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HomeMy WebLinkAboutTim Whittier Welding; 2024-12-16; PWM25-3610UTILPWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 1 City Attorney Approved 6/5/24 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT BUENA VISTA LIFT STATION IMPROVEMENTS; CONT. NO. 55352 This contract is made on the ______________ day of _________________________, 2024 (“Contract”), by the City of Carlsbad, California, a municipal corporation ("City") and Tim Whittier Welding, a sole proprietorship, whose principal place of business is 26830 Kiavo Drive, Valley Center, CA 92082 ("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: Dave Padilla (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 Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A 16th December PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 2 City Attorney Approved 6/5/24 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/advanced-clean-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 C. 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 Procore 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 of the Contractor to regularly check Procore and review updated documents as they are added. There will be no cost to the Contractor for use of Procore. 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, RFIs, 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. Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 3 City Attorney Approved 6/5/24 Tim Whittier, Owner 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 bidding. Signature: ___________________________________ 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. Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 4 City Attorney Approved 6/5/24 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 of this 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 six (6) months after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Tim Whittier Welding 26830 Kiavo Drive (name of Contractor) CSLB Lic. #901580 (street address) Valley Center, CA 92082 (Contractor’s license number) C-60 8/31/25 (city/state/zip) 760-740-9069 (license class. and exp. date) 1000700702 - Pending (telephone no.) tw.welding@att.net (DIR registration number/exp. date) (e-mail address) Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 5 City Attorney Approved 6/5/24 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. CONTRACTOR TIM WHITTIER WELDING, a sole proprietorship CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Tim Whittier, Owner AMANDA L. FLESSE, Utilities Director as authorized by the City Manager (print name, title) By: ATTEST: SHERRY FREISINGER, City Clerk (sign here) By: (print name, title) Deputy City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Contract must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President 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: _____________________________ Assistant City Attorney Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 6 City Attorney Approved 6/5/24 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 of the 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 to be Subcontracted Business Name and Address DIR Registration No. & Expiration Date License No., Classification & Expiration Date % of Total Contract NONE Total % Subcontracted: 0% The Contractor must perform no less than 50% of the work with its own forces. Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 7 City Attorney Approved 6/5/24 EXHIBIT B Buena Vista Lift Station Improvements Access Platform Fabrication and Installation JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 Materials 3”x3”x3/16” angle 4”x4” square stock 1.5”x1/8” flatstock $1,750 (plus tax) 2 Fabrication Ladder and platform $6,000 3 Galvanize $1,500 4 Installation (prevailing wage paid to employees when working the field) $4,500 $13,750 TAX $136 TOTAL $13,886 Does not include: Anything not specifically written out in this contract. Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 8 City Attorney Approved 6/5/24 EXHIBIT C 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.arb.ca.gov/our-work/programs/use-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. 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. Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A PWM25-3610UTIL BUENA VISTA LIFT STATION IMPROVEMENTS CONT. NO. 55352 Page 9 City Attorney Approved 6/5/24 EXHIBIT C (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: ☐ The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. ☐ The Fleet is exempt from the Regulation under Section 2449.1(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 R100 renewable diesel fuel as defined in the Regulation pursuant to Section 2449.1(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 of Contractor: Tim Whittier Welding Signature: Name: Tim Whittier Title: Owner Date: Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A 11/8/2024 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 12/11/2024 Inszone Insurance Services, LLC2721 Citrus Road, Suite ARancho Cordova, CA 95742 Certificate Team 877-308-9663 916-400-2625 certs@inszoneins.com License#: 0F82764 Obsidian Specialty Ins. Company 16871 TIMWHIT-01 State Compensation Ins Fund 35076Tim Whittier Welding26830 Kiavo Dr.Valley Center, CA 92082 806138481 A X 1,000,000 X 50,000 5,000 1,000,000 2,000,000 X Y SCB-GL-000061207 6/27/2024 6/27/2025 2,000,000 B XY9346094-2024 9/9/2024 9/9/2025 1,000,000 1,000,000 1,000,000 Additional Insured on the General Liability. Waiver of Subrogation on the Workers Compensation. The aforementioned coverage is provided to the extent in the attached forms for: City of Carlsbad/CMWD c/o Exigis Insurance Compliance Services. City of Carlsbad/CMWDc/o Exigis Insurance Compliance ServicesP.O. Box 947Murrieta, CA 92564 Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A ~® ACORD ' u ' ,---- Fl □ r-- ,---- ,---- ,---- ,---- I I □ □ ,---- ,---- ,---- H I I I □ Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A Obsidian Specialty Insurance Company 1330 Avenue of the Americas, Suite 23A New York, NY 10019 OSIC AIE OPWS 00 01 0318 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED ENDORSEMENT INCLUDING PRIMARY COVERAGE AND WAIVER OF SUBROGATION The section of the policy entitled III. – WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in a legally enforceable written contract or agreement entered into before your work commenced, that such person or organization be added as an additional insured on your policy. The coverage afforded by this endorsement is only (1) with respect to liability in connection with the original Named Insured’s ongoing operations performed for said Additional Insured during the term of this policy, and (2) only if the Additional Insured performs all obligations required under this policy. The coverage afforded to an Additional Insured is limited to a claim made for a Covered Loss not covered by other insurance available to an Additional Insured, and is limited by the provisions of the Insuring Agreement, Exclusions, Conditions set forth in the policy and all endorsements thereto. No coverage is afforded under the “products-completed operations hazard” for an Additional Insured pursuant to this endorsement. The coverage afforded to an Additional Insured under this endorsement ends as of the date of completion, abandonment, or termination of the work of the Named Insured at any jobsite, project, or structure. There is no coverage hereunder for any Additional Insured in connection with any claim or suit involving any claim for damage that takes place or is alleged to take place following completion of the Named Insured's work. The “work” of the Named Insured will be deemed completed as of the date all work, including materials, parts or equipment furnished in connection with such work, on the project or any structure therein (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or when that portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization, including another contractor or subcontractor engaged in performing operations as part of the same project, whichever is earlier. The coverage provided for the Additional Insured is only to the extent that the additional insured is held liable for the negligence or strict liability of the Named Insured, and is only to the extent of and in the proportion Additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, then the insurance afforded by the policy to the Additional Insured shall be primary insurance, and any insurance or self-insurance maintained by the above Additional Insured shall be excess of the insurance afforded to the Named Insured and shall not contribute to it. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, then we waive any right of subrogation we may have against an entity that is an Additional Insured per the terms of this endorsement because of payments we make for injury or damage arising out of “your work” performed under such written and legally enforceable contract with that Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of the policy apply and remain in effect. Policy No.: Obsidian Specialty Insurance Company Date: By: Time: 12:01 a.m. _______________________ ___________________________ President Secretary Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A SCB-GL-000061207 11/05/2024 • Docusign Envelope ID: 9D0E1FBB-DDD0-4C70-BC46-7304F2799C8A 05/23/2024 lnterinsurance Exchange of the Automobile Club Automobile Insurance Policy Change Confirmation Named Insured and Malllng Address: TIMOTHY ALAN WHITTIER 26830 Kiavo Dr Valley Center, CA 92082 Polley Number: CAA206626523 Polley Term Dates: 04/10/2024 -04/10/2025 IMPORTANT NOTICE: Your Agent Is: Miguel Montoya 800 La T erraza Rd Escondido, CA 92025 This will confirm the policy change(s) you recently made effective 05/24/2024. You will be receiving a Policy Change Declaration in the mail shortly. For your protection California law requires the following to appear on this form. Any person who knowingly presents false or fraudulent Information to obtain or amend Insurance coverage or to make a claim for the payment of a loss Is guilty of a crime and may be subject to fines and confinement In state prison. DRIVER INFORMATION: Driving Safety Record Drivers' Nemes (Last, First) Date of Birth Gender Rated Yeh Year First GOD Chargeable Citations Chargeable Accidents Licensed Whittier, Timothy Whittler, Cameron Whittler, Cory VEHICLE INFORMATION: 12/09/1967 12/09/1999 07/06/2001 M 01 M 01 M 01 1988 y 0 0 2018 y 0 0 2018 y 0 0 No. Year Vehicle Make/Model Garage Annual Verified l21d11!.lltll111 Special Car Rent. Zip Code MIies MIieage Salvage Comp. Collision Equip. Expense 1 2004 DODG/RAM 3500 CREW C 2 1966 DOOG/CORONET 3 1972 PL YM/SATILITE VEHICLE PREMIUM INFORMATION: COll8raQ8S Bodily Injury Property Damage Medical Payments Uninsured/Underinsured Motorist Bodily Injury Comprehensive Collision Car Rental Expense Uninsured Collision Uninsured Deductible Waiver \ 12-MONTH VEHICLE PREMIUM: LIMIT OF LIABILITY (IF APPLICABLE) No. Year 10,287 Yes No $1,000 457 Yes No 2,132 Yes Ne Limits($) Vehicle 1 1,000,000/1,000,000 $422 1,000,000 $190 NotWank'Ci 100,000/300,000 $226 (See Dedi.!cilbles) $185 (See Deductibles) (See Above) $1,023 Vehicle Make/Model Limit of Liability POLICY DISCOUNTS: Please review these carefully as you are warranting that you are entitled to the following discounts. Good Good Student Multi -Multi -Mature Driving Driver Student Away Vehicle Polley Driver Course Loyalty Yes No No Yes Yes No No No Vehicle 2 $110 $50 $65 $225 Grp-Deg. Professional No Primary Driver 01 01 01 Vehicle 3 $146 $66 $80 $2921 Verified MIieage Yes CURRENT 12-MONTH POLICY PREMIUM TOTAL: $1,744 NEW 12-MONTH POLICY PREMIUM TOTAL after Polley Changes: $2,229 SUBJECT(S) OF POLICY CHANGE: Auto · Add/Change Vehicle Auto • Corr:ection Auto • Change of Annual MIieage THIS IS NOT A BILL This policy change will increase your premium by $428 for the remainder of the term. LCAA0203A E20211202 052324 Insurance provided to qualified Auto Club members by the lnterlnsurance Exchange of the Automobile Club. CA Dept. of Insurance Uc. #0003259 Page 1 of 2 8010 (1/22)