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Home My WebLink AboutGreen Facility Cleaning; 2018-07-11; PSA18-454GSPSA18-454GS AGREEMENT FOR SOLAR PANEL CLEANING SERVICES GREEN FACILITY CLEANING THIS AGREEMENT is made and entered into as of the f ) ~ day of -----'__,.......__,._ ____ , 2018, by and between the CITY OF CARLSBAD, a municipal corporatio , ("City"), and GREEN FACILITY CLEANING, a sole proprietorship, ("Contractor"). RECITALS City requires the professional services of a solar panel cleaning consultant that is experienced in solar panel cleaning. Contractor has the necessary experience in providing these professional services, has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in Exhibit "A", attached and incorporated by this reference in accordance with the terms and conditions set forth in this Agreement. 2. TERM This Agreement will be effective for a period of one (1) year from the date first above written. The City Manager may amend the Agreement to extend for two (2) additional two (2) year periods or parts thereof in an amount not to exceed six thousand one hundred forty-four dollars ($6,144) per Agreement year. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicting the effective date and length of the extended Agreement. 3. COMPENSATION The total fee payable for the Services to be performed will be six thousand one hundred forty-four dollars ($6,144). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or the Services specified in Exhibit "A." 4. PREVAILING WAGE RATES Any construction, alteration, demolition, repair, and maintenance work, including work performed during design and preconstruction such as inspection and land surveying work, cumulatively exceeding $1,000 and performed under this Agreement are subject to state prevailing wage laws. 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 such workers employed by him or her in the execution of the 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 City Attorney Approved Version 9/27/17 PSA18-454GS them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 5. STATUS OF CONTRACTOR Contractor will perform the Services as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under the control of City only as to the results to be accomplished. 6. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City's self-administered workers' compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 7. INSURANCE Contractor will obtain and maintain policies of commercial general liability insurance, automobile liability insurance, a combined policy of workers' compensation, employers liability insurance, and professional liability insurance from an insurance company authorized to transact the business of insurance in the State of California which has 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, in an amount of not less than one million dollars ($1,000,000) each, unless otherwise authorized and approved by the Risk Manager or the City Manager. Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims- made coverage. The insurance will be in force during the life of this Agreement and will not be canceled without thirty (30) days prior written notice to the City by certified mail. City will be named as an additional insured on General Liability which shall provide primary coverage to the City. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Contractor will furnish certificates of insurance to the Contract Department, with endorsements to City prior to City's execution of this Agreement. 8. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all four categories. Yes D No~ 9. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. City Attorney Approved Version 9/27/17 2 PSA18-454GS 10. TERMINATION City or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. City will pay Contractor's costs for services delivered up to the time of termination, if the services have been delivered in accordance with the Agreement. 11. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees it 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. Contractor further acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to terminate this Agreement. 12. JURISDICTIONS AND VENUE Contractor agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Agreement is the State Superior Court, San Diego County, California. 13. ASSIGNMENT Contractor may assign neither this Agreement nor any part of it, nor any monies due or to become due under it, without the prior written consent of City. 14. AMENDMENTS This Agreement may be amended by mutual consent of City and Contractor. Any amendment will be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. Ill Ill Ill Ill Ill Ill Ill Ill City Attorney Approved Version 9/27/17 3 PSA18-454GS 15. 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 GREEN FACILITY CLEANING, a sole proprietor~- By: ./? ~ /(sign here) By: Larry Glenn/ Owner (print name/title) (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By ~~ ([/I~ Elaine Lukey ,·PubliCSDirector as authorized by the City Manager "See Attached Noto rial Certificate" If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A. Chairman, President, or Vice-President Group B. Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney By:~~~7,CL{__/~~___,._,,.a~- Deputy City Attorney City Attorney Approved Version 9/27/17 4 CALIFORNIA JURAT CERTIFICATE A nota1y 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 Riverside Subscri_bed and sworn to (or affirmed) before me on this k() 20 \ ~ , by Lcu_.t.J'C e <1ce t-,c V\0_ y-c_\ '~ 'C- dayof~U'C'~ G\t:Dv-\ proved to me on the basis of satisfacto1y evidence to be the persofrW-who appeared before me. ND OFFICIAL SEAL. 1············ ...... NORMA BERMUDEZ :@:-~ , '. Notary P. ubhc -California f -,; .. ,~ · Rrversrde County ;:: · . Commission# 2218845 • My Comm. Expires Oct 19, 2021 (Nota1y Seal) OPTIONAL INFORMATION The jurat contained within this docu1J1ent is in accordance JJ}i/h Calffemia /a]I}. A'!)' affidavit subscribed and s1Porn to before a notary shall use the preceding JJ}Ol'ding or substantial!} siJJJilar 1vordingpursuant to Civil Code sections 1189 and 8202. A jurat certificate cannot be affixed to a document sent by mail or otherwise delivered to a notary public, induding electronic means, whereby the signer did not personally appear before the notary public, even if the signer is known by the notary public. The seal and signature cannot be aflixed to a document without the correct notarial wording. As an additional option an affiant can produce an affidavit on the same document as the notarial certificate wording to eliminate the use of additional documentation. DESCRIPTION OF ATTACHED DOCUMENT (fitle of document) Number of Pages _____ (Including jurat) Document Date ----------- (Additional Information) MMXIV H.WARDALE 925.786.8909 www.totallynotary.net CAPACITY CLAIMED BY SIGNER Individual Corporate Officer Partner ____ Attorney-In-Fact Trustee ---- ----Other: ____________ _ EXHIBIT "A" SCOPE OF SERVICES PSA18-454GS PURPOSE: To establish a solar/photovoltaic (PV) panel cleaning services for three City of Carlsbad facilities; Alga Norte Aquatic Center, located 6565 Alicante Rd, Carlsbad, California 92010, Safety Training Center, located at 5750 Orion St., and Pine Community Center, located at 3209 Harding Ave, Carlsbad, CA 92008. Green Facility Cleaning will provide the necessary equipment, tools and labor for the complete semiannual cleaning of all glass/solar components of all City of Carlsbad PV panels. Semiannual cleanings to take place during the first week in May and the last week in October. SERVICES: Provide necessary equipment, lifts, ladders, tools and labor required to complete the cleaning of each PV panel. Work to include but not limited to: Soft scrub, clean and rinse of panel surfaces of all PV panels at Alga Norte, Safety Training Center, and the Pine Community Center. APPROVED CLEANING MATERIALS: Water solution will consist of de-ionized, filtered water only (no solvents or detergents). Green Facility Cleaning will use manufacture approved cleaning equipment while servicing PV panels, no high-pressure water allowed on the PV panels at any time, and dry scrubbing is NOT permitted at any time. FILTERED WATER/DEIONIZED ONLY: Green Facility Cleaning will utilize City potable water and will create deionize water on site to use in all PV cleaning services. The city provided potable water must be available on site within 500' of service area. If water is not within 500 feet of the service location, Green Facility Cleaning will provide a portable water tank at an additional charge. WATER CAPTURE: Green Facility Cleaning will capture all water runoff used in the process of cleaning the (PV) panels, and will prevent all runoff from entering any storm drain. Green Facility Cleaning will provide all necessary equipment and labor necessary to capture all runoff from the services provided. Any violation of City of Carlsbad Storm Drain policies or City ordinances (and applicable violation fees) will be the sole responsibility of Green Facility Cleaning. REPORTING: Any damaged panels at service location(s) will be reported by Green Facility Cleaning via a Panel Washing Map Report, and delivered via Dropbox or email to the Contact Administrator. Green Facility Cleaning will provide before and after pictures of work performed and will report any abnormal conditions that may be interfering with PV production on the Panel Washing Map Report. Green Facility Cleaning will visually inspect all visible wires, connectors, ground wires, panel bracketing and PV structure, and will report any identified abnormalities on the Panel Washing Map Report after each ser.1ice. JOB QUOTATION ITEM UNIT UNIT QTY DESCRIPTION ANNUAL FEE NO. PRICE 1 LS $1,895.00 2 Alga Norte Solar Panel Cleaning $3,790.00 2 LS $495.00 2 Pine Community Center Solar Panel Cleaning $990.00 3 LS $682.00 2 Safety Training Center Solar Panel Cleaning $1,364.00 *TOTAL $6,144.00 *Includes taxes, fees, expenses and all other costs. Solar Panel Cleaning Services Page 5 of 5 City Attorney Approved 9/27/16 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~, 05/24/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Casey Blankinship NAME: Enterprise Commercial Insurance Services, LLC r.~~N1.Tn c-••· (800) 307-9480 I FAX IA/C Nol: 12320 Race Track Road E-MAIL casey@enterpriseinsgroup.com ADDRESS: License:0H75680 INSURER(S) AFFORDING COVERAGE NAIC# Tampa FL 33626 INSURER A: United Specialty Insurance Company INSURED INSURERB: StarStone National Insurance Company Green Facility Cleaning, LLC INSURERC: Green Facility Cleaning INSURERD: PO Box 421 INSURERE: Nuevo CA 92567 INSURER F: COVERAGES CERTIFICATE NUMBER: 14578 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 POLICY EXP LTR TYPE OF INSURANCE ,.,en un,n POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 D CLAIMS-MADE [X] OCCUR DAMAGE TO RENTED PREMISES !Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 - A y y USA-4206761 02/09/2018 02/09/2019 PERSONAL & ADV INJURY $ 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 P9 D PRO-DLOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY ~ ~~~~~~d~~llNGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) s ~ 01/'JNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ ~ HIRED ~ NON-01/'JNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ ~ ~ $ UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 4,000,000 ~ B X EXCESS LIAB CLAIMS-MADE y y 81812O180ALI 02/09/2018 02/09/2019 AGGREGATE $ 4,000,000 DED I I RETENTION$ Prod/CompOp $ 4,000,000 WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE D NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate holder is named Additional Insured as respects to the General Liability Policy. Endorsements attached. Primary Non-Contributory Endorsement attached. Waiver of Subrogation Endorsement Attached. Excess is a follow form. CERTIFICATE HOLDER City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. 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. AUTHORIZED REPRESENTATIVE All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD / / CGL 1816 0216 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION, PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: CONTRACTORS LIMITED CLAIMS MADE GENERAL LIABILITY COVERAGE FORM CONTRACTORS LIMITED CLAIMS MADE AND REPORTED GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Additional Insured Person(s) or Oraanlzatlon Locatlon(s) of Covered Operations Any person or organization as required by written Various locations as per contract with the named contract to be named as additional insured. insured. 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) designated above. However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. c. The insurance provided for the benefit of the above scheduled additional insured(s) shall be primary and non- contributory, 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 locatlon(s) designated in the Schedule above. D. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits of Insurance and Deductible: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured Is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. CGL 18180218 Includes copyrighted material of Insurance Services Office, Inc., used with Its permission. Page 1 of2 CGL 1816 0216 All other terms and conditions of this policy remain unchanged. CGL 1818 0216 Page2of2 Includes copyrighted material of Insurance Services Office, Inc., used with Its permission. COMMBR.CJAL GBNBRALLIABILITY CG24040S09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: OOMMF.R.aAL GBNBRAL LIABILITY OOVERAGB PART PRODUCTS/COMPI.B'l'BD OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name or Pel'BOl1 or Organization: ~ pen;on or organtzatfcn for whom you are required to waive your right of recovery on this CoVerage Part under b written contract or agreement. Tho following is added to Paragraph 8. Transfer or Rights or Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery wc may haw against the pcmon or organization shown in tho Schedulo above because of payments wc make for il\jury or damage arising out of your onsc,ing operations or "your work" clone under a contract wi1b that person or oqpnization and included in the ~ucts-completecl opaatiom hazml". 'Ibis waiver applies only to tho pencm or orpnization shown in tho Scheclulo above. C:024040509 0 Jnsunmce Services Oflice. Inc.. 2008 Page 1 ofl CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/19/2018 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(les) 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 endorsemenl A statement on this certificate does not confer ri hts to the certificate holder in lieu of such endorsement s . INSURER S AFFORDING COVERAGE NAIC# INSURER A : State Farm Mutual Automobile Insurance Company 25178 INSURED INSURERS: LAWRENCE GLENN JR OBA GREEN FACILITY CLEANING P.O. BOX421 NUEVO CA. 92567 COVERAGES CERTIFICATE NUMBER: INSURERC: INSURER D: INSURERE: INSURER F: 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 \MTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICYEFF POLICY EXP LIMITS LTR , .... ~ ···-POLICY NUMBER IMM/DOIYYYYl IMM/00/YYYYl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -~ CLAIMS-MADE D OCCUR DAMA<.St= r u t<ENTED PREMISES !Ea oecurrencel $ f--MED EXP (Any one person) $ PERSONAL & ADV INJURY $ - R·L AGGRc~t ~~~~ APe=t PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS • COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY y y 560 4909-F01-75B 12/01/2017 12/01/2018 COMBINED SINGLE LIMIT $ 1,000,000 /Ea accident\ f-- ANY AUTO 612 1945-C01-75 03/02/2018 03/02/2019 BODILY INJURY (Per person) $ - X OWNED IZ SCHEDULED BODIL y INJURY (Per accident) $ -ALITOS ONLY AUTOS 575 3863-D07-75A 04/07/2018 04/07/2019 HIRED NON-OWNED PROPERTY DAMAGE $ t--AUTOS ONLY t--AUTOS ONLY !Per accidentl 563 9283-C02-75 03/02/2018 03/02/2018 MEDICAL TO OTHER $ 5,000 UMBRELLA UAB H OCCUR EACH OCCURRENCE $ t-- EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATION I ~ffrurE I I OTH- ANO EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOFUPARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICEFUMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE $ ~li';;~rt~~ ~:;PERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORO 101, Addltlonal Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER City of Carlsbad/CMWD c/o EXIGIS Insurance Complaince Services P.O. Box 4668-ECM #35050 New York, NY 10163-4668 ACORD 25 (2016103) 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. ION. All rights reserved. 1001486 132849.12 03-16-2016 STATE COMPENSATION INSURANCE FUNC ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS 9166235-17 RENEWAL SP HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 14, 2017 AT 12. 01 A.M. PAGE ALL EFFECTIVE DATES ARE AND EXPIRING SEPTEMBER 14, 2018 AT 12. 01 A.M. AT 12:01 AM PACIFIC ST AND ARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME GREEN FACILITY CLEANING PO BOX 421 NUEVO, CA 92567 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 24, 2017 ~;{.~ ti~,,~ .dl.e~:~ PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 1 OF 2572 OLD DP 217 1