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HomeMy WebLinkAboutChris R. Sperbeck Inc dba Doorworkx; 2019-08-14; PWL20-852GSRECORDED REQUESTED BY CITY OF CARLSBAD DOC# 2019-0586254 111111111111 lllll 111111111111111111111111111111 IIIII IIIII IIIII IIII IIII Dec 16, 2019 01 :46 PM OFFICIAL RECORDS Ernest J Dronenburg, Jr, AND WHEN RECORDED PLEASE MAIL TO: SAN DIEGO COUNTY RECORDER FEES $0.00 (S82 Atkins $0.00) City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 PAGES 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on Oct. 25, 2019. 6. The name of the contractor for such work or improvement is Chris R. Sperbeck, Inc. dba Doorworkx. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Project No. P 0-852GS, Project Name: Senior Center Counter Fire Shutter System Installation. 8. The street address of said property is 799 Pine Ave, Carlsb , CA 2008, in the City of Carlsbad. I, the undersigned, say: Scott Chadwick, City Manager VERIFICATION OF CITY CLERK I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on Novtft1bt( d 'fh , 2011._, accepted the above described work as completed and ordered that a Notice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on DeCtMk/ (jfb, 20 / 'f, at Carlsbad, California. CITY OF CARLS~B 1'~ Hectr/ {i(;mei I Otp_;E+ 1 BARBARAENG=L-ES-O~N=----+-''--4-"~-~ C1f City Clerk C d1✓ \\FILES01V\Departments\Public Works\General Services\Agreements & Contracts\DoorWorkX\Senior Center Counter Fire Shutter System Installation -PWL20- 852GS\4. NOC\2.NOC -Senior Center Counter Fire Shutter System Installation -PWL20-852GS.docx CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Chris R. Sperbeck, Inc. dba Doorworkx has completed the contract work required for PWL20- 852GS -Senior Center Counter Fire Shutter System Installation. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS Remove glass from side lite window of storefront system and install counter fire shutter system. VALUE $4,138.82 CERTIFICATION OF COMPLETION OF IMPROVEMENTS Date CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk is hereby authorized to record the Notice of Completion and release the bonds in ace nee with State Law and City Ordinances. Th is hereby directed to commence maintaining the above described APPROVED AS TO FORM: CELIA BREWER, City Attorney \IFILES01V\Departments\Public Works\General Services\Agreements & Contracts\DoorWorkX\Senior Center Counter Fire Shutter System Installation -PWL20-852GS\4 NOC\3.API -Senior Center Counter Fire Shutter System Installation -PWL20-852GS.docx PWL20-852GS Senior Center Counter Fire Shutter System Installation - 1 - City Attorney Approved 2/29/2016 CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT Senior Center Counter Fire Shutter System Installation This letter will serve as an agreement between Chris R. Sperbeck, Inc., dba Doorworkx, a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to remove glass from side lite window of storefront system and install counter fire shutter system, per Exhibit “A - C” and City specifications, for a sum not to exceed four thousand one hundred thirty-eight dollars and eighty-two cents ($4,138.82). This work is to be completed within sixty (60) working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees, and volunteers 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 this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney’s fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers’ Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said 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. Insurance is 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. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4 California Labor Code) and the “Immigration Reform and Control Act of 1986” (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. __________ init __________ init 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. _______ init _______ init 7. 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. DocuSign Envelope ID: F149BD08-C0E3-4E8F-B5F9-491A1505D7C2 PWL20-852GS Senior Center Counter Fire Shutter System Installation - 2 - City Attorney Approved 2/29/2016 8. 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 the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of 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 the execution of the work covered by this Letter of Agreement. 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. 9. City Contact: Charles Balteria, 760-434-2949 Contractor Contact: Chris R. Sperbeck, 760-510-1043 CONTRACTOR, CHRIS R. SPERBECK, INC., dba DOORWORKX, a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California 1046 Commerce Street, Suite G San Marcos, CA 92078 P: 760-510-1043 F: 760-471-7710 doorsfixed@yahoo.com By: By: (sign here) Chris R. Sperbeck / President Paz Gomez, Deputy City Manager, Public Works as authorized by the City Manager (print name/title) By: Dated: (sign here) Chris R. Sperbeck / CFO, Secretary (print name/title) (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. 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: Deputy City Attorney DocuSign Envelope ID: F149BD08-C0E3-4E8F-B5F9-491A1505D7C2 August 14, 2019 PWL20-852GS Senior Center Counter Fire Shutter System Installation Page 3 of 6 City Attorney Approved 9/27/16 EXHIBIT A Senior Center Counter Fire Shutter System Installation Contractor to provide all tools, materials and labor to remove existing glass from side lite window of storefront system and install a new Cookson model #PFL1F22GT 2’ x 3’9’’ (or equivalent) Counter Fire Shutter System at the Carlsbad Senior Center located at 799 Pine Ave, Carlsbad CA, 92008. Scope of Work shall consist of all items mentioned in the contractor’s proposal dated June 14, 2019 and is attached to this document as Exhibit “B” and Exhibit “C”. Notes: Scope of work to include disposal of glass window SCOPE OF WORK AND FEE DESCRIPTION PRICE Senior Center Counter Fire Shutter System Installation $4,138.82 TOTAL* $4,138.82 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: F149BD08-C0E3-4E8F-B5F9-491A1505D7C2 PWL20-852GS Senior Center Counter Fire Shutter System Installation Page 4 of 6 EXHIBIT B DocuSign Envelope ID: F149BD08-C0E3-4E8F-B5F9-491A1505D7C2 PWL20-852GS Senior Center Counter Fire Shutter System Installation Page 5 of 6 EXHIBIT C Materials DocuSign Envelope ID: F149BD08-C0E3-4E8F-B5F9-491A1505D7C2 PWL20-852GS Senior Center Counter Fire Shutter System Installation Page 6 of 6 DocuSign Envelope ID: F149BD08-C0E3-4E8F-B5F9-491A1505D7C2 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 ri hts to the certificate holder in lieu of such endorsement s . PRODUCER BOB WILEY INSURANCE AGENCY INC INSCJRED t.', ·1 ~ .' ( i Chris R. Sperbeck INC. OBA: DOORWORKX 197 Woodland Parkway, #104 PMB471 CQ'(ERAGES CERTIFICATE NUMBER: FAX AJC No: INSURERA: ASSOCIATED INDUSTRIES INS co INSURER B : NATIONAL UNION FIRE INS CO OF PITTSBURGH PA INSURERC : INSURER D : INSURERE: INSURER F: REVISION NUMBER: 760 735-2460 NAIC# Tl:US 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 ~,RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,INSR TYPE OF INSURANCE ADDL SUBR ,&2hli~ .~~i~ LIMITS LTR': IM,On wun POLICY NUMBER ---X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000 000 ,,__ 7 CLAIMS-MADE [Z] OCCUR IJ1'M>\UC: I U r\C:,_ I C:IJ $ 100.000 I?,• PREMISES /Ea occur!9nCel ' ;. MED EXP (Any one person) $ 5 000 ' 1-- A 1--X X AES 118990500 06/27/19 06/27/20 PERSONAL & ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ? nno ooo Fl [Z]PRO-□LOC PRODUCTS • COMP/OP AGG $ 2.000 000 POLICY JECT OTHER: $ C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ IEa""""""ll :.-.,l 1-- · ANYAUTO BODILY INJURY (Per person) $ ,:,-,--OWNED -SCHEDULED BODILY INJURY (Per accident) $ -:-,-AUTOS ONLY -AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY rPer accidenn :-----$ UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ ~ 000 000 ..... ~ ~ '' EXGESS LIAB CLAIMS-MADE EBU084502985 06/27/19 06/27/20 AGGREGATE $ --~1)"-OED I I RETENTION$ $ . WORKERS COMPENSATION I PER I I gJH--AND EMPLOYERS' LIABILITY y / N STATUTE '• ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ ,;. i .. ,~ OFFICER/MEMBER EXCLUOED? N/A ·.,_l_tl "(Mandatory in NH) E.L. DISEASE· EA EMPLOYEE $ J,,. If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ ' :1 . ; t· -DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarila Sc-ule, may be attach.cl If mo,. apace la .-.quired) THE CITY OF CARLSBAD/CMWD IS NAMED AS ADDITIONAL INSURED. INSURANCE IS PRIMARY AND '"NON-CONTRIBUTORY-WAIVER OF SUBROGATION IS INCLUDED ;'.· 30 ,PJ.\Y NOTICE OF CANCELLATION ... ~CERTIFICATE HOLDER ·r.- 'tf~~: i;..:: .-, -···f .. h t ' CITY OF CARLSBAD/CMWD c/o EXIGIS INSURANCE COMPLIANCE SERVICES P .0. BOX 4668 -ECM#35050 NEW YORK, NY 10163-4668 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS • • 15 ACORD CORPORATION. All rights reserved. !:ACORD 25 (2016/03) t- The ACORD name and logo are registered marks of ACORD :: ;, J_ ~; :i ;· POLICY NUMBER: AES118990500 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 foUowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(•) Or Oraanlzation(s): Locatlon(s) Of Covered Operations All persons or organizations where required by written contract with the Named Insured Information reauired to comolete this Schedule if not shown above will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury'' or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project CG 2010 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 □ : , . \ -' ;,;_ f j. ' ; ,i COMMERCIAL GENERAL LIABILITY CG20 33 0704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who la An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy, Such person or or- ganization is an additional insured only with re- spect to liability for "bodily injury", "property damage" or "personal and advertising injury'' caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. 8. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury'', "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying ser- vices, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional ln- sured( s) at the location of the covered operations has been completed; or b. 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 subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 0704 C ISO Properties, Inc., 2004 Page 1 of 1 □ POLICY NUMBER: AES118990500 COMMERCIAL GENERAL LIABILITY CG 2037 07 04 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 Additional Insured Person(s) Or OraanlzaHon(s): Location And Description Of Completed Ooerations "All per5ons or organizations where written contract with the Named Insured requires completed Operations coverage. This form does not apply to your work on "residential property". Information reQuired to complete this Schedule if not shown above will be shown in the Declarations. Section II -Who Is An Insured Is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 «:> ISO Properties, Inc., 2004 Page 1 of 1 C POLICY NUMBER: AES118990500 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD-PARTY) This endorsement modifies insurance provided under the foUowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured (Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are perfonning work.) Paragraph -4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: Wrth respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect ofwor1( performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Includes copyrighted material of Insurance Services Office, Inc., with ils permission Page 1 of 1 POLICY NUMBER: AES118990500 COMMERCIAL GENERAL LIABILITY CG 24 040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: All persons or organizations where required by written contract with the Named Insured Information reauired to complete this Schedule if not shown above, wiU be shown in the Declaratlons. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 C> Insurance Services Office, Inc., 2008 Page 1 of 1 a CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 PAYCHEX INSURANCE AGENCY, INC.150 SAWGRASS DRIVEROCHESTER, NY 14620 CONTACTNAME: PHONE FAX(A/C, NO. EXT):(A/C, No): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: INSURED 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITSINSR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNEDHIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYA ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?Y/N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CERTIFICATE HOLDER CANCELLATION 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 ACORD 25 (2016/03)©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 06/24/2019 CHRIS R SPERBECK INC 1046 COMMERCE ST., STE. G SAN MARCOS, CA 92078 Paychex Insurance Agency Inc 877-266-6850 585-389-7426 Certs@paychex.com Wesco Insurance Company 25011 12/01/2018 12/01/2019WWC3391939 City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668 - ECM #35050 New York, NY 10163-4668 Y N/A X 1,000,000.00 1,000,000.00 1,000,000.00 ~ ACORD" ~ I ~~ D :=i D D § D D D B D D I I I I I I D n't_~ P~~