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HomeMy WebLinkAboutKL Painting Inc; 2025-12-30; PR-MPW-25016PDocusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C December30th 25 Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT PARK BLOCKHOUSES PAINTING PROJECT; CONT. NO. PR-MPW-25016P This contract is made on the ______ day of----------~ 20_ ("Contract"), by the City of Carlsbad, California, a municipal corporation ("City") and KL Painting Inc., a California corporation whose principal place of business is 2440 Lorna Lane, Carlsbad, CA 92008 ("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 Section 1776 of the California Labor Code, which requires keeping accurate payroll records, verifying and PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 1 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: 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 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 observations or punch list items. Providing mobile access will improve communication, efficiency, and PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 2 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: 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: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers {LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners {NAIC) latest quarterly listings report. Commercial General Liability Insurance written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. Property damage insurance in an amount of not less than ........ $2,000,000 Automobile Liability Insurance in the amount of $2,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 3 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C 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 thirty (30) 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. PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page4 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C CONTRACTOR'S INFORMATION. KL Painting Inc. (name of Contractor) 899963 (Contractor's license number) C-33; 1/31/2026 (license class. and exp. date) 2000000347;6/30/2028 (DIR registration number/exp. date) 2440 Lorna Lane (street address) Carlsbad, CA 92008 (city/state/zip) 760-613-9891 (telephone no.) klpainting@gmail.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. PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P [signatures on following page] Page 5 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C CONTRACTOR By: si n her) Kody Kinney, CEO and Secretary (print name/title) (sign here) (print name/title) Tracking#: CITY OF CARLSBAD, a municipal corporation of the State of California By: Kyle Lancaster, Parks & Recreation Director ATTEST: SHERRY FREISINGER, City Clerk By: Deputy City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !LE. 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: ti~ /Jtt>IA.,$ Deputy/ Assistant City Attorney PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 6 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C 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 subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Type of Work Business Name and Address DIR Registration No. License No., to be & Expiration Date Classification Subcontracted & Expiration Date ~)A Total% Subcontracted: 0 ----="------ The Contractor must perform no less than 50% of the work with its own forces. PARK BLOCKHOUSE PAINTING PROJECT %of Total Contract CONT. NO. PR-MPW-25016P Page 7 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: EXHIBITS SCOPE OF WORK AND COST Scope of Work Summary: The contractor will perform cleaning, surface preparation, priming and painting of blockhouses located at multiple City of Carlsbad parks. Work includes both interior and exterior surfaces, with all spoils removed and properly disposed of by the contractor. The finish paint will match existing colors to maintain consistency across facilities. Chase Field -One (1) Blockhouse • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $6,000.00 Hidden Canyon Park-One (1) Blockhouse • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 8 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $6,000.00 Holiday Park -Two (2) Blockhouses • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $12,000.00 La Costa Canyon Park -One (1) Blockhouse • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint o Match existing color o Walls o Ceiling o Door jams PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 9 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $6,000.00 Laguna Riviera Park -One (1) Blockhouse • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $6,000.00 Carlsbad Skate Park -One (1) Blockhouse • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $6,000.00 PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 10 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: Pine Ave Park-One (1) Blockhouse • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats of finish paint o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $6,000.00 Poinsettia Community Park -Three (3) Blockhouses • Clean all walls, fill holes and cracks with paint filler before painting men and women interior blockhouse • Prime all surfaces to be painted o Walls o Ceiling o Door jams o Doors • Paint all surfaces with (2) two coats offinish paint o Match existing color o Walls o Ceiling o Door jams o Doors; exterior and interior sides • All spoils will be hauled off and disposed of by the contractor COST: $18,000.00 Subtotal: $66,000.00 Labor & Materials Bond: $1,650.00 TOTAL COST*: $67,650.00 *Includes taxes, fees, prevailing wage, labor and materials bond, expenses and all other costs. PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 11 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: Bond Number: UCSX372X8233 EXHIBITC LABOR AND MATERIALS BOND WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to KL Painting Inc. (hereinafter designated as the "Principal"), a Contract for: PARK BLOCKHOUSE PAINTING PROJECT CONTRACT NO. PR-MPW-25016P 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, KL Painting Inc., as Principal, (hereinafter designated as the "Contractor"), and United Surety Insurance Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of Sixty Seven Thousand Six Hundred Fifty 0/100 dollars ($67,650), 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, PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 12 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: 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. 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 _9_th ___ day of December KL Painting Inc (SEAL) United Surety Insurance Company(SEAL) -------------(Pr in ci pa 1) (Surety) By: __ ~---,,...-,~-z-~O ___ By:~~ ~1"~ Shaun Sullivan (Signature) Attorney In Fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTl~ICATE) APPROVED AS TO FORM: CINDIE K. McMAHON City Attorney By: 1114-1 Lw)I/\,$ Deputy/ Assistant City Attorney PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 13 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C 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 Ohio County of ___ H_a_m_ilt_o_n _____ _ before me Jessica M. Doll, Notary Public '------------------(insert name and title of the officer) personally appeared ___ S-=--V\--'-~--'-V<\ __ _.:::5_u_\_\_\ V_t\_Y\_____c_ _________ _ 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 Ohio that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signatu (Seal) \,,,,,1111tllH11111111, (~;!.~~~~) . : < : " l JESSICA M. DOLL Notary Public, State of Ohio My Commission Expires: April 15, 2028 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C ucs POWER OF ATTORNEY 171372 KNOW ALL MEN BY THESE PRESENTS: That United Casualty and Surety Insurance Company, a corporation of the State of Nebraska, and US Casualty and Surety Insurance Company and United Surety Insurance Company, assumed names of United Casualty and Surety Insurance Company (collectively, the Companies), do by these presents make, constitute and appoint: Kelly Specht, Kandis Gregory, Anthony Balzano, JoAnn Smith, Cynthia S. Richter, Richard J. Taylor, Madeline Brown, Zachary R. Bradley, Donna Stolzenbach Felicia Thomas, Dawn E. Gittens, Rick Bredow, Ralph Earl Brown Ill, Ann Robertson, Kenda Freeman, Alexis Estrada, Deborah Perry, Shaun Sullivan its true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyshlp to include riders, amendments, and consents of surety, providing the bond penalty does not exceed Three Million Five Hundred Thousand & 00/100 Dollars ( $3,500,000.00 ). This Power of Attorney shall expire without further action on December 31''. 2026. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Board of Directors of the Companies at a meeting duly called and held on the l't day of July, 1993: Resolved that the President, Treasurer, or Secretary be and they are hereby authorized and empowered to appoint Attorneys-in-Fact of the Company, in its name and as its acts to execute and acknowledge for and on its behalf as Surety any and all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so executed by such Attorneys-in-Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected Officers of the Company in their own proper persons. That the signature of any officer authorized by Resolutions of this Board and the Company seal may be affixed by facsimile to any power of attorney or special power of attorney or certification of either given for the execution of any bond, undertaking, recognizance or other written obligation in the nature thereof; such signature and seal, when so used being hereby adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereunto affixed, this 14th day of March, 2025 Corporate Seals Commonwealth of Massachusetts County of Suffolk ss: UNITED CASUALTY AND SURETY INSURANCE COMPANY US Casualty and Surety Insurance Company United Surety Insurance Company R. Kyleliler, Treasurer On this 14th day of March, 2025 before me, Colleen A. Cochrane, a notary public, personally appeared, R. Kyle Fowler, Treasurer of United Casualty and Surety Insurance Company, US Casualty and Surety Insurance Company and United Surety Insurance Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person(s). or the entity on behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the Commonwealth of Massachusetts that the foregoing paragraph is true and correct. WITNESS my hand and seal. "' COLLEEN A. COCHRANE \ t«it31Y Pubac. Col!llro'l'llealth of Mmachlnells My Comiris~on Elp:res 10iW2028 I, Robert F. Thomas, President of United Casualty and Surety Insurance Company, US Casualty and Surety Insurance Company and United Surety Insurance Company do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Boston, Massachusetts this __ 9_th _____ day of December ----------------~· 2025 Corporate Seals Robert F. Thomas, President TO CONFIRM AUTHENTICITY OF THIS BOND OH DOCUMENT EMAIL: CONFIRMBOND@UNITEDCASUALTY.COM Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C Tracking#: EXHIBITD 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. PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 14 City Attorney Approved 6/5/2024 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C 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: □ The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. D The Fleet is exempt from the Regulation under Section 2449.l(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. D Contractor and/or their subcontractor is unable to procure R99 or RlO0 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). p?l. The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached to this certification. Name of Contractor: ""K=-L '-Pa=i""'nt=in""'g"""l""'n""c.'-------------- Signature:_,t~--~~- Name: Kody Kinney Title: CEO and Secretary Date: \ 2: / \ \ } }. 5 l I PARK BLOCKHOUSE PAINTING PROJECT CONT. NO. PR-MPW-25016P Page 15 City Attorney Approved 6/5/2024 07/11/2025 Rock 10 Insurance Services 7125 El Cajon Boulevard Ste. 8 San Diego CA 92115 Chandra Myslin (866) 376-2510 service@rock10insurance.com KL Painting Inc 2440 Lorna Lane Carlsbad CA 92008 Continental Casualty Company 20443 Infinity Select Ins Co 20260K 25-26 MASTER CERTIFICATE A Y Y C6984546722 05/27/2025 05/27/2026 2,000,000 100,000 5,000 2,000,000 4,000,000 4,000,000 B 50011866901 06/27/2025 06/27/2026 1,000,000 Re: All Projects. Additional Insured status applies to City of Carlsbad under the Commercial General Liability Policy subject to attached endorsements. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta CA 92564 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C ACORD® I ~ I X I [8] - - ~ [8] □ - -- -- -- -H I I I I I □ I BEST CHOICE CONTRACTOR PROGRAM Blanket Additional Insured - Owners, Lessees or Contractors Submission No:QCN07274351-2 Policy No:C6984546722 Page 1 of 2 Effective Date:05/27/2025 Insured Name :KL PAINTING INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc. used with permission. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number:C6984546722 Endorsement Effective:05/27/2025 at 12:01 a.m. Named Insured: KL PAINTING INC SCHEDULE Name of Additional Insured Person(s) or Organization(s): (Blanket)(Specific) Any person or organization that the Named Insured is obligated by virtue of a written contract or written agreement to make an additional insured on this Coverage Part, provided such contract or agreement: Is currently in effect or becomes effective during the policy period; and Was executed prior to: a.the bodily injury, or property damage; or b.the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. and Location(s) of Covered Operations: Any location in the “coverage territory”that is subject to the contract or agreement specified above.and A.Section II – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that 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 part of the same project. C.With respect to the insurance afforded to these additional insureds, this insurance also does not apply to 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. D.Primary and Noncontributory Insurance If so required by a written contract or written agreement, this insurance will be primary to, and will not seek contribution from, other insurance under which the additional insured is a named insured. But in all other Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C I BEST CHOICE CONTRACTOR PROGRAM Blanket Additional Insured - Owners, Lessees or Contractors Submission No:QCN07274351-2 Policy No:C6984546722 Page 2 of 2 Effective Date:05/27/2025 Insured Name :KL PAINTING INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc. used with permission. instances, and notwithstanding anything to the contrary in the condition entitled Other Insurance, this insurance will be excess of any other insurance available to the additional insured. E.Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following to the condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit: Any additional insured pursuant to this Coverage Part will, as soon as possible: 1.Give us written notice of any claim, or of any occurrence or offense that may result in a claim; 2.Send us copies of all legal papers received and otherwise cooperate with us in the investigation, defense or settlement of the claim; and 3.Make available any other insurance and tender the defense and indemnity of any claim to any other insurer or self-insurer whose policy or program applies to a loss that we cover under this Coverage Part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. F.Solely with respect to the insurance granted by this endorsement: 1.The words “you” and “your” refer to the Named Insured shown in the Declarations. 2.Your work means work or operations performed by you or on your behalf, and materials parts or equipment furnished in connection with such work or operations. G.Blanket Waiver of Subrogation We waive any right of recovery we may have against an entity that is an additional insured under the terms of this endorsement with respect to payments we make for injury or damage arising out of your work done under a written contract or written agreement with that person or organization, provided such contract or agreement: 1.Requires such a waiver of our rights; 2.Is currently in effect or becomes effective during the policy period; and 3.Was executed prior the bodily injury, property damage or personal and advertising injury that gave rise to the claim. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C BEST CHOICE CONTRACTOR PROGRAM General Aggregate Limit - Per Project Endorsement CNA97898XX (4-2020)Policy No: Page 1 of 1 Endorsement No: Effective Date: Insured Name: Copyright CNA All Rights Reserved. Includes material copyrighted by Insurance Services Office, Inc. used with their permission. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I.For each single construction or service project away from premises the Named Insured owns or rents, a separate Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: A.all damages under Coverage A, except damages because of “bodily injury”or “property damage” included in the “products-completed operations hazard;”and B.all medical expenses under Coverage C; that arise from “occurrences”or accidents which can be attributed solely to ongoing operations at that project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Project General Aggregate Limit applicable to any other project. II.All: A.damages under Coverage B, regardless of the number of locations or projects involved; B.damages under Coverage A, caused by “occurrences”which cannot be attributed solely to ongoing operations at a single project, except damages because of “bodily injury”or “property damage” included in the “products-completed operations hazard”; and C.medical expenses under Coverage C, caused by accidents which cannot be attributed solely to ongoing operations at a single project, will reduce the General Aggregate Limit shown in the Declarations. III.The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the “occurrence”can be attributed solely to ongoing operations at a particular project. IV.When coverage for liability arising out of the “products-completed operations hazard”is provided, any payments for damages because of “bodily injury”or “property damage”included in the “products- completed operations hazard”will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations, regardless of the number of projects involved. V.If a single construction or service project away from premises owned by or rented to the Named Insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, such project will still be deemed to be the same project. VI.The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. C6984546722 05/27/2025 KL PAINTING INC Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBRWVDADDLINSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD 10/7/2025 Ibsen Insurance Agency LLC 414 4th St Ste A Woodland CA 95695 Certificate Department 530-668-8818 530-379-2826 denise@ibseninsurance.com K L PAINTING INC 2440 LORNA LANE Carlsbad CA 92008 Mid Century Insurance Company 21687 A Y Y A09514719 10/1/2025 10/1/2026 6 1,000,000 1,000,000 1,000,000 City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services PO Box 947 Murrieta GA 92564 Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C ACORD® I ~ I ~ □ □ ~ ~ ~ □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ I BLANKET 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.) The additional premium for this endorsement shall be _____% of the California workers compensation premium otherwise due on such remuneration, subject to a minimum charge of ________. All written contracts in the state(s) of: 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 Policy No.Endorsement No. Insured Countersigned By WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 31 (Ed. 6-20) WC 99 06 31 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved. Insurance Company Insurance Company 3.0 $250 CA A0951-47-1910/01/25 K L PAINTING INC (CORP) 2440 LORNA LN CARLSBAD CA 920081034 MID-CENTURY INSURANCE COMPANY Docusign Envelope ID: 5654ED70-CC8E-48A5-865B-C216E2F9BC3C