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Nissho of California Inc; 2025-05-29; PR-MPW-25005P
Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 May 2529th Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS; CONT. NO. PR-MPW-25005P This contract is made on the ______ day of __________ _, 20_ ("Contract"), by the City of Carlsbad, California, a municipal corporation ("City") and Nissho of California, Inc., a California corporation whose principal place of business is 1902 South Santa Fe Ave ., Vista, CA 92083 ("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 Temujin Matsubara (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 POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 1 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: Section 1776 of the California Labor Code, which requires keeping accurate payroll records, verifying and 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:ljww2.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 c·ontrol 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 Proco re support team. It will be the responsibility of the Contractor to regularly check Proco re 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, RFls, submittals, schedules, change orders, project documents, as well as any deficient POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 2 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: 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. 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: ~ff\ ~,.o... ... r.Q. 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 (NAie) 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 POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 3 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: 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. 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 twenty (20) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within forty-five (45) working days after receipt of Notice to Proceed. POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 4 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 CONTRACTOR'S INFORMATION. Nissho of California, Inc. (name of Contractor) 598372 (Contractor's license number) C27; 7/31/2026 (license class. and exp. date) 1000018744;6/30/2025 (DIR registration number/exp. date) 1902 South Santa Fe Ave. (street address) Vista, CA 92083 (city/state/zip) 760-727-9719 (telephone no.) tbaird@nisshoca.com (e-mail address) Tracking#: 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. [signatures on following page] POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 5 City Attorney Approved 6/5/2024 CONTRACTOR (sign here) Tom Baird, Vice President (print name/title) By: (sign here) Cecilia Dolleton, Secretary (print name/title) Tracking#: CITY OF CARLSBAD, a municipal corporation of the State of California By: Kyle Lancaster, Parks & Recreation Department Director ATTEST: SHERRY FREISINGER, City Clerk By: Deputy / Assistant City Clerk lf1 required by City, proper notarial acknowledgment of execution by Contractor must be attached. 11£ 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: ____________ _ Deputy / Assistant City Attorney POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 6 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 ., a California Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: 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 subrnntractor 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 Business Name and Address DIR Registration No. License No., to be & Expiration Date Classification Subcontracted & Expiration Date SoJ ~-~'Svc). f°M'i"'S 1N_, \000 00<\'l.\l \J-\~1/~1' ~~\\q-\\gf\. b ~ -:\Ol\ <,,\10 ~is C 1, 1 ~"'f ~ l\l V..-4'\/0 (,,fi l'.\'),~(o1' ~he, b1,., .__ Total% Subcontracted: ~'6 · oi ~'t? The Contractor must perform no less than 40% of the work with its own forces. POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS %of Total Contract S"Boi1. CONT. NO. PR-MPW-25005P Page 7 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: EXHIBIT B SCOPE OF WORK AND COST Scope of Work Summary: Perform corrective sod repairs at Poinsettia Dog Park. Includes removing all remaining turf in the large and small dog play areas, preparing soil and installing new sod. Work will begin in the large dog play area first. Once completed, work will then begin in the small dog play area. Contractor will: • Remove existing turf in stages in the large and small dog play areas. • Amend and till soil with compost, gypsum and Grow Power soil amendment. Compost will be provided by the city. • Finish area to a fine grade and prepare for sod. • Install 14,700 sq. ft. of TifTuf sod in the large dog play area, followed by 8,000 sq. ft. in the small dog play area. • Flag irrigation heads before sod irrigation. • Check irrigation system for proper head height and spray radius after new sod is installed. • Use 4x8 sheets of plywood (provided by the city) in large dog play area to help protect new sod from equipment passing through to work in small dog play area. Repair any sod damage with TifTuf sod. JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 $1.34 22,700 TifTuf sod (sq. ft.) $30,418.00 2 $5,879.51 1 Equipment rental and delivery $5,879.51 3 $15.05 68 Gypsum (SO-pound bag) $1,023.40 4 $88.79 14 Grow Power soil amendment (SO-pound bag) $1,243.06 5 $50.00 84 Foreman hours $4,200.00 6 $44.00 168 Laborer hours $7,392.00 7 $2,262.24 1 Labor & Materials bond $2,262.24 TOTAL* $52,418.21 *Includes prevailing wage, taxes, fees, labor and materials bond, expenses and all other costs. POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 8 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 EXHIBIT C LABOR AND MATERIALS BOND Tracking#: Bond No.: PPD0103414 Premium: $1,048.00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Nissho of California, Inc. (hereinafter designated as the "Principal"), a Contract for: POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONTRACT NO. PR-MPW-25005P 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, Nissho of California, Inc., as Principal, (hereinafter designated as the "Contractor"), and Developers Surety and Indemnity Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of fifty-two thousand four hundred eighteen dollars and twenty-one cents ($52,418.21), 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 POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 9 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: 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. 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 _1_9t_h __ day of_M_a,:_y __________ _, 2025. _N_i_ss_h_o_o_f _C_a_lif_or_n_ia~, _ln_c_. ____ (SEAL) (Principal) By: <MtJttlttlk===. (Signature) Developers Surety and Indemnity Company (SEAL) By:-~~--~~(-Su~ra-fy~) ~~-- (Signature) Leona Evangelista, Attorney-in-Fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON City Attorney By: U~tli~ Deputy/ Assistant City Attorney POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 10 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 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 MAY f 9 2025 b k h d b on before me, Re e a Ea s, Notary Pu lie ------------ (insert name and title of the officer) personally appeared Leona Evangelisa 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 PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. (Seal) Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 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 5 \ 2 Z ( 2 0 2~ befo;e me, H. Kristine Mun~ay, Notary Public, personally appeared c e c e I • a_ O o t , e +o V\ 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 PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signa~ (Seal) NOTARIZED DOCUMENT TITLE: Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 POWER OF ATrORNEY FOR COREl'OINTE INSURANCE COMPANY DEVELOPERS SllRETY AND INDEI\INITY COMPANY 59 Maiden Lane. 43rd Floor, New York, NY 10038 (212) 220-7120 KNOW ALL HY THESE PRESENTS that, excert as cxprmly limited herein. COllEPOINTE INSURANCE COMPANY and DEVELOPERS SURl:TY AND INDEMNITY COMPANY, do her,•by mukc, constitute and appoint: Richard Hallett, Leona Evangelista, Rebekah Eads, Gabriel Erle and Ma_r_is_s_a_R_o_bi_ns_o_n ___________ , of San Diego, CA as its true and lawful Attorney-in-Fact, to make, execule, deliver and acknowledge, for and on behalf of said companies. as sureties. bonds. undertakings and eontrncts or surctyship giving and grunting unto said Attorney-in-Fact fl1II powa and authority to do and to perform every net necessary, requisite or proper lo be done in connection therewith as each of said company could do, but reserving to each or said company full power of substitution and revocation, and all of the acts or said Allnrncy-in-Fact, pursuant to these rresents, are hereby ratified and confirmed . This Power of Attorney is eflective February 21, 2023 and shall c.~pire on December 31, 2025. ·11,is Power of Attorney is gmntcd u11d is signl'<.l under and by authority of the following resolutions adopted by U1c Board or Directors orCOREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY (collectively. "Company'') on February 10, 2023. RESOLVED. thal Sam Zaza, Prcsidcnl Surely Underwriting. James Bell. Vice Prcsidenl Surety UndcmTiting. and Craig Dawson. Executive Underwriter Surety, each an employee of AmTrust North America, Inc., an affiliate of the Company (the "Authorized Signors"), are hereby authorized to execute a Power of Anorncy. qualili'ing attomcy(s)-in-fact named in the Power of Allorney to execute, on behalf of the Company, bonds, undertakings and contracts or surctyship. or other suretyship obligations; and I hat the Secretary or any Assistant Secretary of the Compm1y b.:, and each of them hereby is, authorized to attest the execution of any such Power ofAttorne)'. RESOLVED. that the signature of any 011e ul' the Authorized Signors and the Secretal)' or any Assistant Secretary of the Company. and the seal ol'thc Company must be affixed to any such Power of Atiorney, and any such signalure or seal may be affixed by facsimile, and such Power of Attorney shall be vulid and binding upon the Compnny when so affixed and in 1hc lt1tu1c with respect to any bond, undertaking or rnnlract ol'surctyship to \\~1ich ii is attached. IN WITNESS WHEREOF. COREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY have cauS<.'<.l these pre&nts to be signed by the Authnri7J:tl Signor and altcsted by their Secretary or Assisiant Secretary this ______ l\i_la_r_d_1 _27_.~2_0_2_3 _____ _ iJ?§= ··••"""'',,, I ~~u~' fl),·. ----,,'---j-ff,lf-'-ftt---l--l~~-1------------,, "~ \' ••••••• 1\1,.... ,, ,. ,<,,_V •• 0 •• ..._;,-._., / ~ ~ ,'o'r-P F?"l;._•. ,, ~ Printed Na~ c: Sam Zaza ________________ : 0 / u ~ ·•. i ': ~ ~[SEAL)~~ : cl~ :~= 4::, O'-. /-C:i -:. .. () ••~fLAW~~~•• 'i ...... 1,, ••••••• ,, ,, * ... ,,,, ,,,. ,,,,,. ... ,. Title: President. Surety Undcr\\Titing ACKNOWLEDGEMENT: A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this cerlificale is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF ~C~a~li~fo~r~n~ia~---------COUNTY OF _O_r_ai_,g_e ________ _ On this n_ day of March , 20ll_, before me, Hoang-Quyen Phu Pham , personally appeared ~S,~11~11~Z~a~z~a ______ _ who rrovcd lo me on the basis or satisliKtory evidence to he the person whose name is subscribed lo within the instrument mul acknowledged to me that they executed the same in their authorized capacity, and that by the signature on the i11st1umenl the entities upon behalf which the person acted. execuled this instnuncnl. I cert ii)', tmder penalty of perjury, under the la\\~ of the State ol'_C~a~l~il~o~rn~"~'---------thal the foregoing paragraph is true and correct. WITNESS my hand and oflicial seal. -···········f • a, >.. HOANc;..QUYEN P. PHAM ,,_ Notary Public -Cillfornli z Orange County ~ Commission II 2◄32970 - My Comm. ElCl>ires Oec 31, 202, CORPORATE CERTIFICATION ·11ie undersigned, the Secretary or Assistunt Secretory or COREPOINlE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY, does hereby certilY tirnl the provisions of the resolutions of the respective Boards of Directors of said corporations set fonh in this Po\\er of Attorney are in force as of the date of this Cerlification. ·111is Certification is executed in the City of Cleveland, Ohio, this Murch 19, 2023. Ooc:uSigned by: By: tlVY'If (IJ fubS Barry W. Moses. Assistant Secretory 686415E7AOE548C ... POA No. N/A ------- DocuSignEnvelopelD: 3352BFD6-5E9D-4 796-837E-C 1 E455E6530F Ed. 0323 Signed and sealed this 191h day of May, 2025 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: 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. POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 11 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Tracking#: EXHIBIT D (CONT.) IN-USE OFF-ROAD DIESEL-FUELED FLEET REGULATION CERTIFICATION Contractor hereby acknowledges that they have reviewed the CAR B'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: D 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.l(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. D Contractor and/or their subcontractor is unable to procure R99 or RlOO 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). D 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). j The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached to this certification. Name of Contractor: Nissho of California Inc. Signature: ~ _____, Name: {c,- Title: Date: POINSETTIA DOG PARK CORRECTIVE SOD REPAIRS CONT. NO. PR-MPW-25005P Page 12 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 NISSOFC-01 BATGL1 ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 5/28/2024 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($), 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 # 0L48969 22ijl~CT C3 Risk & Insurance Services ritlg,N:o, Ext): (619) 233-8000 I FAX 404 Camino Del Rio S. STE 410 (A/C, No):(619) 864-7106 San Diego, CA 92108 ~~DAJ~ss: certs@c3insurance.com INSURERCSl AFFORDING COVERAGE NAIC# INSURER A: Middlesex Insurance Comoanv 23434 INSURED INSURER B: CorePointe Insurance Comoanv 10499 Nissho of California, Inc. INSURERC: 1902 S. SANTA FE AVE. INSURERD: Vista, CA 92083 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. 1r4': TYPE OF INSURANCE ~BJJ~ ~~~ POLICY NUMBER ,_POLICY EFF yy POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -□ CLAIMS-MADE 00 OCCUR DAMAGE TO RENTED 500,000 X X A0221035004 6/1/2024 6/1/2025 PREMISES CEa occurrencA\ $ X Bl/PD Ded $5,000 MED EXP /Anv one person\ $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 -2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY 00 ~tc?r □ LOG PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ A ~TOMOBILE LIABILITY fi,~~~~~~t\SINGLE LIMIT $ 1,000,000 X ANY AUTO X X A0221035001 6/1/2024 6/1/2025 BODILY INJURY /Per Person\ $ -OVI/NED -SCHEDULED -AUTOS ONLY -AUTOS BODILY INJURY /Per accident\ $ -~BtWsoNLY -~8ro~vmi1~ FP~9~.\'c~d\~t~AMAGE $ $ A UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 2,000,000 f--A0221035005 6/1/2024 6/1/2025 2,000,000 X EXCESS LIAB CLAIMS-MADE X AGGREGATE $ OED I X I RETENTION$ 0 $ 8 WORKERS COMPENSATION XI ~ffTUTE I I OTH- AND EMPLOYERS' LIABILITY ER YIN X CPW1002531 6/1/2024 6/1/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE [Y] E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1,000,000 {Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: All operations performed by the named insured on behalf of the certificate holder. Additional insureds are included as/where required by written contract as respects to General Liability, Auto Liability, General waiver of subrogation, Auto waiver of subrogation, General Liability primary non-contributory wording, Auto Liability primary non-contributory wording and Workers Compensation waiver of subrogation but limited to the operations of the Insured under said contract, and always subject to all the policy terms, conditions and exclusions per endorsements attached. Commercial Umbrella or Excess Liability follows form according to the terms, conditions, and endorsements found in the policy. 30 days' notice of cancellation applies 10 days for cancellation due to non-payment of premium. THIS CERTIFICATE CANCELS AND SUPERSEDES ANY CERTIFICATE PREVIOUSLY ISSUED SEE A TT ACHED ACORD 101 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. Box 947 Carlsbad, CA 92008-0000 AUTHORIZED REPRESENTATIVE <"<' ,..,.,: ~r 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: 5149670C-9CA9-4F74-A595-4BCB250A5164 AGENCY CUSTOMER ID: NISSOFC-01 BATGL1 ------------------- LO C #: 1 -------- ADDITIONAL REMARKS SCHEDULE AGENCY License # OL48969 C3 Risk & Insurance Services POLICY NUMBER SEE PAGE 1 CARRIER I : NAICCODE SEE PAGE 1 SEEP 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: NAMED INSURED Nissho of California, Inc. 1902 S. SANTA FE AVE. Vista, CA 92083 EFFECTIVE DATE: SEE PAGE 1 Page 1 of 1 The City of Carlsbad, its Officials, employees and volunteers are named as additional insured with respect to General and Auto Liability, per attached endorsements. Coverage is Primary and Non-Contributory. Waiver of Subrogation applies to General Liability, Auto Liability and Workers Compensation. Excess/Umbrella policy follows form of general liability. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 POLICY NUMBER: A0221035004 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All construction projects away from premise owned by or rented by insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I -Coverage A, and for all medical expenses caused by accidents under Section I -Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 □ Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I -Coverage A, and for all medical expenses caused by accidents under Section I -Coverage C, which cannot be attri- buted only to ongoing operations at a single des- ignated construction project shown in the Sche- dule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section Ill -Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 □ Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 POLICY NUMBER: A0221035004 COMMERCIAL GENERAL LIABILITY CG 712506 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BLANKET ADDITIONAL INSUREDS, PRIMARY & NONCONTRIBUTORY, WAIVER OF SUBROGATION This endorsement modifies the coverage provided under the following Coverage Form(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Coverage enhancements are listed below. For details of each coverage, please read the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds -Automatic Status for 13 Additional Insured Types A. Owners, Lessees Or Contractors -Automatic Status When Required In A Written Construction Agreement With You B. Owners, Lessees Or Contractors -Automatic Status When Required In Written Construction Agreement With You (Completed Operations) C. State or Governmental Agency or Subdivision or Political Subdivision -Permits or Authorizations D. Lessor of Leased Equipment E. Owners or Other Interests From Whom Land Has Been Leased F. Manager or Lessor of Premise G. Mortgagee, Assignee, or Receiver H. Controlling Interest I. Co-owner Of Insured Premises J. Executors, Administrators, Trustees Or Beneficiaries K. State Or Governmental Agency Or Subdivision Or Political Subdivision -Permits Or Authorizations Relating To Premises L. Vendors M. Grantor of Franchise 2. Primary and Noncontributory -Other Insurance Condition 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Additional Insureds -Automatic Status for 13 Additional Insured Types Section II -Who Is An Insured is amended to include the following as additional insureds when you have agreed to add that person or organization as an Additional Insured on your policy in a written contract or written agreement with that person or organization, or because of a permit issued by a state or political subdivision; provided the injury or damage occurs subsequent to the execution of the contract or agreement or issuance of the permit and while the contract, agreement or permit remains in effect. A. Owners, Lessees Or Contractors Automatic Status When Required In A Written Construction Agreement With You 1) A person or organization 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 omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. CG 712506 22 A0221035 Middlesex Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 05/21/2024 4bf65817-f0cc-4360-8681-89c2889846dc Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. 2) With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the 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. b. "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. B. Owners, Lessees Or Contractors Automatic Status When Required In Written Construction Agreement With You (Completed Operations) 1) Any person(s) or organization(s) with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" performed for that additional insured and included in the "products-completed operations hazard", but only when that portion of the "products-completed operations hazard" is not excluded by endorsement. 2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. 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" involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C. State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, 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. 2) This insurance does not apply to: Page 2 of 5 A0221035 Middlesex Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 712506 22 05/21/2024 4bf65817-f0cc-4360-8681-89c2889846dc Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 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". D. Lessor of Leased Equipment 1) Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). 2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. E. Owners or Other Interests From Whom Land Has Been Leased 1) Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the land leased to you by the additional insured person(s) or organization(s). 2) With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to lease that land; b. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured person(s) or organization(s). F. Manager or Lessor of Premise Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you by the additional insured person(s) or organization(s), subject to the following additional exclusions: This insurance does not apply to: 1) Any "occurrence" which takes place after you cease to be a tenant in that premises. 2) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. G. Mortgagee, Assignee, or Receiver Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of a premises by you. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured person(s) or organization(s). H. Controlling Interest 1) Any person( s) or organization( s) with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. 2) This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. I. Co-owner Of Insured Premises Any person(s) or organization(s) with respect to their liability as co-owner of a premises co-owned by you and covered under this insurance. J. Executors, Administrators, Trustees Or Beneficiaries Any executor, administrator, trustee or beneficiary of your estate or living trust while acting within the scope of their duties as such. CG 712506 22 A0221035 Middlesex Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 05/21/2024 4bf65817-f0cc-4360-8681-89c2889846dc Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 K. State Or Subdivision Permits Or Premises Governmental Agency Or Or Political Subdivision - Authorizations Relating To Any state or governmental agency or subdivision or political subdivision, subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: 1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or 2) The construction, erection or removal of elevators; or 3) The ownership, maintenance or use of any elevators covered by this insurance. L. Vendors 1) Any person(s) or organization(s) (referred to throughout this endorsement as vendor), but only with respect to liability for "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: a. The insurance afforded to such vendor only applies to the extent permitted by law; and b. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or 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: (1) The exceptions contained in Subparagraphs d. or f.; or Page 4 of 5 A0221035 Middlesex Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 712506 22 05/21/2024 4bf65B 17-tocc-4360-8681-89c2889846dc Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 (2) 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. M. Grantor of Franchise Any person(s) or organization(s) with respect to their liability as grantor of a franchise to you. However: 1. The insurance afforded to such additional insureds 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. 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. If there is any difference in coverage afforded to an additional insured in this endorsement and that provided under another additional insured endorsement attached to this policy, the broader coverage will apply to that additional insured. 2. Primary And Noncontributory Insurance The following is added to the Other Insurance Condition and supersedes any provision to the contrary: 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. 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic 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 any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 712506 22 A0221035 Middlesex Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 05/21/2024 4bl65817-l0cc-4360-8681-89c2889846dc Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 POLICY NUMBER: A0221035001 COMMERCIAL AUTO CA 76 01 0615 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED -PRIMARY AND NONCONTRIBUTORY -COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Nissho of California Inc Endorsement Effective Date: 06/01/2024 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the "accident" 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 person or organization. CA 76 01 0615 A0221035 Middlesex Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 05/31/2023 1 00001 0000000000 23151 0 N f642bc80-f3c7-4719-a 125-397f6c3e6330 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 POLICY NUMBER: A0221035001 COMMERCIAL AUTO CA 04 4410 13 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: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Nissho of California Inc Endorsement Effective Date: 06/01/2024 Name(s) Of Person(s) Or Organization(s): SCHEDULE Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to thelJaccident" or the "loss" under a contract with that person or organization. CA 04 4410 13 A0221035 Middlesex Insurance Company 1 00001 0000000000 23151 0 N © Insurance Services Office, Inc., 2011 9598133a-b583-4228-823e-Oe0a81 ac3051 Page 1 of 1 05/31/2023 Docusign Envelope ID: 5149670C-9CA9-4F74-A595-4BCB250A5164 Policy Number: CPW1002531 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company WC 04 03 06 (Ed. 04-84) 6/1/2024 Policy No. CPW1002531 Nissho of California, Inc CorePointe Insurance Company Endorsement No. 0 Premium$ Countersigned by __________________ _