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HomeMy WebLinkAboutGotham Poured Rubber Corporation; 2017-08-28; PKRC628Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 This agreement is made on the d S±f1 day of--1o:::,..,,..""-....... b,Ll'"""""' ..... ..__ ___ , 20J.2, by the City of Carlsbad, California, a municipal corporation, (hereinafter calle 'City"), and Gotham Poured Rubber Corporation whose principal place of business is 1749 Julian Avenue, San Diego, CA 92113 (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: Kyle Lancaster (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. TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 1 of 8 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. Signature: ~~ 7~ Print Name: ';J; I I Rv o 4'.\ e.. V I 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. TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 2 of 8 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 fifteen working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within forty-five working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II II Gotham Poured Rubber Corporation (name of Contractor) 818468 (Contractor's license number) C-61/O34 & 012 04/30/2019 (license class. and exp. date) 1000012699 (DIR registration number) 6/30/2018 (DIR registration exp. date) TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 3 of 8 1749 Julian Avenue (street address) San Diego, CA 92113 (city/state/zip) 619-455-54 70 (telephone no.) (fax no.) maryann@gothamsurfacing.com (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 (print na/titk) CITY OF CARLSBAD, a municipal corporation of the State of California By: Assistant ity 1v1oliH!ICier, Deputy City Manager or Department Director as authorized by the City Manager By: ------=:::==----AJEST: ~ ~ ::; \.JcumrLAD.L77LJJ1~ lit (sign here) BARBARA ENGLESON {,) -- :f Q/, .,_ 9-.f)'!;it /l{'lce, p ,u,'jt,,, f City Clerk (print na /t¢e) If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!.L§ 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: _...J:::.Q-=e..k=:!€2"~·e~~::.::!3L-- ~ity Attorney TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 4 of 8 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 Total% Subcontracted: 0 ------- The Contractor must perform no less than fifty percent (50%) of the work with its own forces. TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 5 of 8 City Attorney Approved 9/27/2016 Tracking#: EXHIBIT B JOB QUOTATION Gotham Poured Rubber Corporation (Gotham) will remove the existing upper wearing layer of the Pine Avenue Park tot lot. Once removed, Gotham will install a new layer to match the existing design. All work and goods shall be performed and provided in accordance with the attached proposal. ITEM DESCRIPTION PRICE NO. 1 Remove and dispose of existing top wearing layer $8,455.00 • Includes materials, labor, truck and dump fees • Bottom attenuation layer will be left in place 2 Replace upper wearing layer $34,200.00 • Includes materials, labor and freight • Color -green/black and blue/black • 4750 square feet • ½ inch thick 3 Materials and labor bond $1,280.00 TOTAL $43,935.00 Agreement amount shall not exceed $43,935.00 TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 6 of 8 City Attorney Approved 9/27/2016 Premium Subject To 1\djustment Based On Final Contract Price EXHIBIT C LABOR AND MATERIALS BOND Tracking#: Bond No. 100351394 Premium: S879.00 WHEREAS, the City Council of the Clty of Carlsbad, State of California, has awarded to Gotham Poured Rubber Corporation (hereinafter designated as the "Principal"), a Contract for: TOT LOT SURFACE REPLACEMENT CONTRACT NO. PKRC628 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Gotham Poured Rubber Corporation, as Principal, (hereinafter designated as the "Contractor"), and American Contractors Indemnity Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of forty-three thousand, nine hundred thirty-five dollars ($43,935.00), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code sect]on 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on tl1is bond, and it does hereby waive notice of any change, extension of time, alteratlons or addition to the terms of the contract or to the work or to the specifications. TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page 7 of 8 City Attorney Approved 9/2712016 Tracking#: In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. , ..._.,-r-l'i.. Executed by CONTRACTOR this __ /-',:;"--__ _ day of 91.,,,i_..;-t....L/ Q..C) , 20 ) ,,_( CONTRACTOR: Gotham Poured Rubber Corporation I (prim name nereJ Cfo (title and organization of signatory) (print name here) (.f: 0 y'{) (title and organization of signatory) Executed by SURETY this 9th day of ______ Jt_m_c ______ , 20_1 _7 _, SURETY: By: American Contractors Indemnity Company (name of Surety) 625 The City Drive South, Suite 205, Orange, CJ\ 92868 (address of Surety) (714) 740-7000 {telephone number of Surety) (signature of Attorney-in-Fact) Ted Lee (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER ::zyAttom~ Deputy City Attorney TOT LOT SURFACE REPLACEMENT; CONT. NO. PKRC628 Page8of8 City Attorney Approved 9/27/2016 TOKIO MARINE HCC KNOW ALL MEN BY THESE PRESENTS: POWER OF ATTORNEY That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, TED LEE its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number _1_0_0_3_5_1_3_94 ___________ , issued in the course of its business and to bind the Company thereby, in an amount not to exceed One hundred thousand and 00/100 <~--~$~1 ~00"--'1-=-0~00""'.-=-0~0 __ ). This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1st day of September, 2011. "Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following prnvisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President State of California County of Los Angeles SS: on this 1st day of December 2014. ,,,,"''m""",,,,, ,,_,-.., :'\?-.~CTDJ?s ,,,, lt";·············?fri 2 ~ ; lNCORPORArEO : =i :;: \~t_n 25. ":~:~:/ -:..,,~,, .. F-1l·;;oR~''\,._~' 1111llfliill\\\\\\ By: AMERICAN CONTR Adam 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, accurac , or validit of that document. On this 1st day of December 2014, before me, Maria G. Rodriguez-Wong, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS h d d ff. · 1 1 MARIA G. RODRIGUEZ-WONG my an an o rcra sea . . commission" 21M9771 ~ ,! Notary Publlc • Cllltornla I Signature 1_L-(seal) 1 L01Angt1e1County ~ -P / j O O O O O J1 Comm. Exe Dec 20, 2017 f 1.,,,./ e,ou sea ,,. I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this __ 9_th __ day of _____ J_u_n_e ____ _ 2017 Bond No. 100351394 Agency No. 4046 Kio Lo,~ecretary HCCSZZ POAACIC 0412016 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 Orange On _ _LJ£_ q, K)fJ before me, _______ K_._H_o_,_N_o_ta_ry_P_ub_l_ic __ _ Date Here Insert Name and Title of the Officer personally appeared ______________ T_e_d_L_e_e _____________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(ll) whose name(~ is/aoo subscribed to the within instrument and acknowledged to me that he/~/t~ executed the same in his/hat/ltook authorized capacity(~). and that by his/he(!~ signature(}() on the instrument the person(K), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Seal 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 offi ----------------oPTIONAL---------------- Though this section is 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: Bond JI /('['i§ I ~=>9 Y Document Date: Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer{s) Signer's Name: Ted Lee Signer's Name: ________ _ I ) Corporate Officer -Title(s): _______ [J Corporate Officer -Title(s): ______ _ I Partner - I I Limited I J General U Partner -l_J Limited U General : : Individual Kl Attorney in Fact I ] Individual 1.1 Attorney in Fact i : Trustee ! I Guardian or Conservator I .I Trustee I ] Guardian or Conservator : ; Other:-----~~--------LJ Other: _____________ _ S)gn~r I~ Repr~¥nti~g: (S;mer~--,,.-,-----Signer Is Representing: ________ _ ,~~~~~:~~~~~~~~~~-~m,w~~~~~~~~~~~~ ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 ADDRESS Pine Avenue Park 799 Pine Avenue Carlsbad, CA 92008 SALES REP Mary Ann McBee Gotham PO Box 81903 San Diego, CA 92138 (619) 696-8841 Service@GothamSurtacing.com JOB NAME ESTIMATE 2094 {".. , ,DATE 05/23/2017 ', PIP Remove and Replace ,, 'I/' ~ / ; ~,... ~-~ " " ",;. DESCRIPTION QTY RATE AMOUNT • I ' J ' V ~--" ~ PIP Gotham Poured Rubber, .5", 50% Color (Green, Red or Blue)and 50% Black to replace existing EPDM Includes: Materials, Labor and Freight.; 4750sf **This quote still doing existing design but with 50%/50% Blue and Black 50%/50% Green and Black Removal Remove / Dispose Existing top layer of EPDM; Includes Labor, Materials, Truck and Dump Fees Materlals Payment and Performance Bond **Quote does not include any buffing repair from removing EPDM** **Quote is for prevailing wage** CA Contractors License #818468 IPEMA Certified Quote Good For 30 Days. 4,750 7.20 34,200.00 4,750 1.78 8,455.00 1,280.00 1,280.00 ·~oiA~· ,, ~,935.oo · . ·. , ~ }.-~iji~,>es¾;"'it, ~ .. •"'" ""~""'~" '1"~,,,,s,,:~'\, < ,4,;:? Accepted By Accepted Date ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 5/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If 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:~~CT CSIS Insurance Services CSIS Insurance Services ;l)gN~o ~xtl: ( 88 8) 501-27 47 I FAX {AJC Nol: (805) 446-4881 !oMl~~ss: certificates@csisonline.com 3315 Old Conejo Road INSURER(S) AFFORDING COVERAGE NAIC# Thousand Oaks CA 91320 INSURER A :Markel Insurance Comoanv 38970F INSURED INSURERS: GOTHAM POURED RUBBER CORP INSURERC: 3960 W POINT LOMA BLVD INSURER D: INSURERE: SAN DIEGO CA 92110-5643 INSURERF: COVERAGES CERTIFICATE NUMBER:Master as of 1/22/17 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 SUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE •••<>n >An,n POLICY NUMBER IMM/DDNYYYI IMM/DDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -D CLAIMS-MADE D OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ ~ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl DPRO-DLoc PRODUCTS -COMP/OP AGG POLICY JECT $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ !Ea accident\ f------ ANY AUTO BODIL y INJURY (Per person) $ f------ALL OWNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ f-------NON-OWNED rte?~fc~Je~t~AMAGE HIRED AUTOS AUTOS $ ~ ~ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X l ~~f TUTE I I OTH- AND EMPLOYERS' LIABILITY ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) MWC0074124-03 1/21/2017 1/21/2018 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1. 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 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 Tamara Epping/TE ~~a_ --=z_/'¥U--~ © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD THIS 8'1DORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUU..Y. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -BLANKEr COVERAGE INCLUDING PRIMARY / NON-CONTRIBUTORY AND WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GB\JERAL LIABILITY COVERAGE PART SCHBlULE Name of Additional Insured Person(s} or Organization(s} (Additional Insured}: Location(s) of Covered Operations: All persons or organizations as required by a written Locations as required by a written contract or contract or agreement with the named insured. agreement with the named insured. A. SECTION II -WHO IS AN INSURID is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule 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 additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" casued, 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) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability 11 bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization. Negligence of Additional Insured "bodily injury" or II property damage" arising directly or indirectly out of the negligence of the additional insured(s). U156A-0313 Includes copyrighted material of ISO Properties, Inc., with its permission. Insured Page 1 of 2 C. SECTION IV -COMMERCIAL GeJERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured required by a written contract or agreement with the named insured is primary insurance and we will not seek contribution from any other insurance available to that additional insured. D. SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended and the following added: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY RBv1AIN UNCHANGED. U156A-0313 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 2 of 2 A~RD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) 5/31/2017 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 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 Phone: ?51 ~694-0625 ~~:i~cT Hank Hitt Fax: 951 719-3350 ;A~~NJ~ CvH• (95 J )694-0625, J 00 I rffc Nol: (951 )719-3350 PSA Realty & Insurance Services E-MAIL hhitt@psainsurance.com PO Box 720 ADDRESS: Temecula, California 92593-0720 INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A: Colony Insurance Company 39993 INSURED INSURERS: Integon National Insurance Company 29742 Gotham Poured Rubber Corporation INSURERC: Navigators Insurance Company 42307 PO Box 81903 INSURER D: San Diego, CA 92138 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 9818 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 SUBR POLICY EFF ,~m-Ji~l LTR TYPE OF INSURANCE m~n un,n POLICY NUMBER IMM/DDNYYYI LIMITS ,/ COMMERCIAL GENERAL LIABILITY IO I GL006927700 1/10/2017 1/10/2018 EACH OCCURRENCE $ 1,000,000 A -D CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence\ $ ,/ N MED EXP (Any one person) $ 5,uuu - PERSONAL & ADV INJURY $ 1,000,000 -2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ R [Z]PRO-DLOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ B AUTOMOBILE LIABILITY 2003321750 9/10/2016 9/10/2017 /ic~~~~~~~lNGLE LIMIT $ 1,000,000 - ANY AUTO BODILY INJURY (Per person) $ -OWNED 7 SCHEDULED AUTOS ONLY AUTOS N BODILY INJURY (Per accident) $ 7 HIRED 7 NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) ~ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ ~ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I ~ifTuTE I I OTH- AND EMPLOYERS' LIABILITY ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE D 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 $ C Equipment Floater N 04-IMOJ4947 10/12/2016 10/12/2017 Contractors Tools & Equipment 23,501 Miscellaneous Tools 6,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder its officers, officials, employees, agents and volunteers are named as additional insured per company form U1560A-0313 attached. CERTIFICATE HOLDER Holder's Nature oflnterest: Additional Insured City of Carlsbad ATTN: Parks & Recreation 799 Pine Avenue Suite 200 Carlsbad, CA 92008 ACORD 25 (2016/03) 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. © 1988-2015 ACORD CORPORATION. All rights reserved. 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