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HomeMy WebLinkAboutCharles Doherty Concrete Inc; 2025-01-28; PWM25-3656TRANPWM25-3656TRAN Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 1 City Attorney Approved 6/5/24 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ARMADA WAY CONCRETE REPLACEMENT PHASE 1 This contract is made on the ______________ day of _________________________, 2025 (“Contract”), by the City of Carlsbad, California, a municipal corporation (“City”) and Charles Doherty Concrete Inc., a California corporation, whose principal place of business is 2850 Industry Street, Oceanside, California 92054 (“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: Matt Paxson (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: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 28th January PWM25-3656TRAN Armada Way Concrete Replacement Phase 1 Contract No. 6114 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 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 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: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 PWM25-3656TRAN FALSE CLAlMS. Contractor hereby agrees that any contractdaim s.ubmitte:d·to the. City must be. as.s.e.rted 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 inc1ude fa1se c1aims made with de1iherate 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 de_barment by another jurisdiction is grounds for the City of Carls-bad to dis-qualify the Contractor or subcontr bidding. Signature: Print Name: Charles Doherty REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial GeneralLiabllit¥ and Property Damage Insurance. and a C.ertlfi.cate_of Workers.' Comp:ens.atton 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 l<ey 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 (LASU} 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 (NAie) latest quarterly listings report. Comme.rcia.l General Liability Insurance written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. 1f 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 ofnot 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 timited in any manner. The-above-policies shall have-non-cance-lla-tion clauses providing that thirty (3-0} days written notice shall be given to the City prior to such cancellation. Armada Way Concrete Replacement Phase 1 Contract No. 61-14 -Page 3 City Attorney Approved 6/-5/24 PWM25-3656TRAN Armada Way Concrete Replacement Phase 1 Contract No. 6114 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 thirty (30) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within thirty (60) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Charles Doherty Concrete Inc. 2850 Industry St. (name of Contractor) 707928 (street address) Oceanside, CA 92054 (Contractor’s license number) A, C-8, C-13 - 10/31/2025 (city/state/zip) 760-535-9295 (license class. and exp. date) 1001072972 - 6/30/2025 (telephone no.) cwdoherty@cox.net (DIR registration number/exp. date) (e-mail address) Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 PWM25-3656TRAN AUTHORITY. The individuals executing this Contract and the instruments referenced in it on behalf of Contractor each re.pre.sent and warrant that the\/ have the. legal power,. right and actual authority to bind Contractor to the terms and conditions of this Contract. CONTRACTOR CHARLES DOHERTY CONCRETE INC., a ::Hfornia corporatio"d By: (sign here) Charles Doherty, President and Chief Financial Officer (print name, titl·eJ (sign here) {print 11?Jme, titlefl CITY OF CARLSBAD, a municipal corporation of the State of California B-y: PAZ GOMEZ, Deputy City Manager, PubHc Works, as authorized by the City Manager ATTEST: SHtRRY i=Rl:ISINGtR, City Clerk By: D~puty City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!i.£ corporation. Contract must be signed by one corporate officer from each of the following two groups: Group A Chairman, P-resrdent, 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: C1ND1E 'K. McMAHON, City Attorney BY: ___ bt_·IAA-__ f-\;_~ __ 'D. __ _ Assistant City Attorney Armada Way Concrete Replacement Phase 1 Contract No. 6114 Pag.e 5 City Attorney Approved 6/5/24 0% Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 PWM25-3656TRAN EXHIBIT A USTlNG 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 one0half 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, settfng 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 tohe & fxpiration Date Oassification TotaJ Subcontracted I & Expiration Contract Date Norvt 0 Total% Subcontracted: ______ _ The Contractor must perform no less than 50% of the work with its own forces. Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 6 City Attorney Approved 6/5/24 PWM25-3656TRAN Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 7 City Attorney Approved 6/5/24 EXHIBIT B Armada Way Concrete Replacement Phase 1 Contractor shall provide all equipment, materials and labor, at prevailing wages, to demo, remove, dispose of, and replace 3,188 square feet of concrete sidewalk on Armada Drive starting at the sidewalk north of the north Armada Viewpoint just south of GIA Building (see pictures). Contractor to implement traffic control lane closure for 4 days at a no cost traffic control permit from the City of Carlsbad. Contractor to root prune tree roots under removed concrete and scarify that disturbed existing subgrade to a depth of 6-8”. Root pruning includes the removal and disposal. Contractor to recompact subgrade with 5-ton roller. Any additional compaction required by the City of Carlsbad, and/or by a soils Engineer retained by the City of Carlsbad, is considered additional work above and beyond work in included in the Scope of Work and that extra work will be charged at an hourly rate. Contractor to pump, place and finish 3,188 square feet of natural gray, 4” thick, 3250 PSI concrete. Contractor price includes DIR set up fees for the job for Superior Ready Mix and for 5 concrete loads. If bonding is required, Contractor will add 3% to the current estimate at time of billing. Before any work can start contractor shall apply for a right of way permit and submit Traffic Control Plan. Contractor is responsible to obtain a water meter from Carlsbad Municipal Water District if any water is needed during the project. Any road cleanup from debris left after project must be cleaned up by the contractor before leaving the jobsite. All subcontractors must be added to the contract in exhibit A prior to execution of the contract. All work shall be performed in accordance with the City of Carlsbad’s Engineering Standards, latest edition, the 2024 Standard Specifications for Public Works Construction (Greenbook), 2018 Caltrans Standard plans and Caltrans Specifications and California Manual on Uniform Traffic Control Devices. JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 Sq foot 3188 Concrete removal $12,752 2 Sq foot 3188 Concrete replacement $37,140.20 3 LS 1 Traffic Control $4,600 4 LS 1 DIR Set Up Superior Ready Mix $800 5 per load 5 DiIR set up 6 loads $1,000 6 LS 1 Bond $1,688.77 TOTAL* $57,980.97 *Includes taxes, fees, expenses and all other costs. Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 PWM25-3656TRAN Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 8 City Attorney Approved 6/5/24 EXHIBIT B Armada Way Concrete Replacement Phase 1 (Continued) ` Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 EXHIBITC LABOR AND MATERIALS BOND PWM25-3656TRAN Bond No. RCB0051187 Premium: $1,160 Premium will be adjusted based on final contract amount WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Charles Doherty Concrete Inc (hereinafter designated as the "Principal"), a Contract for: ARMADA WAY CONCRETE REPLACEMENT PHASE 1 CONTRACT NO. 6114 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, CHARLES DOHERTY CONCRETE INC, as Principal, (hereinafter designated as the "Contractor"), and Contractors Bonding and Insurance Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of fifty-seven thousand nine hundred eighty dollars and ninety-seven cents ($57,980.97), 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 ifthe 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. Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 9 City Attorney Approved 6/5/24 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 PWM25-3656TRAN 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 __ 6_th __ day of ____ J_a_n_ua_ry~-----~ 2025. (Signature) Andrew Roberts, Attorney-in-Fact (Name/Title) (Name/Title) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON City Attorney By: Assistant City Attorney Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 10 City Attorney Approved 6/5/24 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 POWER OF ATTORNEY RLI Insurance Company Contractors Bonding and Insurance Company 9025 N. Lindbergh Dr. Peoria, IL 61615 Phone: 800-645-2402 Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each an Illinois corporation, (separately and together, the "Company") do hereby make, constitute and appoint: Matthew C. Gaynor, Kim D. Vasguez, Daniel Frazee, David J. Garcia, Andrew Roberts, Anne Wright, jointly or severally in the City of San Diego , State of California its true and lawful Agent(s) and Attorney(s) in Fact, with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds and undertakings in an amount not to exceed Twenty Five Million Dollars ( $25,000,000.00 ) for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon the Company as if such bond had been executed and acknowledged by the regularly elected officers of the Company. RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of a Resolution adopted by the Board of Directors of each such corporation, and is now in force, to-wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the RLI Insurance Company caused these presents to be executed by its respective and/or Contractors Bonding and Insurance Company, as applicable, have Sr. Vice President with its corporate seal affixed this 19th day of June 2024 . State of Illinois County of Peoria } ss On this 19th day of June , 2024 , before me, a Notary Public, personally appeared Eric Raudins , who being by me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of the RLI Insurance Company and/or Contractors Bonding and Insurance Company and acknowledged said instrument to be the voluntary act and deed of said corporation. Notary Public State or Ohio My Comm. Expires Septemb•r 22. 2025 Notary Public 0476/020202/2 Eric Raudins Sr. Vice President CERTIFICATE I, the undersigned officer of RLI Insurance Company and/or Contractors Bonding and Insurance Company, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable; and furthermore, that the Resolution of the Company as set forth in the Power of Attorney, is now in force. ln testimony whereof, I have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding and Insurance Company this __filb._ day of January , 2025 . RLI Insurance Company Contractors Bonding and Insurance Company By: ~~ OJ_·~ Jeffrey ic Corporate Secretary A0058D19 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 ACKNOWLEDGMENT 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 San Diego on January 6, 2025 before me, Brittney Thompson, Notary Public (insert name and title of the officer) personally appeared _A_n_d_r_e_w_R_o_b_e_rt_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 certify under PENAL TY OF PER paragraph is true and correct. WITNESS my ha d a RY under the laws of the State of California that the foregoing ~············1 • BRITTNEY THOMPSON : 4 • Notary Public • California z i : San Diego County f ~ Commission 112499180 - •'~ My Comm. Expires Sep 7, 2028 (Seal) PWM25-3656TRAN Armada Way Concrete Replacement Phase 1 Contract No. 6114 Page 11 City Attorney Approved 6/5/24 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.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: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 January 6, 2025 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 PWM25-3656TRAN EXHIBIT D (CONT.) IN-USE Off-ROAD DlESEl-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 te the J:)enalty of J:)erjury, that the OJ:)tion cheeked 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 Certfficate(s) of Reported Compliance have been attached hereto. D 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. D Contract.or and/or their subcontractor is unable to procure R99 or RlOO ren.ewable di.esel fuel as defined in the Regulation pursuant to Section 2449.1(f)(3). Contractor shall keep detailed records describing the normal r efueling 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). D The Fleet is exempt from the requirements of the Regulation pursuant to Section 2449(i)(4) because this Project has been deemed an "emer:gency", as that term is defined in Section 2449(c){18). Contractor shal'I only operate t'he @xempted vehides in the emerg@ncy situation and records of the exempted vehicles must be maintained, pursuant to Section 2449(i)(4). D The Fleet does not fall under the Regulation or ar e otherwise exempt and a detailed reasoning is attached to this certification. Name of Contractor: Charles D:--M )'" Signature: ------~...L...---------------- Name: Charles Doherty Title: President Date: Armada Way Concrete Replacement Phase 1 Contract No. 6114 City Attornl;!y Approved 6/5n4 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Monthly CTC-VIS Account Summary From: noreply@cleantruckcheck.arb.ca.gov To: cwdoherty@cox.net Date: Thursday, January 2, 2025 at 11 :06 PM PST Dear CHARLES DOHERTY, Below is a summary of the current status of your CHARLES DOHERTY CONCRETE INC. CTC-VIS account: 1. Vehicle Compliance Certification Status: a. 0 Vehicle Compliance Certification(s) were issued to your entity in the last month. b. In total, 1 vehicle(s) are currently compliant out of 1 registered in your entity. c. 0 of the Vehicle Compliance Certificate(s) will expire within next 90 days. 2. Compliance Fee: a. Fees Due Soon: 0 vehicle(s) are with fee(s) due within next 90 days. b. Fees Past Due: 0 vehicle(s) are with fee(s) already past due. c. Expired Fee: There are 1 expired fee(s) in your Entity. 3. Periodic Test: a. Vehicles with Test(s) Due: 0 vehicle(s) have entered their test submission period, and the test(s) will be due within next 90 days. b. Tests Past Due: 0 vehicle(s) are with test(s) already past due. 4. Enforcement Hold: 0 vehicle(s) are currently under hold due to outstanding CARB Enforcement actions. The status may vary from day to day, for more details and the latest status, please visit your account at httRS :/ /cleantruckcheck. arb .ca .gov. Please review the status of your vehicles to ensure that all your vehicles are compliant with the Clean Truck Check program. If you have any questions or need assistance, please contact GARB at HDIM@arb.ca.gov. CA L l::ORNI.A. . -- Clean Truck Check Team California Air Resources Board hdim@arb.ca.gov Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 CHARDOH-01 TSONY ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 8/1/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies} must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 ~=I~CT Casey Peltzer HUB International Insurance Services Inc. !l'8,N:o, Ext): (760) 707-5657 I Wc, No):(951) 231-2572 1525 Faraday Avenue Suite 150 xt~~SS: Cal.CPU@Hubinternational.com Carlsbad, CA 92008 INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company 41297 INSURED INSURERB: Charles Doherty Concrete INSURERC: 1302 Crestridge Dr. INSURERD: Oceanside, CA 92054 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER ,:~M%~ ,:3M%~ LIMITS LTR INSD WVD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 CLAIMS-MADE 00 OCCUR X X BCS2000736 7/15/2024 7/15/2025 DAMAGE TO RENTED PREMISES /Ea nrrurrencel $ 100,000 X Per Project Agg. ~ MED EXP (Anv one oersonl $ Included PERSONAL & ADV INJURY ~ $ 1,000,000 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY 00 rr&-r DLoc PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 1,000,000 ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ /Ea ar.r.irtent\ ANY AUTO BODILY INJURY /Per oersonl $ ~ -OWNED SCHEDULED ~ AUTOS ONLY -AUTOS BODILY INJURY /Per accident) $ HIRED ~8fo'§i%1~ 1P~?~&:~d~NAMAGE $ ~ AUTOS ONLY - $ A X UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE XLS2004819 7/15/2024 7/15/2025 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 0 $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ ~~;t~ftf[~~ ~~~PERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Operations of the Named Insured during the current policy term. The City of Carlsbad/CMWD is Additional Insured with regard to the General Liability policy, when required by written contract, per the attached endorsement forms CG2010 12/19, CG201212/19 & CG203712/19. Coverage is Primary & Non -Contributory with regard to the General Liability policy, when required by written contract, per the attached endorsement form CG200112/19. Waiver of Subrogation applies to the General Liability policy, when required by written contract, per the attached endorsement form CG240412/19. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad/CMWD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services P.O. Box947 Murrieta, CA 92564 AUTHORIZED REPRESENTATIVE I ~~ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Insured Name: Charles Doherty POLICY NUMBER: BCS2000736 Term: 7/15/2024 to 7/15/2025 COMMERCIAL GENERAL LIABILITY CG 2010 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s) Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION WHEN ALL LOCATIONS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE OCCURRENCE TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (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 2. 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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 1219 © Insurance Services Office, Inc., 2018 Page 1 of2 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of2 © Insurance Services Office, Inc., 2018 CG 2010 1219 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Insured Name: Charles Doherty POLICY NUMBER: BCS2 0 0 0 7 3 6 Term: 7/15/2024 to 7/15/2025 COMMERCIAL GENERAL LIABILITY CG 20 121219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION -PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE OCCURRENCE TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20121219 © Insurance Services Office, Inc., 2018 Page 1 of 2 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products-completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 121219 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Insured Name: Charles Doherty POLICY NUMBER: BCS20007 36 Term: 7/15/2024 to 7/15/2025 COMMERCIAL GENERAL LIABILITY CG 20 371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person{s) Or Oraanization(s) Location And Description Of Completed Operations Any person or organization when All Locations required by written contract or agreement, executed prior to the occurrence to which this insurance applies, that such person or organization be added as an additional insured on vour policv Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 371219 © Insurance Services Office, Inc., 2018 Page 1 of 1 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Insured Name: Charles Doherty POLICY NUMBER: BCS2000736 Term: 7/15/2024 to 7/15/2025 COMMERCIAL GENERAL LIABILITY CG 20 011219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 011219 © Insurance Services Office, Inc., 2018 Page 1 of 1 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Insured Name: Charles Doherty POLICY NUMBER: BCS2000736 Term: 7/15/2024 to 7/15/2025 COMMERCIAL GENERAL LIABILITY CG 24 041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization for whom the insured has agreed to waive rights of recovery, provided such agreement is made in writing and prior to the loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 041219 © Insurance Services Office, Inc., 2018 Page 1 of 1 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 07/08/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT OFFICE MANAGER NAME: State Farm TRAVIS FOSTER INSURANCE AGENCY INC wgN.,::0 Extl· 530-242-1411 I ~ Nol: 530-242-1311 A ® 1007 DANA DR STE C i~tJ~ss: CERTREQUEST@TRAVISFOSTERAGENCY.COM REDDING CA 96003 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURERB: CHARLES DOHERTY CONCRETE INC INSURERC: 2850 INDUSTRY ST INSURERD: OCEANSIDE, CA 92054 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE •••~n ••n•n POLICY NUMBER IMM/DDNVVYI IMM/DDNVVYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ~ D CLAIMS-MADE □ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ ~ MED EXP {Any one person) $ PERSONAL & ADV INJURY $ ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl □PRO-□LOC PRODUCTS -COMP/OP AGG $ POLICY JECT OTHER: $ AUTOMOBILE LIABILITY y 602 9657-A30-55 07/30/2024 07/30/2025 ~~~:~~~llNGLE LIMIT $ 2,000,000 ~ ANY AUTO BODILY INJURY (Per person) $ A ~ OWNED ~ SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY /Per accidentl $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ ~ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION $ $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured (6028BU) with 30 days notice of cancellation (6771 BD) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad/CMWD ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services AUTHORIZED REPRESENTATIVE P.O. Box 947 ~ A J;t,.ff;,u, Murrieta, CA 92564 I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 ---•-•••• ~I...._ I._ I '°'111¥1 I-. 1 --· I I I I POBox2368 Bloomington IL 61702-2368 46A AT1 12 001398 0093 CITY OF CARLSBAD/CMWD C/O EXIGIS INSURANCE COMPLIANCE SVCS PO BOX 947 MURRIETA CA 92564-0947 ~ I ll11il•lllll•lll11,r.,,111l1111111,,111,1,11,11,,111, •• ,.,l,1'1I• I A DATE OF NOTICE: AU('.l 01 2024 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. • 1:Aobrr10,NAL iNS~~e~·s._N~Tic·~:OF_qpv_ERA_(.;·E; ... =:·: ::: :·-:; :.:··: ::. : .. -.: (:'::·::. ::.;:--:: ::.: >·::; _: ::·::::: :.=.·.: ; : ; ·-:--:'::': :_:·.:::· ;:._·:·:::>:=~~/:.·-·: .:=: :' >.H . , ~tate Farm Fire and Casu'alty Company • . . . • • 2BD4-FA96A • 0 •• • ' I . NAMED INSURED: • POLICY NO:· 602 9657-A30-55E. COVERAGE: CHARLES DOHERTY CONCRETE INC YR/MAKE/MODEL: 2015 PETERBIL T DMP SGL Bl AND PD LIABILITY i 2850 INDUSTRY ST VIN/CAMPER: 2NP3LJ9X2FM281121 :i2o~ciLDED COMP cl, OCEANSIDE CA 92054-4812 AGENT NAME: TRAVIS FOSTER INS AGENCY INC $1000 orn: COLL. 'i' AGENT PHONE: (530)242-1411 :!: ENDORSEMENT NO: 6028BU POLICY EFFECTIVE JUL 25 2024 UNTIL TERMINATED ~ POLICY MESSAGES: This policy shown above supersedes pblicy# 6029657-55D. 'al The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance §. provided and subject to all policy provisions. The additional insure.d will be given 20 days notice i1 the policy is terminated. Until such notice "! is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days o1 8 any change o1 interest or ownership coming to their attention. Failure to do so will render this policy null and void. __ . .. . ,., . . . . . .. . . = , .. · .~.l:,.-•-_._L•,.,:. ~•-.,.,••~.-~--~•-.;, ._-:-_ ... -.--"'• •• -..:,•,·••• -•• -• ;••, -----••••'•. -~ • ..:-----••.·-~r .--.• •• :.,·.-..<" _____ ._ ___ •••--•~••••--•-·--~-••t': .. I•,•'. FRT Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 Docusign Envelope ID: 7167B785-3EE8-41D2-BFFD-D39756EF1E95 ACORDe I ~ I I □ ~ ~ Fl □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ . . ~ f'.T""' I