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HomeMy WebLinkAboutRay White Cement; 2018-02-15; PKRC652Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK; CONT. NO. PKRC652 This agreement is made on the / Stf) day of · · ,. City of Carlsbad, California, a mun1cipal corporation, (hereinafter called "City"), a whose principal place of business is 2380 Via Monserate, Fallbrook, CA 9 "Contractor"). City and Contractor agree as follows: , 20.JiI., by the Ray White Cement 8 (hereinafter called DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor's proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Kyle Lancaster (City Project Manager) WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK CONT. NO. PKRC652 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 sub ontractor from participating in contract bidding. I JJ, P~ , d-r. Signature: , t ~ 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. INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK CONT. NO. PKRC652 Page 2 of 6 City Attorney Approved 9/27/2016 Tracking#: 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. 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 45 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II Ray White Cement (name of Contractor) 410673 (Contractor's license number) C-8, 8/31/2019 (license class. and exp. date) 1000003603 (DIR registration number) 6/30/2018 (DIR registration exp. date) INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK CONT. NO. PKRC652 Page 3 of 6 2380 Via Monserate (street address) Fallbrook, CA 92028 (city/state/zip) 760-728-0170 (telephone no.) 760-728-5605 (fax no.) tom@raywhitecement.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 CITY OF CARLSBAD, a municipal corporation of the State of California By: By: Assistant c· y ana eputy City Manager or Department Director as authorized by the City Manager (print name/title) 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: -~~....._;.....,"£-«~'.L".=-~~---qcity Attorney INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK CONT. NO. PKRC652 Page 4 of 6 City Attorney Approved 9/27/2016 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of s:cin 'D, -ec1 6 ) I On fE..6nJD-£-i 1;201g before me, Sz-l(tlh S'C/10{(,(/ tll1W,V fvtbit( Da e Here Insert Name and Title of the Officer personally appeared K uv 111 ()Vl u{ UJ }1 dt C1 n cl Q (tU1.1. W h I fe Name(ls) of Signer(tj who proved to me on the basis of satisfactory evidence to be the person(sr whose name(S, a§!~ subscrib~q to the within instrument and acknowledged t<? me that he/she/@>' executed the same in his/her/~r authorized capacity(©.$), and that by his/her/@ signatur~ on the instrument the person($), or the entity upon behalf of which the person(S) acted, executed the instrument. Place Notary Sea/ Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ihcl)trf] 1kl10 l l '\ 7 Signature of Notary Public , OPTIONAL . \rhough this section is optional, ~pleting this information can d er alteration of the docu \ fraudulent reatta ment of this form to an uninten ed document. \ Desc\;iption of Attached Document Title o}, Type of Document: _____________ Docume Date: __________ _ Number\,f Pages: ___ Signer(s) Ot er Than Named Above: __ __,, _________ _ \ Capacity(• s) Claimed by Signer(s) Signer's Na e: ___________ __ Signer's Name: ___________ _ D Corporate fficer -Title(s): ______ ,._ D Corporate Officer -Tit D Partner -Limited D General D Partner -D Limited General D Individual D Attorney in Fact D Individual D Attorne in Fact D Trustee Guardian or Conservator D Trustee D Guardia D Other:---~~---------Other: ________ ..,_ ____ _ S1 ner Is Representing: ___ __,,_ ____ _ ~~'Q<,~~~~'q(,'C<'.;,~'C<;-~~~~~~~'Q<;,'Q<;,'§,(;.~~'q(,~'< ©2014 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. Classification & Total Expiration Date Contract o/ /nJlv / ' / / Total% Subcontracted: ______ _ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK CONT. NO. PKRC652 Page 5 of 6 City Attorney Approved 9/27/2016 EXHIBIT B SCOPE OF SERVICES Tracking#: Ray White Cement will install concrete at the Ann D. L'Heureux Memorial Dog Park entrance and shade seating area. Work includes: • Excavate existing decomposed granite surface in the entryway and around seating area to a depth of 4" • Remove all excavated material • Form, grade and pour new 4" thick concrete • Install #3 rebar at 24" on center • Wedge or taper outside edge of concrete that surrounds the seating area to make smooth transition to existing mulch area • Use 3250 PSI big rock city mix throughout The City will adjust gates for new concrete slab. JOB QUOTATION ITEM DESCRIPTION PRICE NO. 1 Material and labor $10,560.00 TOTAL $10,560.00 Agreement shall not exceed $10,560.00 INSTALL CONCRETE AT ANN D. L'HEUREUX MEMORIAL DOG PARK CONT. NO. PKRC652 Page 6 of 6 City Attorney Approved 9/27/2016 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 1/31/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Silva and Sons Insurance Services Inc. CONTACT Dennis Silva NAME: 26323 Jefferson Ave, Suite C PHONE 888-7 45-8259 I FAX 951-763-8000 Murrieta, CA 92562 IA/C No Extl: /A/C No): E-MAIL Dsilva@.Silva-lns.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# --- www.Silva-lns.com Lie #0H99310 INSURER A: Rockhill Insurance Company 28053 ---- INSURED INSURERB: National Union Fire Ins Co of Pittsburah PA 19445 Ra~ White Cement Liberty Mutual Insurance Company 23043 23 0 Via Monserate INSURERC: Fallbrook CA 92028 INSURER D: -- INSURER E: - INSURERF: COVERAGES CERTIFICATE NUMBER: 40151434 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 POLICY EFF POLICY EXP LTR •••"n .. n,n POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYl LIMITS A L COMMERCIAL GENERAL LIABILITY ./ ./ RCGLPG00502-04 10/1/2017 10/1/2018 EACH OCCURRENCE $1,000,000 D CLAIMS-MADE D OCCUR DAMAuE Tu RENTED PREMISES /Ea occurrence) $50 000 1------ - MED EXP (Any one person) ~5 000 PERSONAL & ADV INJURY $1 000 000 ~------- GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 n [Z]PRO-DLOC ---- POLICY• JECT PRODUCTS • COMP/OP AGG $2,000 000 --- OTHER Per Proiect Annreaate $ AUTOMOBILE LIABILITY fic~~~~d~~llNGLE LIMIT $ -~---- ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED --- AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ --HIRED f---NON-OWNED PROPERTY DAMAGE - AUTOS ONLY AUTOS ONLY /Per accident\ $ ---··--~ $ B UMBRELLA LIAB H OCCUR ./ ./ EBU023207710 10/1/2017 10/1/2018 EACH OCCURRENCE $1 000 000 ----- ./ EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 --- .I OED I I RETENTION $ -- $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER --Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE D EL. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A ---- (Mandatory in NH) E L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE· POLICY LIMIT $ C COMMERCIAL PROPERTY BFS56226606 1/15/2017 1/15/2018 LEASED/RENTED EQIUPMENT $50,000 / DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Carlsbad, , Job #540G,Project: Ann D. L'Heureux Memorial Dog Park, Cont. No. PKRC652 are named additional insured as respects to the General Liability when required by written contract as per the attached form/ Waiver of Subrogation applies as respects to General liability per attached form/ Primary and Non-Contributory endorsement applies as respects to General Liability as per attached form. / Per Project Aggregate applies as respects to General liability per attached form CERTIFICATE HOLDER CANCELLATION Ci~ of Carlsbad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 16 5 Faraday ACCORDANCE WITH THE POLICY PROVISIONS. Carlsbad CA 92008 AUTHORIZED REPRESENTATIVE -z:;;_:~ I Dennis Silva © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 40151434 I 17-18 GL XS Insurance Tammy Thrasher I 1/31/2018 1,15,21 PM (PST) I Page 1 of 5 RCGLPG00502-04 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -(FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Any person or organization to which you are obligated by virtue of a written contract to provide insurance such as is afforded by this policy, but only with respect to ( 1) occur- rences taking place after such written contract has been executed and (2) occurrences re- sulting from work performed by you during the policy period, or occurrences resulting from the conduct of your business during the policy period. A person or organization that qualifies as an "insured" under the above paragraph of this Endorsement shall be an additional insured solely with respect to such additional insured's liability for Nbodily injury," property damage" or "personal and advertising injuryn caused in whole or in part by your acts or omissions in the performance of "your work" for the addi- tional insured on or at "commercial construction projects." For the purposes of this Endorsement, "commercial construction projects" are defined as buildings or structures constructed for commercial use and also include apartments, hotels, homes for the aged, dormitories or barracks. However, "commercial construction projects" shall not include any building or structure which, in whole or in part, contains individual owner occupied units or dwellings. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect lo liability arising out of "your work" for that insured by or for you. Coverage provided by this policy to the Additional lnsured(s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional lnsured(s) shall be excess and non-contributory, but only if required of the Named Insured and by written contract. CG 20 10 11 85 Copyright, Insurance Services Office, Inc.. 1984 Page 1 of 1 40151434 I 17-18 GL XS Insurance I Tammy Thrasher I 1/31/2018 L15,21 PM (PST) I Page 2 of 5 D RCGLPG00502-04 COMMERCIAL GENERAL LIABILITY CG 20 33 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who ls An Insured is amended to include as an insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability aris- ing out of your ongoing operations performed for that insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. B. With respect to the insurance afforded these addi- tional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury• arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, re- ports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engi- neering activities. Coverage provided by this policy to the Additional lnsured(s) shall be primary insurance and any other insurance maintained by the Additional lnsured(s) shall be excess and non-contributory, but only if required of the Named Insured and by written contract. CG 20 33 07 98 Copyright. Insurance Services Office, Inc., 1997 Page 1 of 1 40151434 I 17-18 GL XS Insurance I Tammy Thrasher I 1/31/2018 1,15,21 PM (PST) I Page 3 of 5 0 RCGLPG00502-04 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT-AGGREGATE LIMITS OF INSURANCE PER PROJECT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. The General Aggregate Limit under LIMITS OF INSURANCE (SECTION Ill) applies separately to each of your projects away from premises owned by or rented to you. CG 25 03 11 85 Copyright, Insurance Services Qffice, Inc., 1984 40151434 I 17-18 GL XS Insurance I Tammv Thrasher I 1/31/2018 1:15:21 PM (PST) I Paqe 4 of 5 RCGLPG00502-04 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AG~NSTOTHERSTOUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization to which you are obligated by virtue of written contract to provide insurance such as is afforded by this policy, but only with respect to (1) occurrences taking place after such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period, or occurrences resulting from the conduct of your business during the policy period. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 RAYWHl1 OP ID: C2 ACORD· CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDDIYYYY) ~-02/02/2018 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~2~?cT Tony Yahyai Wateridge Insurance Services f;tl8tt~ Ext): 858-452-2200 I FAX 10717 Sorrento Valley Rd. (AIC, No): 858-452-6004 San Diego, CA 92121 E-MAIL ADDRESS: TonyYahyai INSURER(S) AFFORDING COVERAGE NAIC# 1NsuRERA: Falls Lake Fire and Casualty 15884 INSURED Ray White Cement INSURERB: PO Box 489 INSURERC: Fall brook, CA 92088 INSURERD: INSURERE: INSURERF: 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 [~~rJ%~ POLICYe:XP LIMITS LTR INSD WVD POLICY NUMBER /MM/DDIYYYYl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -0 CLAIMS-MADE D OCCUR uAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ - PERSONAL & ADV INJURY $ - GEN"L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ Fl DPRO-DLOC POLICY JECT PRODUCTS -COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ r------(Ea accident) ANY AUTO BODILY INJURY (Per person) $ ~ ALL OWNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ~ -NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ r-------$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ r------ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION $ $ WORKERS COMPENSATION XI PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER A Y/N y FLA001536-01 10/01/2017 10/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) EL DISEASE -EA EMPLOYEE $ 1,000,000 I If yes. describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The WC waiver a~lies in favor of the certificate holder. RE: Job #540G, Project: Ann D L' eureux Memorial Dog Park, Cont. No. PKRC652. CERTIFICATE HOLDER CANCELLATION CITYCAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF CARLSBAD ACCORDANCE WITH THE POLICY PROVISIONS. 1635 FARADAY AVE CARLSBAD, CA 92008-7314 AUTHORIZED REPRESENTATIVE I ~· © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC040306 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 2.5% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Blanket Waiver of Subrogation Schedule Job Description As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work This endorsement changes the policy to which it is attached and is effective on the date issued unless otheM'ise stated (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10-01-2017 Insured Ray White Cement (A Corp) Policy No. FLA001536-01 Insurance Company Falls Lake Fire & Casualty Company Endorsement No. Countersigned By ____________________ _ ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~-10/03/2017 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B.Jason Perry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 29122 Rancho Viejo Rd., STE 212 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Juan Capistrano. CA 92675 I NAIC# INSURERS AFFORDING COVERAGE ---~-.,-···-·----------.- INSURED \ INSURER A Allstate i -----------~ RAY WHITE CEMENT, INC. I INSURER B ---·····-____ , ___ i ----PO BOX489 .... -I I INSURER C ------f----.~ FALLBROOK CA 92088-0489 INSURER 0 --------------· ··--_L___ ------- I INSURERE: i COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 17.-c~c=,c-.,--------------,-- l~J: r..~~~ TYPF OFl•m IDANr>= ! l GENERAL LIABILITY ! -=:=] CLAIMS MADE 0 OCCUR : ~-7 COMMERCIAL GENERAL LIABILITY ~~G:,:~ UMIT ,e~s,,s -1 POLICY n ~~,: r I LDC , i I I AUTOMOBILE LIABILITY ANY AUTO ' ' ALL OWNED AUTOS SCHEDULED AUTOS I HIRED AUTOS ~ NON-OWNED AUTOS --------- GARAGE LIABILITY ,-----, I ANY AUTO I l EXCESS I UMBRELLA LIABILITY -'] OCCUR D CLAIMS MADE I , --1 DEDUCTIBLE 7 RETENTION I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N I ANY PROPR.IETOR/PARTNERIEXECUTIVE D OFFICER/MEMBER EXCLUDED? (Manda!Q')I in NH) ~ti~1tt·~~b6J1~1b~s below · OTHER i I POLICY NUMBER 648690744 I I I POLICY EFFECTIVE POLICY EXPIRATION "ATE fMM/DDIYYYYI DATE IMM/DD/VYYY\ 10/01/2017 10/01/2018 LIMITS EACH OCCURRENCE -~ _ DAMAGE TO ""N, 1::D PREMISES /Ea occuITence\ S MED EXP (Any one person) S PERSONAL & ADV INJURY S GENERAL AGGREGATE S PRODUCTS -COMP/OP AGG S ----·---- COMBINED SINGLE LIMIT (Ea accident} s 1,000.000 BOOIL Y INJURY (Per person) ------ BODILY INJURY (Per acc,denl) PROPERTY DAMAGE {Per accident) s ---~1---~-··------------ AUTO ONLY -EA ACCIDENT $ >-----------.-------------- OTHER THAN AUTO ONLY EAACC $ ----+----------·--- AGG S EACH OCCURRENCE $ ---+---- AGGREGATE $ >-----------__ e-L_ _______ __, lo t-----------+--------- s E.L. EACH ACCIDENT --I s ---- E.L. DISEASE -EA EMPLOY¥ E.L DISEASE -POLICY LIMIT,$ DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Blanket Additional Insured: All persons or organizations where required by written contract with lhe Named Insured CERTIFICATE HOLDER I I /·,. l /-1-<J ,I :/ °1~~c~J f~ ()7oJuAuru- ACORD 25 (2009/01} CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTJFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR All rights reserved. The ACORD name and logo are IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01)