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Berk, Susan; 2019-10-02; PSA19-790UTIL
PSA19-790UTIL General Counsel Approved Version 9/27/16 1 AMENDMENT NO. 1 TO AGREEMENT FOR ADMINISTRATIVE TEAM CONSULTATION SUSAN BERK This Amendment No. 1 is entered into and effective as of the _______ day of ______________________________, 2020, amending the agreement dated October 2, 2019, (the “Agreement”) by and between the Carlsbad Municipal Water District, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, ("CMWD"), and Susan Berk, a sole proprietorship, (“Contractor") (collectively, the “Parties”) for additional administrative team consultation. RECITALS A. The Parties desire to alter the Agreement’s scope of work to include individual and team techniques and processes for more effective administrative team communication; and B. The Parties have negotiated and agreed to a supplemental scope of work and fee schedule, which is attached to and incorporated by this reference as Exhibit "A", Scope of Services and Fee. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, CMWD and Contractor agree as follows: 1. In addition to those services contained in the Agreement, as may have been amended from time to time, Contractor will provide those services described in Exhibit "A". With this Amendment, the total annual Agreement amount shall not exceed twenty-five thousand eight hundred fifty dollars ($25,850). 2. CMWD will pay Contractor for all work associated with those services described in Exhibit “A” on a time and materials basis not-to-exceed five thousand eight hundred fifty dollars ($5,850). Contractor will provide CMWD, on a monthly basis, copies of invoices sufficiently detailed to include hours performed, hourly rates, and related activities and costs for approval by CMWD. 3. Contractor will complete all work described in Exhibit “A” by October 1, 2020. 4. All other provisions of the Agreement, as may have been amended from time to time, will remain in full force and effect. 5. All requisite insurance policies to be maintained by Contractor pursuant to the Agreement, as may have been amended from time to time, will include coverage for this Amendment. /// /// /// /// DocuSign Envelope ID: 90397013-DB1B-4324-A1F8-5EACB5AB044A February 3rd PSA19-790UTIL General Counsel Approved Version 9/27/16 2 6. The individuals executing this Amendment 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 Amendment. CONTRACTOR CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad SUSAN BERK, a sole proprietorship By: By: (sign here) Vicki V. Quiram, General Manager as authorized by the Executive Manager Susan Berk, Owner (print name/title) By: (sign here) (print name/title) If required by CMWD, 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, Secretary, President, or Assistant Secretary, Vice-President 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, General Counsel By: _____________________________ Assistant General Counsel DocuSign Envelope ID: 90397013-DB1B-4324-A1F8-5EACB5AB044A PSA19-790UTIL General Counsel Approved Version 9/27/16 3 EXHIBIT “A” SCOPE OF SERVICES AND FEE SCOPE OF SERVICES: Team Consultation. Focus: Individual and team techniques and processes for more effective communication for the Administrative Team of City of Carlsbad, Utilities Department. PREPLANNING AND CONSULTATION 1. Planning consultation with Management Analyst 2. Individual interviews with each member of the Administrative team Cost: $1,500 DESIGN, FACILITATION of COMMUNICATIONS SESSIONS 1. Design and facilitation of Communicating Through Differences sessions for small teams of the Administrative Staff 2. Design and facilitation of full team Communications Workshop 3. Individual coaching and follow-up with each employee 4. Follow-up meeting/consultation with Management Analyst and Utilities Director 5. On-going telephone consultation (no charge) Cost: $4,350 TOTAL COST: $5,850 DocuSign Envelope ID: 90397013-DB1B-4324-A1F8-5EACB5AB044A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE 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 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 SUBRWVDADDLINSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue 32nd FloorNew York, NY 10022 A 05/30/2019 (888) 202-3007 contact@hiscox.com Hiscox Insurance Company Inc 10200 Susan Berk 4234 noeline AveEncino, CA 91436 City of Carlsbad / CMWD C/O Exigis Insurance Compliance Services P.O Box 4668-ECM #35050 New York NY 10163-4668 X X X UDC-1825986-CGL-18 09/28/2018 09/28/2019Y 1,000,000 100,000 5,000 2,000,000 1,000,000 S/T Gen. Agg City of Carlsbad are additional Insured Subject to policy terms and conditions. CERTIFICATE OF EXEMPTION WORKERS’ COMPENSATION/EMPLOYERS’ LIABILITY INSURANCE I, , am the [insert name] [title] of . I hereby certify that [name of company] [name of company] has no employees and is not required by law to maintain workers’ compensation or employers’ liability insurance. Should employ any person [name of company] during the term of the Agreement with the City of Carlsbad for , [description of project or work that is being contracted] then workers’ compensation and employers’ liability insurance will be obtained. [Name] [Title and name of company or corporation] Susan Berk sole proprietor Susan Berk Susan Berk Susan Berk consulting and training Susan Berk Susan Berk PSA19-790UTIL AGREEMENT FOR ADMINISTRATIVE TEAM CONSULTATION (SUSAN BERK) THIS AGREEMENT is made and entered into as of the 1rJ. day of ~ 6cc , 2019, by and between the CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, ("CMWD"), and SUSAN BERK, a sole proprietor, ("Contractor"). RECITALS A. CMWD requires the professional services of a consultant that is experienced in team consultation. 8. Contractor has the necessary experience in providing professional services and advice for design and facilitation of conflict resolution. C. Contractor has submitted a proposal to CMWD and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, CMWD and Contractor agree as follows: 1. SCOPE OF WORK CMWD retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", which is incorporated by this reference in accordance with this Agreement's terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective for a period of one (1) year from the date first above written. The Executive Manager may amend the Agreement to extend it for one (1) additional one (1) year period or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, CMWD needs, and appropriation of funds by the CMWD Board of Directors. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term shall not exceed twenty thousand dollars ($20,000). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. If CMWD elects to extend the Agreement, the amount shall not exceed twenty thousand dollars ($20,000) per Agreement year. CMWD reserves the right to withhold a ten percent (10%) retention until CMWD has accepted the work and/or Services specified in Exhibit "A". Incremental payments, if applicable, should be made as outlined in attached Exhibit "A". General Counsel Approved Version 6/12/18 PSA19-790UTIL 6. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of CMWD. Contractor will be under control of CMWD only as to the result to be accomplished but will consult with CMWD as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of CMWD for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. CMWD will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. CMWD will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify CMWD and the City of Carlsbad within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which CMWD may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At CMWD's election, CMWD may deduct the indemnification amount from any balance owing to Contractor. 7. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of CMWD. If Contractor subcontracts any of the Services, Contractor will be fully responsible to CMWD for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and CMWD. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by CMWD. 8. OTHER CONTRACTORS CMWD reserves the right to employ other Contractors in connection with the Services. 9. INDEMNIFICATION Contractor agrees to indemnify and hold harmless CMWD and the City of Carlsbad, their officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorney's fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney's fee, costs or expense CMWD or the City of Carlsbad incurs or makes to or on behalf of an injured employee under their self- administered workers' compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor's agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to 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 General Counsel Approved Version 6/12/18 2 PSA19-790UTIL 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. 10.1 Coverages and Limits. Contractor will maintain the types of coverages and minimum limits indicated below, unless the Risk Manager or Executive Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. CMWD, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. 10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 10.1.2 Automobile Liability (if the use of an automobile is involved for Contractor's work for CMWD). $2,000,000 combined single-limit per accident for bodily injury and property damage. 10.1.3 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 CMWD's satisfaction, a declaration stating this. 10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor's profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 10.2. Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 CMWD will be named as an additional insured on Commercial General Liability which shall provide primary coverage to CMWD. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to CMWD sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to CMWD's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to CMWD. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then CMWD will have the option to declare Contractor in breach or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by CMWD to obtain or General Counsel Approved Version 6/12/18 3 PSA19-790UTIL maintain insurance and CMWD may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 10.5 Submission of Insurance Policies. CMWD reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of CMWD during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of CMWD. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to CMWD. Contractor will have the right to make one (1) copy of the work product for Contractor's records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in CMWD and Contractor relinquishes all claims to the copyrights in favor of CMWD. 15. NOTICES The name of the persons who are authorized to give written notices or to receive written notice on behalf of CMWD and on behalf of Contractor under this Agreement. ForCMWD For Contractor Name Ligeia Heag1 Name Susan Berk Title Management Anal1st Title Consultant Carlsbad Munici~al Water District Address 4234 Noeline Avenue Address 5950 El Camino Real Encino, CA 91436 Carlsbad, CA 92008 Phone 818-438-8133 Phone 760-438-2722 E-mail susanberk@pobox.com Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. General Counsel Approved Version 6/12/18 4 PSA19-790UTIL 16. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. Yes [8] No D 17. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that the services required by this Agreement. 18. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or CMWD will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the Executive Manager. The Executive Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the Executive Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 20. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, CMWD may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If CMWD decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, CMWD may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by CMWD and all work in progress to CMWD address contained in this Agreement. CMWD will make a determination of fact based upon the work product delivered to CMWD and of the percentage of work that Contractor has performed which is usable and of worth to CMWD in having the Agreement completed. Based upon that finding CMWD will determine the final payment of the Agreement. Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and upon request of CMWD, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to CMWD. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee General Counsel Approved Version 6/12/18 5 PSA19-790UTIL payable under this Agreement. CMWD will make the final determination as to the portions of tasks completed and the compensation to be made. 21. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, CMWD will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any agreement claim submitted to CMWD must be asserted as part of the agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to CMWD, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, 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 information. If CMWD seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for CMWD to terminate this Agreement. 23. JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 24. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon CMWD and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of CMWD, which shall not be unreasonably withheld. 25. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. Ill Ill Ill General Counsel Approved Version 6/12/18 6 PSA 19-790UTI L 26. 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 Susan Berk, sole proprietor By· ~ /~ . -----:a,L,SCU-L ( ~ (sign here) Susan Berk, Owner (print name/title) By: (sign here) (print name/title) Vicki V. Quiram, General Manager as authorized by the Executive Manager If required by CMWD, 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 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, General Counsel By: -C=.-~£ _____ )'(.......,../ _____ _ Deputy General cotf sel General Counsel Approved Version 6/12/18 7 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 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 truthfulness, accuracy, or validity of that document. State of California } County of Lo ~ AV\5J Q S On ~ · :).. ~ · d. 0 l C\ fVo,..,a~.,._,7 \_/Cl .\QVY\..~Cl.V) before me, 1\ .... • '· , '-"-'f\.< o. Date / r.-J Here Insert Name and Title of the Officer personally appeared ___ 0 __ u_S_c>--_v\ ___ L_J_e._,_~ ___________________ _ Name(s) of Signer(s) 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. Place Notary Seal and/or Stamp Above 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. a i:;17 , ae/0-«1,, l--Signature ~cu,/1 l- Signature of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: A_5,e.e,vnC-!l\±¾>f AdM.,v\; th a+·,\l\!-"""GetW\ LO\l\:Su\--t-ci{; Q II\ Document Date: 5 • 2 l. ;i._o \ q NumberofPages:_4-~-- Signer(s) Other Than Named Above: ________________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: 'Susa. v-'B>e, ~ □ Corporate Officer -Title(s): ______ _ D Partner -□ Limited □ General g: Individual □ Attorney in Fact □ Trustee □ Guardian of Conservator D Other: Signer is Representing: _________ _ Signer's Name: ____________ _ D Corporate Officer -Title(s): ______ _ D Partner - D Limited □ General D Individual D Trustee D Other: □ Attorney in Fact □ Guardian of Conservator Signer is Representing: _________ _ l~jiUU~U~~OOJif~~i:i@@l»"Ul ©2017 National Notary Association EXHIBIT "A" SCOPE OF SERVICES SUSAN BERK 4234 Noeline Avenue, Encino, CA 91436 Phone 818-990-7459 cell 818-438-8133 Email susanberk@pobox.com This proposal is based on our conversation of last week regarding Team Consultation. The focus is for setting clear expectations for employee conduct and performance/ resolving areas of conflict. PREPLANNING AND CONSULTATION • Review and assess all relevant documentation including previous Human Resource assessments and performance evaluations related to team member performance and conflict. • Meeting and consultation with Utilities Director and Management Analyst to assess scope of conflict issues, steps previously taken, and to set specific exceptions/ performance outcomes. $8,000 DESIGN, FACILITATION of CONFLICT RESOLUTION • Meeting with Utilities Director, Management Analyst to set out expectations for addressing areas of conflict, setting performance commitments and accountabilities, and consequences for not meeting these commitments. $2,000 • One on one discussions with each of the two employees, in question. $1,000 • Design and facilitation of initial session and subsequent follow-up sessions to address the areas of conflict and develop performance commitments and accountabilities. $2,000 • Individual coaching and follow-up with each employee, followed by a session where the employees present their commitments to the Management Analyst. • Follow up meeting/consultation with Management Analyst and Utilities Director • Travel Expenses (See Exhibit "B" for travel policy) • On-going telephone consultations Not to exceed $20,000 $3,000 $2,000 $2,000 no charge EXHIBIT "B" TRAVEL POLICY (City of Carlsbad Council Policy Statement Category: Specific Subject: TRAVEL POLICY PURPOSE: Policy No. Date Issued: Effective Date: Resolution No. Cancellation Date: Supersedes No. 2 6/27/17 6/27/17 Exhibit B 4 (dated 4/4/06) To establish a policy to be followed by Council Members, other elected officials, commission/board members, volunteers, and all city employees when traveling on city business. This policy supersedes all other travel policies. BACKGROUND: It is periodically necessary for city personnel to attend meetings, travel outside the city to conduct city business, and attend conferences, seminars and training sessions. Costs can vary considerably as there are various modes of transportation, various options for lodging, and relative price fluctuations among different geographic regions. The City Council has adopted a policy to control the costs involved, to ensure the expenditures are in the best interest of the public and an appropriate use of taxpayer funds, and to compensate individuals for actual necessary expenses related to meetings and business travel. DEFINITIONS: City Business Travel shall be defined as travel which requires elected officials, members of a commission or board, volunteers, or city employees to conduct specific items of city business away from their normal place of business. City Employee means any person regularly employed by the city, excluding elected officials, members of commissions, committees, authorities or boards, and volunteers. Commissioner shall mean any person appointed by the city council to an established board, committee, authority or commission. Volunteer shall mean any person donating their time through the city's volunteer program in support of city business and as outlined in a volunteer position description. Out-of-State Travel includes all costs related to business travel outside the State of California. In-State Travel includes all costs related to business travel within the State of California. Miscellaneous Meals/Mileage includes all miscellaneous costs not directly attributable to conferences or training, such as travel to other city facilities. Page 1 of 4 Policy No. 2 POLICY: 1. In all cases requests for travel shall be limited to situations from which the city will derive a benefit through the attendance of a representative. 2. For City Council Members, all travel involving more than five (5) days should be approved in advance by the City Council. Travel of five (5) days or less need not have prior approval if funds are available in the current budget. The Mayor is authorized to approve extended overnight travel for emergency cases. 3. Except for elected officials, commissioners and board members, and City Council appointed employees, the number of City Employees attending any single conference should be limited to those whose attendance will provide a benefit to the city. Any number of elected officials, commissioners, or City Council appointed employees may attend conferences provided that funds are available for such purposes. 4. Anticipated in-state and out-of-state travel should be approved in the operating budget. The City Manager, or his/her designee, may approve any unanticipated in-state travel or unanticipated out-of-state travel to destinations within the continental United States if a business need exists and funds are available. City Council approval is required for unanticipated travel to destinations outside the continental United States and/or when additional funds are required. 5. Each officer, employee, advisory commissioner, and board member of the city is expected to be as thrifty and prudent as possible when traveling at the city's expense. To ensure stewardship of taxpayer funds and that city officers, employees, commissioners and board members are able to travel when necessary to accomplish essential city business, travel funds must be expended in the most economical and efficient way possible. 6. In order to comply with Internal Revenue Service (IRS) and State regulations, receipts are required for all business travel expenses, including all meal and entertainment expenses, for City Council Members and Commissioners. Receipts are also required for all City Employee business travel expenses. In the event a meal or incidental receipt totaling thirty dollars ($30) or less is lost, a City Employee may certify the expense with the information below to receive reimbursement. This certification may occur no more than one time over a two day period, two times over a four day period, or three times over a five day period. For all business travel expenses (including meals and entertainment), the following information must appear on the expense report and/or the receipts submitted: a. The amount of the expenditure. b. The date and place of the expenditure. c. The business purpose of the expenditure. d. The business relationship to the person entertained, as well as the individuals' names. The IRS considers the reimbursements "wages" subject to payroll tax withholding if the expenditures are not substantiated with the aforementioned information. The use of a city Page 2 of 4 Policy No. 2 credit card for payment of business meals and entertainment does not preclude the requirement to complete and submit an expense report with the appropriate support. 7. Travel advances to City Employees need to be substantiated or reimbursed as soon as possible upon completion of trip (normally within 30 days). No further city funds will be advanced for travel until the employee files his/her outstanding expense report. 8. Administration and interpretation of this policy will be as directed from time to time by the City Manager or his/her designee. The policy should be reviewed every five years for effectiveness. TRANSPORT AT/ON: 1. Use of air, train, private automobile, or other mode of public transportation shall be selected on the basis of the least total cost to the city after all expense items are tabulated, including travel time salary costs. 2. When the use of a private vehicle to destinations within 200 driving miles of the city limits is approved, mileage reimbursement shall be at the rate then currently prescribed by IRS regulations. Individuals with an auto allowance will not receive mileage reimbursements. However, use of city-owned vehicles is allowed for travel within 200 driving miles of the city limits. If use of a private vehicle to destinations beyond 200 driving miles is approved by the City Manager or his/her designee reimbursement shall not exceed the cost of a round trip coach or equivalent class air fare plus ground transportation between the airport and place of lodging. Exceptions, including use of a city-owned vehicle, are subject to approval by the City Manager or his/her designee (such as in cases where items required to be transported are not allowed on any other mode of public transportation). Such reimbursement, if applicable, shall be computed based on the mileage from the normal work location to the final destination. For the purpose of determining personal vehicle mileage reimbursement, the designated normal work location for each City Council Member, Commissioner, City Employee or Volunteer is the place where that individual spends the largest portion of his/her regular workday or working _ time, or the place to which he/she returns upon completion of regular or special assignments. The cost of the daily commute to the office is the City Council Member's, Commissioner's, City Employee's or Volunteer's responsibility. 3. When the use of public air carrier is approved, the city shall pay the lowest available fare at the time the reservation is booked. Upgrades to a higher class of air service will be at the employee's expense. The City Manager, or his/her designee, may authorize exceptions when a higher fare results in a lower overall cost to the city such as a fare that includes cancelation insurance. Business related air carrier Wi-Fi charges will be reimbursed up to $10 per flight. 4. Authorized travel time shall be based on that required by the most appropriate and expedient mode of public transportation. The additional travel time from anything less than the most appropriate and expedient mode will not be considered city work hours. Page 3 of 4 Policy No. 2 5. While traveling, City Council Members, Commissioners, and City Employees are encouraged to use public transportation whenever possible. For example, courtesy shuttle service, buses, taxis, or limousine service should be utilized between airports and meeting locations when such services are reasonably available. Rental vehicles should only be used when other transportation is unavailable, untimely, or a rental vehicle is the most economical mode of transportation. In no case shall valet services for parking be reimbursed. 6. Reimbursement for travel time will be made in accordance with Fair Labor Standards Act (FLSA) guidelines. LODGING: 1. Lodging shall be obtained at the most economical rate available for good quality lodging. When there is an officially designated conference hotel, the traveler is encouraged to take advantage of these accommodations. Lodging expenses for spouses are not reimbursable, and any additional expenses beyond those required for the business traveler must be paid by the elected official, Commissioner or City Employee. 2. Business related Wi-Fi charges which are added to the lodging bill will be reimbursed up to $10 per day. Reimbursement of Wi-Fi charges in excess of this limit may be authorized by the City Manager or his/her designee, under special circumstances. MEALS AND INCIDENTAL EXPENSES: 1. Notwithstanding other limits stated elsewhere, the City Council will be reimbursed the actual costs of meals, plus tips and incidental expenses that are substantiated with a physical receipt while on official city business. 2. Each Commissioner or City Employee authorized to travel may submit the actual cost of meals, tips and incidental expenses for reimbursement up to a limit of $70 per day. If it is anticipated that this limit will be exceeded, then prior approval by the City Manager or his/her designee is required. The City Manager or his/her designee may approve such additional expenditures, within the limits of his/her expenditure authority, as necessary. 3. The city will not reimburse the cost of alcoholic beverages. 4. Reasonable amounts for tipping will be reimbursed, however, reimbursement for tips will not be made in excess of 20%. Page 4 of 4 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 05/30/2019 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 BETWEE_N 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 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 CONTACT NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE (888) 202-3007 I FAX IAIC .in "•": (AIC Nol: 520 Madison Avenue E-MAIL cDntact@hiscox.com 32nd Floor ADDRESS: New York, NY 10022 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: Susan Berk 4234 noeline Ave INSURERC: Encino, CA 91436 INSURERD: 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 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 SUBR POLICY EFF POLICY EXP LIMITS LTR •••~n ,.n,n POLICY NUMBER IMM/DDIYYYYl IMM/DDIYYYYl X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence I $ 100,000 MED EXP (Any one person) $ 5,000 - A -y UDC-1825986-CGL-18 09/28/2018 09/28/2019 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 M POLICY □ jr& DLoc PRODUCTS -COMP/OP AGG $ SIT Gen. Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ /Ea accident\ -ANY AUTO BODILY INJURY (Per person) $ -ALL OWNED -SCHEDULED BODILY INJURY (Per accident) $ -AUTOS -AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS /Per accident\ --$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I ~ffTUTE I I OTH- AND EMPLOYERS' LIABILITY ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE □ N/A E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carlsbad are additional Insured Subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Carlsbad / CMWD C/0 Exigis Insurance Compliance Services P.O Box 4668-ECM #35050 New York NY 10163-4668 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ~ /. ' I © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ----------------------------------------------------·-·-···-- PRODUCER MARATHON INS AGENCY 840 APOLLO ST STE 100 EL SEGUNDO, CA 90245 048686 07 TELEPHONE:(310) 341-3550 POLICY NUMBE:R [ . P(?LICY_ PERioo ._ , ~ ~~A~cf cl}!Yv AUTOMOBILE POLICY DECLARATIONS IMPORTANT GQVE..~(3.E EXCLUSION APPLICABLE TO ALL COVERAGES, INCLUDING BUT NOT LIMITED TO, LiABILITY . . . AND. UNINSURED MpTORISTS, PROVIDED NOW OR LATER. : i 0401. 07 006325925 _ _jFROM06/06/2019 12;01AMTO 12/06/201912:01AM;. It ls agreed that the. lnsurah(:t! afforded by this policy . · shiill ·no.t appiy nor accrue t.o the b~nefil of any insured or any third party clalmai)t when an:rmotor vehicle is being _used or operated by a 'person flslad below regardless of where the fiAMEIJ iNSUREif .. SUSAN BERK DRIVERS SUSAN BERK MEYER H BERK . _____ PERSONS INSURED .. ____________ _ ·_· .. _.:_::.P.~r:scin resides or whether the person is licensed to drive. II MAILING -4.23_4 NOELIN_E.AVENUE ___________ ,t ······-··· ADDRESS _ ENCINO_, CA 91436 ·------·-·------,.-_____ _ j~AR YEAR ________ VEHICLE DESCRIPTION , . SERIALNUMBER .. -~·-c. --,-c-c-o=-=sr=-_. O-R-V:-::A~L-U,_E...,.:.,1-N-=EW=-IU-cScc-E-D'"'i-PU-R-,C,....H,..... ,c-DA...,.:T..,.E7 1_H ___ p_JC-ID .. 1 1 1 2014 KIA SORENTO LX UTL 4X2 4D 5XYKT4A69EG456770 _ 2 2017 KIA CADENZA P~EMIUM SEO 4DR KNALC4J18H5073261 'N 11/2013 N 02/2018 i CAR ~t~~ LOSS ~AYEES (LPJ, ADDm~NAL, lml!ESTS (AQ, i.o_ss P;vies ~~D Am~ti,,.~ ~~lS l~).~r<Atii~d ~;;DR;llliesi~l ~,i;~~~~ai.~~;l;IJ~OTH~TIIANT~;~ :;;isTEo AB~: 1 1 LP KIA MOTOR FINANCE CO P O BOX 105299 ATLANTA GA 30348 i 1 Al CITY OF CARLSBAD/CMWD C/0 EXIGIS INS COMP SVCS NEW YORK NY 10163 12 LA HYUNDAI MOTOR AMERICA P.O.BOX 20850 FOUNTAIN VALLEY CA 92728 I I Coverage applies only if premium charge is listed below. Coverage/limits are subject to all policy terms. COVERAGES I BODILY INJURY LIABILITY $250,000 I PROPERTY DAMAGE LIABILITY _ $100,000 ; UNINSURED MOTORISTS ' BODILY INJURY _LIABILITY UNINSURED MOTORISTS PROPERTY DAMAGE LIABILITY COLLISION DEDUCTIBLE WAIVER $15,000 $ $5,000 CAR CAR LIMITS OF. UA~IIJTY ·. EACHPERSON $500,000 EACH ACCIDENT EACHPERSON $30,000 MAXIMUM CAR2 Y CAR CAR CAR --------------·-- EACH ACCIDENT EACH ACCIDENT . -. l, . PREMi!JNIS : . --~AR..C -· ·ci>.R2TcAR_ -~ ~- 191 247 i 249 307 l I 25 381 3 2 ~ 4 15 ' --·· ----------···---- ~-N<:l_N.-FACTO_~Y_EQUIPMENT ITEMS INSURED ANO AMOUNTS OF INSURANCE FOR EACH ITEM ARE STATED HEREIN. ITEMS INSURED ARE SUBJECT TO THE DEDUCTIBLE. ITEMS INSURED UMIT MEDICAL EXPENSE LEASE/LOAN GAP COVERAGE REPAIR OR REPLACEMENT COST COVERAGE COMPREHENSIVE -~:,so~CnBLECAR1 $500 ---~R2 $500 CAR _!________ .1 :3_ . ·--. _?_()..J _________ ~·c_A~_ L~IFO_· _RNIA~~ES~~s _______ _ -2~~:~:-~~:;{;~~---·t;;·{{~o ___ ::_$ ____ .. __ _2_3_~ __ _4_1;_[ _____ ~::_:~DFEE ___________ 1_76 COLLISION ROADSIDE ASSISTANCE (FO~ T_O_WING SERVIC~S)" RENTAL CAR BENEFIT $30 -··· PER-DAY -30 DAYS ·--· . ·-· 22 22 I -· ----·· ·-1--INT-E-RVE_N_O_R_F_EE----~- ENDORSEMENTS ATTACHED TO THE POLICY ------ I . I PREMiUMs __ ~PE'-R'-. c_AR~---'--~-1-------------·---· U-10 12/2018 743 1078 ---·----··-----·--------------------··-. POLICY.FEE'·'· TOTAL PREMIUM 1,822.76 I l~PC>RTA~! INF~RMA_!I0~-- 1 • rc r Non-Towina Services, Limit of Liability is $75 per Occurrence. Maximum 5 Occurrences in total for jTowing and Non:Towing services per policy period. l~?FECTIVE 06/06/2019 12:01AM il'nis revised declarations page reflects the changes you requested for the policy ;p-2r iuJ 1.ndicated above. iTi:e enclosed Auto Insurance Renewal Bill and the U251 IMPORTANT NOTICE are part of this policy. These !specify the amount of your premium, your payment options, any applicable fees, ar.d the due date. iY,.,ur automobile insurance expires and coverage ceases at 12: 0lAM on 06/06/2019. Coverage under ichis policy will become effective provided you pay the premium and any applicable fees as indicated Ion the Auto Insurance Renewal Bill. If you have any questions, please contact your agent or broker at _the phone number provided above. 1FAY PLAN PAYMENT AMT FEE DUE DATE NEXT PAYMENT FEE DUE: DATE !"'•ill Pay $1,822.76 NONE 06/05/2019 ,2 Fay $918.26 S6.00 06/05/2019 !J Fay $614.76 $6.00 06/05/2019 Same-Pay-RCC $311.76 $6.00 06/05/2019 Sdme fay-EFT $307.76 Sj.00 06/05/2019 CAR . occ ORV : RAT /PRN : PTS I SD l GO i M/C MK! MOLi SYL • PD . CLASS . MIL : IJRV ;ClRY, . PTS STD[ .. S!."'t.ll'."f!":S_YM\SY~ ... '~!"P 1 1 00 ! . N Y KA SR , 5K . 13 286 ES 2 2 011 N Y KA CD.46 16 1C6 ES PRODUCER COPY U-177 12/2018 I UNO: M. Pimentel AMOUNT DUE: $ 307.76 $916.50 5613.00 $309.40 $305.40 S~LV u_sEJ M-l~J ~ N BU: 20 I N PL [ 1 I r ! ! $6.00 $6.00 $6.00 $2.00 08/18/2019 07/19/2019 07/06/2019 07/06/2019 P:5 FlG -:oc:.,~P~TI-:1;;~1 li{gfr;STl-t 5 6002 I H 1938 \ N i Y i 1 i 1 l I I ' ' A/T DEV 3 3 DUE DATE: 06/05/2019 MAILING DATE: 05/29/2019 Process Date: 05/28/2019 CERTIFICATE OF EXEMPTION WORKERS' COMPENSATION/EMPLOYERS' LIABILITY INSURANCE Susan Berk sole proprietor I, _______________ , am the _______________ _ [insert name] Susan Berk of _____________ _ [ name of company] [title] Susan Berk I hereby certify that __________ _ [ name of company] has no employees and is not required by law to maintain workers' compensation or employers' Susan Berk liability insurance. Should _________________ employ any person [ name of company] consulting and training during the term of the Agreement with the City of Carlsbad for ___________ _ [description of project or work that is being contracted] then workers' compensation and employers' liability insurance will be obtained. Susan Berk [Name] Susan Berk [Title and name of company or corporation]