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HomeMy WebLinkAboutPlanes, Boats and Automobiles Ltd dba Pba Ltd; 2018-10-24; PWM19-622GSRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2019-0003765 111111111111 lllll 1111111111111111111111111 lllll 11111111111111111111111 Jan 04, 2019 11 :27 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: 207-101-32-00 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 Nov. 15, 2018. 6. The name of the contractor for such work or improvement is PBA LTD. 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 No. PWM19-622GS, Project Name Kelly Storm Channel Debris Removal. 8. The street address of said property is 4870 Kelly Dr., Carlsbad, CA 92008, in the City of Carlsbad. VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City oBlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on SLC-, } J , 20lii_, 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. ~ . I c, I<? Executed on .... ~-"-"'=.-'''--'----'--' 201..Q_, at Carlsbad, California. CITY OF CARLSBAD \ ~RmL~ ~ARBARA ENGLESON u-Lity Clerk IIFILES01V\Departments\Publ1c Works\PW Common\Agreements & Contracts\Contracts\2019 Contracts\MINOR PUBLIC WORKSIPBA\Kelly Storm Channel Debris Removal\6 NOC• Kelly Storm Channel Debris Removal.doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS PBA, LTD has completed the contract work required for PWM19-622GS -Kelly Storm Channel Debris Removal. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE Clean storm channel $21,450.00 CERTIFICATION OF COMPLETION OF IMPROVEMENTS \ ""' f\JvJU \<,I ., \ I g yngi~Manager \_ Date I 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 improvements. tw/t~ P•ll•l8 \J✓' Scott Chadwp, City Manager Date \'\ V APPROVED AS TO FORM: CELIA BREWER, City Attorney By~~ DeputityAttorney Z:\Public Works\PW Common\Agreements & Contracts\Contracts\2019 Contracts\MINOR PUBLIC WORKSIPBA\Kelly Storm Channel Debris Removal\7.API -Kelly Storm Channel Debris Removaldoc PWM 19-622GS CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT KELLY DRIVE STORM CHANNEL DEBRIS REMOVAL This agreement is made on the JL\ ~ day of ___._.a.....,._.,....a..:::..=:....,..,L--____ , 2018, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Pba Ltd, a Limited liability corporation whose principal place of business is 2029 East Mission Ave., Escondido, CA 92027 (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: Clayton Dobbs (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. Kelly Storm Channel Debris Removal Page 1 of6 City Attorney Approved 9/27/16 PWM19-622GS FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ,/?r--i..,_.,,,, Print Name: Ray Files 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. Kelly Storm Channel Debris Removal Page 2 of 6 City Attorney Approved 9/27/16 PWM19-622GS 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 ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within ten (10) working days after commencing work. CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Planes Boats & Automobiles, LTD dba PBA LTD (name of Contractor) 816826 (Contractor's license number) A and B 1/31/19 (license class. and exp. date) 1000018273 (DIR registration number) 6/30/19 (DIR registration exp. date) Kelly Storm Channel Debris Removal Page 3 of 6 2029 East Mission Ave. (street address) Escondido, CA 92027 (city/state/zip) 760-801-5238 (telephone no.) 760-729-7913 (fax no.) pbalimited@gmail.com (e-mail address) City Attorney Approved 9/27/16 PWM 19-622GS 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 PLANES BOATS & AUTOMOBILES, LTD dba PBA LTD a California corporation By: (sign here) Ray Files / President (print name/title) By: rlt&-~~ (sign hre) Kevin Doherty/ CFO (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California 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: CELIA A. BREWER, City Attorney BY ~,t ~ Assistant Crt;:;:n:v Kelly Storm Channel Debris Removal Page 4 of 6 City Attorney Approved 9/27/16 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate i~ attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ____ 0_R_A_N_G_E ___ _ ~ '7!) <7,l\ c-/ Sarah Thomas . O~ tvtv' lV \, ~ b~fore me, _______ , Notary Public, personally appeared fi1l .. who proved to me on the basis of satisfactory evidence to be he person(s) whose name(s) is/are subscribed to the within instrument and acknowle to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their s1gnature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PER.JURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. SARAHTHOMAS ~ COMM ... 2145539 o NOTARY PUBLIC-CALIFORNIA .; ORANGE COUNTY CiJ My Term Exp. March 7, 2020 J Signature of L __ OPTIONAL INFORMATION ---------~ Number of Pages~ Document Date ~ ~~·~· (additional information) CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate i~ attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ___ O_R_A_N_G_E ___ _ ni~ ~f .Z71iV--Sarah Thomas . '-lll.v~-l--v V~ \) before me, _______ , Notary Public, personally appeared ______ _,L_,_""'--L...;:::_+_n;__'--=--\e=---:::_s::....· __________ who proved to me on the basis of factory 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 s1gnature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PER.JURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. [ __ OPTIONAL INFORMATION -----=~~=1 DESCRIPTION OF THE ATTACHED DOCUMENT ,. Number of Pageh Document DateC/. ~-{-~ (additional information) PWM19-622GS EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to Business Name and Address DIR Registration License No., %of be Subcontracted No. Classification & Total Expiration Date Contract NIA NIA N/A N/A N/A Total % Subcontracted: 0% The Contractor must perform no less than fifty percent (50%) of the work with its own forces Kelly Storm Channel Debris Removal Page 5 of6 City Attorney Approved 9/27/16 PWM 19-622GS EXHIBIT B Kelly Storm Channel Debris Removal Remove all debris and sediments from top of trapezoid channel about 900 linear feet. Trucks hauling debris shall have dump beds lined with visqueen to prevent seepage. Debris shall be hauled to landfill. City right of way shall be clean at all times. JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 EA 1 Remove all debris vegetation and sediments from Kelly $21,450 Drive trapezoid channel. Work shall be pure excavation per the Army Corps of Engineers permits and specification. TOTAL* $21,450 *Includes taxes, fees, expenses and all other costs. Kelly Storm Channel Debris Removal Page 6 of 6 City Attorney Approved 9/27/16 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 10/11/2018 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 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lori Lee NAME: E360 Insurance Services PHONE (888) 862-6750 I FAX (888) 256-0809 tAtr Nn Extl: IA/C Nol: 16542 Ventura Blvd., Suite 300 E-MAIL Lori@e360insurance.com Annccc:c:, Encino, CA 91436 INSURER(S) AFFORDING COVERAGE NAIC# Phone (888) 862-6750 Fax (888) 256-0809 INSURER A: State Fund INSURED INSURER B: National General Planes Boats and Automobile LTD INSURERC: Benchmark Insurance Company 2029 E. Mission Ave INSURERD: INSURER E: Escondido CA 92027 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 SUBR /OLICYEFF 1~3~6i~l LTR INSR WVD POLICY NUMBER MM/DD/YYYYl LIMITS ~ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 • CLAIMS-MADE ~ OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence\ $ 50,000 • MED EXP (Any one person) $ 5,000 C • BIC5018852 10/12/2018 10/12/2019 1,000,000 PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~ POLICY • PRO-JECT • LOG PRODUCTS -COMP/OP AGG $ 2,000,000 • OTHER $ AUTOMOBILE LIABILITY fE~'°!~h~d~~tf INGLE LIMIT $ 1,000,000.00 • ANYAUTO BODILY INJURY (Per person) $ • z;1,-~iDONLY ~ SCHEDULED B AUTOS 2006201912 03/07/2018 03/07/2019 BODILY INJURY (Per accident) $ • _.tl~%~0NLY • NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /Per accident\ • • $ • UMBRELLA LIAB OoccuR EACH OCCURRENCE $ C • EXCESS LIAB • CLAIMS-MADE AGGREGATE $ • OED • RETENTION $ $ WORKERS COMPENSATION ~ ~ffTuTE DOTH- AND EMPLOYERS' LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIV~ E.L. EACH ACCIDENT $ 1,000,000.00 A OFFICER/MEMBER EXCLUDED? Y NIA y 9219205-18 09/30/2018 09/30/2019 (Mandatory In NH) E.L. DISEASE -EA EMPLOYE $ 1,000,000.00 / If yes, describe under E.L. DISEASE -POLICY LIMIT 1,000,000.00 DESCRIPTION OF OPERATIONS below $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) ***10 days notice if cancelled for non-payment of premium••• CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad/CMWD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o EXIGIS Insurance Compliance Services ACCORDANCE WITH THE POLICY PROVISIONS. I P.O. Box 4668-ECM #35050 AUTHORIZED REPRESENTATIVE New York, NY 10163-4668 ' .. < -A-__ .,. I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) QF The ACORD name and logo are registered marks of ACORD STATE FUND ONLINE -Print Transcript This bundled document submitted by: Eric Evans DO/DEPT: SC -LA Region Monterey Park (SC) 10-16-2018 08:48 AM HOME OFFICE SAN FRANCISCO ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 04 9219205-18 RENEWAL SC 6-49-53-71 PAGE 1 EFFECTIVE OCTOBER 11, 2018 AT 12.01 A.M. ALL EFFECTIVE OATES ARE AT 12:01 AM PACIFIC AND EXPIRING SEPTEMBER 30, 2019 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PB A, LTD 2029 EMISSION AVE ESCONDIDO, CA 92027 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF CARLSBAD CMWD WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, PB A, LTD IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELO TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 17, 2018 ~~~ PRFSlf)FNT ANn C:FO 2570 STATE FUND ONLINE -End of Bundled Document Last page of the bundled document for: Eric Evans DO/DEPT: SC -LA Region Monterey Park (SC) 10-16-2018 08:48 AM ENDORSEMENT I ENDT. NO. I 7 I G0905 (ed 09/24/09) WAIVER OF SUBROGATION -BLANKET IT IS AGREED, FOR AN ADDITIONAL PREMIUM OF$ lnclnM&D , THAT THE TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS) IS AMENDED AS FOLLOWS: WE WAIVE ANY RIGHT OF RECOVERY WE MAY HAVE AGAINST ANY PERSON OR ORGANIZATION THAT QUALIFIES AS AN ADDITIONAL INSURED PURSUANT TO THE TERMS OF ENDORSEMENT NUMBER 6 BECAUSE OF PAYMENTS WE MAKE FOR BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF (i) YOUR WORK PERFORMED DURING THE POLICY PERIOD UNDER AN INSURED CONTRACT WITH THAT PERSON OR ORGANIZATION, PROVIDED THAT THE BODILY INJURY OR PROPERTY DAMAGE OCCURS SUBSEQUENT TO THE EXECUTION OF THE INSURED CONTRACT, OR (ii) YOUR PRODUCT MANUFACTURED OR SOLD DURING THE POLICY PERIOD UNDER AN INSURED CONTRACT WITH THAT PERSON OR ORGANIZATION, PROVIDED THAT THE BODILY INJURY OR PROPERTY DAMAGE OCCURS SUBSEQUENT TO THE EXECUTION OF THE INSURED CONTRACT. Policy Number BIC5018852 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Insured Planes Boats and Automobiles LTD Effective 10/12/2018 Countersignature of Authorized Representative BENCHMARK INSURANCE COMPANY ,g 2009 WESTCAP ENDORSEMENT PRIMARY BLANKET ADDITIONAL INSURED I ENDT. NO. I 6 I G0103 (ed 09/24/09) IT IS AGREED COVERAGE IS PROVIDED TO THE ADDITIONAL INSURED(S) AS FOLLOWS: 1. SECTION II OF THE POLICY (WHO IS AN INSURED) IS AMENDED TO INCLUDE ANY PERSON OR ORGANIZATION THAT THE NAMED INSURED HAS AGREED IN AN INSURED CONTRACT TO NAME AS AN ADDITIONAL INSURED PROVIDED THE BODILY INJURY OR PROPERTY DAMAGE OCCURS SUBSEQUENT TO THE EXECUTION OF THE INSURED CONTRACT AND THE BODILY INJURY OR PROPERTY DAMAGE ARISES FROM YOUR WORK PERFORMED DURING THE POLICY TERM. 2. PARAGRAPH 6.D. IS HEREBY ADDED TO SECTION IV, COMMERCIAL GENERAL LIABILITY CONDITIONS, OF THE POLICY, AS FOLLOWS: D. NOTWITHSTANDING ANYTHING TO THE CONTRARY IN PARAGRAPHS 6.A., 6.B., OR 6.C. HEREOF, THE INDEMNITY PROVIDED BY THIS INSURANCE IS PRIMARY AND NONCONTRIBUTORY FOR ANY PERSON OR ORGANIZATION THAT IS AN ADDITIONAL INSURED UNDER THIS POLICY AND THAT YOU HAVE AGREED, IN AN INSURED CONTRACT, TO PROVIDE PRIMARY ADDITIONAL INSURED COVERAGE. 3 THE APPLICABLE LIMIT OF THE COMPANY'S LIABILITY SHALL NOT BE INCREASED BY THE INCLUSION OF ANY NUMBER OF ADDITIONAL INSUREDS. 4 OTHER THAN AS EXPRESSLY MODIFIED HEREIN, COVERAGE FOR THE ADDITIONAL INSURED IS GOVERNED BY THE TERMS AND CONDITIONS OF THIS POLICY, INCLUDING THE INSURING AGREEMENTS. 5 THE COVERAGE PROVIDED FOR THE ADDITIONAL INSURED IS ONLY TO THE EXTENT OF DAMAGES FROM BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE NEGLIGENCE OR STRICT LIABILITY OF THE NAMED INSURED. NO COVERAGE IS PROVIDED FOR BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF ACTS, ERRORS OR OMISSIONS OF THE ADDITIONAL INSURED. 6. NO COVERAGE IS PROVIDED TO AN ADDITIONAL INSURED FOR DAMAGES BECAUSE OF BODILY INJURY TO AN EMPLOYEE OF THE NAMED INSURED, WHETHER SUIT IS BROUGHT OR CLAIM IS MADE BY THE EMPLOYEE OR THE PARENT, SPOUSE, CHILD OR SIBLING OF SUCH EMPLOYEE, OR ANY ENTITY SEEKING DAMAGES BECAUSE OF INJURY TO SUCH EMPLOYEE. Policy Number BIC5018852 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Insured Planes Boats and Automobiles LTD Effective 10/12/2018 BENCHMARK INSURANCE COMPANY Countersiqnature of Authorized Representative 11-) 2009 WESTCAP CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) 09/25/2018 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 I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED r REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlfk;ate holder is an ADDmONAL INSURED, the polic:y(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on th· rtifi t d t f . hts t th rt"li h Id . f 1s ce ca e oes no con er ng 0 e ce I cate 0 er in lieu o such endorsement(s). PRODUCER 1 CONTACT Lori Lee , NAM!;: '-~----· i E360 Insurance Services i.lJ8~o .,_,_ (888) 862-6750 I rffc Nol, (888) 256-0809 16542 Ventura Blvd., Suite 300 E;!o'I_A_!k ___ Lori@e360insurance.com Encino, CA 91436 INSURER/SI AFFORDING COVERAGE NAIC# Phone (888) 862-6750 Fax (888) 256-0809 INSU_!l,ERA: State Fund -· ·---INSURED INSURER B: National General Planes Boats and Automobile LTD INSURERC: 2029 E. Mission Ave : INSURERD: ' I [ INSURJ_;~_E: i Escondido C.A. 92027 i 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, i I i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ___J AODL~UBR• i1P0'-'1~ INSR TYPE OF INSURANCE ,~~~i~ LIMITS LTR .INSR wvoi POLICY NUMBER MM/00 [L COMMERCIAL GENERAL LIABILITY ' l EACH OCCURRENCE $ ; DAMAGE TO RENTED --·-·· i L_j CLAIMS-MADE n OCCUR ! PREMISES I Ea occurrence\ $ • ' : MED EXP (Any one person) $ ,-·1 PERSONAL & ADV ~JURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGRE~~TE $ LJ POLICY n rr& • LOG ... PRODUCTS -COMP/OP AGG $ : • OTHER $ I AUTOMOBIL£ LIABILITY ! l i fe~~~~d~~ltNGLE uMIT s 1,000,000.00 i • At-rfAUTO I BODILY INJURY (Per person} s ~ SCHEDULED i ; I• OWNED AUTOS J2006201912 03/07/2018 , 03/07/2019 BODILY INJURY (Per accident) s B AUTOS ONLY 0 NON-OWNED ~,ERT\~AMAGE . • ,.m'f-6~ ONLY I s AUTOS ONLY I ~ent • 0 s • UMBRELLA L1AB [loccuR EACH OCCURRENCE $ • EXCESSUAB • CLAIMS-MADE AGGREGATE $ lO DED 0 RETENTION $ $ WORKERS COMPENSATION ~ ~¥fnrrF DOTH- AND EMPLOYERS' LIABILITY YIN FR ANY PROPRIETORIPARTNER/EXECUTIV~ I 09/30/2018 09/30/2019 E.L. EACH ACCIDENT ~ 1,000,000.00 A OFFICER/MEMBER EXCLUDED? Y N/A y 9219205-18 (Mandatory In NH) I E.L. DISEASE-EA EMPLOYE $ 1,000,000.00 !f yes, descrtbe under -- DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000.00 ' I I I i i I 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarl!s Schedule, if more space is required) .. *10 days notice tf cancelled for non-payment of premium• .. ' ' ' CERTIFICATE HOLDER CANCELLATION ' I J City of Cartsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668 -ECM #35050 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE N"w York, NY 10163-4668 •:.:···= ..•• / .:· . ... ~-------------------------~----------------~-----------~ © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) QF The ACORD name and logo are registered marks of ACORD ! : I ' i I