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Haixin Flooring Inc dba Carpet Club; 2018-04-30; PWM18-128GS
RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2018-0460061 \ 1111111111\ 111111111\ \Ill \Ill\\ 111111111111\1111\II 111111111111111111 Nov 02, 2018 10:37 AM OFFICIAL RECORDS Ernest J. Dronenburg, Jr, SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins $0 00) PAGES 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 209-050-26-00 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on May 11, 2018. 6. The name of the contractor for such work or improvement is Haixin Flooring, Inc. dba Carpet Club. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Project Name: New Vinyl Flooring at Fire Station No. 5 - Meeting Room, Hall and Stairs, Agreement No. PWM18-128GS. 8. The street address of said property is 2540 Orion Way, in the City of Carlsbad. VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the /.y of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City of said City on / 0 _,;:2 ~ , 2018, accepted the above described work as completed and ordered that a Notice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on / O/i2.:l) , 2018, at Carlsbad, California. Cir::: ~t:-n1L21(/~ Word\Masters\Forms\Notice of Completion (City) ~BARBARA ENGLESON V~ City Clerk 3/9/98 j 7 8 CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Haixin Flooring, Inc. dba Carpet Club has completed the contract work required for PWM18- 128GS -New Vinyl Flooring at Fire Station No. 5 -Meeting Room, Hall and Stairs. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS New Cortex waterproof vinyl floor planks, and base. VALUE $8,680.00 CERTIFICATION OF COMPLETION OF IMPROVEMENTS Date ' CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk is hereby authorized to record the Notice of Completion and release the bonds in accordance with State Law and City Ordinances. The City of Carlsbad is hereby directed to commence maintaining the above described impro6:•~ ;1,1,2Z•l/8 Scott Chadwick,rtyManager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By ~ ~ Deputy City Attorney Q \Public Works\PW Common\Agreements & Contracts\Contracts\2018 Contracts\MINOR PUBLIC WORKS\Haixin Flooring\Fire Station 5\API - New Vinyl Flooring at Fire Station No. 5.doc PWM 18-128GS CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT NEW VINYL FLOORING AT FIRE STATION NO. 5-MEETING ROOM, HALL AND STAIRS This agreement is made on the ,3 or-h-day of ~L'L , , 2018, by the City of Carlsbad, California, a municipal corporation, (hereinaft~alled "City"), and Haixin Flooring, Inc. dba Carpet Club, a California corporation whose principal place of business is 518 W. Washington Ave, Escondido, CA 92025 (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: Michael O'Brien (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. Pu rsuant 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. New Vinyl Flooring at Fire Station No. 5 Meeting Room, Hall and Stairs Page 1 of 7 City Attorney Approved 9/27/16 PWM 18-128GS 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 r ntractor from participating in contract bidding. Signature: 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. New Vinyl Flooring at Fire Station No. 5 Meeting Room, Hall and Stairs Page 2 of7 City Attorney Approved 9/27/16 PWM18-128GS 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 aR claims, loss, damage, Injury and liability of . every kind, nature and desaiptlon, directly or Indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged falkB'e of Conbador to comply with any appflcable law, rules or regulations lnclu(ing those related to safety and health; and from any and all claims, loss, damages, Injury and liability, howsoeYer the same may be caused, resulti1g directly or inclractly from the nature of the work covered by the Contract. except for loss or damage caused by the sole or active negllgence or wilful misconduct of the City. The expenses of defense Include all costs and expenses Including attorneys' fees for litigation, atblbatlon, or other dispute l'MOlutlon 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 I California. Start Work: Coi1bacioi" agrees to start within twenty (20) working days after~ of Notice to Proceed. Completion: Contrador agrees to complete work within twenty-five (25) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Halxln Flooring, Inc. dba Carpet Club, a California corporation Ill Ill Ill Ill Ill (name of Contractor) 1032021 (Contractor's license number) C15 and C54 10/31/19 (license class. and exp. date) 6/30/2018 (DIR registration exp. date) New Vinyl Floor1ng at Are Station No. 5 Meeting Room, Hal and Stafra \ Page 3 of7 Escondido, CA 92025 (city/state/zip) 760-740-9545 (telephone no.) 760-740-9648 (fax no.) denls@carpetclub.com (&-mail address) City Attorney Approved 9/27 /16 PWM 18-128GS 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, HAJXIN FLOORING, INC. dba CAR ET C U , a California corporation By: (sign here) CITY OF CARLSBAD, a municipal corporation of the State of California By: H 1(W])rl Jli:2 1 7J (print name/title) { (,6-o ~ C('~ "') By: (sign here) (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. ~ corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chainnan, 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:~ Deputy City Attorney New Vinyl Flooring at Fire Station No. 5 Meeting Room, Hall and Stairs Page4of7 City Attorney Approved 9/27/16 PWM18-128GS 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 Exolration Date Contract NONE Total % Subcontracted: 0% -~----- The Contractor must perform no less than fifty percent {50%) of the work with its own forces New Vinyl Flooring at Fire Station No. 5 Meeting Room, Hall and Stairs Page 5 of7 City Attorney Approved 9/27/16 PWM18-128GS EXtftBrr B New Vinyl Flooring at Fire Station No. 5 -Meeting Room, Hall and StaJra Contractor wll provide all materials and labor required to install new Coretec waterproof vinyl planks ( color: Saginaw) In the Fire Station No. 5 south meeti1g room, adjoini1g hall and stairs, located at 2540 Orion Way In Carlsbad, cantortna 92010. 1 SF 2 HR 3 SF 4 EA 5 LF 6 LF 7 LF JOB QUOTA110N 720 Remove and recycle existing carpet, pad and rubber base in haft, stairs and ,, roo:ni, iy room. 4 Prep floor and stairs. 720 Provide and Install Coretec waterproof vinyl plank In meetina room and hall. 17 Provide and il8tall Coretec waterproof vinyl plank on stus. 68 Provide and lnstaH matching stai" nose (Includes 2 ADA). 128 Johnsonlte rubber 6 Inch wal base (color TBD). 4 Provide and install transitions and reducters where needed. ; TOTAL* *Includes taxes. fees, expenses and a8 other coats. $360.00 $340.00 $6,120.00 $637.50 $714.00 $448.00 $60.00 $8,679.50 Th6 co11tlact IMlit price listed above shall constitute full compensation for all labor, materials and work assocalted with the following: Item 1: Remove and recycle existing carpet. pad and rubber base In hall, stairs and meeting room. Carpet Club wUI provide the City Project Manager co11f,nuatlon from approved recycling vendor. Item 2: Prep floor and stairs to Include: fll cracks and holes In haH, stairs and meeting room, remove old adhesive (If needed) and skim coat as required to manufactures recommended conditions. Item 3: Provk:le and lnstaD Coretec waterproof vtnyt plank (color: Saginaw, 8 Mil., 1.1r x 48" with cork underlayment). Provide adhesive: Mannington Revol -133016 or equivalent. Labor and ea required material to install vinyl planks i"t meeting room and hall included In price. Item 4: Provide and Install Coretec waterproof vinyl plank (color: Saginaw, 8 Mi., 7 .1T X 48" with cork underlayment). Provide adhesive: Mannington Revol -133016 or equivalent. Labor and all required materlal to Install Vinyl planks on stefrs Included. Item 5: Provide and Install Coretec waterproof vinyl (matching) stair nosing (Includes 2 ADA). Color: Saginaw, 8 MH., 7.1r x 48" with cork underfaymant. Two ADA provided stair nose will be Coretec prouduct with matching patems. however, with difference In colorlcontrast to meet all ADA requnmetns. Labor and matial to install Coretec vinyl stai" noses on stairs Included In price. Item 6: Provide and Install Johnsonite rubber 6 inch wall base (color TBD), price to Include manufacture approved adheislve. Item 7: Provide and Install Coretec waterproof vinyl transitions and reducters where needed (matching Saginaw patems and colors). Notes and ackitlonal requirements: Contrador wl clean-up al \\Q'k spaces after each day of wor1</i1stallaton. Al applicable guidelines and sections of The ·Greenbook" 2018 Edition wll be adhered to during the entire Agreement, unla6s otherwise approved In advance by the City PrQject Manager. New Vklyl Flooring at Fi"e Station No. 5 Meeting Room, Hal and Stairs Page 6 of7 City Attorney Approved 9/Z7 /16 PWM 18-128GS EXHIBIT B (continued) New Vinyl Flooring at Fire Station No. 5 -Meeting Room, Hall and Stairs Color Sample: Coretec Saginaw New Vinyl Flooring at Fire Station No. 5 Meeting Room, Hall and Stairs Page 7 of7 City Attorney Approved 9/27/16 AE5!---Ri:/ CERTIFICATE OF LIABILITY INSURANCE I· DATE~ 1 018 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 BEL:.OW. THIS CERTIFICATE' OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER I IMPORTANT: If the certificate holder Is an ADDrTIONAL INSURED, the pollcy(les) must have ADDmONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain pollclea may require an endorsement A -.tatement on this certificate does ·not confer rights to the certificate holder In lieu of 11uch endoraement(s). PRCXXJCER ~:,-:---Dawn Manzano Alliant Insurance Services, Inc. PHONE ' I FAX CA License No. 0C36861 I Air U.. C..+\, 619-849-3788 Ill.If'. .,n\0 619-899-2136 701 8 Street, 6th Floor. ~~ ..... Dawn.ManzanOltllalnantcom San Diego CA 92101 JNSURERIS) AFFOROINO COVERAGE NAICt IHSURER A: Ohio Securttv Insurance Comoanv 24082 INSURl!D MOBICAR-01 INSURER a : Colonv Insurance Comoanv 39993 Haixin Frooring, Inc. DBA Carpet Club INllURERC: 518 WWashin~on Ave Escondido CA 2025 INSURER D: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 839777583 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BB.OW HAVE BEEN ISSUED TO .THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWITHSTANDING ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREJN IS SUB,JECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INIIR ,. ,-POUCYEFF POLICYEXP LIIIITS \ LTR TYPE OF NSURANCE I_,..., I \AI\JT\ POLICY NUIIBER TTT B X COIIUERCIAL OEN!:RAL LIABILITY y 103GL001 Q843()() Mi/2017 < 9/5/2018 EACH OCCURRENCE $1,000 000 - Da.AIM~ 00CClR ~J9,,~lt:U -$100 000 MED EXP lkrv one p,non) $6000 - PERSONAL & NN INJURY $1 000000 ~ GENi.. AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000000 1POOCY0~~ DLoc j PROOUCTS -COMP/OP AGG $2,000.000 OTHER: Dedu:tlJle $6,000 A AUTOIIOBlLE LIABILITY y BAS58123383 9/B/2017 !l/6/2018 SINGLE LJMf1 "'~·-, $1 IYVHVll'I ~ X ANY AUTO BODV.. Y INJURY (Per~) $ f--OWNED -SCHEDULED BODI. Y INJURY (Per EICCldent) $ f--AUTOS ONLY -AUTOS HIRED NON-OWNED ~~~ $ -AUTOS ONLY -AUTOSotl.Y $ UIIBREU.A LIAB HOCCUR EACH OCCURRENCE $ -EXCESS UAB CLAIMS-MADE. AGGREGATE $ DED. I I RETENllON s $ WORKERS COIFENBA.TlON ) I ~fTIJTE I I~ AND EMPLOYER8' LIABILITY Y/N I ANYPROPRIETOR/PARTN ER/EXEClJTJVE D N/A E.L EACH ACCIDENT $ OFACER/MEMBEREXCLUDED? (llendalory In NH) E.L DISEASE -EA EMPLOYEE $ g~~ o't" OPERATIONS below E.L DISEASE-POLICY LIMIT-$ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEKICI.ES (ACORD 101, Addtional Rem.-b Schedule, may be --If more apace la required) RE: City of Carlsbad Public \Norks General Services· Agreement Name Office Carpet Replacement at t<,4onr6e ST Pool Agreement Number P\/oJl..18-98GS Certtflcate Holder Is lnduded as additional Insured as required by wrttten contract. ... ' CERTIFICATE HOLDER CANCELLATION , _SHOULD ANY OF TI-IE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE TI-IE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbacl/CM\ND ACCORDANCE WTTI-1.TI-IE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services P. 0 Box 4668 -ECM #35050 ~4RESBITAffiE New York NY 10163-4668 ~ . I Q 1988-2015 ACO~D CORPORATION. All rights reserved. ACORD 25 (2016/03) Toe ACORD name and logo are registered marks of ACORD · POLICY NUMBER: 103 GL 0019843-00 103 GL 0019843-00 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES'THE POLICY. PLEASE READ IT CAREFULLY. ' ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organlzatlon(s) Locatlon(s) Of Covered Operations All persons or organizations as required by written As designated In written contract with the Named contract with the Named Insured Insured Information required to complete this ,schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an addltlonal insured the person(s) or organization(s) shown in the Schedule, but only with respect to llablllty 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 addltlonal insured. B. Wrth 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" oca.Jning 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 addrtional 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 ~rises 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 \ C. With respect to the insurance afforded to these additional Insureds, the following is added to Section Ill -Limits Of Insurance: 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 103GL0019~ 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. Page 2 of 2 @ Insurance Services Office, Inc., 2012 CG 2010·0413 POLICY NUMBER: 103 GL 0019843-00 103 GL 0019843-00 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modtfles insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organlzatlon(s) Location And Description Of Completed Operations All persons or organizations as required by written As designated in written contract with the Named Insured contract with the Named Insured Information required to complete this Schedule, tf not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or •property damage• caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that addttional insured and lncll!ded In the "products-completed operations hazard•. 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 is added to Section Ill -Limits Of Insurance: 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 LJmtts of Insurance shown In the Declarations. CG 20 37 0413 © Insurance Services Office, In~ .• 2012 Page 1 of 1 103 G L 0019843-00 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSE.MENT CHANGES THE POL.ICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement m<;>cllfles insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLE-r:ED OPERATIONS LIABILITY COVERAGE PART The followlng is added to the Other Insurance Condition and supersedes any provision to the contrary: · Primary And Noncontributory Insurance Thi~ insurance is primary to and will not seek contribution from any .other insurance available to an additional Insured under your policy provided that: (2) You have agreed In writing In a contract or agreement that this insurance would be primary and would not seek contribution from any other Insurance available to the additional insured. (1) The addltional insured is a Named Insured under such other insurance; and · \ CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 103GL001~ DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT -RESTRICTED FORM This endorsement modtfies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: All projects during the policy period. (If no entry appears above, information required to complete this endorsement will be shown In the Declara- tions as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" Under SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses-caused by" accidents under SECTION I -COVERAGE C MEDICAL PAYMENTS, which can be attributed only to ongoing operations at a single designated con- struction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under SECTION I-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except damages because of "bodily injury" or ·property damage" Included in the "products-completed operations hazard", and for medical expenses under SECTION I - COVERAGE C MEDICAL PAYMENTS regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing ·suits·. 3. Any payments made under SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I -COVERAGE C MEDICAL PAYMENTS shall reduce the Designated Construction Project General Aggregate Limit for that des- ignated construction project. Such payments shall not reduce the General Aggregate Limit shown In the Declarations nor shall they reduce any other Designated Construction Project Gen·eral Aggregate- Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damages to Premises Rented to You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. 5. The most we will pay for the sum of all Designated Construction Project General Aggregate Limits combined and to which this insurance applies is $5,000,000. B. For all sums which the insured becomes legally obligated to pay as damages caused by Moccurrences" Under SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE UCG2503-1013 Includes copyrighted material of Insurance Services Office, Inc., 1996 with its permission. Page 1 of 2 103 GL 0019843-00 LIABILITY, and caused by accidents under SECTION I-COVERAGE C MEDICAL PAYMENTS, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under SECTION 1-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I -:-COVERAGE C MEDICAL PAYMENTS shall reduce the amount available under the General Aggregate Limit or the Products- Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability resulting from the Mproducts-completedJoperations hazard" is provided, any payments for damages because of "bodily injury" or "property damage", included in the "products- completed operations hazard~ will reduce the Product~ompleted Operations Aggregate Limit, and not . reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION Ill -LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stlpulated. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. UCG2503-1013 Includes copyrighted material of Insurance Services Office, Inc., 1996 with Its permission. Page 2 of 2 COMMERCIAL AUTO CA8810 0113 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM ) With respect to coverage afforded by this endorsement, the provisions of the policy apply unless mcxlified by the endorsement. COVERAGE INDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE -BROADENED COVERAGE GLASS REPAIR -WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) . HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION II -LIABILITY-COVERAGE Is amended as follows: 1. BROAD FORM INSURED 3 12 19 5 13 1 22 2 23 10 15 6 20. 14 16 11 8 9 4 7 17 18 20 SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an Insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy pericxl. However, "insured" does not include any org~nlzatlon that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile pollcy; or (3) Has exhausted its Limit of Insurance under any other autombbile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply spectfically in excess of this ·policy. e. Any organizatlon you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent, of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-lnsu~d retention plan available to that organization; ® 2013 Liberty Mutual Insurance CA8810 0113 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include j ' the following as an Insured: f. Any "employee" of yours while using a covered "auto" · you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- -rrient Is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under, a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDmONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ) SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED Is amended to Include the following as an Insured: · h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have "agreed In a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization Is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: . (2) Up to $3,000 for cost of ball bonds 0ncludlng bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. · (4) All reasonable expenses Incurred by the Insured at our request, Including · actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following . provision is added: SECTION II -LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply If the "bodily injury" results from the use of a covered "auto" you own or hire .. SECTION Ill -PHYSICAL DAMAGE COVE~GE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE r Paragraph A.4. Coverage Extensions of SECTION Ill -PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or @ 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. . Page 2-of 7 b. Your "employee" hires or rents under a written contract or agreement . in that "employee's" name, but only if the damage occurs while the vehicle is being used In the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: \ (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. · 1 B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described In this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V -DEFINITIONS Is amended by adding the following: "Total loss" means a "loss" In which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SEC_TION Ill -PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: · We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled: · a. For private passenger type vehicles, we will pay up to $50 per disablement b. For "light trucks", we will pay up to $50 per disablement "Light trucks" are trucks that have a moss vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of dis.ablement. 8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION Ill -PHYSICAL DAMAGE COVERAGE, Is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 @ 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per dax for rental reimbursement expenses incurred by you for the rental of an "auto" becaus_e of "accident" or "loss", to an "auto" · for which we also pay a "loss" under Comprehensive,. Specified Causes of Loss or Colllslon Coverages .. We will pay only for those expenses lricurred after the first 24 hours following the "accident'' or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less ·than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quallty, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace· your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your. use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental_ ~lmbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies_ to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined . in provision 11. 10. EXTRA EXPENSE -BROADENED COVERAGE Under SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. The maxlmum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION Ill -PHYSICAL 'DAMAGE . COVERAGE, A. COVERAGE, Is amended by adding the following: ) · ' if you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V -DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an insured." "Personal effects" does not Include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: If you have purchased Comprehensive or Collision· Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any Insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: CA 88 10 01 13 @ 2013 Liberty Mutual Insurance Includes copyrighted material of-Insurance Services Office, Inc., with Its permission. Page 4 of 7 Exdusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits .audio, visual or data signals, whether , or not designed solely for the reproduction of sound, if the equipment is pern,anently Installed In the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or . If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or reP,lace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN / LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we wlll pay for a "total loss" to a covered "auto" owned by or leas,ed to you in any one "accident" is the greater of the: 1. Balance due under the tern,s of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", · b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- norn,al wear and tear, c. Costs for extended warranties, Credit . Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepalred damage which occurred prior to the· ''total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early tern,ination of a lease agreement or as a result of the early tern,ination of any warranty or extended service agreement on a covered "auto", I. Any amount representing taxes, J. Loan or lease tern,ination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition. will be made in detern1irlng the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that Incurred the loss. C. SECTION V -DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: ''Total loss" means a "loss" in· which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon lqan" is one with periodic payments that are insufficient to repay the balance over the tern, of the loan, thereby requiring a large final payment. @ 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted mater:fal of Insurance Services Office, Inc., with Its permission. Page 5 of 7 15. GLASS REPAIR -WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the followfng: No deductible applies to .glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION.COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" Is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police auth,orltles within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown In the Declarations. This provision does not apply to any "loss" if the covered , "auto" is in the charge of any person or org13nfzatlon . engaged in the automobile business. 17. TWO OR MORE DEDUCTIBLES Under SECTION Ill PHYSICAL DAMAGE COVERAGE, If two or more company policies or coverage fonns apply to the same accident, the following applies to paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it wlll be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible .it will be reduced by the amount of the ~maller (or smallest) deductible; or · c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deducti_ble will be waived. For the purpose of this endorsement company means any company that Is part of the Liberty Mutual , Group. SECTION IV -BUSINESS AUTO COf':'DmONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS, Parag~ph 8.2. is amended by adding the followlng: If you unintentionally fail to disclose any hazards, exposures 'or material facts existing as of the Inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report th_e undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.2.a. Is replaced in its entirety by the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; I 4. -An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. @ 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of lnsuranceServlces Office, Inc., with Its permission. Page 6 of 7 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV -BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired , leased, rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V -DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLI CY CONDITIONS, paragraph A. -CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 AC~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/D0/YYYYJ 01/23/2018 ~ ', THIS CERTIFICATE IS ISS.UED 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 POUOES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATNE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poUcy(Jes) must be eridorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain polldes may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In neu of such endorsement(s). PROOUCER CONTACT NAME: Self Insured Solutions PHONE (800) 592--0047 IFAX (800) 592-2541 we. No. !xtJ: WC,No,Est); Administrator, Callfomla Contractors Network, Inc. E-MAIL slscerts@selflnsuredsolutlons.com AllllRESS: - 430 N Vlneyard Ave .. #102 INSURER(S) AFFORDING COVERAGE NAICII Ontario, CA 91764 INS\JllERA: caltfomla Contractors Network, 1nc.• INSURED INSUIEII B: New Yori( Mann~ and General Insurance Company 16608 Halxln Flooring, Inc. INSUR!RC: Afflllate of callfomla Contractors Network, Inc. INSURER D: 518 W. Washington Ave. INS\mRE: Escondido, CA 92025 INSURERF: ( COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TiilS IS TO CERTIFY TliAT TliE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TliE INSURED NAMED ABOVE FOR TliE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY EQUIREMENT, TERM, OR CONDmON OF ANY CONTRACT OR OTiiER OOCUMENT WITH RESPECT TO WHICH TlilS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TiiE INSURANCE AFFORDED BY TliE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TliE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. tlMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POIJCY!Fl' POIJCY EXP LTII TYPE OF INSURANCE IN511 UIVTl POUCY NUMBER ~-.-..... ·---',__ ... _____ LIMITS COMMERCAL GENERAL LIABIUTY EACH OCCURRENCE $ -D QAJMS-MADE D OCCUR DAMAGE TO RENTED ?Rf Ml.SES (Ea occurrence) $ -'MED EXP (Any one person) $ -D D PERSONAL & ArYV ll'UURY $ - GEN'LAGGRD LIMIT APDPfR: GENERAL AGGREGATE $ ~ POLICY PROJECT LDC PRODUCTS -COMP/OP AGG $ OTHER $ AUTOMOBILE LIABIUTY COMBlNED SINGLE LIMIT $ (Ea occident) -ANY AUTO BODILY ll'UURY (Per p,,rson) $ -~ D D AHYOWNED SOlIDULED BODILY ll'UURY (Per accident) $ AUTOS AUTOS --HIRED AUTOS NON-OWNED PROl'ERlY DAMAGE $ --AUTO (Per ICddontj $ UMBREUA LIAB tj OCOJR EACH OCCURRENCE $ -D D EXCESS UAB QAIMS-MADE AGGREGATE $ -OED n RETENTION $ $ WORKERS COMPfNSATION X I WCSTATU-I 10;-AND EMPWYERS' UABIUTY T/N TORYUMITS A AHY PROPRIETOR/PARTNER/EXEOJTNE ~ N/A ~ 4503--0259 01/01/2018 01/01/2019 E.l EAOl AcaDENT $5,000,000.00 OFF!CE/MEMBER EXO.UDED? (Mandatory In NH) E.L DISEASE -EA EMPlOYEE $5,000,000.00 If yes, dacrbi under E.L DISEASE -POLICY LIMIT $5,000,000.00 DE5CRIPTION Of OPERATIONS below B EXCESS WORKERS COMPENSATION D D WC2018EPP00181 01/01/2018 01/01/2019 AND EMPI.OYERS LIABILITY Appllcable to WC Statutory Umlts and Employen Uabllltv Umlts. DESCRIPTION OF OPERATIONS/ LOCATION / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more spea, Is raqulred) All Caltforma Opl!fa!f ons •• Waiver of subrogation applles -see attach~ •• 30 Day Notice of Cancellatlon •eomp11.,. with the requlrement5 of th~ Director of industrial Relations under the provisions of Sections 3700 to 3705, lnclU51ve, of the Labor~ of the State of callfomla, holder of Master Certificate of Cement to Self-Insure No. 4503 CERTIFICATE HOLDER Oty of cartsbad/CMWD rjo EXIGIS Insurance Compliance Services P.O. Box 4668 -ECM #35050, New York, NY 10163-4668 ACORD 25 (2014/01) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WIU BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AIJTHORIZED REPRESENT A llVE A. Seegmiller => 1988-2010 ACORD CORPORATION. All rights reserved The ACCORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY California Contractors Network, Inc. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS We have the right to recover our payments from anyone liable for a covered Injury. 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.) This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule. Schedule Name of Person or Organization: City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668-ECM #35050 New York NY 10163-4668 Insured: Halxin Flooring, Inc. Policy No.: 4503--0259