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HomeMy WebLinkAboutCoast Recreation Inc; 2026-05-06; PR-MPW-26004PTracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 1 City Attorney Approved 12/18/2025 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P This contract is made on the ______________ day of _________________________, 20__ (“Contract”), by the City of Carlsbad, California, a municipal corporation ("City") and Coast Recreation Inc., a Delaware corporation whose principal place of business is 14688 El Molino St., Fontana, CA 92335 ("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 Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 May6th 26 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 2 City Attorney Approved 12/18/2025 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://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. CALIFORNIA AIR RESOURCES BOARD (CARB) IN-USE OFF-ROAD DIESEL FUELED FLEETS REGULATION. Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. More information about the requirements and Contractor’s required certification is provided in Exhibit D. CONSTRUCTION MANAGEMENT SOFTWARE. Procore Project Management and Collaboration System. This project may utilize the Owner’s Procore (www.procore.com) online project management and document control platform. The intent of utilizing Procore is to reduce cost and schedule risk, improve quality and safety, and maintain a healthy team dynamic by improving information flow, reducing non- productive activities, reducing rework and decreasing turnaround times. The Contractor is required to create a free web-based Procore user account(s) and utilize web-based training / tutorials (as needed) to become familiar with the system. Unless the Engineer approves otherwise, the Contractor shall process all project documents through Procore because this platform will be used to submit, track, distribute and collaborate on project. If unfamiliar or not otherwise trained with Procore, Contractor and applicable team members shall complete a free training certification course located at http://learn.procore.com/procore-certification-subcontractor. The Contractor is responsible for attaining their own Procore support, as needed, either through the online training or reaching out to the Procore support team. It will be the responsibility of the Contractor to regularly check Procore and review updated documents as they are added. There will be no cost to the Contractor for use of Procore. It is recommended that the Contractor provide mobile access for Windows, iOS located at https://apps.apple.com/us/app/procore-construction-management/id374930542 or Android devices located at https://play.google.com/store/apps/details?id=com.procore.activities with the Procore App installed to at least one on-site individual to provide real-time access to current posted drawings, specifications, RFIs, submittals, schedules, change orders, project documents, as well as any deficient Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 3 City Attorney Approved 12/18/2025 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. CONTRACTOR PERFORMANCE EVALUATION. The City will use a standardized Contractor Performance Evaluation (“Evaluation”) to assess the Contractor’s effectiveness, reliability, and overall quality of performance under this Contract. Performance will be evaluated across key categories like specifications & standards, responsiveness, cost control, communication, and safety & risk management, using a standardized rating scale described in the Evaluation form. The Evaluation will serve as a formal record of Contractor’s performance and is intended to promote accountability, transparency, and continuous improvement in the Contractor's execution of the work. The City will provide the Contractor with the current Evaluation form and full list of performance criteria at the start of the Project, typically during the pre-construction meeting or initial kickoff. Evaluations may be completed by the Engineer or other designated City representative. The Contractor may provide written comments or responses to the completed Evaluation, which the City will retain with the Evaluation record. Evaluation results may be considered in future City procurements, responsibility determinations, and Contract renewals. Corrective actions for unsatisfactory performance may include written notice, corrective action plans, withholding of payment, suspension of work, termination for cause, and other remedies permitted by this Contract or law. Evaluations may occur at substantial completion, final completion, or when performance issues arise. Nothing described in this section limits the City’s discretion to enforce Contract remedies or take any other action permitted under this Contract or applicable law. 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. Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 4 City Attorney Approved 12/18/2025 Signature: ___________________________________ Print Name: ___________________________________ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers’ Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance written on an “occurrence” basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. Property damage insurance in an amount of not less than……..$2,000,000 Automobile Liability Insurance in the amount of $2,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non-scheduled. The automobile insurance certificate must state the coverage is for “any auto” and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that 30 days written notice shall be given to the City prior to such cancellation. 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 Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Jack Striegel Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 5 City Attorney Approved 12/18/2025 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 fifteen (15) 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. Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 6 City Attorney Approved 12/18/2025 CONTRACTOR’S INFORMATION. Coast Recreation Inc. 14688 El Molino St. (name of Contractor) 1059735 (street address) Fontana, CA 92335 (Contractor’s license number) B, C61, D12, D34; 10/31/2027 (city/state/zip) 714-619-0100 (license class. and exp. date) 1000748830; 6/30/2026 (telephone no.) nrichmond@coastrecreation.net (DIR registration number/exp. date) (e-mail address) AUTHORITY. The individuals executing this Contract and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Contract. [signatures on following page] Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 7 City Attorney Approved 12/18/2025 CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California Coast Recreation Inc., a Delaware corporation By: By: (sign here) Kyle Lancaster, Parks & Recreation Jack Striegel, CEO and Secretary (print name/title) ATTEST: By: SHERRY FREISINGER, City Clerk (sign here) By: Deputy City Clerk (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Contract must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: _____________________________ Deputy / Assistant City Attorney Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 8 City Attorney Approved 12/18/2025 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Type of Work to be Subcontracted Business Name and Address DIR Registration No. & Expiration Date License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than 50% of the work with its own forces. Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 967975 B C61/D34 Tot Lot Pros - 14688 El Molino St., Fontana, CA 92335 42%1000002374 Exp. 6/30/2028 Labor 42% Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 9 City Attorney Approved 12/18/2025 EXHIBIT B SCOPE OF WORK AND COST Summary: Contractor will demolish and remove the existing deck and chain ladder at Calavera Hills Community Park playground. Contractor will provide all required materials and will furnish and install a replacement ladder with all necessary parts. ITEM NO. UNIT QTY DESCRIPTION PRICE 1 $7,591 1 TurboTwister™ Tunnel Slide - TAN for 96" Deck (DB Only). Slide Supports - TAN, Clamps - GREEN $7,591.00 2 $2,150 1 Mobilization to include providing and maintaining Security Fence for the duration of the project. $2,150.00 3 $9,750 1 Demo and dispose of existing TurboTwister™ Tunnel Slide 96" ***Price includes replacing all 3 footings, and disposal of spoils.*** ***Pricing Based on Prevailing Wages*** $9.750.00 Materials Total $7,591.00 Sales Tax (7.75%) $588.30 Freight $3,250.00 Labor Total $11,900.00 TOTAL* $23,329.30 Exclusions The contractor will not be responsible for any damage incurred by unmarked service lines (irrigation mainlines, lateral pipes, wires, etc.). City staff will repair all damages incurred during the project that have not been marked by means of paint, feathers, flags, etc. *Includes prevailing wage, taxes, fees, expenses and all other costs. Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 10 City Attorney Approved 12/18/2025 EXHIBIT D In-Use Off-Road Diesel-Fueled Fleet Regulation Requirements CARB implemented amendments to the In-Use Off-Road Diesel Fueled Fleets Regulations that apply broadly to all self-propelled off-road diesel vehicles 25 horsepower or greater and other forms of equipment used in California. More information about the requirements can be found at https://ww2.arb.ca.gov/our-work/programs/use-road-diesel-fueled-fleets-regulation Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. The City is a “Public Works Awarding Body,” as that term is defined under Title 13 California Code of Regulations Section 2449(c)(46). Accordingly, the Contractor must submit, with their pre-award contract documents, valid Certificates of Reported Compliance (CRC) for the Contractor’s fleet, and for the fleets of any listed subcontractors (including any applicable leased equipment or vehicles). Failure to provide a valid CRC, will limit the city’s ability to proceed with awarding this Contract. Contractor has an on-going obligation for term of this Agreement to provide copies of Contractor’s, as well as all listed subcontractors, most recent CRC issued by CARB. Throughout the Project, and for three (3) years thereafter, Contractor shall make available for inspection and copying any and all documents or information associated with Contractor’s and subcontractors’ fleet including, without limitation, CRC, fuel/refueling records, maintenance records, emissions records, and any other information the Contractor is required to produce, keep or maintain pursuant to the Regulation upon two (2) calendar days’ notice from the City. Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Tracking #: CALAVERA HILLS COMMUNITY PARK TURBOTWISTER SLIDE REPLACEMENT CONT. NO. PR-MPW-26004P Page 11 City Attorney Approved 12/18/2025 EXHIBIT D (CONT.) IN-USE OFF-ROAD DIESEL-FUELED FLEET REGULATION CERTIFICATION Contractor hereby acknowledges that they have reviewed the CARB’s policies, rules and regulations and are familiar with the requirements of In-Use Off-Road Diesel-Fueled Fleet Regulation. Contractor hereby certifies, subject to the penalty of perjury, that the option checked below relating to the Contractor’s fleet, and/or that of their subcontractor(s) (“Fleet”) is true and correct: ☐ The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. ☐ The Fleet is exempt from the Regulation under Section 2449.1(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. ☐ Contractor and/or their subcontractor is unable to procure R99 or R100 renewable diesel fuel as defined in the Regulation pursuant to Section 2449.1(f)(3). Contractor shall keep detailed records describing the normal refueling methods, their attempts to procure renewable diesel fuel and proof that shows they were not able to procure renewable diesel (i.e., third party correspondence or vendor bids). ☐ The Fleet is exempt from the requirements of the Regulation pursuant to Section 2449(i)(4) because this Project has been deemed an “emergency”, as that term is defined in Section 2449(c)(18). Contractor shall only operate the exempted vehicles in the emergency situation and records of the exempted vehicles must be maintained, pursuant to Section 2449(i)(4). ☐ The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached to this certification. Name of Contractor: Coast Recreation Inc. Signature: Name: Title: CEO and Secretary Date: Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 X Jack Striegel 4/24/2026 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 5/5/2026 License # 0E02096 35351 Coast Recreation, Inc. 14688 El Molino St Fontana, CA 92335 37532 10346 A 1,000,000 X X PL264436307 9/1/2025 9/1/2026 500,000 20,000 1,000,000 2,000,000 2,000,000 1,000,000B PL264436307 9/1/2025 9/1/2026 3,000,000A XSE76564504 5/4/2026 9/1/2026 3,000,000 3,000,000 C X EIG541587502 12/1/2025 12/1/2026 1,000,000 Y 1,000,000 1,000,000 IF ANY FORMS ARE REFERENCED BELOW OR ATTACHED TO AND PART OF THIS CERTIFICATE, THEY WILL APPLY AS REQUIRED PER WRITTEN CONTRACT OR WRITTEN AGREEMENT BETWEEN THE LISTED PARTIES AND THE INSURED AND ARE SUBJECT TO THE POLICY PROVISIONS. IN THE ABSENCE OF SUCH WRITTEN CONTRACT OR WRITTEN AGREEMENT, THE REFERENCED OR ATTACHED FORMS MAY NOT BE APPLICABLE. The City of Carlsbad, its officials, employees and volunteers must be named as an Additional Insured as respects General Liability per attached form ESG3206 01/16 including Primary Non Contributing wording and Waiver of Subrogation. 30 Day notice of Cancellation applies per policy provisions. Workers' Compensation Waiver of Subrogation applied per attached form #WC040306. City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, CA 92008 COASREC-02 SURAJMUNGATH DiBuduo & DeFendis Insurance Brokers, LLC 6873 N. West Ave, Ste 101 Fresno, CA 93711 Dia Mathews, CLCS dia.mathews@dibu.com Great American Risk Solutions Surplus Lines Insurance Company Great American E&S Insurance Company Employers Preferred Insurance Company X X X X X X X X Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 ACORD8 I ~ I I I I I I ~ ~ ~ ~ ~ ~ ~ I I I I I I I I I PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company ESG 3206 (Ed. 01 /16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL TY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This is a summary of the various additional coverages and coverage modifications provided by this endorsement. For complete details on specific coverages, consult the Policy wording. Coverage Limit of Insurance Page Non-Owned Aircraft Included 2 Non-Owned Watercraft Included 2 Medical Payments Increased Limits $20,000 3 Who Is An Insured: Broadened Named Insured Included 3 Who Is An Insured: Fellow Employee Included 3 Who Is An Insured: Newly Formed or Acquired Organizations Included 4 Knowledge of Occurrence, Claim or Suit Included 4 Unintentional Errors Or Omissions Included 4 Personal & Advertising Injury Amendment of Discrimination or Included Humiliation 4 Incidental Malpractice Liability Included 5 Additional Insured: Owners, Lessees, and Contractors Included 5 Additional Insured: Vendors Included 6 Primary and Non-Contributory Extension Included 8 Damage to Premises Rented to You (Fire, Lightning, and $500,000 "Explosion") 8 Waiver of Subrogation Included 9 Property Damage -Elevators Included 9 ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 1 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company Coverage Limit of Insurance Page Contractual Liability for Railroad Exposures Included 10 Supplementary Payments: Bail Bonds $2,500 10 Supplementary Payments: Loss of Earnings $500 10 Amended Bodily Injury Definition Included 10 A. Non-Owned Aircraft Under paragraph 2. Exclusions of SECTION I -COVERAGES -Coverage A -Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided: 1. it is not owned by any insured; 2. it is hired, chartered or loaned with a trained paid crew; 3. the pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. it is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non-Owned Watercraft Under paragraph 2. Exclusions of SECTION I -COVERAGES -Coverage A -Bodily Injury and Property Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) less than 55 feet long; and (b) not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply to watercraft 27 to 55 feet long if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 2 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company C. Medical Payments Increased Limits Unless Coverage C -Medical Payments, or the Product-Completed Operations Hazard has been excluded from this Policy, the following applies: Under paragraph 2. Exclusions of SECTION I -COVERAGES, Coverage C -Medical Payments, exclusion f. Products-Completed Operations Hazard is replaced by the following: f. Product-Completed Operations Hazard Included within the "products-completed operations hazard." However, this exclusion does not apply to expenses for dental services. The Medical Expense Limit in paragraph 7. of SECTION Ill -LIMITS OF INSURANCE is replaced by the following Medical Expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $20,000; or b. the amount shown in the Declarations for Medical Expense Limit This provision 7. is subject to all the terms of SECTION Ill -LIMITS OF INSURANCE D. Who Is An Insured: Broadened Named Insured Under SECTION II -WHO IS AN INSURED, the following item 2.e. is added: e. Any subsidiary and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of voting stock on the effective date of this Coverage Part. The insurance afforded herein for any subsidiary not named in this Coverage Part as a Named Insured does not apply to injury or damage with respect to which an insured under this Coverage Part is also an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its Limits of Insurance. E. Who Is An Insured: Fellow Employee 1. The following is added to paragraph 2.a.(1) of SECTION II -WHO IS AN INSURED Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business. However, none of these co-"employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectible insurance available to your "employee" or "volunteer worker." ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 3 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company F. Who Is An Insured: Newly Formed or Acquired Organizations Paragraph 3. of SECTION II -WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. coverage under this provision is afforded only until the next occurring annual anniversary of the beginning of the policy period shown in the Declarations, or the end of the policy period, whichever is earlier; and b. coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization; and d. records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. G. Knowledge of Occurrence, Claim or Suit Under SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any "occurrence", claim, or "suit" by any agent, servant or "employee" of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such "occurrence", claim or "suit" shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership; or c. an executive officer or insurance manager, if you are a corporation. H. Unintentional Errors or Omissions Under SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: If you unintentionally fail to disclose any hazards existing at the inception date of this Policy, we will not deny coverage under this Coverage Form because of such failure. However, this does not affect our right to collect additional premium, exercise our right of cancellation or non-renewal, or enforce other legal rights based upon a material misrepresentation in response to a specific question in the application for this Policy. I. Personal and Advertising Injury Amendment of Discrimination or Humiliation Unless Coverage B -Personal and Advertising Injury Liability is excluded from this Policy or does not apply, the following applies: Under SECTION V -DEFINITIONS, paragraph 14. Personal and Advertising Injury, subparagraph h. is added: ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 4 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company h. discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) not done intentionally by or at the direction of; (a) an insured; or (b) any "executive officer," director, stockholder, partner or member of the Insured; and (2) not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured. J. Incidental Malpractice Liability 1. SECTION II -WHO IS AN INSURED is amended by deleting item 2.a.(1)(d) in its entirety and replacing it with the following: (d) Arising out of his or her providing or failing to provide professional health care services. However, this exclusion does not apply to nurses, emergency medical technicians or paramedics who are employed by you to provide medical or paramedical services. 2. Under SECTION V -DEFINITIONS, paragraph 3. Bodily Injury is replaced by the following: 3. "Bodily injury" means injury, sickness, disease or "incidental medical malpractice" sustained by a person, including death of a person. "Bodily injury" also means mental anguish, mental injury, or shock if directly resulting from physical injury, sickness, or disease to that person. 3. The following is added to SECTION V -DEFINITIONS: "Incidental medical malpractice" means "bodily injury" arising out of the negligent rendering or failure to render medical or paramedical services to persons by any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services provided you are not engaged in the business or occupation of providing any services referred to in this definition. K. Additional Insured 1. Owners, Lessees, or Contractors a. SECTION II -WHO IS AN INSURED is amended to include as an additional insured: (1) Any person or organization, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: (a.) premises or equipment you own, rent, lease or occupy; or (b.) your acts or omissions; or (c.) the acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured. However; (a.) the insurance afforded to such additional insured only applies to the extent permitted by law; and ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 5 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company (b.) if coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: (1) This insurance does not apply to "bodily injury" or "property damage" occurring after: (a.) 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 at the location of the covered operations has been completed; or (b.) 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. (2) The insurance provided to any additional insured does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional 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", or the offense which caused the "personal and advertising injury", involved the rendering or the failure to render any professional services by or for you. c. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION Ill -LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: (1) Required by the contract or agreement; or (2) Available under the applicable Limits of Insurance shown in the Declarations; Whichever is less. 2. Vendors a. SECTION II -WHO IS AN INSURED, is amended to include as an additional insured: (1.) Any person or organization (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. However: ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 6 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company (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. b. With respect to the insurance afforded to these vendors, the following additional exclusions apply: (1.) The insurance afforded the vendor does not apply to: (a.) "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; (b.) any express warranty unauthorized by you; (c.) any physical or chemical change in the product made intentionally by the vendor; (d.) repackaging, unless 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; (e.) 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; (f.) demonstration, installation, servicing or repair operations, except such operations performed by the vendor in full compliance with the manufacturer's written instructions at the vendor's premises in connection with the sale of the product; (g.) 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; (h.) "bodily injury" or "property damage" arising out of the sole negligence of the vendors for its own acts or omission of those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) the exceptions contained in subparagraphs (d.) or (f.); or (ii) 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. (2.) 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. c. With respect to the insurance afforded to these vendors, the following is added to SECTION Ill -LIMITS OF INSURANCE: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the most amount of insurance: (1.) Required by the contract or agreement; or ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 7 of 1 0) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company (2.) Available under the applicable Limits of Insurance shown in the Declarations; Whichever is less. 3. Primary and Non-Contributory Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1.) The Additional Insured is a Named Insured under such other insurance; and (2.) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an Additional Insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an Additional Insured on other policies. L. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION I -COVERAGE A -Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, or "explosion," to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in SECTION Ill - LIMITS OF INSURANCE. 2. Paragraph 6. Under SECTION Ill -LIMITS OF INSURANCE is deleted in its entirety and replaced by the following: 6. Subject to paragraph 5. Above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, or "explosion," while rented to you or temporarily ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 8 of 1 0) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company occupied by you with the permission of the owner, for all such damage caused by fire, lightning, or "explosion," proximately caused by the same event, whether such damage results from fire, lightning, or "explosion," or any combination of the three, is the higher of $500,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance item (ii) of the Occurrence Form and item (iii) of the Claims-Made Form where the words, fire insurance, appear they are changed to, insurance for fire, lightning, or "explosion." 4. As regards coverage provided by this provIsIon L. Damage to Premises Rented to You, SECTION V -DEFINITIONS, paragraph 9. Insured Contract, subparagraph a. is replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, or "explosion," to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract." 5. As regards coverage provided by this provision L. Damage to Premises Rented to You, SECTION V -DEFINITIONS is amended by the addition of the following definition: "Explosion" means a sudden release of expanding pressure accompanied by a noise, a bursting forth of material and evidence of the scattering of debris to locations further than would have resulted by gravity alone. "Explosion" does not include any of the following: (a) artificially generated electrical current including electrical arcing, that disturbs electrical devices, appliances or wires; (b) rupture or bursting of water pipes; (c) explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your control; or (d) rupture or bursting caused by centrifugal force. M. Waiver of Subrogation Under SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 8. Transfer or Rights of Recovery Against Others to Us, the following paragraph is added: b. If required by a written "insured contract" executed prior to the occurrence or offense, we waive our right of recovery we have against any person or organization named in such "insured contract," because of payments we make for injury or damage arising out of your ongoing operations or "your work" for that person or organization. N. Property Damage -Elevators 1. Under paragraph 2. Exclusions of SECTION I -COVERAGE A -Bodily Injury and Property Damage Liability, subparagraphs (3), and (4) of exclusion j. Damage to Property do not apply if such "property damage" results from the use of elevators. ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 9 of 10) PL2644363-07Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 E&S Insurance Company 2. The following is added to SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. 0. Contractual Liability for Railroad Exposures Under SECTION V -DEFINITIONS, paragraph 9. Insured Contract, subparagraph f.(1), is deleted in its entirety. P. Supplementary Payments 1. In the Supplementary Payments -Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. In the Supplementary Payments -Coverages A and B provision, paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the claim or "suit," including actual loss of earnings up to $500 a day because of time off work. Q. Amended Bodily Injury Definition Under SECTION V -DEFINITIONS, definition 3. Bodily injury is replaced by the following: 3. "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including death of a person. "Bodily injury" also means mental anguish, mental injury, or shock, if directly resulting from physical injury, sickness, or disease to that person. ESG 3 2 0 6 (Ed. 01 / 1 6) (Page 1 0 of 1 0) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) 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.) This endorsement, effective Policy No. Endorsement No.Issued to Premium By: Carrier Code (Ed. 4-84) Authorized Representative Countersigned at on at 12:01 AM standard time, forms a part of Of the WC 04 03 06 © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Schedule Person or Organization Job Description WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _____% of the California workers' compensation premium otherwise due on such remuneration. With respect to all employees subject to the workers' compensation laws of the state of California, any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2 This policy is subject to a minimum charge of $250 for the issuance of waivers of subrogation 12/01/2025 EIG 5415875 02 COAST RECREATION, INC. $5,885 00920 EMPLOYERS PREFERRED INS. CO. Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 Affirmation of Fleet Wide Compliance Certification ID: 193227 This certificate affirms that Entity ID: E92496 Tot Lot Pros 14688 El Molino St Fontana, CA 92335-6205 has attested in the Clean Truck Check electronic reporting system to report a complete list of vehicles subject to Heavy-Duty Inspection and Maintenance (HD I/M) Regulation and the California Air Resources Board (CARB) hereby verifies that as of 7/14/2025, all of the attested vehicles are compliant with the Clean Truck Check.* A complete list of the attested vehicles is listed in the following page(s). *This Affirmation of Fleet Wide Compliance shall be used for the fleet’s purposes of proving their fleet compliance status with their freight contractors and brokers. This Affirmation of Fleet Wide Compliance shall not constitute proof of a vehicle compliance with the Clean Truck Check beyond the issued date. Page 1 Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7 ~ CALIFORNIA AIR RESOURCES BOARD ~ CLEAN TRUCK CHECK S.No VIN Numbers 1 1FD0X4GT3KEG78987 Page 2 Docusign Envelope ID: 09464FF3-EF99-415C-B806-4D047CD2F2D7