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HomeMy WebLinkAboutAthletic Turf Solutions; 2019-12-04; PKRC11041CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ALGA NORTE COMMUNITY PARK -SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Tracking#: This agreement is made on the ?:t::\:h day of Usz (,~n g r:' , 20.ft, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"}, and Athletic Turf Solutions whose principal place of business is 1784 Felicita Lane, Vista CA 92083 (hereinafter called "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, 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) WAGE RATES. 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 Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer'' for the purposes of section 4107 and 4107. 5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 1 of 8 City Attorney Approved 1/25/2019 Tracking#: 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 agreement 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 years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or ubcontractor from articipating 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 of Injuries including accidental death, to any one person in an amount not less than ........ $1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ....... $1,000,000 Property damage insurance in an amount of not less than ........ $1,000,000 Automobile Liability Insurance in the amount of $1,000,000 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 thirty (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. ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 2 of 8 City Attorney Approved 1/25/2019 Tracking#: INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from 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. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within 15 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 20 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II II Athletic Turf Solutions (name of Contractor) 840523 (Contractor's license number) C12/D12, 06/30/2020 (license class. and exp. date) 1000528949 (DIR registration number) 6/30/2020 (DIR registration exp. date) ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 3 of 8 1784 Felicita Lane (street address) Vista, CA 92083 (city/state/zip) 619-316-8804 (telephone no.) (fax no.) athleticturfsolutions@yahoo.com (e-mail address) City Attorney Approved 1/25/2019 Tracking#: AUTHORITY. The individuals executing this Agreement 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 Agreement. CONTRACTOR (sign here) CITY OF CARLSBAD, a municipal corporation of the State of California By: 1-ArnA/?A /j. :f?Rrr~N, PARTrJC¢'__ \ (print ~ffie) -' y Manager, Deputy City Manager or Department Director as authorized by the City Manager By: ~ (sign here) JlfYl-es D .f3fzt;Eocj\) . @R:rNE rz (print name/title) BARBARA ENGLESON City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f_g corporation, Agreement 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: CELIA A. BREWER, City Attorney BY, ~ 5'~ AC~oLCiy Atty ~,--;-) ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 4 of 8 City Attorney Approved 1/25/2019 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 sub-contractor 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 sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor 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 Portion of Project to Business Name and Address be Subcontracted NoNt: Total% Subcontracted: ______ _ ALGA NORTE COMMUNITY PARK SKA TE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 5 of 8 DIR Registration No. License No., %of Classification & Total Expiration Date Contract City Attorney Approved 1/25/2019 Tracking#: EXHIBIT B Athletic Turf Solutions will remove existing synthetic turf, grade subsurface to level, and install new synthetic turf. JOB QUOTATION Scope of Work Remove existing synthetic turf grass and dispose (debris bin provided by City). Assess current base and re-grade with decomposed granite. Assess existing header board for synthetic turf grass edge attachment and make corrections. Install synthetic turf grass (Desert Rye 80 oz) 2 inch soft two tone green with brown and green thatch. Cut and splice synthetic turf grass in designated areas and attach turf edge to existing header board. Start brooming the fibers upward to allow in-fill material to be dropped to the bottom of the turf backing. In-fill material will be Easyfill (round anti bacterial sand), approximately 2.5 lbs per sq. ft. to help reduce fiber compaction and to allow cushion for heavy foot traffic. Continue brooming turf fibers until the material simulates a natural manicured lawn. Area 1 north of skate park edge -dog bone approx. 529 sq ft Area 2 right side of skate park -eye shape approx. 400 sq ft Area 3 south end -mini amphitheater approx. 1380 sq ft Area 4 south left curbside approx. 1400 sq ft Area 5 far left near restrooms approx. 354 sq ft Total: 4063 SQ ft Cost: Removal of existing material and base preparation:$ 20,146.00 Turf Installation: $ 39,382.00 TOTAL: $ 59,528.00 Note: The City of Carlsbad, Parks Maintenance Division will provide the dumpster(s), hauling off demolished material, and temporary traffic control (as-needed). Agreement amount shall not exceed $59,528.00 ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 6 of 8 City Attorney Approved 1/25/2019 EXHIBIT C LABOR AND MATERIALS BOND Tracking#: 72212873 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Athletic Turf Solutions (hereinafter designated as the "Principal"), a Contract for: ALGA NORTE COMMUNITY PARK -SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 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. NOWWTHEREFORE, WE, Athletic Turf Solutions, as Principal, (hereinafter designated as the "Contractor"), and estern Surety Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of Fifty-nine thousand five hundred twenty eight Dollars ($59,528), 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 lime, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC11041 Page 7 of 8 City Attorney Approved 1/25/2019 Tracking#: 72212873 In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonera te the Surety from its obligations under this bond. Executed by CONTRACTOR this ,d<';~ day of )Jov~b-VY . 20 fj . CONTRACTOR: , A+A trt,·0 Tu:rf '5of ul-tcr,,s (name of Contractor) By:lJ~lffrud~ (sign here) TArnA~ H-Bf<ic.bb'Elv (print name here) By: ~ A f\'\£5 J> . Is RE.EDE rv (print name here) (title and organization of signatory) Executed by SURETY this 13th day of November 20.19._. SURETY: By: Western Surety Company (name of Surety) 101 South Reid Street Sioux Falls, SD 57103 (address of Surety) Aleka Dawn Brid es (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs. the corporation must att ach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER City Attorney By: (1 ~ ~ / As.i..~Oty Attorney a ~ ALGA NORTE COMMUNITY PARK SKATE PARK TURF REPLACEMENT CONT. NO. PKRC 11041 Page 8 of B City Attorney Approved 1/25/2019 Western Surety Company POWER OF ATTORNEY -CERTIFIED COPY Bond No. ___ 7_2_;::_,_1_2_8_-_I .3 ____ _ Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents malu>, comtitute and appoint Ale}:a Dawn __ Dri--:lgec-~.s~--------~-------~----- its true and lawful attorney(.-)-in-fact. "~th full power and authority hereby conferred, to execute, acknowledge and deli Yer for and on its behalf as Sm·ety, bonds for: Principal: Ath:..etic T1Jr·: so:..utic:1s <:1bligee: Cit~· of ,.=:arlsbad Amount: $1,000,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Vice President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in-fact may do within the above stated limitations. Said appointment is made under and by authority of the follow~ng bylaw of Western Sm·ety Company which remains in full force and effect. "Section 7 All bonds, policies. undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name-of the r:omp,my by the Presicknt, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other ofiic·.,rs as the Board ofDired0.-,rs may authorize. The President. ,m,• i'ice President. Secretary. any Assistant Secretary, or the Treasm·er may appoint Attornpy, in F:tct or agent, who shall hm·e auth,)rity to issue bonds. policies, or undertaldngs in the nan1e of the Company. The corporate ,eal is not necessary for the ,·aJidity of any bonds. policies, tmdertaldngs, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." If Bond No. -; 2 ·· 12 8 7 3 is not issued on or before midnight of December 20, :::019 , all authority conferred in this Power of Attorney shall expire and terminate. t..\\Hr-r.~;~,,, IJ;¥~¼,~~f~. Western Smety Company has caused these presents to be signed by its Vice President, Paul T. I3ruflat, and its cor{l~~aJ·t't1·bi;.~this 13t!1 dayof Nc,ve:nter , ?(119 . (] .• , 4 _r_'._:;<;;~ W/1 ~~ ,;!l, :' ••::"~ -~ -;*>·. t2f it t~ t:';w .-'f! ·i S'PJ1.Tt'Of S01.7rH.8~ . irA 1:r>,. :~Ir::.•·· ·~•·•·',.. "' ... :,· cmitrtbitt!N-~ "' -"''#:'f?St ::s;J.l;~l .. On this 13th day of N c.>veml::,er , in the :,ear 2 1) 19 , before me, a notary public, personally appeared Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN SURETY CO.MP ANY and acknowledged said instrument to be the voluntary act and deed of said corporation. +~~~~~~~~~~~~~~~~~~~~~~~~· ~ J.MOHR ~ ~ I I Q."--vY"> $~NOTARY PUBLIC.(AA)$ Notary Public -South Dakota 8 SOUTH DAKOTA 1 I I +~~~~~~~~~~~~~~~~~~~~~~~· M:: r:·:,rrcii.ccsi:,n Ez,:,ir-?s Jun8 r:, .2021 I the tmdersigned officer of \Ve.stern Surety Company, a stock corporation of the State of South Dakota. do hereby certify that the attached Power of Attorney is in full force and effect and is irrev0cable., and fmthermore, that Section 7 of the b:,•laws of the Company as set forth in the Power of Attorney is now in forcP. In testimony whereof. I h,we hereunto set my hand ,rnd se;il 0f\Nestern Smety Company this ___ l ___ ,, t_h _____ clay nf 1r,:,verrJ:,er 201 •~ To validate bond authenticity. go to ·www.cnasurety.com > Owner/Obligee Senices > Validate Bond Coverage. Form F5306-10-2017 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California county of Sacramento On 11/14/2019 before me, Joe Balbiani Notary Public (insert name and title of the officer) personally appeared Aleka Dawn Bridges 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 PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. A C ORD9 I DATE (MM/00/YYYY) ~ CERTIFICATE OF LIABILITY INSURANCE 11/6/2019 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERT IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE A FFORDED 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 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER l~~~t''-' Vira Rodriguez Alta Vista Insurance Agency Pl)gNJo Extl: 8887242124 I (A/C, No): 7606301597 PO Box 1480 ~-~•L vira@altavistainsurance.com ADDRESS: INSURER($) AFFORDING COVERAGE NAIC# Vista CA 92085 INSURER A: A IAIN SPECIA L TY fNS CO 17159 INSURED INSURER B: Athletic Turf Solutions INSURER C: I 784 FELICITA LANE INSURER D: INSURER E: VISTA CA 92083 INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i,n;," LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER 'VLO~ ~, (MM/00/YYYY) (;~l5'6NWvi LIMITS ~ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 □CLAIMS-MADE [KloccuR V "''"''"V'-ru M;CN rE0 PREMISES (Ea occurrence) s 100,000 -MED EXP (Any one person) s 5,000 -A y CIP392614 09/25/2019 09/25/2020 PERSONAL & ADV INJURY $ 1,000,000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~ □PR~ □LDC PRODUCTS -COMP/OP AGG $ POLICY JECT OTHER: $ AUTOMOBILE LIABILITY (Ea acciden;tNbLI: LIMI I $ -ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ -HIRED -NON-OWNED ~vr~, UAMA{.jl: AUTOS ONLY AUTOS ONLY (Per accident) $ --$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION s $ r,'YORKERS COMPENSATION ls¥ATUTE l l U H- ~ND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ bm:~f;i:::i~ 'b1~PERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERA TIO NS / LOCATIONS / VEHICLES (ACORD 101, Additional Remar1<s Schedule, may be attached If more space Is required) The City of Carlsbad, Its Officers, Officials, Employees, Agents and Volunteers are named as additional insured per the attached endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Parks & Recreation AUTHORIZED REPRESENTATIVE 799 Pine Ave Ste 200 Vw-..,Roi<.-i8.- 1 Carlsbad CA 92008 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional i nsured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "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: 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 of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 Agency License Details The license status information shown below represents information taken from the California Department of Insurance (CDI) licensing database at the time of your inquiry. This information may not always be current. For example, items sent to the CDI may be pending review or simply may not have yet been entered into our licensing database. For instance, continuing education hours quoted may not reflect courses taken in the last 45 days. This database will reflect concluded disciplinary actions against licensees. Complaints and ongoing investigations are confidential and, therefore, not available. Section 12938 (a) of the California Insurance Code, in part, requires the CDI to make all fully executed stipulations, orders, decisions, and settlements available to the public on its Web site. You can search for key documents regarding any enforcement action the department has filed against this licensee on the Enforcement Action Documents Search Pag~. Please note Enforcement Action Documents (i.e. legal pleadings and orders generated during the enforcement action) are available on this Web site only for enforcement actions taken on or after July l, 200 l. If an enforcement action was taken prior to July I, 200 I, this Web site will only provide a summary description of the enforcement action. Documents relating to actions taken prior to July l, 2001 may be obtained by submitting a written request to the CDI. If there are enforcement actions, they will be displayed below. Please scroll down to view. Glossary of Terms Name: ALTA VISTA INSURANCE AGENCY OBA: ALTA VISTA INSURANCE AGENCY FMR: ALTA VISTA INSURANCE AGENCY INC. License#: 0561903 License type: Accident and Health License type: Casualty Broker-Agent License type: Property Broker-Agent License type: Life-Only Status: Active Status: Active Status: Active Status: Active Status Date: 08/06/1987 Exp Date: 11/30/2020 Status Date: 09/07/1978 Exp Date: 11/30/2020 Status Date: 09/07/1978 Exp Date: l l/30/2020 Status Date: 08/06/1987 Exp Date: l l/30/2020 Business Address: 1020 S. SANTA FE AVESUITEK VISTA, CA 92084 Bond Information Bond Amount: $10,000 Bond #: FX -68463882 Surety Co: 13188 -WESTERN SURETY COMPANY Company Appointments This licensee is authorized to transact on behalf of the following insurers: ACE AMERICAN INSURANCE COMPANY For: Casualty Broker-Effective: 09/13/201 l Agent PRODREJ:r/VE~ COMMEHCIAL 11/18/2019 Policy Number: 044529496 Underwritten by: 41 -Progressive Express Insurance Co. Certificate of Insurance certificate Holder Insured Agent City of Carlsbad 799 PINE AVE Carlsbad, CA 92008 ATHLETIC TURF SOLUTIONS 1784 FELICITA LANE PROG COMMERCIAL PO BOX 94739 CLEVELAND OH 44101 VISTA CA 92083 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Policy Effective Date: 12/08/2019 Insurance Coverage(s) Bodily Injury Property Damage -Combined Single Limits Uninsured Motorist Hired Auto Bodily Injury/Property Damage Employers Non Owned Auto BIPD Description of Location/Vehicles/Special Items Scheduled autos only 2003 Dodge RAM 2500 -3D7KA28DX3G744610 2007 Chrysler Aspen -1A8HX58217F503831 2004 Carson Trailer -4HXDT12274C075585 2017 RAM 2500-4HXDT12274C075585 Certificate Number 3222019132872499 Policy Expiration Date: 12/08/2020 Limits $1,000,000 CSL $300,000 CSL $1,000,000 CSL $1,000,000 CSL Comprehensive $500 Deductible/Collision $500 Deductible/Roadside Assistance/Rental Reimbursement Comprehensive $500 Deductible/Collision $500 Deductible/Roadside Assistance/Rental Reimbursement Comprehensive $500 Deductible/Collision $500 Deductible Comprehensive $500 Deductible/Collision $500 Deductible City of Carlsbad, its officers, officials, employees, agents, and volunteers are named as Additional Insured. Please be advised we will not notify certificate holders in the event of mid-term cancellation. Form 5241 (10/02) Progressive P.O. Box 94739 Cleveland, OH 44101 1-800-895-2886 PROGREIIIVE. COMMERCIAL Policy number: 04452949-9 Underwritten by: Progressive Express Ins November 18, 2019 Page 1 of 1 Certificate of Insurance Certificate Holder Additional Insured CITY OF CARLSBAD PA 799 PINE AVE CARLSBAD, CA 92008 Insured . .. . ............. . ATHLETIC TURF SOLUTIONS 1784 FELICITA LANE VISTA, CA 92083 --~~ent_ PROG COMMERCIAL PO BOX 94739 CLEVELAND, OH 44101 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. ······ ...................... . Policy Effective Date: Dec 8, 2018 Insurance coverage(s) ················· .. ····"·"•"'"'''''''''''' Bodily Injury/Property Damage Description of LocationNehicles/Special Items ~~~l!~~_le_d, .a.~t.o_s e>_n_ly ............................. .. 2003 DODGE RAM 2500 3D7KA28DX3G744610 2007 CHRYSLER ASPEN 1A8HX58217F503831 2004 CARSON TRAILER 4HXDT12274C075585 2017 RAM RAM 2500 3C6UR4HLXHG536594 Certificate number 32219A13949 Policy Expiration Date: Dec 8, 2019 Limits $1,000,000 Combined Single Limit Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form 5241 (10/02) Athletic Turf Solutions 1784 Felicita Lane, Vista, Ca 92083 License # 840523 Office: 760-757-0796 Cell: 619-316-8804 or 8807 November 4, 2019 To Whom It May Concern, This letter is written to acknowledge that Tamara H. Breeden and James D. Breeden are the sole partners of Athletic Turf Solutions -Tax ID# 33-0885627. Thank you, Tamara H. Breeden, Partner James D. Breeden, Partner ◄-► ta CONTRACTORS STATE LICENSE BOARD 9821 Business Park Drive, Sacramento, California 95827 Mailing Address: P.O. Box 26000. Sacramento, CA 95826 800-321-CSLB (2752) www.cslb.ca.gov • CheckTheLicenseFirst.com Exemption from Workers' Compensation STATE OF CALIFORNIA Governor Edmund G. Brown Jr. Before the Contractors State License Board (CSLB) can issue a new license or reinstate, reactivate, or renew an existing license, the applicant or licensee must have on file a Certificate of Workers' Compensation Insurance or a Certificate of Self-Insurance issued by the Director of Industrial Relations, or must obtain an exemption by completing and submitting this form. To be exempt from workers' compensation, an applicant or licensee must submit this form to CSLB, certifying under penalty of perjury that he or she does not employ anyone in a manner that is subject to the workers' compensation laws of California. (See Business and Professions Code Section 7125.) DO NOT SUBMIT THIS FORM IF: You have an inactive license. The license qualifier is a Responsible Managing Employee {RME). You hold a C-39 Roofing classification -all contractors with a C-39 Roofing classification are required by Section 7125 to have a Certificate of Workers' Compensation Insurance or a Certificate of Self-Insurance on file with the Board. Contractors with a C-39 Roofing classification are not eligible for exemption from workers' compensation. You have employees. For exemption from workers' compensation, complete all of the requested information in Section 1, check~ one of the boxes in Section 2. and date and sign the form in Section 3. Please type or print neatly and legibly in black or dark blue ink. SECTION 1 -REQUIRED BUSINESS NAME AND ADDRESS Business Name {as it currently appears on CSLB records) License or Application Fee Number Athletic Turf Solutions 840523 Business Mailing Address (number/street or P.O. box) City State Zip Code 1784 Felicita Lane Vista CA 92083 Business Street Address (number/street only-NO P.O. boxes) City State Zip Code Business Phone Number Business Fax Number Business E-mail Address (760 ) 757-0796 athleticturfsolutions@yahoo.com □ Check this box if the address shown above is new. CSLB will update your license I application business address of record. SECTION 2 -REQUIRED CHECK BOX YOU MUST CHECK ONLY ONE OF THE BOXES BELOW. ~ I do not employ anyone in the manner subject to the workers' compensation laws of California. OR □ I am an out-of-state contractor, and I do not hire employees who reside in California. (You must provide a certificate of insurance from your workers' compensation insurance carrier in your home state.) SECTION 3 -REQUIRED SIGNATURE I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and accurate. I understand that, upon employing anyone in a manner that is subject to the workers' compensation laws of the State of California. the claim of exemption executed under this form will no longer be valid. I also understand that, as soon as I employ anyone subject to the California's workers' compensation laws, I must obtain a Certificate of Workers' Compensation Insurance, submit that certificate to CSLB within 90 days of its effective date, and continuously maintain the coverage provided by the certificate in accordance with the law. I further understand that failure to comply with this requirement is grounds for disciplinary action. (The definition of "perjury" is telling a lie while under oath.) FALSIFICATION OF A R DISCIPLINARY ACTION. Date Printed Name of Contractor (Owner, Partner, or Officer) 5/1/18 James Breeden NOTICE ON COLLECTION OF PERSQNAL INFORMATION __ ,,,- CSLB collects the personal information 1equested on thos form as authorized by Business and Profess,ons Code Section 30. CSLB uses this information to 1denbfy and evaluate apphcants for hcensure, l~ue and renew licenses. and enforce licensing standards set by law and egulahon. Submission of the requested information is mandatory. CSLB cannot consider this Exempbon from Workers Compensation form unless you provide all of the requested information. You may review the records maintained by CSLB that contain your personal information, as permitted by the Information Practices Act. CSLB makes every effort to protect the personal information you provide us: however. 1t may be disclosed in response to a Pubhc Records Act request as allowed by the lnfonTiation Practices Act; to another government agency as required by state or federal law: or in response to a court or administrative order, a subpoena, or a search warrant. This application contains an applicant authorization for the Franchise Tax Board to disclose to CSLB any outstanding final liabihtIes for the purpose of admInistenng Business and Professions Code Section 7145.5. For more infomiation on the Information Practices Act, visit the Office of Privacy Protection·s website al www.privacy.ca.gov. I IIIIIJllllll l~lllllll ~111111~ 11111~ II 1111 13L-50 (rev. 4111) FOR CSLB USE ONLY