hard-Iron 1M is required. Stainless steel N-impeller is available as an option. Table 22: Adaptive N-hydraulic Impeller material Non-explosion Explosion proof Pressure class Installation types proof version version Cast iron, gray 3102.900 3102.910 LT-Low head L,P,S, T,Z,X MT-Medium head SH -Super head - Hard-Iron TM 3102.920 3102.930 LT-Low head L, P, Sl_!J Z, X MT-Medium I head SH -Super head Stainless steel 3102.960 3102.970 LT-Low head L,P,S, T,Z,X MT-Medium head SH -Super head The pump can be used in the following installations: L Vertical semipermanent, wet well column pipe arrangement where the well is divided into a suction part and a discharge part. Pump end equipped with guide vanes. P Semipermanent, wet well arrangement with the pump installed on two guide bars. The connection to the discharge is automatic. S Portable semipermanent, wet well arrangement with hose coupling or flange for connection to the discharge pipeline. Flygt 3102 Technical Specification 23 PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 5 N-pump, Premium Efficiency Motor (IE3) Application limits Motor data Motor encapsulation Cables 24 T Vertical permanent, dry well arrangement with flange connection to the suction and discharge piping. Z Horizontal permanent, dry well arrangement with flange connection to the suction and discharge piping. X Optional installation, wet or dry well arrangement without predetermined mechanical connection and with drilled flanges. Dry well arrangement requires cooling system or de- rated motor. Feature Description Liquid temperature Maximum 40°C (104°F) Depth of immersion Maximum 20 m (65 ft) pH of the pumped liquid 5.5-14 Liquid density Maximum 1100 kg/m3 Feature Description Motor type Line started permanent magnet synchronous motor (LSPM) Frequency 60 Hz Power supply 3-phase Starting method • Direct on-line • Star-delta • Soft starter • Variable frequency drive (VFD) Number of starts for Maximum30 each hour Code compliance IEC 60034-1 Voltage variation • Continuously running: Maximum ±5% • Intermittent running: Maximum ±10% Voltage imbalance Maximum2% between phases Stator insulation class H (180°C, 356°F) Motor encapsulation is in accordance with IP68. Application Type Direct-on-line start Flygt SUBCAB® - a heavy duty 4 cores motor power cable with two twisted pair screened control cores. Conductor insulation rating of 90°C, which allows for increased current. Superior mechanical strength and high abrasion and tear resistant. Chemical resistant within pH 3-10 and ozone, oil, and flame resistant. Used up to 70°C water temperature. Cables< 10 mm2 with unscreened control cores. Flygt 3102 Technical Specification PWM25-3626UTIL Exhibit "F" (cont'd)Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 5 N-pump, Premium Efficiency Motor (IE3) Application Type YID start Flygt SUBCAB® - a heavy duty 7 cores motor power cable with two twisted pair screened control cores. Conductor insulation rating of 90°C, which allows for increased current. Superior mechanical strength and high abrasion and tear resistant. Chemical resistant within pH 3-10 and ozone, oil, and flame resistant. Used up to 70°C water temperature. Cables < 7G6 mm2 with unscreened control cores. Variable Frequency drive Screened Flygt SUBCAB® - a heavy duty 4 screened cores motor power cable with four twisted pair screened control cores. Conductor insulation rating of 90°C, which allows for increased current. Superior mechanical strength and high abrasion and tear resistant. Chemical resistant within pH 3-10 and ozone, oil, and flame resistant. Used up to 70°C water temperature. Monitoring equipment Thermal contacts opening temperature 125°C (257°F) Materials Table 23: Major parts, except mechanical seals Denomination Material ASTM EN Major castings Cast iron, gray 35B GJL-250 Pump housing, Cast iron, gray 35B GJL-250 alternative 1 Pump housing, Cast iron, gray ASTM A 48 NO 30B GJL-200 alternative 2 Impeller, alternative 1 Cast iron, gray 35B GJL-250 Impeller, alternative 2 Cast iron, Hard-Iron TM A532 IIIA GJN-HB555(XCR23) Impeller, alternative 3 Stainless steel, Duplex CD-4MCuN 10283:2010-1.4474 Insert ring, alternative Cast iron, gray 35B GJL-250 1 Insert ring, alternative Cast iron, Hard-Iron TM A532 IIIA GJN-HB555(XCR23) 2 Lifting handle Stainless steel AISI 316L 1.4404, 1.4432, ... Shaft Stainless steel AISI 431 1.4057 +QT800 Screws and nuts Stainless steel, A4 AISI 316L, 316, 316Ti 1.4401, 1.4404, ... O-rings, alternative 1 Nitrile rubber (NBR) 70° -- IRH O-rings, alternative 2 Fluorinated rubber (FPM) -- 70° IRH Oil, part no 901752 Medical white oil of -- paraffin type. Fulfills FDA 172.878 (a) Table 24: Mechanical seals Alternative Inner seal Outer seal 1 Corrosion resistant cemented Corrosion resistant cemented carbide (WCCR)/ Aluminum oxide carbide (WCCR)/ Aluminum oxide (Al2O3) (Al2O3) Flygt 3102 Technical Specification 25 PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 5 N-pump, Premium Efficiency Motor (IE3) Surface treatment Options Accessories Alternative Inner seal Outer seal 2 Corrosion resistant cemented Corrosion resistant cemented carbide (WCCR)/ Aluminum oxide carbide (WCCR)/ Corrosion (Al203) resistant cemented carbide (WCCR) 3 Corrosion resistant cemented Corrosion resistant cemented carbide (WCCR)/ Corrosion carbide (WCCR)/ Aluminum oxide resistant cemented carbide (Al203) (WCCR) 4 Corrosion resistant cemented Corrosion resistant cemented carbide (WCCR)/ Corrosion carbide (WCCR)/ Corrosion resistant cemented carbide resistant cemented carbide (WCCR) (WCCR) Priming Finish Painted with a primer, see internal standard Navy gray color NCS 5804-B0?G. Two-component M0?00.00.0002 high-solid top coating, see internal standard M0?00.00.0004 for standard painting and M0?00.00.0008 for special painting. • Leakage sensor in the stator housing (FLS) • Leakage sensor in the oil housing (CLS) • Surface treatment (Epoxy) • Zinc anodes • Other cables Discharge connections, adapters, hose connections, and other mechanical accessories Electrical accessories such as pump controller, control panels, starters, monitoring relays, cables 5.2 Motor rating and performance curves 26 These are examples of motor rating and curves. For more information, please contact your local sales and service representative. Star-delta starting current is 1/3 of Direct on-line starting current. Flygt 3102 Technical Specification PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 5 N-pump, Premium Efficiency Motor (IE3) MT 6 5 3 2 P{hp] / [kW] 319 GPM at41 Feet TOH with 462 impeller 60 355 GPM at 44 Feet TOH (Existing per OWG 357-5B) 50 40 20 6+---+----+--+-+----"-...-""~-~-+---------1 4 ----+-----,,---+-+----+----+' ........... ______ -------< 10 463 2 +---+--+-++--+-+-----l----3iii.,..-3111.-3'-----I 0 0+---+---+-+---+---+-----1,--+---------l 0 100 200 300 400 500 600 700 800 900 Q [l/s] / [usgpm] WS005220A Table 26: 460 V, 60 Hz, 3-phase Rated Rated Curve/ Revolutions power, kW power, hp Impeller No per minute, rpm 4.1 5.5 462 1800 4.1 5.5 462 1800 4.1 5.5 463 1800 4.1 5.5 463 1800 4.1 5.5 464 1800 4.1 5.5 464 1800 4.1 5.5 465 1800 4.1 5.5 465 1800 Rated Starting Power current, A current, A factor, cos cp 6.2 41 0.9 6.2 41 0.9 6.2 41 0.9 6.2 41 0.9 6.2 41 0.9 6.2 41 0.9 6.2 41 0.9 6.2 41 0.9 Installation P,S,X P,S,T,X,Z P,S,X P,S,T,X,Z P,S,X P,S,T,X,Z P,S,X P,S,T,X,Z 28 Flygt 3102 Technical Specification PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B xylem NT 3102 MT 3~ Adaptive 463 Technical specification ft] Head V 4 2-'\ fr: \ 8-\ v_ ~ 4 ~ ' ' V "' 4 "' "' --' 8 71.9°!\. '- 4 ~ ~ --\ ~ v_ V 4 2 1l 6 4 2 0 0 100 200 300 400 500 600 Water, pure Installation: T-Vertical Permanent, Dry Project I Project ID ~ I~ ~ \ I~ 700 800 '-463 172mm ~63 72iiim [US g.p.m.] Curve/SO Note: Picture rright not correspond to the current configuration. General Patented self cleaning semi-open channel impeller, ideal for pumping in waste water applications. Possible to be upgraded with Guide-pin® for even better clogging resistance. Modular based design with high adaptation grade. Impeller Impeller mate rial Discharge Flange Diameter Suction Flange Diameter Impeller diameter Number of blades Motor Motor# Stator variant Frequency Rated voltage Number of poles Phases Rated power Rated current Starting current Rated speed Power factor 1/1 Load 3/4 Load 1/2 Load Motor efficiency 1/1 Load 3/4 Load 1/2 Load Configuration H ard-1 ran TM 3 15/16 inch 3 15/16 inch 172 mm 2 N3102.930 18-11-4AS-D IE3 5.5hp FM 71 60 Hz 208 V 4 3- 5.5 hp 15 A 104 A 1800 rpm 0.85 0.78 0.63 91.7 % 90.8 % 88.3 % I Created by Created on 3/7/2018 I Last update PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B xylem NT 3102 MT 3~ Adaptive 463 Performance curve Pump Motor Discharge Flange Diameter 3 15/16 inch Motor# Suction Flange Diameter 100 mm Impeller diameter 6¾" Number of blades 2 [ft] 52 48 44 40 36 32 28 24 20 16 12 _Hearl -'~ - "I"---,_ 8 4 0 Purrp B"fici~ncy -· -~ ----- ~--- [%] 40 20 ~- ~ V 0 -/ Power input P1 Stator variant Frequency Rated voltage Number of poles Phases Rated power Rated current Starting current Rated speed ~ ~ I I I 7t1-:-9°o I I [hp] 4.0 3.0 2.0 -Snat! pow ~r P2 -~ - Project ==r=-- [ft] 20 16 12 8 NPSH-valuJs 0 100 Water.pure ------- 200 I Project ID 300 400 N3102.930 18-11-4AS-D IE3 5.5hp 71 60 Hz 208 V 4 3- 5.5 hp 15A 104 A 1800 rpm ------ --------------- I I ------------ -........ ~ I~ =-+----- "' Power factor 1 /1 Load 0.85 3/4 Load 0.78 1/2 Load 0.63 Motor efficiency 1/1 Load 91.7 % 3/4 Load 1/2 Load "-........ 90.8 % 88.3 % "'-463 r 72nm '63 ~+2rrm- ~ I I I - 500 600 I Created by ~89 ~ 1i!fffl9 ~ss1wi!~ I I -I -~i ll I I ,x3 172nm P1 21=~3-1-,jfmf-~ - 463 172nm P2 ....-463 fl 72nrn ,/ _,,,,,,,-463 ff 72nrn ~ ----- 700 800 I Created on 3/7/2018 [USg.p.m] Curve/SO I Last update PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B xylem NT 3102 MT 3~ Adaptive 463 Duty Analysis [f 5 t] Head 7 5 6 5 5 54 5 3, \ 5 2- 5 1~ \ 0~ \ 5 4 4 4 4 4 44 4 4 4 4 9-' \ 8~ \, 7 6' 5' 3 2 1' 3 0( 9 3 8' 3 7 3 6 3 34 3 5 3, 3 2 3 1' 3 o' 2 9 2 8 2 7, 2 2 2 6( 5, 4 2 3 2 2 2 1 2 o, 1 1 1 9( 8, 7 1 6 1 5 1 4 1 3, 1 2, 1 1 1 o' :; 8 7 6 5, 4, 3 2 1 -~ 0 '-... 100 '-... '-... ......... ......... I"-... ......... " " ......... '\. " 200 300 " " " " b 7r ~9% '\. " i\. ......... ......... ......... '\. ......... '-... ......... '-... '-... ......... '-... '-... '-... '-... \ '-... '-... '\.-.63 -n.rrm- 400 500 600 700 800 [USg.p.m.] Water, pure Curve/SO Curve issue 6 Project I Project ID ------- I Created by I Created on 3/7/2018 I Last update PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B xylem NT 3102 MT 3~ Adaptive 463 VFD Curve Head -"~ -" ~ ~ ~ ' ' '- ' ~ ~ ~ ~ ~ " ."' ~ ~ "-I L9!'"--" ~ ' ~[l .......,_ "--"--I'--.. ~ ~ '-~-~ ~ '--- ~ ~ r·1.:no ' ~ '---rt ~ ~ " ~ ~ [ft] 52 48 44 40 36 32 28 24 20 16 12 ------ f I ~ .::l"/o ...____ ~ I'---.. '~ ~ ~ Project 8 4 0 R.nro B'fici~ncv Overall Effi~iency ...,.-:;:::::: ·~ ,u ~ ~ [%] 60 50 40 30 20 10 ~1::::..---- /2 ~L ~ --., ff' [hpj r 5.0 4.0 3.0 2.0 1.0 0.0 [ft] Power inpuf P1 --Shaf-l-1)0W·er-P2 20 16 12 8 4 -t:::::::==-------- NPSH-valuJs ------ ~ r-----..... I -~ ~~ ----- 0 100 200 300 400 ------ I Project ID '---...._ " "'-" ~ ~ ~ "" ~ ~ ~ '---...._.~ ~. N50 Hz 5 '-463 ~ 72rrrn 5 Hz 463 fl 72rrrn "'-40 Hz "Tv '"- ~ ::::::-:::--------~ ~~ ,~1 ~ ...........,__ ~ ' ~~ "' -~A~~ "----~ ~ -~ CV •~ v~ ~ ~ ·-"<f!lsi -v~Rlfl-t!ls--,2Am- I I -.C3 172 rrrn-t!P1ll ~~§1liAm--~-- 463 172rrrn P2 ~ Hz vv MZ 1,:: LI~ -·- 40 Hz ...A63 tt 72rrrn ,/,? B'Hz 463 fl 72rrrn ·-.....--::: ~ __.,--Jl{t ~ ..,,.,..,--~~ - 500 600 700 800 [USg.p.m] I Created by I Created on 3/7/2018 Curve/SO I Last update PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B xylem NT 3102 MT 3~ Adaptive 463 VFD Analysis -·Heau -'\'\ -'\ -\ \. ~ '\ "" ~ ' " \ ~ I\. '\. "" ~ "" ~ "" "" "" "" ~ "" "" [ft] 56 54 52 50 48 46 44 42 40 38 36 34 32 30 28 26 24 22 20 18 16 14 12 10 "" "" ',~ 7i1_go~ 8 6 4 2 0 .'""' ~ ~ "- "-"' ~ --...._ "i"--. ~ "' ~ "- """ ~ -~ 71.~ ~ "' "-~· no P.. """ "" "'n "'- f I .v ,o ......_ "'-"n "" .v,o ~ "- "' ~ ~ ~ ~ ~ '\. "" "" "-~ "" ~ '""' "-"' I"" "" "'\. '""' "" '\ '\ ~ ~ "" '""' ~ ~ "'\. "-453 fl 72rrrn ~ ""' i"-so1-1z ~.J OL "'4o Hz ~_, nL 0 100 200 300 400 500 600 700 800 [USg.p.m] Project I Project ID ----- I Created by I Created on 3/7/2018 Curve/SO I Last update PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B xylem NT 3102 MT 3~ Adaptive 463 Dimensional drawing Project I Project ID ------ I Created by I Created on 3/7/2018 I Last update PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 6 Dimensions and Weight 6 Dimensions and Weight 6.1 Drawings These drawings are included as examples. All drawings are available as Acrobat documents (.pdf) and AutoCad drawings (.dwg). Contact a local sales and service representative for more information. DNlOD 467 ~ CX,NX 3102 MT 30 33 182 " m LO M12 (4x) Weight (kg) Pump 112 --~-... -,, .. ---1 1:8 180724 111100 ---li;a;;;-------17395323 3 Flygt 3102 Technical Specification PWM25-3626UTIL Exhibit "F" (cont'd) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 18j M12(4x) ~ CX,NX 3102 MT Flygt 3102 Technical Specification 6 Dimensions and Weight Weight (lbs) Pump 250 --lii!:=-----,H=-" --I 1: 8 180724 ........................ lci;::;---C-'-----t7.395.32.3 .3 31 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 11/19/2024 Edgewood Partners Ins. Center (EPIC)[Fresno Branch - Branch ID 15283] DIV# 4515250 N. Palm Avenue, Suite 220Fresno CA 93704 Certificate Department 925-244-7700 925-901-0671 EPICcerts@epicbrokers.com Zurich American Insurance Company 16535 Travelers Property Casualty Co of Amer 25674HPS Mechanical, Inc.3100 E. Belle TerraceBakersfield, CA 93307 Berkley Assurance Company 39462 2035279716 A X 2,000,000 X 1,000,000 X Contractual Liab 10,000 2,000,000 4,000,000 X GLO038114409 7/1/2024 7/1/2025 4,000,000 A 2,000,000 X BAP038114509 7/1/2024 7/1/2025 B X X 5,000,000CUP1S80861724NF7/1/2024 7/1/2025 5,000,000 X 0 A X N WC038114309 7/1/2024 7/1/2025 1,000,000 1,000,000 1,000,000 C Pollution Liability PCAB50252530724 7/1/2024 7/1/2025 Each OccurrenceAggregateDed $5,000,000$10,000,000$25,000 When required by written contract or agreement as respects the General Liability additional insuredapplies per form UGL2162-ACW 02/19. Primary wording and Waiver of Subrogation are included per formUGL1345CCW 03/20. When required by written contract or agreement as respects to Auto Liability,additional insured, primary wording and waiver of subrogation applies per form UCA424HCW 10/21. Whenrequired by written contract or agreement as respects to Workers Compensation, blanket waiver ofsubrogation applies per form WC040306 04/84 RE: All Projects /ADDITIONAK INSURED: The City of Carlsbad City of Carlsbad/CMWDc/o EXIGIS Insurance Compliance ServicesP.O. Box 947Murrieta CA 92564 f------□ f------□ f------ f------ Fl □ □ f------ f------~ ' f------ f------f------ f------H l I I I I □ 3ROLF\1R(II'DWHRI3RO([S'DWHRI3RO(II'DWHRI(QG3URGXFHU 1R$GG¶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® ZURICH (-09 4 Additional Insured -Automatic -Owners, Lessees Or Contractors ZURICH II) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. I Effective Date: This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured under a written contract or written agreement executed by you, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" and subject to the following: 1. If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a. The Insurance Services Office (ISO) ISO CG 20 10 (10/01 edition); or b. The ISO CG 20 37 (10/01 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" arises out of: (1) Your ongoing operations, with respect to Paragraph 1.a. above; or (2) "Your work", with respect to Paragraph 1.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 1., insurance afforded to such additional insured: (a) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (b) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 2. If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a. The Insurance Services Office (ISO) ISO CG 20 10 (07/04 edition); or b. The ISO CG 20 37 (07/04 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-2162-A CW (02/19) Page 1 of 4 in the performance of: (a) Your ongoing operations, with respect to Paragraph 2.a. above; or (b) "Your work" and included in the "products-completed operations hazard", with respect to Paragraph 2.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 2., insurance afforded to such additional insured: (i) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (ii) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 3. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a. Under the ISO CG 20 10 (04/13 edition, any subsequent edition or if no edition date is specified); or b. With respect to ongoing operations (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, in the performance of your ongoing operations, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 3., insurance afforded to such additional insured: (a) Only applies to the extent permitted by law; (b) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and (c) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement. 4. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a. Under the ISO CG 20 37 (04/13 edition, any subsequent edition or if no edition date is specified); or b. With respect to the "products-completed operations hazard" (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury" or "property damage" is caused, in whole or in part by "your work" and included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 4., insurance afforded to such additional insured: (1) Only applies to the extent permitted by law; (2) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; (3) Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to your execution of the written contract or written agreement; and Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-2162-A CW (02/19) Page 2 of 4 (4) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. B. Solely with respect to the insurance afforded to any additional insured referenced in Section A. of this endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C. Solely with respect to the coverage provided by this endorsement, the following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV -Commercial General Liability Conditions: The additional insured must see to it that: (1) We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; (2) We receive written notice of a claim or "suit" as soon as practicable; and (3) A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. Solely with respect to the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV -Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition under Section IV - Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. E. This endorsement does not apply to an additional insured which has been added to this Coverage Part by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-2162-A CW (02/19) Page 3 of4 F. Solely with respect to the insurance afforded to an additional insured under Paragraph A.3. or Paragraph A.4. of this endorsement, the following is added to Section Ill -Limits Of Insurance: Additional Insured -Automatic -Owners, Lessees Or Contractors Limit The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Section A. of this endorsement; 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. All other terms, conditions, provisions and exclusions of this policy remain the same. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-2162-A CW (02/19) Page 4 of 4 (-09 4 General Liability Supplemental Coverage Endorsement 0 ZURICH., THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. I Effective Date: This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following changes apply to this Coverage Part. However, endorsements attached to this Coverage Part will supersede any provisions to the contrary in this General Liability Supplemental Coverage Endorsement. A. Broadened Named Insured 1. The following is added to Section II -Who ls An Insured: Any organization of yours, other than a partnership or joint venture, which is not shown in the Declarations, and over which you maintain an ownership interest of more than 50% of such organization as of the effective date of this Coverage Part, will qualify as a Named Insured. However, such organization will not qualify as a Named Insured under this provision if it: a. Is newly acquired or formed during the policy period; b. Is also an insured under another policy, other than a policy written to apply specifically in excess of this Coverage Part; or c. Would be an insured under another policy but for its termination or the exhaustion of its limits of insurance. Each such organization remains qualified as a Named Insured only while you maintain an ownership interest of more than 50% in the organization during the policy period. 2. The last paragraph of Section 11-Who Is An Insured does not apply to this provision to the extent that such paragraph would conflict with this provision. B. Newly Acquired or Formed Organizations as Named Insureds 1. Paragraph 3. of Section II -Who Is An Insured is replaced by the following 3. Any organization you newly acquire or form during the policy period, other than a partnership or joint venture, and over which you maintain an ownership interest of more than 50% of such organization, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury'' arising out of an offense committed before you acquired or formed the organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03120) Page 1 of 12 An additional premium will apply in accordance with our rules and rates in effect on the date you acquired or formed the organization. 2. The last paragraph of Section II -Who Is An Insured does not apply to this provision to the extent that such paragraph would conflict with this provision. C. Insured Status -Employees Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced by the following: 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1 )(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1 )(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However: Paragraphs (1 )(a) and (1 )(d) do not apply to your "employees" or '.'volunteer workers", who are not employed by you or volunteering for you as health care professionals, for "bodily injury" arising out of "Good Samaritan Acts" while the "employee" or "volunteer worker" is performing duties related to the conduct of your business. "Good Samaritan Acts" mean any assistance of a medical nature rendered or provided in an emergency situation for which no remuneration is demanded or received. Paragraphs (1 )(a), (b) and (c) do not apply to any "employee" designated as a supervisor or higher in rank, with respect to "bodily injury" to co-"employees". As used in this provision, "employees" designated as a supervisor or higher in rank means only "employees" who are authorized by you to exercise direct or indirect supervision or control over "employees" or "volunteer workers" and the manner in which work is performed. D. Additional Insureds -Lessees of Premises 1. Section II -Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) who leases or rents a part of the premises you own or manage who you are required to add as an additional insured on this policy under a written contract or written agreement, but only with respect to liability arising out of your ownership, maintenance or repair of that part of the premises which is not reserved for the exclusive use or occupancy of such person or organization or any other tenant or lessee. This provision does not apply after the person or organization ceases to lease or rent premises from you. However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. 2. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section Ill -Limits Of Insurance: Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 2 of 12 The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement referenced in Subparagraph D.1. above (of this endorsement); or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph D. shall not increase the applicable Limits of Insurance shown in the Declarations. E. Additional Insured -Vendors 1. The following change applies if this Coverage Part provides insurance to you for "bodily injury" and "property damage" included in the "products-completed operations hazard": Section II -Who Is An Insured is amended to include as an additional insured any person or organization (referred to throughout this Paragraph E. as vendor) who you have agreed in a written contract or written agreement, prior to loss, to name as an additional insured, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business: However, the insurance afforded to such vendor: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such vendor. 2. With respect to the insurance afforded to these vendors, the following additional exclusions apply: a. The insurance afforded the vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing , or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (8) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (a) The exceptions contained in Subparagraphs (4) or (6); or (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. b. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 3 of 12 c. This insurance does not apply to any of "your products" for which coverage is excluded under this Coverage Part. 3. With respect to the insurance afforded to the vendor under this endorsement, the following is added to Section Ill - Limits Of Insurance: The most we will pay on behalf of the vendor is the amount of insurance: a. Required by the written contract or written agreement referenced in Subparagraph E.1. above (of this endorsement); or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph E. shall not increase the applicable Limits of Insurance shown in the Declarations. F. Additional Insured -Managers, Lessors or Governmental Entity 1. Section II -Who Is An Insured is amended to include as an insured any person or organization who is a manager, lessor or governmental entity who you are required to add as an additional insured on this policy under a written contract, written agreement or permit, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omission of .those acting on your behalf; and resulting directly from: a. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit; b. Ownership, maintenance, occupancy or use of premises by you; or c. Maintenance, operation or use by you of equipment leased to you by such person or organization. However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. 2. This provision does not apply: a. Unless the written contract or written agreement has been executed, or the permit has been issued, prior to the "bodily injury", "property damage" or offense that caused "personal and advertising injury"; b. To any person or organization included as an insured under Paragraph 3. of Section II -Who Is An Insured; c. To any lessor of equipment if the "occurrence" or offense takes place after the equipment lease expires; d. To any: (1) Owners or other interests from whom land has been leased by you; or (2) Managers or lessors of premises, if: (a) The "occurrence" or offense takes place after the expiration of the lease or you cease to be a tenant in that premises; (b) The "bodily injury", "property damage" or "personal and advertising injury" arises out of the structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor; or (c) The premises are excluded under this Coverage Part. 3. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section Ill -Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 4 of 12 a. Required by the written contract or written agreement referenced in Subparagraph F.1. above (of this endorsement); or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph F. shall not increase the applicable Limits of Insurance shown in the Declarations. G. Damage to Premises Rented or Occupied by You 1. The last paragraph under Paragraph 2. Exclusions of Section I -Coverage A -Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Damage To Premises Rented To You Limit of Insurance applies to this coverage as described in Section Ill -Limits Of Insurance. 2. Paragraph 6. of Section Ill -Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or in the case of damage by one or more "specific perils" to any one premises, while rented to you or temporarily occupied by you with permission of the owner. H. Broadened Contractual Liability The "insured contract" definition under the Definitions Section is replaced by the following: "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury", "property damage", or "personal and advertising injury" arising out of the offenses of false arrest, detention or imprisonment, to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. I. Definition -Specific Perils The following definition is added to the Definitions Section: "Specific perils" means: Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 5 of 12 a. Fire; b. Lightning; c. Explosion; d. Windstorm or hail; e. Smoke; f. Aircraft or vehicles; g. Vandalism; h. Weight of snow, ice or sleet; i. Leakage from fire extinguishing equipment, including sprinklers; or j. Accidental discharge or leakage of water or steam from any part of a system or appliance containing water or steam. J. Limited Contractual Liability Coverage -Personal and Advertising Injury 1. Exclusion e. of Section I -Coverage B -Personal And Advertising Injury Liability is replaced by the following: 2. Exclusions This insurance does not apply to: e. Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for "personal and advertising injury" if: (a) The "personal and advertising injury" arises out of the offenses of false arrest, detention or imprisonment; (b) The liability pertains to your business and is assumed in a written contract or written agreement in which you assume the tort liability of another. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement; and (c) The "personal and advertising injury" occurs subsequent to the execution of the written contract or written agreement. Solely for purposes of liability so assumed in such written contract or written agreement, reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "personal and advertising injury" described in Paragraph (a) above, provided: (i) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same written contract or written agreement; and (ii) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 2. Paragraph 2.d. of Section I -Supplementary Payments -Coverages A and B is replaced by the following: d. The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; 3. The following is added to the paragraph directly following Paragraph 2.f. of Section I -Supplementary Payments -Coverages A and B: Notwithstanding the provisions of Paragraph 2.e.(2) of Section I -Coverage B -Personal And Advertising Injury Liability, such payments will not be deemed to be damages for "personal and advertising injury" and will not reduce the limits of insurance. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 6 of 12 K. Supplementary Payments The following changes apply to Supplementary Payments -Coverages A and B: Paragraphs 1.b. and 1.d. are replaced by the following: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. L. Broadened Property Damage 1. Property Damage to Contents of Premises Rented Short-Term The paragraph directly following Paragraph (6) in Exclusion j. of Section I -Coverage A -Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1 ), (3) and (4) of this exclusion do not apply to "property damage" to premises (other than damage by "specific perils"), including "property damage" to the contents of such premises, rented to you under a rental agreement for a period of 14 or fewer consecutive days. A separate Limit of Insurance applies to Damage to Premises Rented to You as described in Section Ill -Limits Of Insurance. 2. Elevator Property Damage a. The following is added to Exclusion j. of Section I -Coverage A -Bodily Injury And Property Damage Liability: Paragraphs (3) and (4) of this exclusion do not apply to "property damage" arising out of the use of an elevator at premises you own, rent or occupy. b. The following is added to Section Ill -Limits Of Insurance: Subject to Paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to property loaned to you or personal property in the care, custody or control of the insured arising out of the use of an elevator at premises you own, rent or occupy is $25,000 per "occurrence". 3. Property Damage to Borrowed Equipment a. The following is added to Exclusion j. of Section I -Coverage A -Bodily Injury And Property Damage Liability: Paragraph (4) of this exclusion does not apply to "property damage" to equipment you borrow from others at a jobsite. b. The following is added to Section Ill -Limits Of Insurance: Subject to Paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to equipment you borrow from others is $25,000 per "occurrence". M. Expected or Intended Injury or Damage Exclusion a. of Section I -Coverage A -Bodily Injury And Property Damage Liability is replaced by the following: a. Expected Or Intended Injury Or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. N. Definitions -Bodily Injury The "bodily injury" definition under the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death sustained by that person which results from that bodily injury, sickness or disease. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 7 of 12 0. Insured Status -Amateur Athletic Participants Section II -Who Is An Insured is amended to include as an insured any person you sponsor while participating in amateur athletic activities. However, no such person is an insured for: a. "Bodily injury" to: (1) Your "employee", "volunteer worker" or any person you sponsor while participating in such amateur athletic activities; or (2) You, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company) while participating in such amateur athletic activities; or b. "Property damage" to property owned by, occupied or used by, rented to, in the care, custody or control of, or over which the physical control is being exercised for any purpose by: (1) Your "employee", "volunteer worker" or any person you sponsor; or (2) You, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). P. Non-Owned Aircraft, Auto and Watercraft Exclusion g. of Section I -Coverage A -Bodily Injury And Property Damage Liability is replaced by the following: g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons for a charge; (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; (5) An aircraft that is hired or chartered by you or loaned to you, with a paid and licensed crew, and is not owned in whole or in part by an insured; or (6) "Bodily injury" or "property damage" arising out of: (a) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (b) The operation of any of the machinery or equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment". Q. Definitions -Leased Worker, Temporary Worker and Labor Leasing Firm 1. The "leased worker'' and "temporary worker'' definitions under the Definitions Section are replaced by the following: "Leased worker'' means a person leased to you by a "labor leasing firm" under a written agreement between you and the "labor leasing firm", to perform duties related to the conduct of your business. "Leased worker'' does not include a "temporary worker''. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW(03/20) Page 8 of 12 "Temporary worker" means a person who is furnished to you to support or supplement your work force during "employee" absences, temporary skill shortages, upturns or downturns in business or to meet seasonal or short- term workload conditions. 'Temporary worker" does not include a "leased worker". 2. The following definition is added to the Definitions Section: "Labor leasing firm" means any person or organization who hires out workers to others, including any: a. Employment agency, contractor or services; b. Professional employer organization; or c. Temporary help service. R. Definition -Mobile Equipment Paragraph f. of the "mobile equipment" definition under the Definitions Section is replaced by the following: f. Vehicles not described in Paragraph a., b., c. or d. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the following types of permanently attached equipment, exceeding a combined gross vehicle weight of 1000 pounds, are not "mobile equipment" but will be considered "autos": (1) Equipment designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; (2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. S. Definitions -Your Product and Your Work The "your product" and "your work" definitions under the Definitions Section are replaced by the following: "Your product": a. Means: (1) Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a) You; (b) Others trading under your name; or {c) A person or organization whose business or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance, use, handling, maintenance, operation or safety of "your product"; and (2) The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. "Your work": a. Means: (1) Work, services or operations performed by you or on your behalf; and Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 9 of 12 (2) Materials, parts or equipment furnished in connection with such work, services or operations. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance, use, handling, maintenance, operation or safety of "your work"; and (2) The providing of or failure to provide warnings or instructions. T. Duties in the Event of Occurrence, Offense, Claim or Suit Condition The following paragraphs are added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV -Commercial General Liability Conditions: Notice of an "occurrence" or of an offense which may result in a claim under this insurance or notice of a claim or "suit" shall be given to us as soon as practicable after knowledge of the "occurrence", offense, claim or "suit" has been reported to any insured listed under Paragraph 1. of Section II -Who Is An Insured or an "employee" authorized by you to give or receive such notice. Knowledge by other "employees" of an "occurrence", offense, claim or "suit" does not imply that you also have such knowledge. In the event that an insured reports an "occurrence" to the workers compensation carrier of the Named Insured and this "occurrence" later develops into a General Liability claim, covered by this Coverage Part, the insured's failure to report such "occurrence" to us at the time of the "occurrence" shall not be deemed to be a violation of this Condition. You must, however, give us notice as soon as practicable after being made aware that the particular claim is a General Liability rather than a Workers Compensation claim. U. Other Insurance Condition Paragraphs 4.a. and 4.b.(1) of the Other Insurance Condition of Section IV -Commercial General Liability Conditions are replaced by the following: 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: I a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. However, this insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. Other insurance includes any type of self insurance or other mechanism by which an insured arranges for funding of its legal liabilities. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is property insurance, Builder's Risk, Installation Risk or similar coverage for "your work"; (ii) That is property insurance purchased by you (including any deductible or self insurance portion thereof) to cover premises rented to you or temporarily occupied by you with permission of the owner; (iii) That is insurance purchased by you (including any deductible or self insurance portion thereof) to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 10 of 12 (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I -Coverage A-Bodily Injury And Property Damage Liability; or (v) That is property insurance (including any deductible or self insurance portion thereof) purchased by you to cover damage to: Equipment you borrow from others; or Property loaned to you or personal property in the care, custody or control of the insured arising out of the use of an elevator at premises you own, rent or occupy. (b) Any other primary insurance (including any deductible or self insurance portion thereof) available to the insured covering liability for damages arising out of the premises, operations, products, work or services for which the insured has been granted additional insured status either by policy provision or attachment of any endorsement. Other primary insurance includes any type of self insurance or other mechanism by which an insured arranges for funding of its legal liabilities. (c) Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. V. Unintentional Failure to Disclose All Hazards Paragraph 6. Representations of Section IV -Commercial General Liability Conditions is replaced by the following: 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. Coverage will continue to apply if you unintentionally: a. Fail to disclose all hazards existing at the inception of this policy; or b. Make an error, omission or improper description of premises or other statement of information stated in this policy. You must notify us as soon as possible after the discovery of any hazards or any other information that was not rovided to us rior to ince tion of this Coverage Part. W. Waiver of Right of Subrogation Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Commercial General Liability Conditions is replaced by the following: 8. Transfer Of Rights Of Recovery Against Others To Us a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. If the insured waives its right to recover payments for injury or damage from another person or organization in a written contract executed prior to a loss, we waive any right of recovery we may have against such person or organization because of any payment we have made under this Coverage Part. The written contract will be considered executed when the insured's performance begins, or when it is signed, whichever happens first. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. X. Liberalization Condition Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 11 of 12 The following condition is added to Section IV -Commercial General Liability Conditions: Liberalization Clause If we revise this Coverage Part to broaden coverage without an additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in the state shown in the mailing address of your policy. All other terms, conditions, provisions and exclusions of this policy remain the same. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1345-C CW (03/20) Page 12 of 12 Blanket Notification to Others of Cancellation or Non-Renewal U-CA-832-A CW (01/13) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A.If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has been cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured if you are required by written contact or written agreement to provide such notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been sent to the first Named Insured. Such list: 1.Must be provided to us prior to cancellation or non-renewal; 2.Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed; and 3.Must be in an electronic format that is acceptable to us. B.Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mail or deliver such notification to each person or organization shown in the list: 1.Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or 2.At least 30 days prior to the effective date of: a.Cancellation, if cancelled for any reason other than nonpayment of premium; or b.Non-renewal, but not including conditional notice of renewal. C.Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such mailing or delivery will not: 1.Extend the Coverage Part cancellation or non-renewal date; 2.Negate the cancellation or non-renewal; or 3.Provide any additional insurance that would not have been provided in the absence of this endorsement. D.We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided to us as described in Paragraphs A. and B. of this endorsement. All other terms and conditions of this policy remain unchanged. #"19 4 5 4 ZURICH U-CA-424-H CW (10/21) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Coverage Extension Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. Effective Date: This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1.The following is added to the Who Is An Insured Provision in Section II – Covered Autos Liability Coverage: The following are also "insureds": a.Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any “employee” of yours is also an “insured” while operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your permission, while performing duties related to the conduct of your business. b.Anyone volunteering services to you is an "insured" while using a covered "auto" you don’t own, hire or borrow to transport your clients or other persons in activities necessary to your business. c.Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a.and A.1.b.in this endorsement. d.Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. 2.The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment – Supplementary Payments Paragraphs a.(2) and a.(4)of the Coverage Extensions Provision in Section II – Covered Autos Liability Coverage are replaced by the following: (2)Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II – Covered Autos Liability Coverage does not apply. %$39 4 Amended Who Is An Insured g Primary and Excess Insurance Provisions Condition ® ZURICH I U-CA-424-H CW (10/21) Includes copyrighted material of Insurance Services Office, Inc., with its permission. If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you by us, the following applies for each covered "auto" on a per vehicle basis: 1.If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2.If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. M. Temporary Substitute Autos – Physical Damage 1.The following is added to Section I – Covered Autos: Temporary Substitute Autos – Physical Damage If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following types of vehicles are also covered "autos" for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its: 1.Breakdown; 2.Repair; 3.Servicing; 4."Loss"; or 5.Destruction. 2.The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos – Physical Damage We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. N. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a.of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a.In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1)How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; (2)The "insured’s" name and address; and (3)To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. O. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: .Waiver of Transfer Of Rights Of Recovery Against Others To Us U-CA-424-H CW (10/21) Includes copyrighted material of Insurance Services Office, Inc., with its permission. This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. P. Employee Hired Autos – Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official’s duties as respect their obligations to you. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". Q. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this Coverage Form if you unintentionally: (1)Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2)Make an error, omission, improper description of "autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. R. Hired Auto – World Wide Coverage Paragraph 7.b.(5) of the Policy Period, Coverage Territory Condition is replaced by the following: (5)Anywhere else in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, S. Bodily Injury Redefined The definition of "bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. T. Expected Or Intended Injury The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II – Covered Auto Liability Coverage is replaced by the following: Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. U. Physical Damage – Additional Temporary Transportation Expense Coverage Paragraph A.4.a. of Section III – Physical Damage Coverage is replaced by the following: 4. Coverage Extensions a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". WC 99 06 43 Page 1 of 1 (Ed. 01-13) Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. 2012 Copyright National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 43 BLANKET NOTIFICATION TO OTHERS OF CANCELLATION OR NONRENEWAL ENDORSEMENT This endorsement adds the following to Part Six of the policy. PART SIX CONDITIONS Blanket Notification to Others of Cancellation or Nonrenewal 1. If we cancel or non-renew this policy by written notice to you, we will mail or deliver notification that such policy has been cancelled or non-renewed to each person or organization shown in a list provided to us by you if you are required by written contract or written agreement to provide such notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been sent to you. Such list: a. Must be provided to us prior to cancellation or non-renewal; b. Must contain the names and addresses of only the persons or organizations requiring notification that such policy has been cancelled or non-renewed; and c. Must be in an electronic format that is acceptable to us. 2. Our notification as described in Paragraph 1. above will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to you. We will mail or deliver such notification to each person or organization shown in the list: a. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or b. At least 30 days prior to the effective date of: (1) Cancellation, if cancelled for any reason other than nonpayment of premium; or (2) Non-renewal, but not including conditional notice of renewal. 3. Our mailing or delivery of notification described in Paragraphs 1. and 2. above is intended as a courtesy only. Our failure to provide such mailing or delivery will not: a. Extend the policy cancellation or non-renewal date; b. Negate the cancellation or non-renewal; or c. Provide any additional insurance that would not have been provided in the absence of this endorsement. 4. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided to us as described in Paragraphs 1. and 2. above. All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy No8$9 Endorsement No. Premium $ Endorsement Effective45 Insured)14.FDIBOJDBM*OD Insurance Company;VSJDI"NFSJDBO*OT$P © Page 1 of 1 WORKERS’ COMPENSATION AND EMPLOYERS’ LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT------ CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers’ compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description 0 ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION 1PMJDZ8$9 &GGFDUJWF45 WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B 1.. CALIFORNIA ' DEPARTMENT OF INSURANCE Docusign Envelope ID: D1E7B971-B6BF-45C2-8EEE-0B81CBE5FD2B