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HomeMy WebLinkAboutDoherty Concrete; 2019-01-23; PKRC689Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK; CONT. NO. PKRC689 This agreement is made on the ::U, r.9-. day of ~ , 20-1!_, by the City of Carlsbad, California, a municipal corporation, (hereinafter~ity"), and Doherty Concrete whose principal place of business is 2850 Industry Street, Oceanside, CA 92054 (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: Tim Selke (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. CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK CONT. NO. PKRC689 Page 1 of 6 City Attorney Approved 9/27/2016 Tracking#: FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor,ay prevented from further bidding on public contracts for a period of up to five years and that d~b e by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcon or participating in contract bidding. Signature: · 0. / Print Name: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than ........ $1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ....... $1,000,000 Property damage insurance in an amount of not less than ........ $1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. 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. CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK CONT. NO. PKRC689 Page 2 of6 City Attorney Approved 9/27/2016 Tracking#: INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys' fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within 15 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 45 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II II Doherty Concrete (name of Contractor) 707928 (Contractor's license number) A, C-8, and C-13 I exp. date 6/30/2019 (license class. and exp. date) 1000019050 (DIR registration number) 6/30/2019 (DIR registration exp. date) CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK CONT. NO. PKRC689 Page 3 of6 2850 Industry Street (street address) Oceanside, CA 92054 (city/state/zip) 760-535-9295 (telephone no.) (fax no.) cwdoherty@cox.net (e-mail address) City Attorney Approved 9/27/2016 Tracking#: AUTHORITY. The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR By: /title) By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California Parks & Recreation Director BARBARA ENGLESON City Clerk AA If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .If....§ corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY -is!aG-c:&:rn~ ~v~ CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK CONT. NO. PKRC689 Page 4 of 6 City Attorney Approved 9/27/2016 Tracking#: EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to Business Name and Address DIR Registration License No., %of be Subcontracted No. Classification & Total Expiration Date Contract ~() ~vhs Total% Subcontracted: ___ (:)~--- The Contractor must perform no less than fifty percent (50%) of the work with its own forces. CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK CONT. NO. PKRC689 Page 5 of 6 City Attorney Approved 9/27/2016 EXHIBIT B SCOPE OF WORK Tracking#: Doherty Concrete will provide labor, equipment, tools and materials to remove and replace damaged chain link fence, posts and rails at La Costa Canyon Park. All work shall be performed according to the attached proposal dated January 3, 2019. • Remove existing fence, posts and rails • Install new 4' 9-gauge core 2" black vinyl coated mesh chain link fencing with 1 5/8" black top rails to match existing pattern and layout • Cut existing concrete mow curb to remove existing posts • Install new black schedule 40, 2 3/8" line posts and black 2 7/8" terminal posts • Reform concrete mow curb and pour new concrete around new posts • Clean up site and dispose of existing fence Agreement amount shall not exceed $16,600.00. CHAIN LINK FENCE REPAIR AT LA COSTA CANYON PARK CONT. NO. PKRC689 Page 6 of 6 City Attorney Approved 9/27/2016 ESTIMATE# 1235 ACTIVITY ADDRESS MORGAN ROCKDALE DATE 01/03/2019 *SCOPE OF WORK Charles Doherty Concrete 2850 Industry Street Oceanside, CA 92054 760-535-9295 cwdoherty@cox.net SHtPtO LA COST A CANYON PARK 3018 PUEBLO ST CARLSBAD, CA 92009 QTY Estimate RATE AMOUNT PROVIDE LABOR AT PREVAILING WAGES, MATERIALS AND EQUIPMENT TO REMOVE AND REPLACE 332 LN FT OF 4 FT 9 GAUGE CHAIN LINK FENCING WITH 1 5/8 TOP RAIL TO INCLUDE (3) TERMINAL POSTS WITH (8) MAKE UPS 332 50.00 16,600.00 AS REQUESTED PROVIDE QUOTE TO UPGRADE MATERIALS TO BLACK VINYL COATED WIRE, BLACK POWDER COATED TOP RAIL, POSTS AND FITTINGS. EXISTING CONCRETE MOW CURB UNDER FENCE WILL NEED TO BE CUT ON TWO SIDES OF EACH (35) LINE POSTS THE EXISTING POLES AND SETS WILL BE REMOVED FOR THE INSTALLATION OF NEW LARGER POSTS THE MOW STRIP WILL BE FORMED AND FINISHED TO MATCH AT 35 LINE POSTS TERMINAL POSTS TO BE 2 7/8 LINE POSTS TO BE 2 3/8 *PRICE INLCUDES MATERIAL, LABOR AND EQUIPMENT REQUIRED TO COMPLETE THE WORK DESCRIBED ABOVE. *PRICE DOES NOT INLCUDE REPAIRS OR RELOCATION OF ANY IRRIGATION OR ANY ADDITIONAL WORK NOT LISTED WITHIN. TOTAL Accepted By Accepted Date $16,600.00 ) I ~ CHARDOH-01 K~l:'RIANE ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE(IIIIIDDIYYYY) \a-.--08101/2018 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{&), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holdar is an ADDITIONAL INSURED, the policy(iea) muat have ADDITIONAL INSURED provisl01111 or be endorsed. If SUBROGATION IS WAIVED, aub)ect to the terms and conditions of the policy, certain policies may require an endorNment A statement on this certific• does not confwr rlahts to the certlflcabl holder In lieu of such endorsement{s). PftOIIUCER Lice .... 0757178 t~CT Carl■bed, CA • MMA • HUB International lnaurance Services Inc. ~:o. &ti: (760) 804-0402 I rM Noi:(760) s04-0942 1525 Fara~ Avenue, Suite 2DD !r.lCIII,-,. Carlsbad, C 92D08 1'<15'1-SIN'FORDIIIO COYERAGE NAICII 1NSURER" : Admiral Insurance Comnanv 24856 INSURED INSURER a: Watford Insurance Comnanv 25585 Charin Doherty Concreta INSURER c ; National Union Flnt lnaurance Company of Pltt■bu,vh, PA 19445 Charlie 1302 CrNtridga Dr. INSURERD: Oceanside, CA 92054 INSURERE: IN-l!RF: 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. NOl'MTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'MTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU THE TERMS, EXCLUSIONS AND CONDITIONS Of SUCH POLICIES. LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. .!'!' TYPI! 01' INSURANCE ADDI SUBR POLICY NUMBER POUCYEFF POUCYEXP UMITS . A X COIII.ERCIAL GENERAL UAIIIUTY EAC-.H OCCURRENCE s 1,000,000 -LJ CLAIMS-MADE 00 OCCUR ~~~J9c~~, X CA00002~3 D7/05/2018 07/1512019 s 300,000 -X Per Project A99. -MED EXP CA,,. one DllfSOlll $ 5,000 -PERMNAI & ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PE~· GENERAL AGGREGATE s 2,000,000 Fl POLICY □ ~fc?,= □ LOC PRODUCTS. CC-IOI' AGG s 2,000,000 OTHER: $ B AUTOMOBIU. LIABILITY -~~~~ltolGLE LIMIT s 1,000,000 ANY AUTO WIC1001835-00 07/31/2018 07/31/2019 BODILY IN.AJRY !Par,_.,.,.,, S -01.'.NED X SCHEDULED -AUTOS ONLY ,._ AUTOS 9001L Y INJURY CPer eccidontl $ X ~Lrwl's ONL v X ~8fii~t~ r.c.,.OP~~GE s - s C X u-eLLALIAB ~ OCCUR EACH OCCURRE..,." s 2,000,000 -EBU 06-t083224 07/05/2018 D7/15/2019 2,000,000 EXCESSUAB CLAIMS-MADE AGGREGATE s OED l l RETENTION s Prods/CompOps s 2,000,000 WORKERS COIIPENSA110N I ~~~TIITF I 12~-AND EMPt.OYERS' UABIUTY YIN A'NY PROPRIETORIPARTNERJE)(ECUllVE □ NIA E I . EACH ACCIDENT s ~,!,a~=E.:ftt~ EXCLUDED? E.l. DISEASE • EA EMPlO""c $ ~~~ ~6f>ERATIONS belOw E.l. DISEASE • POLICY LIMIT s DESCRJPTION Of OPERATIONS/ LOCATIONS/ Yl:tllCU.S (ACORD 101, Acldlllollll "-lb SchecM•, may be -h■d I -.. e, la~ Certlflcala hold•r la named • Addlllonal lnauNd with rwapect to General U.blllty par fOffll CG2010 0613 & CG 3 0413. CEATIFIC.6 TE MOLDER I City of Carlsbad 1635 Faraday Ave Carlsbad, CA 92008-7314 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEUED BEFORE THE EXPIRATION DATE lHEREOF, NOTICE WIU. BE DELIVERED IN ACCORDANCE WITH lHE POUCY PROVISIONS. AUTHORIZEDREPRESENTA11\IE ~ @1988-2015 ACORD CORPORATION. All rights resltl'Ved. The ACORD name and logo are registered marks of ACORD ✓ ✓ Policy Number: CA000024840-03 CG 20 34 0413 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -LESSOR OF LEASED EQUIPMENT-AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organi- zation(s). However, the insurance afforded to such additional in- sured: I. Only applies to the extent pennitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such ad- ditional insured. A person's or organization's status as an additional in- sured under this endorsement ends when their contract or agreement with you for such leased equipment ends. B. With respect to the insurance afforded to these addi- tional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section Ill - Limits Of Insurance: The most we will pay on behalfofthe additional in- sured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Lim- its of Insurance shown in the Declarations. CG 20 34 04 13 © Insurance Services Office, Inc., 2012 Page I of I C ----, CHARDOH-01 ~RO~AS ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 12/17/2018 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER ij2ijl~CT Paramount Exclusive Insurance Services, Inc. rtg,NJo, Ext): (818) 986-7283 I FAX 15760 Ventura Blvd. Suite 500 (A/C, No):(818) 986-4949 Encino, CA 91436 it1~AJ!.~~: INSURER/SI AFFORDING COVERAGE NAIC# INsuRER A: Benchmark Insurance Co. 41394 INSURED INSURER B: Charles Doherty INSURER C: 1302 Crestridge Dr. INSURER D: Oceanside, CA 92054 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. 1~;: TYPE OF INSURANCE ~.~.P..\-~.Y.';'~ POLICY NUMBER POLICYEFF POLICY EXP LIMITS .. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ~ □ CLAIMS-MADE □ OCCUR ~~~~~~;[9E~~~~~nce\ $ f-MED EXP rAnv one oerson) $ PERSONAL & ADV INJURY f-$ GEN'LAGGREGATE LIMIT APPLIES PER· GENERAL AGGREGATE $ ==i POLICY □ ~r8r □ LOC PRODUCTS -COMP/OP AGG $ OTHER: $ ~TOMOBILE LIABILITY /f:~~~~~~?NGLE LIMIT $ ANY AUTO BODILY INJURY rPer nerson\ $ --OWNED SCHEDULED f-AUTOS ONLY -AUTOS BODILY INJURY rPer accident\ $ f-~l.lWfsoNLY -~8r5§~1~ f te?~&:\'d~t?AMAGE $ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION X I ~f:T, 'T~ I I OTH- AND EMPLOYERS' LIABILITY ER Y/N CST5014558 12/5/2018 12/5/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE [I] E.L. EACH ACCIDENT $ p,r:~~:m,~,~~~~ EXCLUDED? NIA 1,000,000 E.L. DISEASE -EA EMPLOYEE $ ~~itirttt~ tf~PERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad Parks Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 799 Pine Ave Suite 200 Carlsbad, CA 92008 AUTHORIZED REPRESENTATIVE I {}4d,Wv Sl.e,) ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD