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Home My WebLink AboutBear Electrical Solutions Inc; 2020-08-06; PWM21-1189TRANPWM21-1189TRAN ECR & CVR Conduit Repair Page 1 of 6 City Attorney Approved 1/25/2019 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT EL CAMINO REAL & CAMINO VIDA ROBLE CONDUIT REPAIR This agreement is made on the ______________ day of _________________________, 2020, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Bear Electrical Solutions, Inc., a California corporation whose principal place of business is 1341 Archer St., Alviso, CA 95002-0924 (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: Tam Tran (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. DocuSign Envelope ID: A081B606-EACD-466D-9AD3-6A5AC17560A2 6th August PWM21-1189TRAN ECR & CVR Conduit Repair Page 2 of 6 City Attorney Approved 1/25/2019 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: ________Robert Asuncion______________ 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. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. DocuSign Envelope ID: A081B606-EACD-466D-9AD3-6A5AC17560A2 PWM21-1189TRAN ECR & CVR Conduit Repair Page 3 of 6 City Attorney Approved 1/25/2019 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 thirty (30) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within fourteen (14) working days after commencing work. CONTRACTOR’S INFORMATION. Bear Electrical Solutions, Inc. 1341 Archer St. (name of Contractor) 982079 (street address) Alviso, CA 95002-0924 (Contractor’s license number) A,C-10,C-31 3/31/21 (city/state/zip) 408-449-5147 (license class. and exp. date) 1000002158 (telephone no.) N/A (DIR registration number) 6/30/22 (fax no.) robert@bear-electrical.com (DIR registration exp. date) (e-mail address) /// /// /// /// /// DocuSign Envelope ID: A081B606-EACD-466D-9AD3-6A5AC17560A2 PWM21-1189TRAN ECR & CVR Conduit Repair Page 4 of 6 City Attorney Approved 1/25/2019 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 BEAR ELECTRICAL SOLUTIONS, INC., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Robert Asuncion/Vice-President & Secretary Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: (sign here) Andrew Bader/CFO (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: A081B606-EACD-466D-9AD3-6A5AC17560A2 PWM21-1189TRAN ECR & CVR Conduit Repair Page 5 of 6 City Attorney Approved 1/25/2019 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 be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. DocuSign Envelope ID: A081B606-EACD-466D-9AD3-6A5AC17560A2 0.00 None None None None None None None NoneNone None PWM21-1189TRAN ECR & CVR Conduit Repair Page 6 of 6 City Attorney Approved 1/25/2019 EXHIBIT B EL CAMINO REAL & CAMINO VIDA ROBLE CONDUIT REPAIR Contractor shall replace the damage conduit on NE corner of intersection. Jackhammer out existing sidewalk for trench, trench for conduit run. Furnish and Install 2.5" conduit (pull rope to be included in conduit) from existing pull box to new pull box Location. Furnish and install #5 pull box. With lid, back fill trench, compact and re-pour sidewalk. Return to completely demo and re-pour sidewalk. Exclusions: N/A JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LS 1 El Camino Real & Camino Vida Roble Conduit Repair $17,270 TOTAL* $17,270 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: A081B606-EACD-466D-9AD3-6A5AC17560A2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 1/24/2020 Woodruff-Sawyer &Co.50 California Street,Floor 12SanFranciscoCA94111 415-391-2141 415-989-9923 Hartford Casualty Insurance Company 29424 BEARELE-01 Hartford Fire Insurance Company 19682BearElectricalSolutions,Inc.1341 Archer StreetAlvisoCA95002 437749080 B X 1,000,000 X 300,000 10,000 1,000,000 2,000,000 X Y 57UEAFN9382 2/1/2020 2/1/2021 2,000,000 A 1,000,000 X X X 57UEAFN9268 2/1/2020 2/1/2021 A X X 5,000,00057RHAFN93502/1/2020 2/1/2021 5,000,000 RE:Traffic Signal Maintenance &Repair Services.The City of Carlsbad,agents and employees,and volunteers are additional insured,wherein coverage isPrimaryandNon-Contributory.Policies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium. 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(5) Property Damage To Borrowed3. Legal Action Against Us Equipment Or Use Of ElevatorsNo person or organization has a right under this If the loss arises out of "property damage"Coverage Part:to borrowed equipment or the use ofa.To join us as a party or otherwise bring us elevators to the extent not subject tointo a "suit" asking for damages from an Exclusion j.of Section I - Coverage A -insured; or Bodily Injury And Property Damageb.To sue us on this Coverage Part unless all of Liability; its terms have been fully complied with.(6) When You Are Added As An Additional A person or organization may sue us to recover Insured To Other Insurance on an agreed settlement or on a final judgment Any other insurance available to youagainst an insured; but we will not be liable for covering liability for damages arising outdamages that are not payable under the terms of of the premises or operations, or productsthis Coverage Part or that are in excess of the and completed operations, for which youapplicable limit of insurance. An agreed have been added as an additional insuredsettlement means a settlement and release of by that insurance; orliability signed by us, the insured and the (7) When You Add Others As Anclaimant or the claimant's legal representative. Additional Insured To This Insurance4. Other Insurance Any other insurance available to anIf other valid and collectible insurance is additional insured.available to the insured for a loss we cover under However, the following provisions apply toCoveragesAorBof this Coverage Part, our other insurance available to any person orobligations are limited as follows:organization who is an additional insureda. Primary Insurance under this coverage part. This insurance is primary except when b.(a) Primary Insurance When Requiredbelow applies. If other insurance is also By Contractprimary, we will share with all that other This insurance is primary if you haveinsurance by the method described in c.agreed in a written contract or writtenbelow.agreement that this insurance beb. Excess Insurance primary. If other insurance is also This insurance is excess over any of the other primary, we will share with all that insurance, whether primary, excess,other insurance by the method contingent or on any other basis:described in c.below. (1) Your Work (b)Primary And Non-Contributory To Other Insurance When Required ByThat is Fire, Extended Coverage, Builder's ContractRisk, Installation Risk or similar coverage for "your work";If you have agreed in a written contract, written agreement, or permit(2) Premises Rented To You that this insurance is primary and non-That is fire, lightning or explosion contributory with the additionalinsurance for premises rented to you or insured's own insurance, this insurancetemporarily occupied by you with is primary and we will not seekpermission ofthe owner;contribution from that other insurance. Page 16 of 21 HG 00 01 09 16 Policy No. 57UEAFN9382 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/30/2020 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 be endorsed. If SUBROGRATION 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 Willis Towers Watson 12980 Metcalf Ave Suite 500 Overland Park KS 66213 CONTACT NAME: San Jose PHONE (A/C, No Ext): (408) 321-9901 FAX (A/C, NO): (360) 828-0699 EMAIL ADDRESS: Jerry.Sparks@bbsihq.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:ACE American Insurance Company 22667 INSURED Barrett Business Services, Inc. L/C/F BEAR ELECTRICAL SOLUTIONS, INC. 1341 ARCHER STREET SAN JOSE, CA 95131 INSURER B: INSURER C: INSURER D: INSURER E: 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 ISSUES 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJ- ECT LOC EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurence)$ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident)$ BODILY INJURY (Per person)$ BODILY INJURY (Per accident)$ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EXCESS LIAB OCCUR DED RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X C66386909 Covered states: CA 02/01/20 02/01/2021 9 WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4668 - ECM AUTHORIZED REPRESENTATIVE New York NY 10163 Authorized Rep c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: _____________________________________ LOC: #:______________________________________ ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Lockton Affinity POLICY NUMBER C66386909 CARRIER NAIC CODE ACE American Insurance Company 22667 NAMED INSURED: Barrett Business Services, Inc. L/C/F BEAR ELECTRICAL SOLUTIONS, INC. 1341 ARCHER STREET SAN JOSE, CA 95131 EFFECTIVE DATE:02/01/20 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER:City of Carlsbad/CMWD ADDRESS:P.O. Box 4668 - ECM New York NY 10163 RE: Traffic Signal Maintenance & Repair Services. ACORD 101 (2008/01)c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Policy Number Symbol: Number: Policy Period TO Effective Date of Endorsement Issued By (Name of the Insurance Company) Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1.( ) Specific Waiver Name of person or organization: ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: 3. Premium: The premium charge for this endorsement shall be percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Minimum Premium: _______________________________________ Authorized Agent WC 99 03 22 Barrett Business Services, Inc. L/C/F BEAR ELECTRICAL SOLUTIONS, INC. 1341 ARCHER STREET SAN JOSE, CA 95131 C66386909 2/1/2020 2/1/2021 2/1/2020 Ace American Insurance Co. X INCLUDED INCLUDED