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HomeMy WebLinkAboutNissho Of California Inc; 2019-01-08; PKRC685Project: PKRC685, PINE AVENUE PARK ARTWORK REFURBISHMENT Change Order No. 1 CITY OF CARLSBAD CONTRACT CHANGE ORDER NO. 1 PROJECT: PKRC685, PINE AVENUE PARK ARTWORK REFURBISHMENT CONTRACT NO. PKRC685 ACCOUNT NO. 3207000-9060/46032-9083 & 9031 CONTRACTOR: Nissho of California, Inc. ADDRESS: 1902 South Santa Fe Avenue Vista, CA 92083 P.O. NO. P136863 The Contractor is directed to make the following changes as described herein. Changes shall include all labor, materials, equipment, contract time extension, and all other goods and services required to implement this change. Payment stated on this change order includes all charges, direct or indirect, arising out of this additional work including charges for field overhead, extended home office overhead, delays, disruptions, cumulative impacts, loss of efficiency, extended equipment costs and overtime premium costs and is expressly agreed between the City and the Contractor to be the complete and final costs hereof. The requirements of the specifications, where pertinent and not in conflict with this change order, shall apply to these changes. Pursuant to the Standard Specifications for Public Works Construction, perform the following: Item 1: Increase to contract cost. ........................................................... $5,014.00 TOTAL INCREASE TO CONTRACT COST .............................................. $5,014.00 TIME FOR COMPLETION OF ALL WORK UNDER THIS CONTRACT SHALL NOT BE INCREASED AS A RESULT OF THIS CHANGE ORDER. Project: PKRC685, PINE AVENUE PARK ARTWORK REFURBISHMENT Change Order No. 1 RECOMMENDED BY: AP:;JBY ~ ~1Lt1 DATE) CONTRACTOR / 6 /-:}/r' G MANAGER (DATE) p 5'//41. (DATE) NISSHO OF CALIFORNIA, INC. 1902 South Santa Fe Avenue, Vista, California 92083 Phone 760.727.9719 Fax 760.727.8706 License #598372 WORK ORDER Cit Of Carlsbad Pine Park Project Name City of Carlsbad Client Name Nissho Internal Only (Maintenance Department) 760-434-2922 Tom Baird Client Phone # Authorized by (Print) Project Manager (Print) Authorized by (Sign) Date Sales Rep Approval (Sign) DETAILED DESCRIPTION OF WORK TO BE PERFORMED Pro osal for addions to the Pine Ave Park Artwork Refurbishment. Addions are as follows. Addin Pads, Rental of "Old Granite" slam s, Cost for lnte ral color and release a ent, U Fiber mesh, and additional labor for lacement of added Rocks. MATERIALS QTY PRICE lnstallin of 3-3' X 2' Ent ads: Materials: Rebar,Forms,Concrete and Sealer $ 442.00 Labor: Grade, Set Forms.Install Rebar, Pour and Finish Concrete.Remove Embedded $ 1,458.00 $ 500.00 rade 5,000 PSI W/Fibermesh, Relaese A ent Brickform Baja La Cresta Boulders 2 $ 242.00 LABOR HRS RATE Labor to set extra Rocks GRAND TOTAL $ $ $ $ $ $ $ $ $ $ $ $ 019 TOTAL 442.00 1,458.00 500.00 850.00 484.00 TOTAL 1,280.00 5,014.00 THESE SIGNATURES BELOW CERTIFY THAT THE AREAS HAVE BEEN THOROUGHLY INSPECTED BY THE UNDERSIGNED REPRESENTATIVE. IT HAS BEEN DETERMINED THAT THE INSTALLATION IS IN ACCORDANCE WITH THE PLANS OR THE AGREED UPON SPECIFICATIONS BY THE DEVELOPER/CLIENT AND NISSHO OF CALIFORNIA, INC. Nlssho of California Representative Client Representative Print Print 1gn Date ign Date Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT PINE AVENUE PARK ARTWORK REFURBISHMENT, CONT. NO. PKRC685 This agreement is made on the --=-......._......__ day of ---=:::.....~>oL...~~~::::::;:~--' 2ofi_, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), a Nissho of California, Inc. whose principal place of business is 1902 South Santa Fe Avenue, Vista, CA 083 (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: Kasia Trojanowska (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. PINE AVENUE PARK ARTWORK REFURBISHMENT CONT. NO. PKRC685 Page 1 of 6 City Attorney Approved 9/27/2016 Tracking#: FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subco~tor from participating in contract bidding. Signature: __ ;a_.__1/ ___________ _ Print Name: ~ ,3a., =cf 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. PINE AVENUE PARK ARTWORK REFURBISHMENT CONT. NO. PKRC685 Page 2 of 6 City Attorney Approved 9/27/2016 Tracking#: INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys' fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within 15 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 120 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II II Nissho of California, Inc. (name of Contractor) 598372 (Contractor's license number) C27 7/31/2020 (license class. and exp. date) 1000018744 (DIR registration number) 6/30/2019 (DIR registration exp. date) PINE AVENUE PARK ARTWORK REFURBISHMENT CONT. NO. PKRC685 Page 3 of 6 1902 South Santa Fe Avenue (street address) Vista, CA 92083 (city/state/zip) 760-727-9719 (telephone no.) 760-727-8706 (fax no.) tbaird@nisshoca.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 Byd) (sign here) 7"t:1oo 6,a-,,Ji U1. co X,, (., .. 4 ..... \- (print name/title) (sign here) 4:,1cl!1 a /J olle:(a, SQ c;tL{tcuy (print nam~/title) . CITY OF CARLSBAD, a municipal corporation of the State of California By ~ CHRIS~i Parks & Recreation Department . BARBARA ENGLESON ~Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f_g 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: PINE AVENUE PARK ARTWORK REFURBISHMENT CONT. NO. PKRC685 Page 4 of 6 See attached Califoil'iia AH-Purpose Acknowledgment City Attorney Approved 9/27/2016 . --C.Ai;.lFCB..NJA ALL•PURP£lSE ACKNOWLEDGMENT CiViL CODE§ ii89 A notaiy public or other officer completing this certificate verifies only the identity of the individual who sigried the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Seal Above I certify under PENAL 1Y OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. VvlTNESS my hand and official seal. Slgnature ___ :_,,.~,------~------~~-&f-..-;-i-~_,,_ 8 .__ _____ b __ 17 c __ .-. ___ -.. _ ----~------'-----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 ~-h,--; f Title or Type of Document: 'M I nee eu l2 If u lN crt:-.s { trf JLult Document Date: __________________ Number of Pages: ____ _ Signer(s) Other Than Named Above: _____________________ _ Capacir.1{ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ___________ _ □ Corporate Officer -Title(s): ______ _ □ Corporate Officer -Title(s): ______ _ □ Partner -□ Limited □ General □ Partner -□ Limited □ General □ Individual □ Attorney in Fact □ Individual □ Attorney in Fact □ Trustee □ Guardian or Conservator □ Trustee □ Guardian or Conservator □Other: _____________ _ □ Other: _____________ _ Signer ls Representing: ________ _ Signer Is Representing: ________ _ • ©2015 National Notary Association• www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 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. Classlflcation & Total Exoiration Date Contract Ci.J.', <: ·c~ ~ b ')(.l'\_ L \--C--C \fl ) \-(\,-\. L-\-\ t:.V\ 'til\\Ot,\.c, ef-\v\9? 4U \ ..:::,i:'.,\, I!~~,., ~)"\\J'}.~l)_C-,'}_,\ IL\ Y\ f),_ 1 ... ,,~~ b-.-1., (\.l\\ ,.._ (·-u.--.1•r-., . J :'.R€. l.\lA\¼--\ C:,\?\.'7'J ~ ·. c;\ ?, \ \ \ C\ L\\) Total % Subcontracted: ________ _ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. PINE AVENUE PARK ARTWORK REFURBISHMENT CONT. NO. PKRC685 Page 5 of 6 City Attorney Approved 9/27/2016 Tracking#: EXHIBITB SCOPE OF SERVICES Nissho of California, Inc. will refurbish artwork at the Pine Avenue Park Community Garden. All work shall be performed in accordance with the attached proposals. Work includes: • Construct 10-foot diameter stamped concrete pad • Remove existing boulders and 3-foot diameter concrete • Construct new concrete mow curb to define planting area • Furnish and install rock drinking fountain and spigot • Furnish and install 1-gallon and 5-gallon willow plants • 1-year warranty from date of completion FEES ITEM DESCRIPTION PRICE NO. 1 Concrete pad $5,142.50 2 Concrete mow curb, rock drinking fountain and planting $16,882.33 Subtotal $22,024.83 As-needed services -requires preapproval by City $2,900.00 Total $24,924.83 Agreement shall not exceed $24,924.83. PINE AVENUE PARK ARTWORK REFURBISHMENT CONT. NO. PKRC685 Page 6 of 6 City Attorney Approved 9/27/2016 NISSHO OF CALIFORNIA, INC. 1902 South Santa Fe Avenue, Vista, California 92083 Phone 760.727.9719 Fax 760.727.8706 License #598372 WORK ORDER Cit of Carlsbad-Oak Park Project Nam11 760-434-2922 alent Phone # City of Carlsbad CllentName Kyle Lancaster Authorized by (Print) Authorized by Sign) Date DETAILED DESCRIPTION OF WORI< TO BE PERFORMED Nlssho Internal Only (Maintenance Department) Tom Baird Project Manager (Print) 10/18/2018 Date Sales Rep Approval (Sign) Mgmt. Approval Pro osal for Nlssho of Callfomla to lnstan a 1 o• diameter slam ed concrete ad. Please note that If a custom slam Is re ulred, an extra chu e wRI be Incurred. MATERIALS QTY PRICE TOTAL 10' Diameter slam ed concrete ad $ 5142.50 $ $ $ $ $ $ $ $ $ LABOR QTY PRICE TOTAL Labor for the above work $ GRAND TOTAL $ 5,142.60 THESE SIGNATURES BELOW CERTIFY THAT THE AREAS HAVE BEEN THOROUGHLY INSPECTED B T EU RS E REPRESENTATIVE. IT HAS BEEN DETERMINED THAT THE INSTALLATION IS IN ACCORDANdE WITH THE PLANS OR THE AGREED UPON SPECIFICATIONS BY THE DEVELOPER/CLIENT ANO NISSHO OF CALIFORNIA, INC, Nlssho of Caftfomla Representative Client Repraaentative Print Print Sign Date Sign Date NISSHO OF CALIFORNIA, INC. 1902 South Santa Fe Avenue, Vista, Callfornla 92083 Phone 760.727.9719 Fax 760.727.8706 WORK ORDER 760-434-2922 Client Phone # City of Carlsbad CllentName Kyle Lancaster Authorized by (Print) License #598372 Nlssho Internal Only (Maintenance Deparlment) Tom Baird Project Manager (Print) 10/2/2018 Dale Authorized by (Sign) Date Sales Rep Approval (Sign) Mgmt. Approval DETAILED DESCRIPTION OF WORK TO BE PERFORMED 2019. Pro osal for Nlssho lhe Install custom water fountain to match schematics to Install 'mow curbs' around the Sallx. MATERIALS QTY PRICE TOTAL 05 Gal Sallx laevte ala 25 17.17 429.25 01 Gal Selbe laevl ala 20 6.77 135.40 Planlln Amendments 36.89 Drlnkln Fountain Rock wt core. Includes dellve 3187.49 Crane to Set Rock Drlnkln Fountain 1 561.30 6" x a• Concrete Mow Curb 4 900.00 LABOR QTY PRICE TOTAL 6 632.00 16,882.33 THESE SIGNATURES BELOW CERTIFY THAT THE AREAS HAVE BEEN THOROUGHLY INSPEC ED BY THE NDERSIGNED REPRESENTATIVE. IT HAS BEEN DETERMINED THAT THE INSTALLATION IS IN ACCORDANCE WITH THE PLANS OR THE AGREED UPON SPECIFICATIONS BY THE DEVELOPER/CLIENT AND NISSHO OF CALIFORNIA, INC. Nissho of Callfomla Representative Client Representative Print Print Sign Date Sign Date Client#· 436527 NISSHCALIF1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 11/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~){~!~"' Barbara Smith Marsh & Mclennan Agency llC rA~8Ntro Extl: 858-457-3414 I riet No): 858-452-7530 Marsh & Mclennan Ins. Agency llC !t1tJ~ss: barbara.smith@marshmma.com PO Box 85638 INSURER($) AFFORDING COVERAGE NAIC# San Diego, CA 92186 INSURER A : Starr Indemnity & liability Company 38318 INSURED INSURER B: Nissho of California, Inc. INSURERC: 1902 S. Santa Fe Avenue INSURERD: Vista, CA 92083 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB~ ,&Sh\g)'J~i :,&Sh\%~1 LIMITS LTR INSR WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY X X 1000025611181 06/01/2018 06/01/2019 EACH OCCURRENCE $1 000 000 -~ CLAIMS-MADE [!] OCCUR ~~~tff,'~J?E~~~JirPencel $300 000 MED EXP (Any one person) $5 000 -PERSONAL & ADV INJURY $1,000,000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Fl [!] PRO-□LOC PRODUCTS -COMP/OP AGG $2,000,000 POLICY JECT OTHER: $ A AUTOMOBILE LIABILITY X X 100198575181 06/01/2018 06/01/2019 COMBINED SINGLE LIMIT $1,000,000 /Ea accident\ -X ANY AUTO BODILY INJURY (Per person) $ -01/VNED ~ SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ --X HIRED X NON-01/VNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY /Per accident\ -$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ A WORKERS COMPENSATION X 1000003246 06/01/2018 06/01/20H X JPER I JOTH- AND EMPLOYERS" LIABILITY y / N IC:TATUTE ~R ANY PROPRIETORIPARTNERIEXECUTIVE[N] E.L. EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $1 000 000 lf 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) RE: All operations performed by the named insured on behalf of the certificate holder. The City of Carlsbad, its Officials, employees and volunteers are named as additional insured with respect to General and Auto Liability, per attached endorsements. Coverage is Primary and Non-Contributory. Waiver of Subrogation applies to General Liability, Auto Liability and Workers Compensation. CERTIFICATE HOLDER CANCELLATION City of Carlsbad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Pine Ave. Park Artwork Refurbishment ACCORDANCE WITH THE POLICY PROVISIONS. Cont. No. PKRC685 799 Pine Avenue, Suite 200 AUTHORIZED REPRESENTATIVE Carlsbad, CA 92008-2428 ~"'1NwY~' I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3826163/M3590206 ' WSADH INSURED: Nissho of California, Inc. POLICY#: 1000025611181 / POLICY PERIOD: 0610112018 TO: 0510112019 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 Location(s) Of Covered Operations Organization(s): Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown al:x>ve, 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 "l:x>dily 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 al:x>ve. 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 "l:x>dily 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. 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 Limits of Insurance shown in the Declarations. CG 20100413 © Insurance Services Office, Inc., 2012 Page 1 of 1 INSURED:Nissho of California, Inc. POLICY#: 1000025611181 POLICY PERIOD: 06/01/2018 TO: 06/01/2019 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARE ULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All persons or organizations as required by written contract with the Named Insured As designated in written contract with the Named 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 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 additional insured and included 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 Limits of Insurance shown in the Declarations. CG 20 37 0413 Insurance Services Office, Inc., 2012 Page 1 of 1 INSURED: Nissho of California, Inc. POLICY#: 1000025511181 POLICY PERIOD: 0510112018 TO: 0510112019 COMMERCIAL GENERAL LIABILITY CG 24 040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Blanket as required by written contract. Information reauired to comolete this Schedule, ~ not shown above, will be shown in lhe Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the •products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 040509 @ Insurance Services Office, Inc., 2008 Page 1 of 1 INSURED: Nissho of California, Inc. POLICY#: 100002s611181 POLICY PERIOD: 0610112018 TO 0610112019 • Starr Indemnity & UabHlty Company ..... , Primary and Non-Contributory Condition This endoraement modfies irn;uran~ provided under the: Commtrcial General Llabllty CoVerage Pert A. SECTION IV -CONDITIONS. condition 4. Other Insurance i$ M1endet1 as follaws 1. The following 18 acklBd to paragrapti 4.11. d the Otta. lnsuninc. con<lillon. This msurance is pnmary ms1.ntnce as respects our coverage to the addt,tiOflal insured. whfwe the written contract 01 wntten agreeme-nt require& ltlat this insurance be pnmary ;!!Ind non-oontnbl.ltory. In ll'lat ewent ~ Will not seek conlrlbulian from i!ln)' other insuraooe policy .!V'ii!llli!lble lo the ackht1onal insured on v.tiich ttle adclruonsl insised ifil a Named lneured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. 0G 107104/11. Page 1 of1 COPY1111ht • c. v. aarr 1, ~ and 8larr lndlmllib' & lJablllty co~. Al 11111ts ,-wd. lndl.ldn c:g~ m-t• gfJ$0 Pnlpertiw, lni;... .-d'lllftbb P•mbuoin. INSURED: Nissho of California, Inc. POLICY#: 1000025611181 POLICY PERIOD: 0510112018 ~ Starr Indemnity & Liability Company Dallas, TX 1-.866-519-2522 TO: 0510112019 Amendment of Limits of Insurance (Per Project or Per Location Aggregate Limit) Policy Number: Effective Date: Named Insured: This endorsement modifies insurarce provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM I. Your policy Is amended to Include either a Per Project General Aggregate Limit, a Per Location General Aggregate Umit or a Per Project and Per Location General Aggregate Limit. Please select only one of the following: 1. 2. Per Project General Aggregate Umlt Per Location General Aggregate Limit Per Project and Per Location General Aggregate Limit [ ] OVerall Polley Aggregate Lhnlt IF NEm-tER OF THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. IF MORE THAN OtE OF THE THESE BOXES ARE CHECKED, THIS ENOORSEMENT IS VOID. II. SECTION Ill -LIMITS OF INSURANCE, i!'! !!!mended to include the following: 1. The Limits of Insurance and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. aaims made or "suits" brought; or c. Persons or organizations making claims or bringing "sLits". 2. The General Aggregate Limit is the most we will pay for the Slm of: •· Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injuy" or "property damage" included intt-e products-oo01)1eted operations hazard"; and 1:. Damages under Coverage B. 3. Persons or organizations making claims or bringing "slits". 4. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of 'bodily injixy'' and "property damage" included in the ''products-completed operations hazard". 0G 139 (07-11) Page 1 on Copyrighl e C. V. Starr a Company Ind Slwr lndanrity a UabililyC~. All rv,ts •-d. lndudff oopyri(lhled m,twlal of 180 Properhs, Inc., UMd With ii$ penr,ls$ion. INSURED: Nissho of California, Inc. POLICY#: 1000025611181 POLICY PERIOD: 06/01/2018 • Slarr Indemnity &, Liability C.Ompany Dallas, TX 1-.866-519-2522 TO: 0510112019 5. Subject to 2 above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or orgarization. 6. Subject to 2 or 3 above, whichever applies, the Each Occurrence Limit ig the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrehee". 7. SUbject to 6 above. the Damage to Premises Rented to You Limit is the most we will pay under Coverage A because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, wtile rented to you or temporarily occupied by you with permission 1,/ the owner. 8. Subject to 5 above, the Medical Expense Lirrit i$ the most we will pay under Coverage C for all meacal expenses because of ''bodily injury" 8UStained 1,/ any one person. 9. Subject to 2, 4, &. 6, ancVor 7 above, the Per Project Agg-egate Limit Is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage 8; and c. Medical expenses under Coverage C ariSing out Of the any single Location described above. 10. Subject to 2, 4, 5, 6, and/or 7 above, the Per Location Aggregate unit is the most we will pay under Coverages A, B, and C combined for the sum of: d. Damages under Coverage A; e. Damages under Coverage B; and f. Medical expenses 1.11der Coverage C arising out Of the any single Location described above. 11. The Overall Policy Aggregate is the most we will pay in any policy period regardless of number Of projects or locations. The Limits or Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shovm In the Declarations, unless the Policy period is e>Ctended after issuance for an additional period of less ltlan 12 months. In that case, the additional period will be deemed pert cl the last preceding period for purposes of determining the Limits of Insurance Ill. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced l:t)' the Limits of Insurance set forth below. Limits of lnswnce General Aggregate Limit $ 2,000,000 Each Occurrence Limit $1,000,000 Products-Completed Operations Aggregate Limit $2,000,000 0G 139 (07-11) Page 2 of3 Cop)'right@ C. V. Starr & Companr and Shrr Indemnity & Uability Compa,y. All riQhls rw-d. lndudec copyngt,ttd material or 110 Propertie$, lno., used With its permisaon. INSURED: Nissho of California, Inc. POLICY#: 1000025611181 POLICY PERIOD: 0610112018 • Starr Indemnity & Liability Company Dalles, TX 1-866-519-2522 Personal & Advertising 111ury Limit Damage to Premises Rented to You Medical Expense Limit IV. SECTION V -DEFINmONS: is amended to include the following: $1,000,000 $ 100,000 $ 5,000 TO: 0610112019 23. '1.ocalion" means premises invoMng the same or comecting lols, or premises whose connection Is Interrupted only by~ street. roadway, waterway, or right-of-way railroad. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY ,--;,~-k--,L· £ .@~· Nehemiah E. Ginsburg, Gene~ounsel OG 139107-11) Page 3 of 3 Copyright e C. V. 81sr & 0oq,mlp ald Stsr lndermily & Li8bility Compm,y. M rii:,.is reswwd. lndude!J copyrighted mlllerlal cl ISO Propdes, Inc., used with It, permission. INSURED: Nissho of California, Inc. POLICY#: 100198575181 POLICY PERIOD: 0510112018 • Starr Indemnity & Liability Company Dallas, TX 1-866--519-2522 TO: 0610112019 Additional Insured -Where Required Under Written Contract or Written Agreement Endorsement This endorsement modifies the insurance coverage form(s) Dsted below that have been purchased by you and evidenced as such on the dedarations page_ Please read the endorsement and respective policy(ies) carefully_ Business Auto Coverage Form THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It Is hereby agreed that SECTION II -COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, is amended to inducfe the following: d. Ally person or organiZation whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organiZation of the type provided by this policy, but only with respect to liability arising out of use of a covered ~auto·_ Ho~ver, the insurance provided Will not exceed the lesser ot (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said written contract or written agreement All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Nehemiah E. Ginsburg:terierai SICA 1016 (0-1./U) Pap 1 tlfl INSURED: Nissho of California, Inc. POLICY#: 100198575181 POLICY PERIOD: 0610112018 TO 0610112019 COMMERCIAL AUTO CA 04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another dale Is indicated below. Named Insured: Nissho of California, Inc. Endorsement Effective Date: 06/01/2018 Name(s) Of Person(s) or Organization(s): SCHEDULE WHERE REQUIRED BY WRITTEN CONTRACT. lnfonnation reauired to romolete this Schedule ifnot shown above will be shown in the Declarations. The Transfer or Rights Of Recovery Against Others To us ronditlon does not apply to the person(s) or organlzation(s) shown In the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04441013 C Insurance Services Office, Inc., 2011 Page 1 of1 INSURED: Nissho of California, Inc. POLICY#: 100198575181 POLICY PERIOD: 061011201s TO 0610112019 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insura1ee provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Wltn respect to coverage provtded by this endorsement, the provisions of the Coverage Form apply uiiess modified by the endorsement. This endorsement identifies perso1(s) or organization(s) who are "insureds'' for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This e1dorsement does not alter coverage provided In the Coverage Form. SCHEDULE Name Of Person(s) Or Oraanization(sl: Whara raqcired by wrillan agrtltlmenl signed irior lo a loss lnfonmrtion required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown In tne Schedule Is an "insured" for CoveredAutos LiabilityCoverage, but only to the extent that person or organization qualifies as an •insured· under the Who lsAn Insured provision contained In Paragraph A.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Secilon I • Covered Autos Coverages of the Auto Dealers Coverage Form. CA20481013 © Insurance Services Office, Inc., 2011 Page 1 of 1 INSURED: Nissho of California, Inc. POLICY#: 1000003246 POLICY PERIOD: 051011201s WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY TO: 0610112019 WC 040306 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be_*_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERA TING AIRCRAFT FOR HIRE. *The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. This endorsement changes the policy to which It is attached and Is effective on the date Issued unless otherwise stated. (The lnfonnatlon below Is required only when this endorsement Is Issued subsequent to preparation of the policy,) WC 040306 (Ed. 4-84) Countersigned By _ _,,ti .... ' ... _·" ..... ·._· ~-·''.._-•. ·_._._· _· -_R"i_L_; _~_,;..__ .1