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S and J Builders and Restoration Services Inc; 2018-05-15; PWM18-150GS
CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT URGENT SENIOR CENTER MOLD ABATEMENT PWM18-150GS TIFICATION OF AGREEMENT is entered into as of the L5tli.-day of _....L..J!...J...:=-=-1-------' 2018, but effective as of the 16th day of April, by and between the City of Carlsbad, alifornia, 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: Brian Bacardi (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. Urgent Senior Center Mold Abatement Page 1 of 14 City Attorney Approved 9/27/16 A-' PWM18-150GS 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 subcontra t~o~~ating in contract bidding. Signature: "V ~ Print Name: • SG6,....) I w: S • ....J 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. Urgent Senior Center Mold Abatement Page 2 of 14 City Attorney Approved 9/27/16 PWM 18-lSOGS 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 agreed to start within one (1) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within fifteen (15) 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 (name of Contractor) 689944 (Contractor's license number) General B, C-36 2/29/20 (license class. and exp. date) 1000018498 (DIR registration number) 6/30/18 (DIR registration exp. date) Urgent Senior Center Mold Abatement Page 3 of 14 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 PWM18-150GS 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: ~ 0 CZ $2 ~ (sign here) CITY OF CARLSBAD, a municipal corporation of the State of California By: Elaine Lukey / ic Works Director 8,ro.t;,L. c.:>,,~~E'S~\ (print name/title) as authorized by the City Manager By~ (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !f....§ 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: e/4~ Deputy City Attorney Urgent Senior Center Mold Abatement Page 4 of 14 City Attorney Approved 9/27/16 Secretary of State · Statement of Information (California Stock, Agricultural Cooperative and Foreign Corporations) IMPORTANT-Read instructions before completing this form. Fees (FIiing plus Disclosure) -$25.00; Copy Fees -First page $1.00; each attachment page $0.50; Certification Fee -$5.00 plus copy fees 51-550 1. Corporation Name (Enter the exact name of the corporation•• it is currently recorded wilh the Colifornlu Secretary of Slate) S & J BUILDERS AND RESTORATION SERVICES, INC. 3. Business Addresses a. Str'eel Address of Principal Executive Offico -Do not list a P.O. Box 10815 Wheatlands Avenue, Suite J b,Maling Address of Corparalion, if different than ltom 3a c. Street Add•••• of Principal Collfornla Office, If any and if different lhan Item Ja. Do not list a P.O. Box f 6-6 4 4 5 9"'2' !FILED Secretary of State State of California DEC 2 0 2016 µ,. 70 --p;-\ pv-- This Space For Office Use Only 2. 7-0igit Secretary of State FIie Number (2207947 City (no abbreviation,) s1a1e Zip Code Santee CA 92071 City (no abbreviations) Slate Zip Code City (no abbreviations) Stale Zip CQdo CA 4. Officers The Corporation Is required to list ali three of the officers set forth below. An additional title for the Chief Executive Officer and Chief Financial Officer may be added; however, the preprinted liUes on lhis form must not bo altered. a. Chlo! E.ocutive Ofllcert Flrst Name Gracie Addre&s 10815 Wheatlands Avenue Suite J b. Secrotary First Namo Gracie Address 10815 Wheatlands Avenue, Suite J · c. Chief Flnanclul Officer/ Adoross First Nome Sean 10815 Wheatlands Avenue, Suite J Middle Name Middle Name Middle Name Last Name Wilson City (no obbrevla1lons) Santee LUtName Wilson City (no obbrovlatlons) Santee Lesl Namo Wilson City (no abbreviations) . Santee Suffis Slate Zip Code CA 92071 Suffix State Zip Code CA 92071 SuffiK Sia te Zip Code CA 92071 5. 0irector(s) California Stock and Agrlcuttural Cooperative Corporations ONLY: Item 5a: At least one name and address must be nsted. II the Ca<poration hos additional directoro, enter the namc(s) and addressos on Form Sl·SSOA (see instructions), a. Firsl Nome I Middle Name J Lost Nemo I Surfi< Sean Wilson ·-----~~ity (no"';;bl>rovlatlons) l\ddross I State I Zip Codo 10815 Wheatlands Avenue, Suite J antee CA 92071 b. Number ol vacancios on the Soaro of Directors, ii any I___ ... J 6. Agent for Service of Process ftom 6a and 6b: If the agent Is an Individual, the agent must reside In Califotnla and llem 6a and 6b must be completed with the agent's name and California address. Item 6c: If the agent is o California Registornd Corporoto Agent. a current agent rogistratlon certlflcale must be on file with the California Secretary of State and Item 6c must be completed (leave Item 6a-6b blank). a. California Agent's Firsl Name (if agenl is no! a corporation) I Middle Nam,i" Sean b. Slrtel Address fir agenl is not 8 corporation}-Do not Hat D P.O. Box 10815 Wheatlands Avenue, Suite J c. California Regislerod Corporate Agent's Name (if agent Is e co,poratian) -Oo not complete item 6a or 8b 7. Type of Business · Dcsclibo tllo type of business or services ol lhe Corporaillon Construction -Insurance work $1-550 (REV ,1112016) I Lasl Narno Wilson I Cily (no abbreviations) Santee l Suffix I Slate CA I Zip Code 92071 ·,. l}ntltu 2016 California ,:-i,,..,."'-1 State www.sos.ca.gov/business/be Attachment to Statement of Information (California Stock and Agricultural Cooperative Corporations) A. Corporation Name Sl-550A Attachment I 6 -6 4 4 5 ·9 .2 S & J BUILDERS AND RESTORATION SERVICES, INC. B. 7-Dlglt Secretary of State FIie Number C2207947 This Space For Office Use Only C. List of Additional Director(s) -If the corporation has more than one director, enter the additional directors' names and addresses. 5b. Firs! Name Middle Name Gracie Wilson J Last Namo, I Suffix --~-------------------------1-----------------------,~--~---~--- ! State I Zip Code Address City (no abbrevlallons) 10815 Wheatlands Avenue, Suite J Santee CA 92071 l-5-c._F_·ir-•I_N_a_m_• _________________________ 1 _M_l-dd-le-Na_m_e _____ .l_L_a_s_rN_a_m_e ________ ,_ ___ , __ ,_::_ l Slale I Zip Code Address City (no abbreviations) Sd, Firs! Name Middle ~~:_ ____ _l,_L_a_st_N_•_m_e ________ , I Suffix ---A-dd-re-ss-----------------------l·-C-ity-(no abbreviations) rStat;-·1Zip-Code 5e. first N-am_•----------·----------------1--M-id_d_le_N_•_m_e _____ !,l,_la_•_I_N_•m_e ________ ..----·.--·1_::_ I Slate I Zip Code Address City (no abbreviations) Sf. Firs1 Name Middle i'/ame I Last Name J Suffix I---A-d-dr-e-,s-----------------------i-C-i-ly-(n_o_a_b_b,-e-vl-at-io-n,-)--··-------------,~, ·Zip·C;~ 5g. Firs! Namo Middle Name I Last Nome ·--··' Suffix_ --·Add;;;---------------------------,-C-Uy_(_no-ab-b-,e-v-ia-lio_n_s_) --''-----------,, State I Zip Code Sh. Firs! Name Address . 51. First Name Address Sj. First Name --------------·· Address S1·550A • Attachment (EST 11/2016) City (no abbreviations) I SuffiK Stale Zip Code --·· 1··· ·· 1· .I ·-- City (no abbrevialions) I Suffix I ·Zip c'od~· · · ···· --~~~I: ~-m~--. -___ I_:'~·~~----·-... --· ,--r-r: - City (no abbreviations) State I Zip Coda 2016 California Secretary of State www.sos.ca.gov/business/be PWM 18-lSOGS 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: --"-g' _____ _ The Contractor must perform no less than fifty percent (50%) of the work with its own forces Urgent Senior Center Mold Abatement Page 5 of 14 City Attorney Approved 9/27/16 ~ PWM18-150GS EXHIBIT B Urgent Senior Center Mold Abatement Contractor to provide all materials tool and labor for mold remediation and of the fitness room and common hallways located at the Carlsbad Senior Center: 799 Pine Avenue Carlsbad, CA 92008. The scope of work and costs involved are as follows: IJESCRIPTION I Bond. Pcrmil-' 2. Add for pt.·r~onal prott:1.:11, c l'lJUiptm .. ·nt Heavy duty (,encral :t Carhon vapor filter ( for air :-.~Tuhhcn • JI," XI(,'" -+. t-fatardou:,, Material Remediation ( AFTER If OURS J QTY 1.IMJ EA 2-1.00 EA X.(Xl EA 1.(Xl EA REMOVE REPLACE O.!Kl IX.42 IUKJ 77.10 S&.I will ad_juster labor hours to 1.5 rate if city request after hours or weekend work. 5. Remediation de;trancc tc.;tin~ 1.00 EA TAX O&P .\4.26 88.42 12:l.:lt, TOTAL AS INCURRED 564.76 775.50 OPEN EXCLUDED ------·· -------·------------------·----------·----. ---__ ----·-·----------·-----------------_____ . -~----------======· ... ----------------- Totals: General Excerisc Room Door Window Window Window Door Door DESCRIPTION t,. Conll"nl Manipularion chal"!!c -per hour 1.059.97 SF Walls 2.272.36 SF Walls & Ceiling 134.71 SY Flooring 145.76 LF Ceil. Perimeter 6' X6'8" 5' X 5' 9 .\/8" 5' X 5' 9 .\/8" 5' X 5' 9 3/8" .\' X 6' 8" 3'X6'8" QTY REMOVE REPLACE 1200 IIR (l.()(l 98.00 1,4_/,() 211.78 1340.26 Height: 8' 5" 1.212.39 SF Ceiling l.212.39 SF Floor 13.\.76 LF Floor Perimeter Opens into HALLWAY_ 2 Opens into HALLWAY_2 Opens into HALLWAY_ 2 Opens into HALLWAY_2 Opens into BACK_EXIST_H Opens into Exterior TAX O&P O.flll 235.20 TOTAL 1,411.20 Labor to p1L~b equipment lo the «nter for the room for remediation and repair work. Push back into to place once containment is removed. 7. Containment Barrier/Airtock/Dcnlll. 2J4.\.K5 SF 0.00 1.28 12.72 61KJ.28 3,614.41 Chamber Work area conuinment n.-. Walls and ceiling ll. Ped & =ii zil'P"r UKlEA o.m 16.51 0.81 1.30 20.62 Urgent Senior Center Mold Abatement Page 6 of 14 City Attorney Approved 9/27/16 PWM18-150GS CONTINUED . Excerisc Room DESCRIPTION QTY Rt'.MOVE REPLACE TAX O&P TOTAL Y. Tear out damage dl)1\'w':tll, ckanup, t:rl.76 l.F 8.29 ll.00 .U2 221.78 1,33:1.97 hag, per LF . to 2' IO. HEPA Vacuuming -hourly charge X.00 HR ll.(K} llll.l'.l ll.lK) 161.80 970.84 Initial HEPA Vue II. Mold Ckaning Technician -per 12.00 IIR o.mi 98.ll0 0.1)0 235.20 1,411.20 hmn Wet wipe framing and back side or halh,ay drywall. 12. HEPA Va1.:uu1ning -hourly charge 8.00 HR ti.OU 101.13 0.00 161.80 970.84 Final HEPA \'ac prior to clearance leslin!(, l.l. Apply :.mti-mkrohial :.tgent 21\7.51 SF o.m ll.40 ll.-11 21.40 128.81 14. :'.cg. air fan/Air scruh.-l.argc (per 12.00 DA O(Kl 12-1.54 0.00 298.90 I, 793.38 24 hr period )-No monit. I). Equipment Uc1:ontamination ,hargc 4.(X) EA 0.00 .'\h.67 0.88 4534 272.90 -per piece nf equipment 16. Pl::L..,lic hag -used for disposal of '.IS.00 EA 0.00 2.89 7.84 20.24 129.2'.l '-·ontaminatcd item~ 17. Seal stud wall 267.51 SF 0.(K) 4.07 .1.11 217.76 l,'.l(l9.64 18. Mold Ckaning Technician -per 16.00 HR 0.0ll 98.0ll o.no 313.60 1,881.60 hour Labor to insh1II containment in wall cavitiC's prior to clt'arancc festinJ,t. Pull carpet tiles back from \\'all and reset floor containment 14. Containment 535.<n SF 0.00 1.28 2.90 136.96 824.70 Barricr/Airlock/Dcc,m. Chamber 20. !Material Only) Sheathing -OSR 128.00 SF 0.00 0.:\2 5.11\ 13.32 85.()4 1/2" 21, CaqX-llll'f -Gcncrul Framer -p,,r 16,CMl HR 0.00 108.41 O.<Kl 346,92 2,081.48 hour Labor to rut and install shear 22. ( Material Only) 5/ll .. -drywall per 133.76 LF 0.00 1.90 llJ.70 50.82 324.66 L.F -up IO 2' tall 2.1. (Material Only) Te<ture drywall -401.27 SF 0.(MJ o.m 0.93 2.40 15.37 Orang~ Peel 24. Drywall Installer/ Finisher -per 32.(Ml HR 0.lKl 106.01 0.<Xl 678.46 4.070.78 hour 25. Seal more than the floor perimeter 401.27 SF 0.CXl 1.14 2.49 91.50 551.44 w/fatcx ha~d srain blocker -one coar 26_ Paint more than th.e floor perimeter 5.l'dl3 SF CUMl 2.10 7.88 224.72 1,'.156.16 -two coats Feather into e,isting 27. Painter -per hour 3.00 HR ().(Ml 99.86 0.CMl 59.92 359.50 Additional labor to r ... ather in paint .:!H. Cm·c h.1,c moJding · ruhh<r or D'.l.76 1.F EX,LUDED vinyl. 4" high 14. C'arp.·t t1k 1,212 .. 19 SF EX,LUDED To,.-1,: l:xt:c-ri-.c Rtlonl 1>815 4.1-11.62 24,917.77 Urgent Senior Center Mold Abatement Page 7 of 14 City Attorney Approved 9/27/16 -~(> q"'___,j !<I Door Window D1K1r Window Missing Wall · Goes to Floor Missing Wall DESCRIPTION Hallway I 504 . .lo SF Walls 786.30 SF Walls & Ceiling 31.13 SY Flooring 78.20 L.F Ceil. Perimeter .l' X 6' 8" 2' 3 1/16" X 6' 6" 6' X6' 8" 2' 3 1/16" X 6' 6" 9' 8" X 6' 8" 5' 5" X 8' 5" QTY REMOVE RF.Pl.ACF. 281.94 SF Ceiling 281.94 SF Floor PWM18-150GS Height: 8' 5" 59.53 LF Floor Perimeter Opens into BACK_EXIST_II Opens into Exterior Opens into Exterior Opens into Exterior Opens into Exterior Opens into HALLWAY_2 TAX O&P TOTAL -------------------------- 30. HEPA Vacuuming -houri} d1argc :~I. \fold Cleaning Tcdmu:im1 -per hour 0.50 IIR }JHJ HR 0,(KI Llll.1.1 o.m 98.lXI Wet wipe dry\\all below base line on affected common wall, lo the exercise room only. ~:?. HEPA Va,uumin~ -Carpel -!PER 112.IHJ SF 0.(Xl 1.14 SFI HEPA vac carpel a long the affected walls onlJ _1}, :\pply anti-microhial agent 28.IHJ SF o.on 0.40 _14. Seal the r,,,urfacc area w/lah.'\ biN:d '1.33 Sr 0.{Kl 0.80 ,t.iin hind.er . one ..:o;.1t ,1:\, :"leg. air f,m/Air .~ruh.-1..arg~ tper 2.IKl DA 0.IXl 124.54 24 hr period •-So rnoni1. 36. Peel & ,cal zipper I.IX) EA 0.IXl 16.:\1 37. Tear oul damage drywall, cleanup. 41.lXl L.F 8.29 0.00 bag, per LF -lo 2' 38 llEPA V;,u:uuming . hourly drnr gt· .\.IXI HR 0.IXI 101.1.1 Initial HEPA Vac .w. HEPA Vacuuming -hourly <·hargc 4.()() HR 0.00 101.13 Final HEPA Vac prior lo clearance leslin~- 40. Apply anti-mkmbial agent 59.53 SF 0.(Xl 0.40 41. Neg. air fan/Air scrub.-Largc (per 4.IKI DA 0.{XI 12454 .24 hr perioc.1)-No monit. 4~. Equipment decontamination (.·hargc 1.00 EA 0.00 56.67 -per pitxc of equipment -H Plasllc bag -U!,.L"<i for disposal of l:UlO EA 0.00 2.X9 com.amin.atcd ilt."nt"i 44. (Malcrial Only! 5/8" -drywall per 29.77 LF 0.00 1.90 LF -up 10 2' lall 45. (Malcrial Only) Texture drywall -17X.60 SF o.m 0.03 Ornngc reel 46 Drywall ln,1allcr I Finishe.r -per 24.m flR (){K) 106.01 hour 47. Seal more rhan the tloor pt!rime1er x•uo SF o.m 1.14 w/lale, based ldain bk,cker -t111e coal 4 R. Paint more than the floor perimeter ll'l.07 SF O.(K) 2.10 -two •. :oats •aithff into eusli~ 49. Painter -per hour 2.0ll HR {l.00 99.86 Additional lllhor to leather in paint 50. Cove ha\t' molding -ruhhcr or 5'15:l LF \'!n}l. 4" high '\1. ('arpcllik 281.1/4 SF Totah: 11.,llway I Urgent Senior Center Mold Abatement Page 8 of 14 0.00 10.12 60,t,9 ll.{KI 58.80 352.80 O.IKI 25.54 153.22 ().()4 2.24 13.48 0.06 1.50 9.!)2 0.IXI 4'1.82 298.90 0.l!I _1.}0 20.02 1.02 67.98 408.89 0.00 80.90 485.42 0.00 80.90 485.42 0.09 4.76 28.66 0.tXl 99.64 597.80 0.22 IU4 68.23 3.36 8.68 55 .. 19 4.38 1 U2 72.26 11.42 1.08 6.86 {}(X) 508.84 3.053.08 0.55 2036 122.71 1.75 50.02 301.82 U.!Kl 39.94 239.66 EXCLUDED EXCLUDED 12.70 1,137.08 6,834.9.1 City Attorney Approved 9/27/16 Door Window Window Window Missing Wall Hallway 2 611.98 SFWalls 873.36 SF Walls & Ceiling 29.04 SY flooring 87.77 LF Ceil. Perimeter 6' X 6' 8" 5' X 5' 9 3/8" 5' X 5' 93/8" 5' X 5' 9 3/8" 5' 5" X 8' 5" llESCRIPTIOI\ QTY REMOVE REPLACE 52. HEPA Vacuuming -hourly charge ~1. Mold Cleaning Tr:chnician • per hour 0.50 HR 1.lXI IIR (l.(Xl 101.13 0.(XI 98.00 \\-' et wipe drJwHII belo\\' base line on affected common walls to the exercise room only. 54 HEPA Varnuming ·Carpet· (PER 158.(Xl Sr 0.(Xl 1.14 SF) HEPA ,·ac carpet a Ion~ the affected walls only .,5. Apply anli-microhial a~cnl 28.(K) SF 0.00 0.40 56. Seal the surface area w/latcx hascd 9J:l SF 0.(XJ 0.80 ,tain blocker -nne coal Prime drywall below base line common walls only. 57. Neg. air fan/Air ,cruh. Large 1per 2.lXl DA O.<Xl 124.54 24 hr period).No monit. 58. Containment 1,241.32 SF 0.lXl 1.28 Barricr/Airlo,k/Decon. Chamber Work area containment R1K1r, Walls and ceiling W. Peel & ,eal ,ipper l.<Ml EA 0.lXl 16.51 6'). Tear nut d,1magc <ll)'Wall. cleanup. 41.(lfl LF 8.29 ().()() bag. per LF -to 2· 61. HEPA Vacuuming -hourly charge 4.(Kl HR o.m 101.1 :i Initial HEPA \lac 62. HEPA Vacuuming -hourly charge 4.<MlHR 0.lXI 101.1.l Final HEPA Vac prior to clearance testing. H Apply anti-mi(rohial agcnl Xl.77 SF o.m 0.40 64. Neg. air fan/Air ,cruh.-Larµe 1per 4.m DA 0.<XI 124.54 24 hr period)-No monil. 05, E(lui1m..:nt dec(lnta11tin.:1tinn <.:haQ.!l.' 1.(K) EA o.m 'i6.h7 · per picl·c of equipment M. Pla,tic hag -used tor disposal of 15.m E.-\ (}.()() 2.84 ~ontaminateJ 11cnh h7. 1Mat,·rialOnl}15/l\"'-drywallpcr 40.8K l.F 0.fKI I.'~} I.F -upto }' t:111 M. ,Material Only, Texture drywall. 245 . .lO SI· O.{KI 0.0.~ Orange Pc-cl t,'I, L>rywall ln,-ia!Jcr / fini,.J,cr -po:r 16.!Kl HR O.tK> 106.01 h<lllf 70. Sca1 more than the floor pcnmet~r 122M Sf {).()(} 1.14 v./la1cx f'a~~ ~ain blo,:ker -one o1:oat 71. Painl "10fe than the tloor perimeter 16.l.54 Sf ll.!Kl 2.10 · twocoa:1" Feather into existin~ n Painter -pc-r hour 2.!Kl HR 0.00 '19.86 Additional labor to feather in paint TY.. Cove ha!\C molding ruhhcr or 81.77 LF VIO}J. 4" high 74. Ca11iet ulc 26 UX SF Totah.: Hall\\i.l}' 2 Urgent Senior Center Mold Abatement Page 9 of 14 261.38 SF Ceiling 261.38 SF Floor PWM 18-1SOGS Height: 8' 5" 81. 77 LF Hoor Perimeter Opens into EX CERISE_ ROO Opens into EXCERISE_ROO Opens into EXCERISE_ROO Opens into EXCERISE_ROO Opens into HALLWAY_! TAX (UK) 0.(X) (l.00 0.04 o.<x, O.<Kl 6.73 0.81 1.02 0.00 o.m 0.1.1 o.m 0,22 6.02 0.:57 O.lX) 0.7\i :!.-II o.m 22. IJ O&P 10.12 58.80 36.02 2.24 1.50 49.82 317.78 .1..10 67.98 80.90 80.90 li.54 99.64 IU4 8.68 1554 1.48 J.,9.24 27.9\i h8.h8 .W.94 1.328.40 TOTAL 60.69 :152.80 21\i.14 D.48 9.02 298.90 1.913.40 20.62 408.89 485.42 485.42 .W.38 597.80 68.2, 55.W 'l'l.2:i 9.41 2.o:l5.40 168.54 414.52 2.W,66 EXCLUDED EXCLUDED 7.992 . .14 ......i.-- City Attorney Approved 9/27/16 Door Door Door Back exist Hall 151.82 SF Walls 191.01 SF Walls & Ceiling 4.35 SY Flooring 25. 17 LF Ceil. Perimeter .1' X 6' 8" .. ,, X 6' 8" .,, X 6' 8" l>ESl 'R IPTIO!\ QTY REMOVE REPLA<'E 7<. HEPA Vacuuming -hourly charge 76. Mold Cleaning. Tcchnidan -r,cr hour 0.50 IIR UX) HR O,(Xl (J.()(J 101.1.1 98.IXI "'ct wipe drrwall below base line on affected common wadis to the exercise room onl~·. 77, HEPA Vacuuming -C al'jlt'I -r PER 39.14 SF 0,(X) 1.14 SF! HEPA ,·ac carpel a long the affected walls onl) 78 Apply anti-microbial agent 6.00 SF 0,00 040 7<J. Seal the \Urfacc area \,\,/latex ha~t·d 2.(XI SF o.m 0,80 ,tain hloi:ktr -one-coat Prime dQwall below base line common walls ont,·. KO. Neg. air fan/Air \Cruh.-Largl.! (per l.(X) DA (l.(Ml 12454 ~4 hr period )-No mnnit. 81. 1--.:quiptnL·nt dt.·contamin~1tion ,:harpc I.IKI EA 0.(l(J '6.67 · pt~r piece of equipment X:!. Containment .'26.82 Sr 0.(Kl l.:!8 Barrii:r/Airlo(k/Dc"-·lm. Chamber Work area containm.,nt ffcM>r, Wall., and ceiling 83. Ped & S<:al tipjlt'r l.<Xl EA o.m 16.'il 84, Tc,.r out damage JryVi.all. ,.:lcanup, 41.fKJ Lr l-L:!Y o.m hag, per LF to 2' K'i. HEPA Vai:uuming -hourly charge 2.(K) HR 0.IKJ IOl.1.1 Initial HEPA Vac 86. HEPA Vacuuming -hourly charge 2.00 HR 0.tKl 101.13 f'inal HEPA Var prior to clearance testing. R7. Apply anti-microOial agent 16.17 SF 0.00 0.40 88. Neg. air fan/ Air scrub. Large ( per 4.IKI DA ().(Kl 12454 24 hr pcnoJ)-No monil. 8Q. Equipmcnl d(,"\.:Onlamination <:har!!,C 1.00 EA (l.<Xl 56.67 · per pk.."Cc of equipment 90. Pla:-.llc hag · ust.'U for disposal of l'i.(K) EA 0.(XI 2.89 coruaminatcd items 'II. , Marena! Onl~ I 5/X'" -dr);wall per X.08 LF 0.()() 1.90 I.F -up 10 1' 1all 9:!. (Ma1crial Only) Tcx.ture drywall -4X.'\o SF o.m 0,03 Orange Peel 9.'. l>rywall lnslaikT / Finisher -per X.<Xl HR 0,00 IOMII hou1 ?-4. Seal mon."" than 1hc tklt.w pcrirtk"h.·r 24.25 SF 0.00 1.14 w/lat .... ·x 00"'-l.·.d "-aln hlockcr -one eel.It '15. Paint 111on: than the t100I' perimet(."r 3233 Sf 0.(K) 2.10 -l\\'0('03.t'S halhtt into existing %. Pam1cr -per hour 1.(Xl IIR 0,(M) 99.86 Urgent Senior Center Mold Abatement Page 10 of 14 PWM18-150GS Height: 8' 5" 39.19 SF Ceiling _"\9,19 SF Floor Io. 17 LF Floor Perimeter Opens into HALLWAY_! Opens into E~terior Opens into EX CERISE_ ROO TAX O&P 0.(XJ l0,12 0.00 19.60 o.m 8.94 0.01 0.48 0.01 0.32 0.IXI 24.90 0.22 11.34 1.77 K.1.66 0.81 3.30 1.112 h7.9X 0.lX) 40,46 0.00 40.46 11,02 1.30 (),I)() 9\/,64 0.22 I 1.34 3.36 8.6K 1.19 3.08 0.11 (UO 0.<Xl 169.ol 0.15 554 0.48 13.'\8 0JKl 19.98 TOTAL 60,1>9 117.60 53,62 2,8'1 1.93 149.44 1>8.2.< 503.76 20.62 408,8'1 :!42.72 242.72 7.7'1 5'17.80 68.23 55.39 19,62 1.87 1,017.70 33.34 81.95 119.84 .,.-,- City Attorney Approved 9/27/16 DESCRIPTION Additional labor to feather in paint 97. Cove hase molding -rubber or vinyl. 4"' high 9X. Ctrpc·t tik Tolah: Bat·k exist Hall Total: Main Level QTY REMOVE REPLACE 16.17 i.F W.19 Sr Line lt<•m Totals: CITY(WCARLSBAD-S-MDl Additional Charges California Lumber A<isc~~ment Fee Additional Charges Total Grand Total Areas: 2.328.1.l SF Wall, 1.794.90 SF Floor 0.00 SF Long Wall 1.794.9() Floor Area l .4X2.02 Exterior Wall Arca 0.00 Surface Ar<·a 0.(Kl Total Ridge Length Coverage Remediation Repairs Total Urgent Senior Center Mold Abatement 1.794.90 SF Ceiling I <J9.43 SY Flooring 0.(K) SF Short Wall I ,8R0.57 Total Area 175.83 Exterior Perimeter of Walls O.IKl Number of Squares O.(K) Total Hip Length % Item Total 29.()38.70 15.923.24 64.59'4 '.15.4 I<;; HKl.()(l~I Page 11 of 14 PWM18-150GS TAX O&P TOTAL EXCLUDED EXCLUDED 9.37 181.95 181.95 644.62 7,463.50 7,463.50 -1, 123.ln SF w.,11, and Ceiling 291.23 I.F Floor Perimeter 336.89 LF Ceil. Perimeter 2.328. I 3 Interior Wall Area (J.(Kl Total Perimeter Length ACVTotal 29,038.70 15.924.00 44.962.70 % 35.42% 100.1)()% 3.876.64 44,961.94 44,961.94 Charge 0.64 $0.64 ~ City Attorney Approved 9/27/16 PWM18-150GS allway Exccrisc Room = :;: ]9' ~· IT~- "' \7' II' JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 LS 1 Mold abatement and restoration of fitness center and $44,962.70 adjacent hallway. TOTAL* $44,962.70 *Includes taxes, fees, expenses and all other costs. Urgent Senior Center Mold Abatement Page 12 of 14 City Attorney Approved 9/27 /16 EXHIBITC LABOR AND MATERIALS BOND PWM18-150GS Bond no. 100392282 Premium $899.00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to S&J Builders and Restoration Services, Inc., (hereinafter designated as the "Principal"), a Contract for: URGENT SENIOR CENTER MOLD ABATEMENT 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, S&J BUILDERS AND RESTORATION SERVICES, INC., as Principal, (hereinafter designated as the "Contractor"), and American Contractors Indemnity Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of FOURTY FOUR THOUSAND NINE HUNDRED SIXTY TWO DOLLARS SEVENTY CENTS ($44,962.70), 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. Urgent Senior Center Mold Abatement Page 13 of 14 City Attorney Approved 9/27/16 PWM18-150GS 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. 3 r~ Executed by CONTRACTOR this _____ _ day of __ 111_~-------' 20__!L. CONTRACTOR: S & J Builders and Restoration Services, Inc. By~~ ~(sign here) 5-c...,v' I cJ / \~ • ..1 (print name here) U<f \ T<-e.• (title and organization of signatory) By: ---~..........,,,-~=~,,-~t:~~--~-~---- (sign here) B-cn,Q.C-t:0o.-c, e. ( J ill Sc.:,r--.... (print name here) .,..--YCE:,-::>, d.ocrl ~ :\ --::Cl,.'..\dec"\ (title and organization of signatory) Executed by SURETY this 2nd day of May , 20.J.L. SURETY: American Contractors Indemnity Company (name of Surety) 801 S. Figueroa Street, Suite 700, Los Angeles, CA 90017 (address of Surety) (310) 649-0990 (telephone number of Surety) By: Ariel T. Heredia (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: (~~ DeputyityAttorney Urgent Senior Center Mold Abatement Page 14 of 14 City Attorney Approved 9/27 /16 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of _____ O_ra_n~g_e ____ _ On ~ 1 Z.~_2LB __ before me, Ted Lee, Notary Public Date Here Insert Name and Title of the Officer personally appeared -------------'---A'-'---ri=e-'---1 T--'-'-. H'-'-"'e'-'re'""d:.;.;ia::.._ ___________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(ll) whose name(~ is/~ subscribed to the within instrument and acknowledged to me that he/~/t1'Wy executed the same in his/oot/~ authorized capacity(~), and that by his/00(/too)t signatureO() on the instrument the person("), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Seal Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ----r v----------- Signature of Notary Public ----------------oPTIONAL---------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Bond 11 /003'11--l-'t> l---Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: _____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: Ariel T. Heredia Signer's Name: ____________ _ Corporate Officer -Title(s): ______ _ [ i Corporate Officer -Title(s): ____ _ ' Partner -I ! Limited l J General l ! Partner -l Limited l J General Individual Xl Attorney in Fact I : Individual ! I Attorney in Fact · Trustee /] Guardian or Conservator f Trustee I l Guardian or Conservator . Other: ... _____________ ··-·-·--·-·····-····--I Other: ____________ _ Signer Is Representing: _________ _ Signer Is Representing: _________ _ ·~*''¼v~"<-~'<"(;,'<X,'(J(:,'<.'(;'<',(;,'<'(;'<.~"(~*'"X-'C(;.'0<;-'P(;..~~~~'0(;.'q{;:g(;<;}CQ:$g;,'§k;g;,'Q(;,'<J(;,'<µ;"q{;."'§<:,"t'i<,='<;i<;t~'<,K,g,'<¼'<J(;~'l ©2014 National Notary Association· www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 TOKIO MARINE HCC KNOW ALL MEN BY THESE PRESENTS: POWER OF ATTORNEY That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, ARIEL T. HEREDIA its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number _1'"'0""'0"-'3"-'9'-"2 ... 2,.,,8""2~--------- the course of its business and to bind the Company thereby, in an amount not to Forty-four thousand, nine hundred sixty-two and 70/100 (~ ___ $~4~4~·=9=62=·~7=0 ___ ). issued in exceed This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1st day of September, 2011. "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 on behalf of the Company, to execute, acknowledge and deliver. any and all bonds, recognizances, contracts. agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating 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." The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 18th day of December 2017. ,,,,,,~~'~"r'~t,,,,,, State of California tt~~::~:-~~:-t!1 AMERICAN CONTRA County of Los Angeles SS: ;~;_ sEn,s. 1000 /--<if By: \~\; .. , ... {o/ ~ .. /1,,[4LiFOii~'t,\,~" 'll11r11t11\\\\\ 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, accurac , or validit of that document. On this 18th day of December 2017, before me, Patricia Kanegawa Perez, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person 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. /4_ Signature (seal) I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of _____ M_a_y ___ _ 2018 Bond No. 100392282 Agency No. 4046 Kio Lo,£cretary HCCSZZPOAACIC 12/2017 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 • A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) ~are subscribed to the within instrument and acknowledged to me that t}tl~e/they executed the same in hi//~/their authorized capacity(ies), and that by !)it/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 1············ ... ... .. ANGELA MARIE VANCE : ~-• ...... ··-... _ Notary Public -California f i ...... ',,,. · San Diego County i · •-Commission# 2201781 · My Comm. Expires Jun 18, 2021 Place Notary Seal Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m~and and official :eal. Signature {Jr,4,d ~ l/4nu____,. r Signaure of Notary Public ----------------OPTIONAL---------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: _____________ Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ Signer's Name: ____________ _ [] Corporate Officer -Title(s): ______ _ D Corporate Officer -Title(s): ______ _ LJ Partner -LJ Limited D General [J Partner -D Limited C General D Individual D Attorney in Fact D Individual D Attorney in Fact n Trustee D Guardian or Conservator D Trustee D Guardian or Conservator Cl Other: ______________ _ D Other: _____________ _ Signer Is Representing: _________ _ Signer Is Representing: _________ _ • ©2014 National Notary Association· www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 -~ S&JBU-1 op ID: AJ ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 03/02/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 ~2!'i!ACT Steve Henkelman JPL Insurance Group, Inc JPL Insurance Services PHONE 619-220-8014 (A/C, No, Ext): I rffc, No):619-220-8015 3033 5th Avenue, Ste. 325 ~~D"M~ss: Steve@Jplinsurance.com San Diego, CA 92103 Steve Henkelman INSURERCSl AFFORDING COVERAGE NAIC# INSURER A, Financial Pacific Insurance Co 31453 INSUREDS & J Builders And Restoration INSURER B : Arch Specialty Ins Co 21199 Services, Inc INSURER c : Cypress Insurance Company 10855 10815 Wheatlands Ave. Ste. J Santee, CA 92071 INSURER D, California Automobile Ins Co. 38342 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 11~:: TYPE OF INSURANCE ~J',; ~.~~f POLICY NUMBER ,_g2!:!£'!:.!cff POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE [K] OCCUR DAMAGE TO RENTED 100,000 y 12EMP9285805 10/15/2017 10/15/2018 PRFMISES (Ea nrr, rrencA \ $ X CPL 12EMP9285805 10/15/2017 10/15/2018 MED EXP (Anv one oersonl $ 5,000 - PERSONAL & ADV INJURY -$ 1,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY [K] .l'if8,= 0 LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: CPL $ $1MIU$2MIL D AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea orcjrlon(\ $ 1,000,000 - X ANY AUTO y BA040000032483 03/01/2018 03/01/2019 BODILY INJURY (Per personl $ -OWNED -SCHEDULED -AUTOS ONLY -AUTOS BODILY INJURY CPer accident) $ HIRED NON-OWNED /P~?~6°c~~t~AMAGE $ -AUTOS ONLY -AUTOS ONLY ~ B X UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ -12EMX0523004 10/15/2017 10/15/2018 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ C WORKERS COMPENSATION XI ~ffrnTE I I ~~H-AND EMPLOYERS' LIABILITY Y/N y SJWC922387 01/01/2018 01/01/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) EL DISEASE -EA EMPLOYEE $ If yes, describe under $ 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT B Professional Liabi 12EMP9285805 10/15/2017 10/15/2018 Agg/Occ $2MIU$1MIL 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 res~ects General Liability The Ci~ of Carlsbad, its officials, employees and vo unteers are additional insure , including 8rima!)' and non- contributo~ wording. As respects auto liability, itfi of Carlsbad has been added as a ditional msured1 so that all communica ion regarding non-payment 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 Insurance Complaince Services AUTHORIZED REPRESENTATIVE PO Box 4668-ECM #35050 ~~~ New 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: AJ 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 03/02/2018 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 Multlllne Policy It is agreed that Section Ill -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 EMP01010001 14 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410B (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 $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. BLANKET WAIVER Person/Orga nlzatlo n Job Description All CA Operations SCHEDULE Blanket Waiver -Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium 2234.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2018 Insured Insurance Company Cypress Insurance Company WC 99 0410B (Ed. 9-14) Policy No. SJWC922387 Endorsement No. Premium$ Countersigned by _______________ _ Policy: BA040000032483 COMMERCIAL AUTO CA88100113 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE -BROADENED COVERAGE GLASS REPAIR -WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE-ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION II -LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED PROVISION NUMBER 3 12 19 5 13 1 22 2 23 10 15 6 20 14 16 11 8 9 4 7 17 18 20 SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: CA88100113 d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization; © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earnings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II -LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE CA 88 10 01 13 Paragraph A.4. Coverage Extensions of SECTION Ill -PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V -DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION Ill -PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE CA88100113 Paragraph A.4.a., Coverage Extension of SECTION Ill -PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500 © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE -BROADENED COVERAGE Under SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V-DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE CA 8810 01 13 SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclusions 4.c. and 4.d. is deleted and replaced with the following: © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN/ LEASE GAP COVERAGE CA 88 10 01 13 A. Paragraph C., LIMIT OF INSURANCE of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V -DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: 'Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 15. GLASS REPAIR -WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 17. TWO OR MORE DEDUCTIBLES Under SECTION Ill PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same accident, the following applies to paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deductible will be waived. For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group. SECTION IV -BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS CA88100113 SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV -BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V -DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION CA88100113 COMMON POLICY CONDITIONS, paragraph A.-CANCELLATION condition applies except as follows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancellation. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 0 m --- iiaiiiiiia - N iiaiiiiiia g 0 IL 00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. CANCELLATION 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance writ- ten notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpay- ment of premium; or b. 30 days before the effective date of cancellation if we cancel for any oth- er reason. 3. We will mail or deliver our notice to the first Named lnsured's last mailing ad- dress known to us. 4. Notice of cancellation will state the effec- tive date of cancellation. The policy pe- riod will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium re- fund due. If we cancel, the refund will be pro rata. If the first Named Insured can- cels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. CHANGES This policy contains all the agreements be- tween you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. EXAMINATION OF YOUR BOOKS AND RECORDS We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D. INSPECTIONS AND SURVEYS 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspec- tions, surveys, reports or recommenda- tions and any such actions we do under- take relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition ap- ply not only to us, but also to any rating, advisory, rate service or similar organiza- tion which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make rela- tive to certification, under state or mu- nicipal statutes, ordinances or regula- tions, of boilers, pressure vessels or elevators. E. PREMIUMS The first Named Insured shown in the Dec- larations: 1. Is responsible for the payment of all pre- miums; and 2. Will be the payee for any return premi- ums we pay. F. TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY Your rights and duties under this policy may not be transferred without our written con- sent except in the case of death of an individ- ual named insured. IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 2 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV -BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V -DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION CA 88 10 01 13 COMMON POLICY CONDITIONS, paragraph A.-CANCELLATION condition applies except as follows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancellation. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7