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AVI Systems Inc; 2019-10-03; 2019-MPW/IT06
Tracking#: 2019-MPW/IT0G CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT EMERGENCY OPERATIONS CENTER-CR2 PROJECTOR ($60,000 or Less) This agreement is made on the ~y-.Q day of O~::\:cloe.c , 20 \'v-, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and AVI SYSTEMS INC, whose principal place of business is 7270 Trade Street, Suite 102, San Diego, CA 92121-2384 (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: Javier Ruiz (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 41 07. 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. EOC -CR2 Projector Page 1 of 11 City Attorney Approved 1/25/2019 Tracking#: 2O19-MPW/ITO6 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 subcontractor from participating in contract bidding. Signature: Print Name: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance 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. 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 EOC -CR2 Projector Page 2 of 11 City Attorney Approved 1/25/2019 Tracking#: 2019-MPW/IT06 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 30 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 45 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. 6,ame of Contractor) 192 s "-Ii (Contractor's license number) (lice~j ~a~~~nd ~~p~~t~l \ 0000 Jw~1'1 (DIR registration number) (p l 3 c f ~ ;2...'l, (DIR registration exp. date) 1 :210 -r ni.J-e S-tv-.u.:t, Ste. \02. (street address) ~Q,V"l \)\e\o, CA 9'J-.lJ.\-1~&Lf (city/state/zip) c i5 i) (pvo -43DD (telephone no.) (~5i) loq5., 1?,-1/-/ (fax no.) ~cw.vJal~h @au,?tib~S. ~ (e-mail add ss) 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 C(sign here) Cltr. 5'h4kr-~~~4 / (print name/title) LFO (signhe~7 'bPr11,~ ~'-"V'--K"'"~ 1 ~VP (print name/tit e) EOC -CR2 Projector Page 3 of 11 CITY OF CARLSBAD, a municipal corporation of the State of California I V ant City anager, Deputy City Manager or Department Director as authorized by the City Manager City Clerk City Attorney Approved 1/25/2019 Tracking#: 2019-MPW/IT06 If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f....2 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. ~-~EWrf, tity Attorney BY: vlLU(' {.!,_ Assistant City Attorney EOC -CR2 Projector Page 4 of 11 City Attorney Approved 1/25/2019 Tracking#: 2019-MPW/IT0G 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 DIR Registration License No., % of be Subcontracted No. Classification & Total Exoiration Date Contract 116)1,{, Total% Subcontracted: --~----- EOC -CR2 Projector Page 5 of 11 City Attorney Approved 1/25/2019 EXHIBITS JOB QUOTATION PRODUCTS AND SERVICES SUMMARY GSA contract GS-3SF-0230X Equipment Integration Shipping & Handhng Tax Grand Total *Includes taxes, fee's, expenses and all other costs. EOC -CR2 Projector Page 6 of 11 Tracking#: 2019-MPW/IT06 $27,414.00 $9,190.00 $845.00 $2,151.87 $39,600.87 City Attorney Approved 1/25/2019 Tracking#: 2019-MPW/ITOG SERVICES TO BE PROVIDED City of Carlsbad Emergency Operations Center • Projector install: • AVI will provide and install (3) new Epson laser proJeclors to be ceiling mounted. At each projector location will be a Barco Cl1ckshare umt. This allows for wireless presentation via USB dongle. Projectors will be controlled via manufacturer provided IR remote. • AVI will provide and install Pl new 0a-Lite wall moun1ed screens Screens will be controlled via manufacturer pro111dt.'<l 1-gang keypad. A. ExduSIOOS. The following work IS not Included in our Scope of Work: • All conduit. high voltage. wInng panels. breakers. relays. oox~~-receptaeles. etc. • Concrete saw cutting and/04 core drilling. • Fire wall. ceiling, roof and floor penetration. • Necessary gypsum llOard replacement andlo• repmr. • Necessary ceiling tile or T-bar modifications, replacements and/or repa,r. • All nullwork (moldings. trim. cut outs. etc.). • Patching and Pa1nt111g. • Permits (unless specifically pro11Ided f04 and ioon!lfied withm the contract). e. Construction Considerations. In order to accomplish the outhned goals of this project. the Customer 111111 be respoosibte for contracting with an outside entity to make the necessary modificaoons to the space as directed by AVI Systems. The costs associated with these modificatioos are not meludt.'d in this proposal. • NOTICE: This Scope of Work Is dllllventd on the basis of the following AssumptioM. The room(s) match(es) the drawwigs provided • Site prnparation by the Customer and their contractors indudes electrical and data placement per AVI Systems speaficatioo. • Site preparation will be verified by AVI Systems proJect manager or representative before scheduling of the Installatioo. All work areas should be clean and dust free poor to the beginning of on-SIie integratioo of electronic equipment. • Customer communication of readiness will be considered accurate and executable by AVI Systems project manager. • In the event of any arn11al to site that AVI Systems is not able to execute work and definable progress. the Customer will be ctiarged a $250.00 Mobilization Fee to offset the lost time due to the lack of readiness. The MobihzaltOo Fee will be presented as a Contract Change Order and will/may han work unlll acceptance by the Customer and rescheduling of the 1ntegratioo effort is agreed upon. • Rescheduling and redeplOyment of AVI Systems teehnicIans due to unacceptable site preparation may cause scheduling delays of up to 10 business days. • There rs ready access to the building,' faality and the room(s) for equipment and materials .. • There Is secure storage for equipment during a multiple--0ay mtegration. • If Customer fun"llshed equipment and existing cabl1119 is to be used. AVI Systems assumes that these rtems are in good working condition at this !lme and will integrate into the designed solution. Any repair. replacement andfor configuration of these items that may be necessary will be made at an addillOnal cost. • Alt Network configurations Includ111g IP addresses are to be provided. operationaA and funcllOnal before AVI Systems integration begins. AVI Systems will not be responsible for testing the LAN coooections. • Cable or Satellite drops must be in place willl converter ooxes operational befom the completion of mtegrallOf\. Any delay resultmg m extra work caused by late arrival of these items will resun rn a change order f04 time and materials. • Document review / feedback on drawings l correspondence will be completed by the Customer wilhrn two business days • The documented Change Control process w,11 be used to the maXJmum extent possible -the Customer will have an assigned person willl llle authority to communicateIappro11e project Field Directed Change Ofders ano Contract Change Orders (see AppendlX) • In developing a comprehensive proposal for equipment and integration services AVI Systems' Sales Represemalives and Eng.-ing teams must make some assumptions regarding the physical construction of your facility. the availability of tecmical infrastructure and site conditions for installation. If any of the conditions we have indicated in the site survey form are incorrect or have changed for your particular project or project site, please let your Sales representative know as soon as possible. Coodilions of the site found during integration effort which are different from those documented may have an effect on the price of the system soluion. integration or services. To ensure that you have an accurate proposal based on your facility and specific to the condtions of your project please review all project documentation carefuly. c. Integration P101ect Management Processes EOC -CR2 Projector Page 7 of 11 City Attorney Approved 1/25/2019 Tracking#: 2019-MPW/IT0G AVI Systems will follow a foundational project management process which may indude the following actions/deliverables (based on the s1ze/oomplexity/durat1on of the integration project): • Site Survey -performed pnor to Retail Sales Agreement and attached • Project Welcome Notice -emailed upon receipt of Purchase Order • Project Kick-Off meeting with Customer Representative(s)-either by phone or in-person • Project Status re111ews -informal or formal -either by phone or in-person (based on the size/complexity/duration of the project} • Project Change Control -cornpnsed of Field Directed Change Order and/or Contract Change Order submitbls (see Appendix) • Project Punch List I Substantial Completion (see Appendix) -at Customer walk-through -prior to Sen/ice transition (if purchased) D. Knowledge Transfer (Training) This is geared specifically towards the end-user I operator. The purpose of this knowledge transfer is to provide operators with the necessary knowledge ID confidently and comfortably operate all aspects of the integrated system. Areas covered include the following: • Equipment and system overview • Equipment operation and function • Equipment start up, stop, and shut Down • Equipment automatic and manual operation • Discussion and doct.11nentation relating to control system operation • Discussion and documentation relating ID system processor and i1s control applications • Powering up, powering clown AV system via control system • Manual operation of display systems, audio system and all other related components • Use/operation of patch panels. when and where to be used • Who to call when help is required Integration Scope of Wolk/Responsibilities AVI Systems will provide serviceslworil for the project as described above in the Scope of Work, or per the attached separate Scope of Work document detailing the scope of work to be performed. AVI Systems Responsibilities • Provide equipment. materials and service items per the contract products and services detail • Provide systems equipment integration and supervisory responsibility of the equipment integration • Provide systems configuration, validation and testing • Provide project timeline schedules • Provide necessary infonmalion, as requested, to the owner or other parties involved with this project to insure th.at proper AC electrical power, cableways, conduits and/or structural support/backing are provided to properly integrate the equipment within the facdities • Provide manufacturer supplied equipment documentation • Pl'Olride final documentation and "as built" system drawings (CAD) • Provide system training following integration to the designated Customer Representative or team member(s} Customer Responsibdities 1. Provide for the construction or modification of the facilities for soundproofing, lighting. electrical. HVAC. slJUCtural support of equipment. and decorating as appropriate 2. Provide for the ordering, provisioning, installation. wiring and verification of any Data Networit (LAN. WAN. Tl. ISDN, etc.) and Telephone Line (Analog or Digital) equipment and services prior to on-site integration 3. Provide aY necessary cableways and/or conduits required to facilitate AV systems wiring 4. Provide all necessary conduit. wiring and delllCes for technical power to the AV systems equipment 5. Provide reasonable access for AVI Systems personnel to the facilities during periods of integration, testing and training, including off-hours and weekends. 6. Provide a secure area to house all integration materials and equipment (during multi-day integration) 7. Provide a designated representative who will be available for consultation and meetings Provide timely review and approval of all documentation (Technical Reports. Drawings, Contracts, etc.) EOC -CR2 Projector Page 8 of 11 City Attorney Approved 1/25/2019 PRODUCTS AND SERVICES DETAIL PRODUCTS: 88500LS DA-LITE V11H73502D EPSON RPMAUW CHLEF CMA440 CHIEF AVI-TBD-MATERIAL AVI SYSTEMS RQ861520NA BARCO CBL-HD-6 CRE5TRON EOC -CR2 Projector Qaf{jgtigp CONTOUR TNSD 150D DMHC Pro L 11 00U Laser ProjeCIOr UNIVERSAL RPMA CEILING PLATE 8" X 24" projector pipe -length TBD ClickShare-200 5et NA, lrn:1 Ba Crestron® Certified HDMI® Interface Cable, 18 Gbps, 6 ft (1.8 m) Integration Materials Engineering & Drawings Project Management On Sile Integration Testing & Acceptance Sub-Total: Page 9 of 11 Tracking#: 2019-MPW/IT0G .sill l:lia fJkpfk:d 3 $2,434.00 $7,302.00 3 $5,878.00 $17,634.00 3 5186 00 $558.00 3 594.00 $282.00 3 $52.00 $156.00 1 $1,395.00 51,395.00 3 529.00 $87.00 $352.00 51 .084.00 $1,212.00 $6,330.00 $212.00 $3&,604.00 !36604.00 City Attorney Approved 1/25/2019 " , Tracking#: 2019-MPW/IT0G EXHIBITC LABOR AND MATERIALS BOND Bond# 30079175 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to AVI SYSTEMS, INC. (hereinafter designated as the "Principal"), a Contract for: EMERGENCY OPERATIONS CENTER -CR2 PROJECTOR in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, AVI Systems, Inc. as Principal, (hereinafter designated as the "Contractor"), and Western Surety Company 151 N. Franklin St. Chicago, II 60606 as Surety, are held firmly bound unto the City of Carlsbad in the sum of thirty-nine thousand, six hundred, eighty-seven cents ($39,600.87), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. EOC -CR2 Projector Page 10 of 11 City Attorney Approved 1/25/2019 Tracking#: 2019-MPW/ITOG In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this-~'-~---day of A, \.l~ Us-\--, 2o_li. CONTRACTOR: (name of Contractor) By: _7<~-°::......:..:nrL.J-=--· "--~~0:\-'--"'i....,,,.L,:..___ __ \: (sign here) (print name here) (print name here) (title and organization of signatory) Executed by SURETY this __ 1_4t_h ___ day of __ A_u_g_u_st ______ __, 20~. SURETY: Western Surety Company (name of Surety) 151 N. Franklin St., 17th Floor, Chicago, IL 60606 (address of Surety) (701)356-8174 (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 attach 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 Attorn/1(; By: tt ... Assistant City Attorney EOC -CR2 Projector Page 11 of 11 City Attorney Approved 1/25/2019 CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT Civil Code § 1189 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 truthfullness, accuracy or validity of that document. ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• State of NORTH DAKOTA County of __ c_A_s_s ______ _ } August 14, 2019 • Anthony Gross, North Dakota Notary On ______ ~ ________ be,ore me, . Date Namt and flile of Notary personally appeared ____ G_a_i_l T_._H_a_y_e_s ________________________ _ Name and or Namee ol Slgnal(s) Who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) ls/are subscribed to the within Instrument and acknowl~ged to me that hp/she/they executed the same In his/her/their authorized cepaclty(les), and that by his/her/their slgnature(s) on the Instrument the person(s), or the entity i.ipon behalf of which the person(s) acted, executed the Instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and correct. Witness my hand and official seal. Signature 4 4 4-• Norary Public Signature OPTIONAL ANTHONY GROSS Notary Public State of North Dakota My Commission Ex Ires Nov. 4, 2020 Place Notary Public Seal Above ---------------------------------- Though the Information below Is not requlf&d by law, It may prove valuable to the persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Tltle or Type of Document ______________________________ _ Document Date ___________________ Number of Pages: _________ _ Signer's Name: ______________ _ □ lndlvldual D Corporate Officer -Tltle(s):. ______ _ D Partner -D Limited □ General D Guardian or Conservator !El Attorney-In-Fact D Trustee D Other: ----------Signer Is representing ____ _ Great American Insurance Company 111(,tlT Tl IU\HJl'IIINI Of ~,t<;~~UI Topoflhumb □ lndivldual D Corporate Officer-Tltle(s):. ______ _ D Partner -D Limited □ General D Guardian or Conservator □ Attorney~ln•Fact D Trustee D Other: ----------SI g n er is representing ____ _ 111(,l!T Tl II IMUl'l ,1~ f lJ, ',H,t,[ 11 Topolltunb ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ' . ACKNOWLEDGMENT OF PRINCIPAL State of ~o :ro.oo ' County of ~ :no av On this I (o -t ~ day of ~i, , ao lC\ b:fore me a Notary Public in and for the State of i<;.o :no 00 personally appeared Jv> :ncL, Em±:L know to me to be the I}..g~A 1 , of the principal described in the within instrument and who executed the same and acknowledge to me that he/she executed the same for on behalf of the said principal. NOTARY PUBLIC (SEAL) Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents, That WESTERN SURE'IY COMPANY, a South Dakota corporation, is a duly organized and existing corporation having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint Daniel W Werner, Gail T Hayes, Joan R Kjonaas, Zared Lefor, Kim Burnham, Phoebe L Kuntz, Michael J Doub, Anthony Gross, Charles P Klabo, Kristina Holtgard, Individually of Fargo, ND, its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature -In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney, pursuant to the authority hereby given, are hereby ratified and confinned. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof, duly adopted, as indicated, by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 21st day of December, 2018. State of South Dakota County of Minnehaha WESTERN SURETY COMPANY On this 21st day of December, 2018, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURE'IY COMPANY described in and which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires June 23, 2021 J. Mohr, Notary Public CERTIFICATE I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force, and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 14th day of August 2019 WESTERN SURETY COMPANY Form F4280-7-2012 Go to www.cnasurety.com >Owner/ Obllgea Servkt"s >-Validate Bond Coverage, If you want to verify bond authenticity. Authorizing By-Law ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMP ANY This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders of the Company. Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. AVISYST-01 LBENTZ ACORD" CERTIFICATE OF UABIUTY INSURANCE I DATE (MM/DDNYYY) ~ 4/4/2019 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). PRODUCER 2~AAl~cT Lesley Bentz Choice Insurance r~g,NN\,Ext): (701) 224-7047 I FAX 207 E Front Ave (AIC, No): Bismarck, ND 58504 itM}l~ss: l.bentz@bankwithchoice.com INSURER/SJ AFFORDING COVERAGE NAIC# INSURER A ,Atlantic Soecialtv Insurance Comoanv 27154 INSURED INSURER B: AVI Systems, Inc. INSURERC: 8019 Bond Street INSURERD: Lenexa, KS 66214 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POIJCIES OF INSURANCE LISTED BELOW HAVE BEEN I.SSUED 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. INSR TYPE OF INSURANCE ADDL ,.v.~i POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INS:D IMM/DDNYYYl IMM/DDNYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE · $ 1,000,000 ~ □ CLAIMS-MADE 00 OCCUR 711016643-0000 4/1/2019 4/1/2020 DAMAGE TO RENTED 1,000,000 PREMISES /Ea occurrence\ $ MED EXP /Anv one oerson\ $ 10,000 ~ ~ PERSONAL & ADV INJURY $ 1,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ~ POLICY 00 ~r8r □ LOG PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY -COMBINED SINGLE LIMIT /Ea accident\ $ 1,000,000 X ANY AUTO 711016643-0000 4/1/2019 4/1/2020 BODILY INJURY /Per nersonl $ -OWNED -SCHEDULED -AUTOS ONLY f--AUTOS BODILY INJURY /Per accident) $ X HIRED X NON-OWNED FP~?~[c~d~SAMAGE $ -AUTOS ONLY ~ AUTOS ONLY $ A X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 10,000,000 -EXCESS LIAB CLAIMS;MADE 711016643-0000 4/1/2019 4/1/2020 AGGREGATE $ 10,000,000 DED I X I RETENTION$ 0 $ A WORKERS COMPENSATION X I ~-\%1 /TF I I OTH-AND EMPLOYERS' LIABILITY ER Y/N 406045940-0000 4/1/2019 4/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE 00 N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) . · EL DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ 1,000,000 A Tech E&O 760010594-0000 4/1/2019 4/1/2020 Occurrence/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carlsbad is included as an Additional Insured on a Primary/Non-contributory basis re General Liability and Auto Liability as per written contract. 30-day Notice of Cancellation applies in favor of Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1635 Faraday Avenue Carlsbad, CA 92008 AUTHORIZED REPRESENTATIVE I ~~ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS !ENDORSEMENT CHANGES THIE POUCY. PLEASE READ !T CAREFUll Y. @VANTAGE FOR AUTOMOBILE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provi- sions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured By Contract 12. 2. Airbag Discharge 13. 3. Auto Theft Reward 14. 4. Blanket Waiver of Subrogation 15. 5. Bodily Injury Redefined -Mental Anguish 16. Employee Hired Autos Fellow Employee Exclusion Glass Repair -Waiver of Deductible Hired Auto Physical Damage Coverage Lease Gap Coverage 6. Broad Form Named Insured 17. 7. Communications Equipment 18. 8. Diminution in Value 19. 9. Drive Other Car -Executive Officers 20. 10. Duties In The Event of Accident, Claim, Suit or Loss Liability Coverage -Supplementary Payments Newly Formed or Acquired Organizations Physical Damage -Transportation Expenses Rental Reimbursement -Private Passenger Vehicles 11. Employees As Insureds 21. Towing-Any Covered Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is An Insured provision under SECTION II -LIABILITY COVERAGE is amended to include as an additional "insured" any person or organization with whom you agreed in a written contract, written agreement or permit, to provide insurance such as is afforded under this Coverage Form. Such person or organization is an "insured" only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part by your maintenance, operation or use of your covered "autos". With respect to the insurance afforded to these additional "insureds", this insurance does not apply: a. Unless the written contract or agreement has been executed or the permit has been issued prior to the "bodily injury" or "property damage"; b. To any person or organization included as an "insured" by endorsement or in the Declarations; or c. To any lessor of "autos" when their contract or agreement with you for such leased "auto" ends. 2. AIRBAG DISCHARGE If you purchased physical damage coverage for a covered "auto" under this policy, we will pay to reset or re- place an airbag that accidentally discharges without the vehicle being involved in an accident. No deductible applies to this additional coverage. However, this coverage only applies if the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and conviction of anyone stealing a covered "auto". A reward will not be paid to you, a family member, employee or any public official while performing their duty. 4. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights of Recovery Against Others To Us condition under SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A. LOSS CONDITIONS is replaced by the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract", provided the contract is in writing and executed prior to the "bodily injury" or "property damage". 5. BODILY INJURY REDEFINED -MENTAL ANGUISH The definition of "bodily injury" under SECTION V -DEFINITIONS is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time. VCA 201 01 09 Includes copyrighted material of Insurance Services Office, Inc. Copyright 2004, OneBeacon Insurance Group LLC E-INSURED Page 1 of 5 6. BROAD FORM NAMED INSURED a. The Who Is An Insured provision under SECTION II -LIABILITY COVERAGE is amended to include the following: Any organization which is a legally incorporated entity in which you own a financial interest of more than 50% of the voting stock on the·effective date of this Coverage Form will be a Named Insured until the 180th day or the end of the policy period whichever comes first, provided there is no other similar insurance avail- able to that organization. b. Paragraph a. of this provision 6. does not .apply to "bodily injury" or "property damage" for which an "in- sured" is also an "insured" under any other automobile policy or would be an "insured" under such a poli- cy, but for its termination or the exhaustion of its Limit of Insurance. 7. COMMUNICATIONS EQUIPMENT a. The exclusion for electronic equipment under Exclusions of SECTION Ill ·_ PHYSICAL DAMAGE COVERAGE does not apply to loss of any permanently installed, non-removable communications equip- ment designed for use as a: · 1. Citizen's band radio; 2. Two-way mobile radio or telephone; 3. Scanning monitor receiver; or 4. GPS Navigation System, including its antenna and other accessories. b. No Deductible applies to this additional coverage. c. The most we will pay for this coverage is $5,000 per occurrence. 8. DIMINUTION IN VALUE The "diminution in value" exclusion under SECTION Ill -PHYSICAL DAMAGE COVERAGE, 8. Exclusions does not apply if the covered "auto" is a private passenger "auto" and is leased, rented, hired or borrowed without a driver for a period of 30 days or less and is used in the conduct of the insured's business. The most we will pay for "loss" arising out of an "accident" is the lesser of $7,500 or 20% of the actual cash value of the "auto" as determined by Kelley Blue Book or other independent valuation sources. 9. DRIVE OTHER CAR -EXECUTIVE OFFICERS a. The Who Is An Insured provision under SECTION II -LIABILITY COVERAGE is amended to include: If you are designated in the Declarations as: 1. An individual; you and your spouse. 2. A partnership; your partners and their spouses. 3. An organization other than an individual or a partnership; your "executive officers" and their spouses. b. SECTION II -LIABILITY COVERAGE and SECTION Ill -PHYSICAL DAMAGE COVERAGE are ex- tended to include "autos" you don't own, hire, lease or borrow while in the care, custody or control of an "insured" listed in 9.a. This does not include any "auto": 1. Owned by any "insured" listed in 9.a., or any member of their household, including any such "auto" that is owned but not insured; 2. Used by an "insured" listed in 9.a. while working in the business of selling, servicing, repairing or parking autos; or 3. Insured under another policy of insurance. If Medical Payments, Uninsured/Underinsured Motorist, Personal Injury Protection or other compulsory coverages required by the governing jurisdiction are covered on this policy, then insureds listed in 9.a. above and family members residing in the same households are "insureds" while: 1. Occupying as a passenger; or 2. A pedestrian when struck by, any "auto" you do not own, hire, lease or borrow, except any "auto" owned by that "insured" listed in 9.a, their family members or an "auto" insured under any other policy. c. The limits and deductibles applicable to this provision will be the largest applicable to any owned "auto" for the specific insurance. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc. VCA 201 01 09 Copyright 2004, OneBeacon Insurance Group LLC ct The following definition is added to the DIEFINITIONS section of the policy: "Executive officer" means a person holding any of the officer positions created by your charter, consti- tution, by-laws or any similar governing document. e. The Other Insurance Condition, under Section IV -BUSINESS AUTO CONDITIONS, does not apply to the provisions of this Drive Other Car endorsement. There is no "other insurance" applicable to this en- dorsement. 10. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Under SECTION IV -BUSINESS AUTO CONDITIONS -the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is amended as follows: The requirements that you must: a. Notify us of an "accident", claim, "suit" or "loss"; and b. Send us documents concerning a claim or "suit", apply only when such "accident", claim, "suit" or "loss" is known to: a. You, if you are an individual; b. A partner, if you are a partnership; c. An executive officer of the corporation or insurance manager, if you are a corporation; or d. A manager, if you are a limited liability company. 11. EMPLOYEES AS INSUREDS The Who Is An Insured provision under SECTION·II -LIABILITY COVERAGE is changed by adding the fol- lowing: Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. This coverage is excess over any other collectible insurance. 12. EMPLOYEE HIRED AUTOS The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contact or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. For purposes of this coverage grant, paragraph 5.b. of the Other Insurance Condition in the Business Auto Coverage Form is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: 1. Any covered "auto" you lease, hire, rent or borrow; and 2. Any covered "auto" hired or rented by your "employee" under a contract in that individual "employ- ee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". This coverage is excess over any other collectible insurance. 13. FELLOW EMPLOYEE EXCLUSION The Fellow Employee exclusion under SECTION II -LIABILITY COVERAGE does not apply if the "bodily in- jury" results from the use of a covered "auto" you own or hire. This coverage is excess over any other insur- ance. 14. GLASS REPAIR -WAIVER OF DEDUCTIBLE Under paragraph 0. -Deductible -of SECTION Ill -PHYSICAL DAMAGE COVERAGE, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 15. HIRED AUTO-PHYSICAL DAMAGE COVERAGE If hired "autos" are covered "autos" under SECTION II -LIABILITY COVERAGE and if Comprehensive, Speci- fied Causes of Loss, or Collision coverages are provided under this policy for any "auto" you own, then SECTION Ill -PHYSICAL DAMAGE COVERAGE is extended to "autos" you hire, subject to the following limit: The most we will pay for "loss" to any hired "auto" is the lesser of: a. $75,000 for "autos" of the private passenger type and $50,000 for all other "autos"; VCA 201 01 09 Includes copyrighted material of Insurance Services Office, Inc. Page 3 of 5 Copyright 2004, OneBeacon Insurance Group LLC b. The actual cash value; or c. The cost of repairing or replacing it with other property of like kind or quality. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. We will also cover loss of use of the hired "auto" if the following conditions are met: a. It results from an accident; b. You are legally liable; and c. The lessor incurs an actual financial loss. The most we will pay for this loss of use coverage is $1,000 per ''accident". 16. LEASE GAP COVERAGE Under paragraph C. Limit of Insurance -of SECTION Ill -PHYSICAL DAMAGE COVERAGE, the following is added: If a covered "auto" is leased, we will also pay the difference between the actual cash value of a covered "au- to" at the time of "loss" and the remaining balance on your lease if the following conditions are met: a. The "auto" has a long term lease and is covered on this policy. b. The lessor is added as an Additional Insured in a written lease agreement. c. You are legally obligated for the remaining balance. We will not pay for any amounts representing excess wear and tear charges; additional mileage charges; taxes; overdue payments; penalties, interest or charges resulting from overdue payments; or lease termination fees. 17. LIABILITY COVERAGE EXTENSIONS -SUPPLEMENTARY PAYMENTS Under SECTION II -LIABILITY COVERAGE, the Coverage Extension for Supplementary Payments is re- vised as follows: a. The limit for the cost of bail bonds is amended to $3,500. b. The limit for reasonable expenses incurred by the "insured" is amended to $500 a day. 18. NEWLY FORMED OR ACQUIRED ORGANIZATIONS a. The Who Is An Insured provision under SECTION II -LIABILITY COVERAGE is amended to include as an "insured" any organization that is formed or acquired by you and over which you maintain majority ownership. b. Paragraph a. of this provision 18. does not apply to any organization: 1. That is a joint venture or partnership; 2. That is an "insured" under any other policy; 3. That has exhausted its Limit of Insurance under any other policy; or 4. 180 days or more after its acquisition or formation by you, unless you have given us notice of the ac- quisition or formation. c. Paragraph a. of this provision 18. does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. 19. PHYSICAL DAMAGE-TRANSPORTATION EXPENSES COVERAGE Under SECTION Ill -PHYSICAL DAMAGE Coverage Extensions, the limit for Transportation Expenses is amended to $75 per day and the maximum is amended to $2,250. 20. RENT AL REIMBURSEMENT . We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" of the private passenger type because of "loss" to a "covered auto" of the private passenger type. Payment applies in addition to the other- wise applicable amount of each coverage you have on a "covered .auto". No deductibles apply to this coverage. We will pay those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, six (6) days after the "loss". Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc. VCA 201 01 09 Copyright 2004, OneBeacon Insurance Group LLC Payment is limited to the lesser of the following amounts: 1. Necessary and actual expenses incurred. 2. The maximum daily payment of $25 for any one day. This coverage does not apply while there are spare or reserve "autos" available to you. If "loss" results from the total theft of the private passenger "auto", we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the PHYSICAL DAMAGE COVERAGE Extension. 21. TOWING -COVERED AUTOS Under SECTION Ill -PHYSICAL DAMAGE COVERAGE, Coverage for Towing is amended as follows: a. This coverage applies to any covered "auto" for which a premium charge for towing and labor is shown in the Schedule or in the Declarations. b. The limit is $100. VCA 201 01 09 Includes copyrighted material of Insurance Services Office, Inc. Page 5 of 5 Copyright 2004, OneBeacon Insurance Group LLC POLICY NUMBER: 711016643-0000 COMMERCIAL GENERAL UABIUTY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED~ OWNERS, LESSEES OR CONTRACTORS ~ SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: · COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Carlsbad (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A Section II -Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to i- ability arising rut of your ongoing operations per- formed for that insured. 8. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: CG 20 10 10 01 © ISO Properties, Inc., 2000 (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization . other than . another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 1 of 1 □ POLICY NUMBER: 711016643-0000 COMMERCIAL GENERAL UABIUTY CG 20 3710 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. ADDITIONAL INSURED = OWNERS, LESSEES OR CONTRACTORS= COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Carlsbad Location And Description of Completed Operations: Additional Premium: NIA (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II -Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only witf:1 respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations haz- ard". CG 20 3710 01 © ISO Properties, Inc., 2000 Page 1 of 1 □