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HomeMy WebLinkAboutExact Construction; 2018-07-10; PKRC667Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT CONCRETE REPAIR AND IMPROVEMENTS; CONT. NO. PKRC667 This agreement is made on the / CJt.b day of • , 20.fR. by the City of Carlsbad, California, a municipal corporation, (hereinafter call a " ity"), and Exact Construction whose principal place of business is 1195 Angelus Avenue, San Dieg , CA 92114 (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. CONCRETE REPAIR AND IMPROVEMENTS CONT. NO. PKRC667 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 may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. ~ff:.--:~;~ Signature:~~ ~/ ~ Print Name: ,/J, / ,,If: · ,rO~-' 7/4it--- 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. CONCRETE REPAIR AND IMPROVEMENTS CONT. NO. PKRC667 Page 2 of 6 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 Exact Construction (name of Contractor) 896546 (Contractor's license number) Class Band C-8, exp. date 5/31/2019 (license class. and exp. date) NA -Small Project Exemption (DIR registration number) (DIR registration exp. date) CONCRETE REPAIR AND IMPROVEMENTS CONT. NO. PKRC667 Page 3 of 6 1195 Angelus Avenue (street address) San Diego, CA 92114 (city/state/zip) 619-254-5497 (telephone no.) 619-464-7366 (fax no.) aharon@exactconstruction.org (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 tenns and conditions of this Agreement. CONTRACTOR By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: ~ARBARA ENGLESON p City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f_§ 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 :-~r~ttomey BY: --"~-L--......_ ____ ...=....__-- Deputy City Attorney ~ For Notary, See Attached CA Al P•pose Ack. For ~·v-,~ A . ~tu..e, CONCRETE REPAIR AND IMPROVEMENTS CONT. NO. PKRC667 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 Exoiration Date Contract Total % Subcontracted: ~ ... The Contractor must perf~fty percent (50%) of the work with its own forces. CONCRETE REPAIR AND IMPROVEMENTS CONT. NO. PKRC667 Page 5 of 6 City Attorney Approved 9/27/2016 EXHIBIT B SCOPE OF WORK Tracking#: Exact Construction will remove and replace concrete and install new concrete at various City sites. ITEM DESCRIPTION PRICE NO. 1 La Costa Canl{on Park $3,650.00 • Remove existing concrete bench pads and repour (1) new 6'x1 0' pad and (2) new 7'x3.5' concrete bench pads 2 Laguna Riviera Park $3,300.00 • Remove a 21 'x 5'9" section of sidewalk and a 6'x11' section of sidewalk and replace with new 4" concrete 3 Holidall Park $4,350.00 • Install new 200 square foot 5.5" thick concrete slab with #4 rebar tied 18" on center. Rebar will be doweled into existing concrete 18" on center 4 Car Count~ Park $10,250.00 • Remove and replace 146 lineal feet of 5' wide concrete sidewalk 5 Fire Station ##6 $2,685.00 • Remove 45w of existing concrete curb. Prepare site, form and pour new 8.5' long concrete sidewalk and curb walls TOTAL* $24,235.00 *Includes taxes, fee's, expenses and all other costs. Agreement shall not exceed $24,235.00 CONCRETE REPAIR AND IMPROVEMENTS CONT. NO. PKRC667 Page 6 of 6 City Attorney Approved 9/27/2016 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of c:::nia County of ~~~/\J-=--D--~'-=-'~--0-=-----' on06)Z±J~& I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. r ·.::···AL.a NAVA Rue?' ·1 ?::a COMM.#2097025 m fl) • Notary Publlc-Calitomla re W . SAN DIEGO CCiJNTY ..& J .. ,,, , .. !'i;Ot"T·1'?.* [8; ~ (Seal) ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 6/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 ~2:i~cT Customer Service Department Target Insurance Services :A~9NJ_ Fri\• (800) 450-8013 I rffc Nol: (866) 227-3052 xCert 6630 Flanders Drive it1cfJ~ss, certificates@premieragencyservices.com INSURER!Sl AFFORDING COVERAGE NAIC# San Diego CA 92121 INSURER A :Associated Industries Ins Co Inc 23140 INSURED INSURER B :Homeland Ins Co of New York 34452 Exact Construction INSURERC: 1195 Angelus Avenue INSURERD: INSURER E: San Diego CA 92114 INSURER F: COVERAGES CERTIFICATE NUMBER:GL 17-18 PL 18-19 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 ADDL I5UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,.,c:n lwvo POLICY NUMBER !MM/DD/YYYYl IMM/DD/YYYYl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A I CLAIMS-MADE [iJ OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence) $ 100,000 X AES104135601 8/2/2017 8/2/2018 MED EXP (Any one person) $ 2,500 f----- f-----PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 R ~PRO-DLOC PRODUCTS -COMP/OP AGG 2,000,000 POLICY JECT $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ /Ea accident\ f----- ANY AUTO BODILY INJURY (Per person) $ f-----ALL OWNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ f------NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS I Per accident\ $ f------ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ f----- EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION $ $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS" LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Pollution Liability 793-00-80-01-0000 5/9/2018 5/9/2019 Policy Aggregate $1,000,000 Contractors Pollution $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is required) City of Carlsbad is named as Additional Insured per the attached Endorsement. *Additional Insured status is subject to all policy terms, exclusions and conditions* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: Parks & Recreation ACCORDANCE WITH THE POLICY PROVISIONS. 799 Pine Avenue Suite 200 Carlsbad, CA 92008 AUTHORIZED REPRESENTATIVE ~~•/,.a . H *Account Carl/MP -© 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS0251?014011 The ACORD name and logo are registered marks of ACORD I / Pol icy: AES 104135601 COMMERCIAL GENERAL LIABILITY CG 203307 04 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 Is 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. B. 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 servic- es, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opi- nions, reports, surveys, field orders, change orders or drawings and specifications; 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 in- 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 2033 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 D A~Ro• CERTIFICATE OF LIABILITY INSURANCE I DATE (NIWOIYYYYI 06/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES HOT 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 ADDmOHAL INSURED, the pollcy(lea) must hava ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain pollcln may requlN an endorsement A statement on this certificate don not confer r1ahts to the certificate holder In lleu of such endoraementfs). PROOUCER l:;~~--1 JOROANNE CALE StateFann STATE FARM INSURANCE JACK DALE AGENCY !'!f.2N.t ·-·· 619 -437 1709 If~-,, A. 1001 B AVE t213 ~..... JORDANNE.DALE.PUAR@STATEFARM.COM CORONADO CA 92118 INSURER/SI AFFORDING COVEMO& NAICI INSUflER A, State Farm General Insurance Company 25151 INSURED INSURER 8: AHARON MILLET INSUREIIC: 1195 ANGELUS AVE INSURERD: SAN DIEGO CA 9211-4 INSURER I! : INSURER,: COVERAGES CERTIFICATE NUMBER• REVISION NUMBER· THIS IS TO CERTIFY Tl-IA T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT'MTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'MTH RESPECT TO 1/.tilCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHO\AM MAY HAVE BEEN REDUCED BY PAID CLAIMS. ':41: TYl'I! OF INSURANCE ,,~--.. ..,.,. ""' .,..., NUNB!lt .-vu<.T terr .-UU..TICAr' UIIITS . .__ COMMERCIAL GENERAL LWIIUTY EACH OCCURRENCE s 'l CLAIMS-MACE D OCCUR -.. ~ IV"'-,., I t:U s PRFMl!:F!: ,c-. -MEO EXP (Any OM oenonl $ -PERSONAL & ADI/ INJURY s RNl. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s POLICY D ~ D LOC PROOUCTS • CONPIOP AGG s OTHER s AUTOMON.E UA81JTY y 296451-4D1155F 04-11-2018 10-11-2018 ,u ~.~NGLE Ul'11r s 750,000 -ANY AUTO 800ILY INJURY (Pwpanon) s -()ll,flED z: SCHEDULED -AUTOS ONLY AUTOS 800ILY INJURY (PW acodlnl) S HIRED NON-O ...... EO ~~E • AUTOS ONLY AUTOS ONLY --s UMBREU.A I.WI HOCCUR EACH OCCURRENCE s -EXCEIILIAB CLAIMS-MADE AGGREGATE s OED I I RETENTION s s WORKERS COMPENSATION I ~~TUTE I I ~AH-AND EMPLOYERS' UAIIUTY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT s OFFICEM.IEMl!ER EXCLUDED? (Mandatory In NH) E.l. DISEASE • EA EMPLOYEE S ~-•.fflcnlleunder SCRIPTION OF OPERATIONS below E.L DISEASE• POUCV LIMIT S DESCRPTION OF OPERATIONS/ LOCATIONS/ VEHICLH (ACORD tot, A*'"'-1 it.urb Sctieck*, ... , be attached If -apace 11 ...,i,.d) CERTIFICATE HOLDER CITY OF CARLSBAD 799 PINE AVE #200 CARLSBAD CA 92008 ACORD 25 (2018/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA110N DATE 11fEREOF, NOTICE Will BE DELMRED IN ACCORDANCE THE POLICY PR S. 88-2015 ACORD CORPORATION. All rights reserwd. The ACORD name and logo are reglste marks of ACORD POLICYHOLDER COPY STATE COMP~NSATION INSU~ANC:E P.O. BOX 8192, PLEASANTON, CA 94588 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-27-2018 CITY OF CARLSBAD PARKS & RECREATION ADMIN 799 PINE AVE STE 200 CARLSBAD CA 92008-2428 SP GROUP: POLICY NUMBER: 1974447-2017 CERTIFICATE ID: 46 CERTIFICATE EXPIRES: 08-01-2018 08-01-2017/08-01-2018 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period that will expire or did expire as indicated above. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. ~tlq Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-06-27 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CARLSBAD PARKS & RECREATION ADMIN ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2014 IS -ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER MILLET, DONWYN AHARON OBA: EXACT CONSTRUCTION 1195 ANGELUS AVE SAN DIEGO CA 92114 (REV.7-2014) SP PRINTED [HIM,CN] 06-27-2018 SP CERTHOLDER COPY STATE COMPENSATION !NSU~ANCE P.O. BOX 8192, PLEASANTON, CA 94588 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-27-2018 CITY OF CARLSBAD PARKS & RECREATION ADMIN 799 PINE AVE STE 200 CARLSBAD CA 92008-2428 SP GROUP: POLICY NUMBER: 1974447-2017 CERTIFICATE ID: 46 CERTIFICATE EXPIRES:08-01-2018 08-01-2017/08-01-2018 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period that will expire or did expire as indicated above. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. ~t!q Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-06-27 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CARLSBAD PARKS & RECREATION ADMIN ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2014 IS -ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER MILLET, DONWYN AHARON OBA: EXACT CONSTRUCTION 1195 ANGELUS AVE SAN DIEGO CA 92114 (REV.7-2014) SP [HIM,CN] PRINTED 06-27-2018 SP