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Ray White Cement; 2019-11-08; PKRC718
Tracking#: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ADA ACCESSIBILITY IMPROVEMENTS AT COMMUNITY PARKS; CONT. NO. PKRC718 This agreement is made on the ~¼, day of 'J\..c1Jst)1v~gS::' , 20.Ji., by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Ray White Cement whose principal place of business is 2380 Via Monserate, Fallbrook, CA 92028 (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: Tim Selke (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. ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 1 of9 City Attorney Approved 1/25/2019 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 su ntractor from participating in contract bidding. Signature: 1/4~ Print Name: b,une 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. 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 ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 2 of 9 City Attorney Approved 1/25/2019 Tracking#: 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 II II Ray White Cement (Name of Contractor) 410673 (Contractor's license number) C-8 exp. date 8/31/2021 (license class. and exp. date) 1000003603 (DIR registration number) 6/30/2020 (DIR registration exp. date) ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 3 of9 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 1/25/2019 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. (pnnt name/title) By: t~iavJJ W ,i tt f ~. (print name/title) ~1J1T: n Y<Lt: _L. J,J« J ~~ ~ BARBARA ENGLESON f~ City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f..J! corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A 9hairman, \_}>resident, or Vice-President Group B Secretary, Assistant Secretary, \Pf O 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: ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 4 of 9 City Attorney Approved 1/25/2019 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 Total % Subcontracted: ______ _ ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 5 of 9 City Attorney Approved 1/25/2019 EXHIBIT B SCOPE OF WORK Tracking#: Ray White Cement will provide labor, equipment, tools and materials to install new ADA accessible Class C curb ramps with yellow truncated domes at Calavera Hills, Poinsettia and Stagecoach Community Parks. ITEM DESCRIPTION PRICE NO. 1 Calavera Hills Community Park $22,700.00 Reconstruct 4 ADA concrete ramps: • Saw, break, remove and haul away existing asphalt ADA ramps • Remove approximately 80 LIFT of 6" curbs and gutters and 560 SOFT concrete sidewalks • Remove and haul away dirt generated from new ramps • Form and pour new concrete ADA ramps • Install 3 x 4 yellow truncated domes • Concrete shall be 3250 PSI • Provide traffic control as needed • Clean up site and dispose of existing material 2 Poinsettia Community Park $17,150.00 Install 3 new ADA concrete ramps: • Saw, break and remove existing concrete ramps • Remove existing concrete curbs and sidewalk as needed to pour new ramps • Form, grade, compact and pour new ADA ramps • Install yellow 3' x 4' truncated domes • Concrete shall be 3250 PSI • Provide traffic control as needed • Clean up site and dispose of existing material 3 Stagecoach Community Park $11,500.00 Reconstruct of 2 ADA concrete ramps: • Saw, break, remove and haul away existing asphalt ADA ramps • Remove approximately 40 LIFT of 6" curb and 320 SQFT 4" concrete sidewalks • Remove and haul away dirt generated from new ramps • Form, grade, compact and pour new concrete ADA ramps • Install 3 x 4 yellow truncated domes • Concrete shall be 3250 PSI • Provide traffic control as needed • Clean up site and dispose of existing material TOTAL $51,350.00 ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 6 of 9 City Attorney Approved 1/25/2019 Tracking#: City will: • Repair asphalt patching at new ramps • Re-stripe parking lot after-work is complete • Turn off irrigation during construction of ramps Agreement amount shall not exceed $51,350.00 ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 7 of 9 City Attorney Approved 1/25/2019 EXHIBIT C LABOR AND MATERIALS BOND Tracking#: Bond No. 4411980 Premium: $ 501 . 00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Ray White Cement (hereinafter designated as the "Principal"), a Contract for: ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONTRACT NO. PKRC718 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Ray White Cement, as Principal, (hereinafter designated as the "Contractor"), and SureTec Insurance Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of Fifty-One Thousand Three Hundred and Fifty Dollars ($51,350.00), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 8 of 9 City Attorney Approved 1/25/2019 Tracking#: Bond No.4411980 In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this of ~ix4 I 0 \ L, r'1 . 2o_LC?{ day si n here) ~S{l.}h,tj_ (print name here) CFo By: _....,,....z;;;J_(t-it-1 ~an_d_o_r .. g-a-n-iz-~-io_n...,o-~'""""•~n-a-to_ry_) -- / ~ '. (sign he~~) L. ld:COJ1£ WV t/i: Q (print name h ~·c& (title and organization of signatory) Executed by SURETY this __ 9_t_h ___ day of ___ O_c_t_o_b_e_r _____ ~ 20~. SURETY: SureTec Insurance Company (name of Surety) 3131 Camino Delrio North, Ste. 1450 San Diego, CA 92108 (address of Surety) (619) 400-4100 (telephone number of Surety) By: -11.1\t-W--,~ L , \-h ._,._ (signature of Attorney-in-Fact) Jerome L. Hren (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER City Attorney By: ADA ACCESIBILITY IMPROVEMENTS AT COMMUNITY PARKS CONT. NO. PKRC718 Page 9 of9 City Attorney Approved 1/25/2019 POA #: 510016 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Jerome L. Hren its true and lawful Attorney-in-fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bond penalty does not exceed Five Million and 00/100 Dollars ($5,000,000.00) and to bind the Company thereby as fully and to the same extent as if such bond were signed by the CEO, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or tenninating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20"' of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its CEO, and its corporate seal to be hereto affixed this 29th day of August , A.O. 2018 . \SRANc .,.ro .~ ........ f:' ~--·· ••,, C' ~~~i :.,:;:;=.., " \ \.~.I;J PANY On this 29th day of August , A.D. 2018 before me personally came John Knox Jr., to me known, who, being by me duly sworn, did depose and say, that he resides in Houston, Texas, that he is CEO of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the seal of said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Company; and that he signed his name thereto by like order. Xe avez, Notary Public commission expires September I I, M. Brent Beaty, Assistant Secretary ofSURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthennore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this 9th Any instrument issued In excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call (713) 812-0800 any business day between 8:30 am and 5:00 pm CST. 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 is attached, and not the truthfulness, accuracy, or validity of that document. State of California d County of Riversi e on October 9, 2019 before me, Jennifer H. Hoagland, Notary Public -----------(insert name and title of the officer) personally appeared _J_e_r_o_m_e_L_._H_re_n ____________________ _ 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. 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. Signatu~, h1~ ~~ (Seal) 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 is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego } } On OCJDb~'( ttY) 20,q before me, Y--1f\nSCO \j0\rf:;CW)7 ~DJf-'H.~ B2bhl, (Here insert name and Ille othe cer) personallyappeared&\~mond :S. Wn'1tG or1c\ J)\4Y)·(, w,tc , who proved~ me on the basis of satisfactory evidence to be the person@ whose nameGYis/~subscribed to the within instrument and acknowledged to me that he/shee.._ executed the same in his/her/~uthorized capacit@, and that by his/her~~ignatur@on the instrument the perso~ or the entity upon behalf of which the perso@ acted, executed the instrument. 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. Notary Public Signature (Notary Public Seal) , ......... ,,, ... ,,, ~;;;;:;;;; .... l ,ac::::::.:~"=:.: 1 ' SAN DIEGO COUNTY MJC-. E.,_ JIU 23. 2023 cs O sccoc see a o c CCC INSTRUCTIONS FOR COMPLETING THIS FORM ADDITIONAL OPTIONAL INFORMATION 171isform complies with c1111'e11t Califo111ia stall/tes l'egal'di11g notat)' wol'di11gand, DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached dorument continued) Number of Pages _L_ Document Date l O h ( \ q CAPACITY CLAIMED BY THE SIGNER □ Individual (s) □ Corporate Officer (Title) □ Partner(s) □ Attorney-in-Fact □ Trustee(s) 0 Other _________ _ if needed, should be completed and attached to the document. Acknowledgments from othel' states may be completed fol' documents being sent to that state so long as the wording does not l'equil'e the Califo111ia notary to violate Califomia notat)' law. • State and Cowtty infonnation must be the State and Cowity where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization nrust be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural fomis by crossing off incorrect forms (i.e. ke/she/flley.-is /are) or circling the correct fomis. Failure to correctly indicate this infonnation may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a suflicient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the oflice of the county clerk. ❖ Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. ❖ Indicate title or type of attached document, number of pages and date. ❖ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate oflicer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed docwnent with a staple. 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 is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego } } On uC:lobeC /(1i 2Ldq before me, ,r,S CUCc\(Q~ t)Dty1(U vubl,L ' (f4re insert namew#a 6tie0ttfie officer) personally appeared ..L..:.1,,,,,Q..Ju.s..-....i.:~~___..,.........,_~µ.t.J~"'-'--~L!.L.l~---~--- who proved to me on the basis of satisfactory evidence to be the person whose name~ i subscribed to the within instrument and acknowledged to me that he/sh h xecuted the same in his/her/~uthorized capacit~ and that by his/her ei sign~~etQ on the instrument the persor@), or the entity upon behalf of which the perso~acted, executed the instrument. 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. (Notary Public Seal) 00 I C IRIS ALCARAZ I CommissiOn No. 2248172 NOTARY PUBLIC-CALIFORNIA ~ SAN DIEGO COUNTY APRU. 28. 2022 INSTRUCTIONS FOR COMPLETING THIS FORM ADDITIONAL OPTIONAL INFORMATION This /om, complies with c1111"ent Califomia stanites rega1•ding nota1)' wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the Califomia notai)' to violate California notary (Title or description of attached document) (Tille or description of attached dorument continued) Number of Pages __ Document Date ___ _ CAPACITY CLAIMED BY THE SIGNER □ Individual (s) □ Corporate Officer (Title) □ Partner(s) □ Attorney-in-Fact □ Trustee(s) □ Other __________ _ law. • State and Cowtty infonnation must be the State and County where the docwnent signer(s) personally appeared before the notary public for acknowledgment. • Date ofnotariz.ation must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public mu~t print his or her name as it appears \\ithin his or her commission followed by a comma and then your title (notary public). • Print the name(s) of doc'Ulllent signer(s) \\ho personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/lhey,-is /fife) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area pennits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. ❖ Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. ❖ Indicate title or type of attached document, number of pages and date. ❖ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed docwnent with a staple. ACORD9 CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/00/YYYY) ~ 10/11/2019 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 endorsemenl 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. .,vNTA,;T Dennis Silva NAME: 26323 Jefferson Ave, Suite C PHONE 888-745-8259 I rffc Nol: 951-763-8000 /A ll'" a.t-C _,.\, Murrieta, CA 92562 E-MAIL Dsiiva@Silva-ins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # www.Silva-ins.com Lie #OH99310 INSURER A: Scottsdale insurance ComDanv =~ 41297 INSURED INSURER B: James River Insurance ComDanv 12203 Ra~ White Cement Everest National Insurance ComDanv 10120 23 0 Via Monserate INSURER C: Fallbrook CA 92028 INSURER D: Libertv Mutual insurance ComDanv 23043 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 51766896 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. NOlWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF l~~LJ%~1 LIMITS LTR TYPE OF INSURANCE ,.,en wvn POLICY NUMBER IMM/DO/YYYYI A LL COMMERCIAL GENERAL LIABILITY ✓ ✓ RBS0029245 10/1/2019 10/1/2020 EACH OCCURRENCE $1 000000 D CLAIMS-MADE □ OCCUR 1.11"\M l"'\Ut; I U "t;;l'I I t:U $50 000 f--PREMISES /Ea occurrence\ MED EXP /Anv one oersonl $5 000 f-- PERSONAL & ADV INJURY $1000000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 R POLICY 0 m?-r □Loe PRODUCTS· COMP/OP AGG $2 000 000 OTHER: Per Proiect Annreaate $2 000 000 AUTOMOBILE UA81LITY COMBINED SINGLE LIMIT s /Ea accident\ f--ANY AUTO BODILY INJURY (Per person) $ -OVl'NED -SCHEDULED BODILY INJURY (Per accident) $ -AUTOS ONLY -AUTOS HIRED NON-OVl'NED PROPERTY DAMAGE s -AUTOS ONLY -AUTOS ONLY /Per accident\ $ B UMBRELLA LIAB HOCCUR ✓ ✓ 00095854-0 10/1/2019 10/1/2020 EACH OCCURRENCE S 1 000000 -✓ EXCESS LIAB CLAIMS-MADE AGGREGATE S2 000 000 OED I I RETENTION s $ C WORKERS COMPENSATION 7600019547191 10/1/2019 10/1/2020 ✓ I ~f:TUTE I I OTH- AND EMPLOYERS" LIABILITY ER Y /N ANYPROPRIETOR/PARTNER/EXECUTIVE GJ N /A E.L EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE s 1 nnn nnn ~ti~ti'p'fi~ O~PERA TIONS below E.L. DISEASE -POLICY LIMIT s 1000000 D COMMERCIAL PROPERTY BFS(20)56226606 1/15/2019 1/15/2020 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, All operation of the named insured for the certificate holder in regards to concrete Caiavera Park, Poinsettia Park, Stagecoach Park , reconstruction of ADA ramps -Various Location --Ray VVhite Cement Job 540--- are named additional insured as respects to the General Liability when required by written contract as per the attached form I Waiver of Subrogation applies to General liability and Workers Compensation I Primary and Non-Contributo~ endorsement applies as respects to General Liability as per attached form. / Per Project Aggregate applies as respects to General liabi ity per attached /Umbrella is over GL 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 Parks & Recreation Administration ACCORDANCE WITH THE POLICY PROVISIONS. 799 Pine Ave Suite 200 Carlsbad CA 92008 AUTHORIZED REPRESENTATIVE ~~ I Dennis Silva © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 51766896 I 19·20 GL XS we CP I Tammy Thrasher I 10/11/2019 3,05,13 PH (PDT) I Page 1 of 6 This certificate cancels and supersedes ALL previously issued certificates. RBS0029245 COMMERCIAL GENERAL LIABILITY CG 20 33 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSE.ES 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 Is 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 51766896 I 19-20 GL XS we CP I Tammy Thrasher I 10/11/2019 3,0S,13 PM (PDT) I Page 2 of 6 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of1 □ RBS0029245 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 "bodily injury," property damage" or "personal and advertising injury" 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 to 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 201011 85 Copyright, Insurance Services Office, Inc., 1984 51766896 I 19-20 GL XS WC CP I Tammy Thrasher I 10/11/2019 3,05,13 PM (PDT) I Page 3 of 6 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 1 □ RBS0029245 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 111) applies separately to each of your projects away from premises owned by or rented to you. CG 25 0311 85 Copyright, Insurance Services Qffice, Inc., 1984 51766896 I 19-20 GL XS WC CP I Tammy Thrasher j 10/11/2019 3:05:13 PM {PDT) I Page 4 of 6 This certificate cancels and supersedes ALL previously issued certificates. RBS0029245 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 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 51766896 I 19-20 GL XS WC CP I Tammy Thrasher I 10/11/2019 3:05:13 PM (PDT) I Page 5 of 6 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 1 □ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 0306 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 lo 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 tho remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. % of the California workers' compensation premium SCHEDULE PERSON OR ORGANIZATION :,l!Y PE.R.Sntl OP. rnv;.t..il: :;:.r..T: 01; r<JP. ViliOM THE tl:\MEI1 I IJSUF.E-.:Li HAS ;._(;PI::l::1 1 SY 'dP.: TTE!i ,:·r)l·/T!I.J\C',' Tr~, FUP!!: :,:! JOB DESCRIPTION This endorsement changes the policy to which it is attached ancl 1s effective on the date issued unless otherwise stated. (The infonnation below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 101112019 Insured Ray White Cement Policy No 7600019547191 Insurance Company Everest National Insurance Company Endorsement No. 001 Premium $ INCL . Countersir111ed By _______________ _ • 1998 by tho Worl<cm' Compons:itlon lnsuranec Rating Bureau of Callloml:i. All rl!Jh!s reserved. From tho WCIRB's California VVorkcrs' Compensation Insurance Forms M.1nual • 1999. ~Allstate BU114-3 -.Ou rp 1'1 gooj "lcJnd,. Cl CW A02 10 11 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies fisted in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. AHeration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certifica1e holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Hokier: CITY OF CARLSBAD, MINOR PUBLIC WORKS ALGA NORE AND POINSETTIA PARK ARE NAMED AS ADDITIONAL INSURED AS RESPECTS TO THE GENERAL LIABILITY WHEN REQUIRED BY WRITTEN 799 PINE AVE STE 200 CARLSBAD, CA USA 920082428 Named Insured: RAY WHITE CEMENT INC. PO BOX 489 FALLBROOK CA 92088-0489 Automobile Lia bilitv Insurer Name: Allstate Insurance Company Polic •Number: 6486 90744 X 1 --Any Auto 2 -Owned Autos Only 3 -Owned Priv. Pass. Autos Only 4 --Owned Autos Other Than Priv. 5 -Owned Autos Subject to 6 -Owned Autos Subject to a Compulsory UM Law Pass. Autos Only No Fault 7 --Specifically Described Autos 8 -Hired Autos Only 9 -Nonowned Autos Onlv Policy Effective Date : 10-01-2019 I Policy Expiration Date: 10-01-2020 Limits of $2,000,000 Combined Single Limit (each accident) Insurance: Bl Per Person Bl Per Accident I PD Per Accident DesaiDtion of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured -Proiect Owner THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: ENTRADA PREMIER INSURANCE CENTER Authorized Representative: Date: 07-19-19 Includes copyrighted material of Insurance Services Office, Inc., with its permission Cl CW A021011 Allstate Insurance Company Page 1 of 1 Pdditional Insured Copy II II ~Allstate. You re •r+ gooa ha:'\ds BU114·3 POLICY NUMBER: 648690744 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULL V. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 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 this endorsement. This endorsement identifies person(s} or organization(s} who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: RAY WHITE CEMENT INC. Endorsement Effective Date: 10-01-2019 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF CARLSBAD, MINOR PUBLIC WORKS ALGA NORE AND POINSETTIA PARK ARE NAMED AS 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 ... 799 PINE AVE STE 200 CARLSBAD, CA USA 920082428 Information required to comolete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An 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 0.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. CA20481013 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1 II ~Allstate. Yo.; re in go:,d har,ds POLICYWRITING INDEX POLICY NUMBER I EFFECTIVE DATE I EXPIRATION DATE 648690744 10-01-2019 10-01-2020 NAMED INSURED AND MAILING ADDRESS RAY WHITE CEMENT INC. PO BOX 489 FALLBROOK CA 92088-0489 ASSEMBLY INFORMATION NON-FILL-IN FORMS REQUIRED -MANUALLY ATTACH MCP 65 11-10 CERTIFICATE OF INSURANCE MCP 67 08-07 INSURANCE POLICY ENDORSEMENT POLINDEX 01 00 BU114·3 Page 1 l'ddlUonal Insured Copy Ill