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HomeMy WebLinkAboutVista Fence Company Inc; 2026-06-24; PR-MPW-26011PDocusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE June24th 26 Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE WAIVER REQUEST FORM FACTORS IN SUPPORT OF REQUEST TO MODIFY INSURANCE REQUIREMENT(S) Generally, a modification to the coverage requirement will be accepting a lower limit of coverage or waiving the requirement(s). Requested by: (Name and Department) (Date) Proposed modification(s) to the __________________ requirement(s) for (Type of insurance) (Name of contract) Reduce coverage to the amount of: $ Waive coverage Other: FACTOR(S) IN SUPPORT OF MODIFICATION(S) (check those that apply) Significance of Contractor: Contractor has previous experience with the City that is important to the efficiency of completing the scope of work and the quality of the work-product. [explain] Significance of Contractor: Contractor has unique skills and there are few if any alternatives. [explain: include number of candidates RFP sent to and number responded if applicable] Contract Amount/Term of Contract: $ . Work will be completed over a period of . Professional Liability coverage is not available to this contractor or would increase the cost of the contract by $ [explain]. Other (e.g. explain why exposures are minimal, how exposures are covered in another policy, exposure control mechanisms, and any other information pertinent to your request): Approved by Risk Manager for this contract only: (Signature) (Date) Marsha Weeks, Parks & Recreation 6/9/2026 CGL/Auto/PL Joint Use School Fencing Repair Project n GL: $1M occurrence/$2M aggregate. Auto: $1M. n Waive Professional Liability n Given the scope of work, the lower insurance limits are sufficient Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE 6/24/2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 6/2/2026 INSURICA 556 N Diamond Bar Blvd. #207 Diamond Bar, CA 91765 626-214-7900 626-214-7969 Agency License #: 6011031 Sutton Specialty Insurance Company 16848 Kemper Financial Indemnity Company 39004 A 1,000,000ISCP040000795414/22/2026 4/22/2027 100,000 3 5,000 3 1,000,000 2,000,000 2,000,0003 B 50018572701 4/29/2026 10/29/2026 1,000,000 3 Roger Gutierrez RG Business Insurance Agency Inc. certificates@rgbusinessinsurance.com Vista Fence Company Inc 1131 S. Santa Fe Ave. Vista CA 92083 90883319 3 3 City of Carlsbad 799 Pine Avenue, Suite 200 Carlsbad CA 92008 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carlsbad named Additional Insured as respects General Liability per attached. Auto Liability per attached. 90883319 | 26-27 GENE 26-26 AUTO | Yvonne Pauley | 6/2/2026 3:34:12 PM (PDT) | Page 1 of 6 This certificate cancels and supersedes ALL previously issued certificates. Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE An affiliate of CDS Insurance Services / 2001 E. Financial Way, Suite 201, Glendora, CA 91741 / License #0555729 Re: Certificates of Insurance Notice of Cancellation Notification Roger Gutierrez President 6/2/2026 Vista Fence Company Inc. City of Carlsbad799 Pine Avenue, Suite 200Carlsbad CA 92008 To Whom It May Concern: This letter is to confirm that we agree to provide advance written notice of cancellation within (30) days of the effective date of cancellation should the insured’s policies cancel. With the exception of Non-payment of premium of which 10 days notice will be provided to the following: Holder: City of Carlsbad named Additional Insured as respects General Liability per attached. Auto Liability per attached. Project #: Sincerely, 90883319 | 26-27 GENE 26-26 AUTO | Yvonne Pauley | 6/2/2026 3:34:12 PM (PDT) | Page 2 of 6 This certificate cancels and supersedes ALL previously issued certificates. Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE SSI AIE ONO 00 01 0318 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUTTON SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON ORGANIZATION ONGOING OPERATIONS ONLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Project/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to “bodily injury” or “property damage” that takes place after, and the Additional Insured's status as an additional insured hereunder terminates, upon the earlier of: 1. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: Sutton Specialty Insurance Company Date: By: Time: 12:01 a.m. _______________________ ___________________________ Lloyd Yavener, President Michelle Freitag, Secretary 90883319 | 26-27 GENE 26-26 AUTO | Yvonne Pauley | 6/2/2026 3:34:12 PM (PDT) | Page 3 of 6 This certificate cancels and supersedes ALL previously issued certificates. Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE SSI AIE OOP 00 01 0318 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUTTON SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION INCLUDING PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: As required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's work. Designated Project/Location to which this endorsement applies: All Projects and Locations (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section III - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed during the policy period for the additional insured(s) at the location(s) designated above. B. This insurance does not apply to “bodily injury” or “property damage” that takes place after, and the Additional Insured's status as an additional insured terminates, upon the earlier of when: 1. All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. C. If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, the insurance afforded by the policy to the Additional Insured(s) listed in the Schedule for the described location(s) is primary insurance. Any other insurance or self-insurance maintained directly by the Additional Insured(s) is excess of this insurance and shall not contribute to it. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: Sutton Specialty Insurance Company Date: By: Time: 12:01 a.m. _______________________ ___________________________ Lloyd Yavener, President Michelle Freitag, Secretary 90883319 | 26-27 GENE 26-26 AUTO | Yvonne Pauley | 6/2/2026 3:34:12 PM (PDT) | Page 4 of 6 This certificate cancels and supersedes ALL previously issued certificates. Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE 90883319 | 26-27 GENE 26-26 AUTO | Yvonne Pauley | 6/2/2026 3:34:12 PM (PDT) | Page 5 of 6 This certificate cancels and supersedes ALL previously issued certificates. Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE 90883319 | 26-27 GENE 26-26 AUTO | Yvonne Pauley | 6/2/2026 3:34:12 PM (PDT) | Page 6 of 6 This certificate cancels and supersedes ALL previously issued certificates. Docusign Envelope ID: 5F8AFDB7-44FB-8BB0-8140-880482FFEDDE