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HomeMy WebLinkAboutS and J Builders and Restoration Services Inc; 2017-11-16; PWM18-65GSRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2018-0091087 111111111111 lllll 11111111111111111111111111111111111111111111111111111 Mar 08, 2018 11 :06 AM OFFICIAL RECORDS Ernest J. Dronenburg, Jr, SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins $0.00) PAGES: 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 209-050-26-00 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation and Carlsbad Municipal Water District (CMWD), a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on January 12, 2018. 6. The name of the contractor for such work or improvement is S&J Builders and Restoration Services, Inc. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Ballistic Rubber Panel Fastener Installation, Project No. PWM 18-65GS. 8. The street address of said property is Safety Training Center, 5750 Orion Street, Carlsbad, CA 92010-7201. CITY OF CARLSBAD/ CMWD VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of CarlsbadLCarlsbad Village Drive, Carlsbad, California, 92008; the City/Executive Manager of said City on Qh, lp , 20J.Jl., accepted the above described work as completed and ordered that a Notice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on doh. >-? , 20 I'S', at Carlsbad, California. Cl! OF CARLSBAD/CMWD , ~ lli'«~Jo £11/c 2z!Ww~I~ BARBARA ENGLESON U - City Clerk Word\Masters\Forms\Notice of Completion (City) 3/9/98 l/ L( CITY OF CARLSBAD AND CARLSBAD MUNICIPAL WATER DISTRICT ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS S&J Builders and Restoration Services, Inc., has completed the contract work required for Project No. PWM18-65GS, Ballistic Rubber Panel Fastener Installation at the Carlsbad Safety Training Center. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS (Specify if City or CMWD) Ballistic Rubber Panel Fastener Installation (City) VALUE $6,817.00 CERTIFICATION OF COMPLETION OF IMPROVEMENTS Date CITY MANAGER'S/EXECUTIVE MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk or Secretary to the Board of Directors is hereby authorized to record the Notice of Completion and release the bonds in accordance with State Law and City Ordinances. The City of Carlsbad and Carlsbad Municipal Water District are hereby directed to commence maintaining the above described improvements. , City Manager/ Executive Manager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By ~ Depufy City Attorney C:\Userslpwise\Desktop\Secretary Stuff\NOC & API\API (Public Works).doc CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT BALLISTIC RUBBER PANEL FASTENER INSTALLATION PWM18-65GS This agreement is_ ma~e on the . ./{0...J::h_ day of ()j~ , 2017, by the City of Carls~ad, C~liforn1a, a municipal corporation, (hereinafter called "City"), and S&J Builders and Restoration Services, Inc., a California corporation whose principal place of business is 10815 Wheatlands Ave., Suite J, Santee, CA 92071 (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: Jason Kennedy (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. Ballistic Rubber Panel Fastener Installation; Cont. No. 4070 Page 1 of 6 City Attorney Approved 9/27/16 PWM18-65GS 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 subcontract from ~~g in contract bidding. Signature: ~ 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. 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. Ballistic Rubber Panel Fastener Installation; Cont. No. 4070 Page 2 of 6 City Attorney Approved 9/27/16 PWM18-65GS 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 forty-five (45) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within twenty (20) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. S&J BUILDERS AND RESTORATION SERVICES, INC., a California corporation Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill (name of Contractor) 689944 (Contractor's license number) Class B, C36 2/28/2018 (license class. and exp. date) 1000018498 (DIR registration number) 6/30/2018 (DIR registration exp. date) Ballistic Rubber Panel Fastener Installation; Cont No. 4070 Page 3 of 6 10815 Wheatlands Ave., Suite J (street address) Santee, CA 92071 (city/state/zip) 619-449-2014, ext. 106 (telephone no.) 619-449-0887 (fax no.) swilson@sandjbuild.com (e-mail address) City Attorney Approved 9/27/16 PWM18-65GS 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 S&J BUILDERS AND RESTORATION SERVICES, INC., a California corporation By: ~p I«-? (p.;-;;s;e- (sign here) CITY OF CARLSBAD, a municipal corporation of the State of California ~c~ L.:> ... ,~c---'lrtte; .~ ~ (print name/title) Elaine Lukey, Public Works Director, as authorized by the City Manager By: ,S&-...J T Ll ~ (5,c-.> C.FO (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: {{/£cc~ Deputy City Attorney Ballistic Rubber Panel Fastener Installation; Cont. No. 4070 Page 4 of 6 City Attorney Approved 9/27/16 PWM18-65GS 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: The Contractor must perform no less than fifty percent (50%) of the work with its own forces. Ballistic Rubber Panel Fastener Installation; Cont No. 4070 Page 5 of 6 City Attorney Approved 9/27/16 PWM18-65GS EXHIBIT B Contractor to provide all equipment, materials (except Sika adhesive) and labor necessary to install ballistic rubber panel fastener at Safety Training center located at 5750 Orion St., Carlsbad, CA 92010 JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 LS 1 Contractor will counter sink ballistic rubber sound tiles, $6,817 drill into block wall, and fasten sound panels with concrete screws and washers. Fastners will be installed in the center of 350 rubber tiles. Fill counter sink holes with Sika adhesive (supplied by City). Apply Sika adhesive around sound tiles to fill gaps and aid in panel adhesion to concrete wall surface. TOTAL* $6,817 *Includes taxes, fees, expenses and all other costs. Ballistic Rubber Panel Fastener Installation; Cont. No. 4070 Page 6 of 6 City Attorney Approved 9/27/16 -S&J Builders and Restoration Services Inc Builders & ReS1oration Services, Inc. I 0815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Client: Property: City of Carlsbad -Safety Training Center 5750 Orion St Carlsbad , CA 92008 Operator: SWILSON Estimator: Sean Wilson Position: Senior Estimator Company: S&J Builders Business: 10815 Wheatlands Ave Suite J Santee, CA 92071 Reference: Company: City of Carlsbad Type of Estimate: Reconstruction Date Entered: Date Est. Completed: Price List: Labor Efficiency: Estimate: 10/19/2017 10/19/2017 Date Assigned: 10/10/2017 Date Job Completed: CASD8X MAR17 SJ PVW Restoration/Service/Remodel CJTYOFCARLSBAD-STC-R Exhibit "B" Business: (760) 434-2943 Business: (619) 449-2014 x 106 E-mail: swilson@sandjbuild.com Sean Wilson from S&J Builders met with Jason Kennedy (Facility Manager) on site and requested a bid to fasten previous installed sound tiles to the block wall. Top three rolls only. Caulk around sound tiles as needed to complete the third day of labor. Caulking to be supplied by the City. Thank you for the opportunity to bid your repair project. Respectfully, Sean Wilson Buildcrs&RestoratlonServices,lnc, DESCRIPTION S&J Builders and Restoration Services Inc I 0815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Range CITYOFCARLSBAD-STC-R Main Level 4,528.33 SF Walls 7,918.33 SF Walls & Ceiling 376.67 SY Flooring 286.00 LF Ceil. Perimeter QTY REMOVE REPLACE I. Carpenter -per hour 48.00 HR 0.00 108.41 3,390.00 SF Ceiling 3,390.00 SF Floor Height: 15' 10" 286.00 LF Floor Perimeter TAX O&P TOTAL 0.00 1.040.74 6,244.42 Two men crew for 3 days -Counter sink sound tiles, drill into block wall and fasten sound panels with concrete screws and washers center of 350 tiles. (top three rolls), Caulk counter sunk holes with city supplied caulking. Apply caulking around sound tiles to complete the third day. Time estimate excludes painting of sound tiles 2. Concrete bits, screws and washers 3. Material Only Caulking -latex fire sealant-Material only 4. Scissor lift -20' platform height - electric powered 5. Painting (sound tiles) Totals: Range Total: Main Level 350.00 EA 1.00 LF 3.00 DA 1.00 EA General DESCRIPTION QTY 6. Bonds, Permits & City fees 1.00 EA 7. Commercial Supervision/ Project 2.00 HR Management -per hour Totals: General Linc Item Totals: CITYOFCARLSBAD-STC-R CITYOFCARLSBAD-STC-R 0.00 0.69 REMOVE REPLACE 0.00 110.00 18.72 48.30 18.72 1.089.04 18.72 1,089.04 TAX O&P 0.00 44.00 0.00 44.00 18.72 1,133.04 10/19/2017 308.52 BY CITY BY CITY EXCLUDED 6,552.94 6,552.94 TOTAL AS OCCURRED 264.00 264.00 6,816.94 Page:2 S&J Builders and Restoration Services Inc Builders & Restoration Servlcas, Inc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Grand Total Areas: 4,528.33 SF Walls 3,390.00 SF Floor 0.00 SF Long Wall 3,390.00 Floor Area 4,859.22 Exterior Wall Area 0.00 Surface Area 0.00 Total Ridge Length CITYOFCARLSBAD-STC-R 3,390.00 SF Ceiling 376.67 SY Flooring 0.00 SF Short Wall 3,485.78 Total Area 288.67 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length 7,918.33 SF Walls and Ceiling 286.00 LF Floor Perimeter 286.00 LF Ceil. Perimeter 4,528.33 Interior Wall Area 0.00 Total Perimeter Length I 0/19/2017 Page: 3 -S&J Builders and Restoration Services Inc Boildors&R11storatlonServ!tt1s,lnc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 Line Item Total Overhead Profit 619-449-0887 fax Lie 689944 Material Sales Tax Replacement Cost Value Net Claim CITYOFCARLSBAD-STC-R Senior Estimator Summary 10/19/2017 5,665.18 566.52 566.52 18.72 $6,816.94 $6,816.94 Page:4 -Builders & Restoration Services, Inc Line Items Total S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Recap of Taxes, Overhead and Profit Overhead (10%) Profit (10%) 566.52 566.52 566.52 566.52 CITYOFCARLSBAD-STC-R Material Sales Tax (7.75%) 18.72 18.72 Storage Rental Tax (7.75%) 0.00 0.00 10/19/2017 Page: 5 S&J Builders and Restoration Services Inc Builders& Restoration Services, Inc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Estimate: CITYOFCARLSBAD-STC-R Area: Main Level Range Area Subtotal: Main Level General Subtotal of Areas Total CITYOFCARLSBAD-STC-R Recap by Room 5,445.18 96.12% 5,445.18 96.12% 220.00 3.88% 5,665.18 100.00% 5,665.18 100.00% 10/19/2017 Page:6 -S&J Builders and Restoration Services Inc BuildOfS & Restoratton Services, Inc. O&P Items 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 FRAMING & ROUGH CARPENTRY LABOR ONLY O&P Items Subtotal Overhead Profit Material Sales Tax Total CITYOFCARLSBAD-STC-R Recap by Category Total % 5,445.18 79.88% 220.00 3.23% 5,665.18 83.10% 566.52 8.31% 566.52 8.31% 18.72 0.27% 6,816.94 100.00% 10/19/2017 Page: 7 8uffders & Restoration Semen, klc. S&J Builders and Restoration Services Inc 1081 5 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Li e 689944 CITYOFCARLSBAD-STC-R I 0/19/201 7 Page: 8 S&J Builders and Restoration Services Inc Build6rs & Restoration Services, Inc. Image No. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Type 64-IMG 2514 CITYOFCARLSBAD-STC-R Image Detail Date Taken 10/18/2017 Taken By 10/19/2017 Page:9 Main Level 30'8" 30' Range ~I; ~ CITYOFCARLSBAD-STC-R I 0/19/2017 ~ Li \fain Level Page: 10 S&JBU-1 OPID·AM ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 10/25/2017 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 619-220-8014 22AAI~cT Steve Henkelman JPL Insurance Group, Inc , PHONE 619-220-8014 I rM. No): 619-220-8015 JPL Insurance Servicesr-(AJC, No, Ext): 3033 5th Avenue, Ste. 325-1 ith"M~ss: Steve@jplmsurance.com San Diego, CA 921031 Steve Henkelman INSURER/SI AFFORDING COVERAGE NAIC# INSURER A, Financial Pacific Insurance Co 31453 INSUREDS & J Builders And Restoration_J INSURER B, Arch Specialty Ins Co 21199 10815 Wheatlands Ave. Ste. JJ INSURER c, Cypress Insurance Company 10855 Santee, CA 92071 INSURER D, California Automobile Ins Co. 38342 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ~.?Jl~ ~i POLICY NUMBER , ._l~~LJ<;_)'. !cfF .f~L_l<;_UX!' LIMITS ITI> B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE 00 OCCUR X 12EMP9285805 10/15/2017 10/15/2018 ~~~b~iJ?E:~~~u~?encel $ 100,000 X CPL 12EMP9285805 10/15/2017 -10/15/2018 MED EXP IAnv one nerson\ $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 - ~'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY oo mg:: D LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: Pollution $ $1 MIL/$2MIL D AUTOMOBILE LIABILITY ~~~~b~~~llNGLE LIMIT $ 1,000,000 X ANY AUTO X BA040000032483 03/01/2017 03/01/2018 BODILY INJURY /Per oerson) $ OWNED -SCHEDULED I----AUTOS ONLY ~ AUTOS BODILY INJURY /Per accident) $ HIRED NON-OWNED fpf},9~t?c~di;,~t?AMAGE $ -AUTOS ONLY ~ AUTOS ONLY $ B X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ I----12EMX0523004 10/15/2017 10/15/2018 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ I OED I I RETENTION$ $ C WORKERS COMPENSATION XI ~~fTUTE I I OTH-AND EMPLOYERS' LIABILITY ER Y/N X SJWC816720 01/01/2017 01/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA 1,000,000 (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Professional Liabi 12EMP9285805 10/15/2017 10/15/2018 Agg/Occ $2MIL/$1 MIL ./ A Bailees 60497187 10/15/2017 10/15/2018 Bailees 257,500 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As respects General Liability The Ci~ of Carlsbad, its officials, employees-, and volunteers are additional insure , includiniprimaa; and non-l contributo~ wording. As respects auto liabilit, 1ty of arlsbad has been _: added as a ditional msured1 so that all communication regarding non-payment 1 of premium will be mailed direct to you, whether it is 30-day for CERTIFICATE HOLDER CANCELLATION CARLSBA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad/CMWD ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS lnsurance7 Complaince Services I AUTHORIZED REPRESENTATIVE PO Box 4668-ECM #350501 :fJP~~ 1New York, NY 10163-4663 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE INSURED'S NAME CARLSBA S & J Builders And Restoration S&JBU-1 OP ID: AM underwriting reasons or 10-day for non-payment of premium. All Forms attached and apply when required by written contract. Umbrella extends General, Professional and Pollution liabiity, and workers' compensation only. Date PAGE 2 10/25/2017 I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED/ PRIMARY COVERAGE INCLUDING COMPLETED OPERATIONS (COVERAGES A, B, D & F) This endorsement modifies insurance provided under the Environmental Multiline Policy It is agreed that Section 111-WHO IS AN INSURED is amended to include the following: Under Coverages A,B,D and F the person or organization shown in the schedule below shall be an Additional Insured, but only to the extent liability arises out of YOUR WORK for that Additional Insured and not due to any actual or alleged independent liability of said Additional Insured. This Endorsement does not apply to BODILY INJURY or PROPERTY DAMAGE arising out of the sole negligence or willful conduct of, or for defects in design furnished by the Additional Insured. With respect to the coverage afforded to the Additional Insured, this insurance is primary and non- contributory, and our obligations are not affected by any other insurance carried by such Additional Insured whether primary, excess, contingent or on any other basis. This Endorsement does not increase the Company's limits of liability as specified in the Declarations of this policy. Additional Insured: ANY PERSON OR ORGANIZATION FOR WHOM YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE WRITTEN CONTRACT MUST BE EFFECTIVE PRIOR TO THE DATE OF THE LOSS OCCURRENCE All other terms and conditions of this Policy remain unchanged. Policy Number: 12 EMP 92858 05 Named Insured; S & J BUILDERS AND RESTORATION SERVICES, INC.; S & J BUILDERS AND RESTORATION SERVICES PARTNERSHIP This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 10/15/2017 00 EMP0101 00 01 14 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04108 (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. BLANKET WAIVER Person/Organization Job Description All CA Operations SCHEDULE Blanket Waiver -Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium 2372.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2017 Insured Insurance Company Cypress Insurance Company WC 99 04108 (Ed. 9-14) Policy No. SJWC816720 Endorsement No. Premium$ Countersigned by _______________ _ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY NOTICE OF CANCELLATION OR MATERIAL CHANGE This endorsement modifies insurance provided under the Environmental Multiline Policy In consideration of the premium charged, it is hereby agreed that the Policy is amended by the following additions: 1. The following is added to Section V, COMMON CONDITIONS: We shall provide 30 days written notice (except 10 days for non payment of premium) prior to a MATERIAL CHANGE OF POLICY TERMS or Cancellation of the Policy to CITY OF CARLSBAD P.O. BOX 4668 -ECM35050 NEW YORK, NY 10163 2. The following is added to Section VII, DEFINITIONS: MATERIAL CHANGE OF POLICY TERMS means a change of the Declarations regarding: a. A change in the POLICY PERIOD, or b. A removal of a Coverage Section, or c. A removal of any Named Insured or Insured specifically identified by name in the policy, or d. A reduction of the amount of Limits of Liability, which reduction is not the result of payment of CLAIMS or CLAIM EXPENSES, or e. A reduction in the amount of the Policy Aggregate, which reduction is not the result of payment of CLAIMS or CLAIM EXPENSES. All other terms and conditions of this Policy remain unchanged. Additional Premium: $100 Surplus Lines Tax: $3.00 Stamping Fee: $.20 Policy Number: 12 EMP 92858 05 Named Insured: S & J BUILDERS AND RESTORATION SERVICES, INC.; S & J BUILDERS AND RESTORATION SERVICES PARTNERSHIP This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 10/24/2017 00 EMP0068 00 08 04 Page 1 of 1 WC 00 00 00 C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY PART SIX-CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurabil- ity of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organiza- tions have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and six- teen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days af- ter your death, we will cover your legal representa- tive as insured. D. Cancelation 1. You may cancel this policy. You must mail or de- liver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or de- liver to you not less than ten days advance writ- ten notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice:· 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to com- ply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. Page 6 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.