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HomeMy WebLinkAboutRay White Cement; 2020-01-08; PKRC1923CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT RAY WHITE CEMENT AT SENIOR CENTER SIDEWALK AND BIKE PAD CONTRACT PKRC1923 Tracking#: This letter will serve as an agreement between Ray White Cement, a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary for demolition of existing decomposed granite sidewalk and bike pad and replace with concrete, per the Contractor's proposal dated December 17, 2019 and City specifications, for a sum not to exceed Two Thousand seven hundred seventy-five dollars ($2,775). This work is to be completed within 30 calendar days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1 . City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees and volunteers, 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 this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers' Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said 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. Insurance is 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. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4, California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. ____ init ____ init 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. ___ init ___ init 7. 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. Ray White Cement Senior Center Sidewalk & Bike Pad; PKRC 1923 --1 --City Attorney Approved 2/29/2016 Tracking#: 8. 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 the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of 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 the execution of the work covered by this Letter of Agreement. 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. 9. City Contact: Temuiin Matsubara 760-434-2844 Contractor Contact: Tom White 760-728-0170 CONTRACTOR Ray White Cement PO Box 489 Fallbrook, CA 92088 760-728-0170 tom@raywhitecement.com ( print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Dated: Department DirectQL "orized by the City Manager t/ ~(t-tJ (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. 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: Ray White Cement Senior Center Sidewalk & Bike Pad; PKRC 1923 --2 --City Attorney Approved 2/29/2016 Tracking#: Scope of Work Remove four (4) inches of decomposed granite from existing sidewalk and bike pad. Grade and haul away spoils. Form and pour new four (4) inches thick concrete sidewalk 15' x 4' and bike pad 5' x 4'. Total square footage for walkway and bike pad= 80 sq.ft. Concrete strength 3250 PSI,¾" rock mix, 3/8" rebar 24" OC installed in concrete Install expansion joints Surface finish on concrete -medium broom finish Cost: $2,775.00 Ray White Cement Senior Center Sidewalk & Bike Pad; PKRC 1923 --3 --City Attorney Approved 2/29/2016 AC~~ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/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 endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). www.Silva-lns.com INSURED Ray White Cement 2380 Via Monserate Fallbrook CA 92028 COVERAGES Lie #OH99310 CERTIFICATE NUMBER· 51766896 NAIC# 41297 12203 10120 INSURER D: Libe 23043 INSURER E : INSURER F : 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 --··-····-POLICY NUMBER IMM/DD/YYYYI 1MM/DD/YYYYI LIMITS A LL COMMERCIAL GENERAL LIABILITY ✓ ✓ RBS0029245 10/1/2019 10/1/2020 EACH OCCURRENCE $1 000 000 D CLAIMS-MADE w OCCUR UAMAc,l;To1IENTED t---PREMISES IEa occurrence\ $50 000 MED EXP (Any one person) $5 000 -PERSONAL & ADV INJURY S 1 000 000 t--- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 R POLICY [2J m?-r □LOG PRODUCTS -COMP/OP AGG s2 ooo ooo OTHER: Per Proiect Annreaate s2 ooo ooo AUTOMOBILE LIABILITY fE~~~~~tf'INGLE LIMIT $ -ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED BODILY INJURY (Per accident) $ t---AUTOS ONLY -AUTOS HIRED NON-OWNED ;p~?:~~J.;,t~AMAGE $ -AUTOS ONLY -AUTOS ONLY $ B UMBRELLA LIAB HOCCUR ✓ ✓ 00095854-0 10/1/2019 10/1/2020 EACH OCCURRENCE s 1 000 000 -✓ EXCESS LIAB CLAIMS-MADE AGGREGATE $2 000 000 DED I I RETENTION$ $ C WORKERS COMPENSATION 7600019547191 10/1/2019 10/1/2020 ✓ I ~ffTUTE I I OTH- AND EMPLOYERS' LIABILITY ER YI N ANYPROPRIETORIPARTNERIEXECUTIVE @ N/A E.L. EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE s 1 nnn nnn ~tii~~tfi~ ~:~PERATIONS below E.L. DISEASE -POLICY LIMIT $1 000 000 D COMMERCIAL PROPERTY BFS(20)56226606 1/15/2019 1/15/2020 LEASED/RENTED EQIUPMENT $50,000 DESCRIPTION OF OPERATIONS I 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 Calavera Park, Poinsettia Park, Stagecoach Park , reconstruction of ADA ramps -Various Location--------Ray White Cement Job 540-------------- are named additional insured as respects to the General Liability when required by written contract as per the attached form / Waiver of Subrogation applies to General liability and Workers Compensation / 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 /Umbrella is over GL CERTIFICATE HOLDER City of Carlsbad Parks & Recreation Administration 799 Pine Ave Suite 200 Carlsbad CA 92008 ACORD 25 (201 6/03) CANCELLATION 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 ~ ~ Dennis Silva · © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 51766896 I 19-20 GL XS WC CP I Tammy Thrasher I 10/11/2019 3 : 05: 13 PM (PDT) I Page l 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, 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 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 WC CP I Tammy Thrasher I 10/11/2019 3:05:13 PM (PDT) ! Page 2 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. 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 I 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 Ill) 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 I 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. CG24041093 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 paymenls 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 undor a written contract that requires you lo obtain this agreement from us.) You must maintain payroll records accurately segregating tho remuneration or your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be / otherwise due on such remuneration. % ol the California workers' compensation premium SCHEDULE PERSON OR ORGANIZATION ,\llY PF:RSntl (JR ORr;_;,i:z.;T:on FOP. \•/liOl-1 TliE rl!d·lE!l l lJSlJHED HAS ,;'.._r;ilEEL• SY ·,·lR:TTEli COWI'Hi\CT TC! FUPi!::.::l JOB DESCRIPTION This endorsement changes the policy to which it is attached ancl is olfoctive on Ille dale issued unless otherwise staled. (The information below is required only when U1is endorsement is issued subsequent to preparation of tile policy.) Endorsement Effective 10/1/2019 Insured Ray White Cement Policy NO7600019547191 Insurance Company Everest National Insurance Company Endorsement No. 001 Premium $ INCL . Countersigned By _______________ _ • 1998 by tho Workers' Compons.iUon Insurance RilUng Bureau of California. All rlnhts rosorvcd. From tho WCIRB's California Workers' Compensation Insurance Forms M.1nual -1999. BU114-3 Cl CW A00.1011 CERTIFICATE OF INSURANCE This certificate is issued for infonnational purposes only. It certifies that the policies listed 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. Alteration 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 certificate 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 Holder. 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 Liabilitv Insurer Name: Allstate Insurance Comoanv Polic1Number. 648690744 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 --Soecifically Described Autos 8 -Hired Autos Onlv 9 -Nonowned Autos Onlv Policv 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 Descriotion of Ooerations/Locations/Vehicles/Endorsements/Soecial Provisions Interested Party Tvoe: 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 A00.1011 Allstate Insurance Company Page 1 of 1 Additional Insured Copy II II ~Allstate. You·r~ in gooa hands BU114-3 POLICY NUMBER: 648690744 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" tor 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 D.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. CA20481013 © Insurance Services Office, Inc., 2011 Mditional Insured Copy Page 1 of 1 II @) Allstate. Yo:.. re in go-)d hands 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 Page 1 BU114·3 Pddltlonal Insured Copy 111 ~ Allstate. Y-:i1 . ."r~ ,n good hands BU114·3 CUSTOMER NUMBER: 397325 ENTRADA PREMIER INSURANCE CENTER 27601 FORBES RD STE 54 LAGUNA NIGUEL, CA 92677-1242 CITY OF CARLSBAD, MINOR PUBLIC WORKS ALGA NORE AND POINSETTIA PARK ARE NAMED 799 PINE AVE STE 200 CARLSBAD, CA 92008-2428 100001907196486907440115000080001004 l'<lditional Insured Copy RUN DATE: 07-19-19