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Home My WebLink AboutS and J Builders and Restoration Services Inc; 2019-04-11; PWM19-736GSRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2019-0367979 111111111111 lllll 111111111111111111111111111111 IIIII IIIII IIIII IIII IIII Aug 28, 2019 11 :13 AM OFFICIAL RECORDS Ernest J. Dronenburg, Jr., SAN DIEGO COUNTY RECORDER FEES $0 00 (S82 Atkins $0 00) PAGES 1 Space above this line for Recorder's use. PARCEL NO: 204-100-06-00 NOTICE OF COMPLETION Notice is hereby given that: 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. 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 July 16, 2019. 6. The name of the contractor for such work or improvement is S&J Builders and Restoration Services. 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: Project No. PWM19-736GS, Project Name: Senior Center Mold Remediation. 8. The street address of said property is 799 Pine Ave, Carlsbad, CA 92008, in the City of Carlsbad. crLSBAO (_,... ---. £\c;.~l"lt..1...u."-y Chadwick, City Manager VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Ca ls bad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on fh, 20Jj_, accepted the above described work as completed and ordered that otice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on A'9V.Sf J7l~20J!!., at Carlsbad, California. CITYOF~ ~ c / H~£~eov-f~ cil~ e,J,,,r '1"' BARBARA ENGLESON I J c/ City Clerk \\FILES01V\Departments\Public Works\General Services\Agreements & Contracts\S&J Builders\Senior Center\Senior Center Mold Remediation -PWM19- 736GS\NOC\2.NOC -Senior Center Mold Remediation -PWM19-736GS.docx CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS S&J Builders and Restoration Services has completed the contract work required for PWM19- 736GS -Senior Center Mold Remediation. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS Remediate mold in entry way, auditorium, refreshment closet, storage room and ceiling area. VALUE $46,976.30 CERTIFICATION OF COMPLETION OF IMPROVEMENTS John Maashoff, Public Works Manager CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk 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 is hereby directed to commence maintaining the above described improvements. ~~ <i{~Lo ( 19 V Scott Chadwick, City Manager -D-a~te _________ _ APPROVED AS TO FORM: CELIA BREWER, City Attorney IIFILES01V\Departments\Pubhc Works\General Serv,ces\Agreements & Contracts\S&J Builders\Senior Center\Senior Center Mold Remediation -PWM19-736GSINOC\3.API - Senior Center Mold Remediation -PWM19-736GS.docx Project: PWM19-736GS, Senior Center Mold Remediation Change Order No. 01 CONTRACT CHANGE ORDER NO. 01 PROJECT: Senior Center Mold Remediation PWM19-736GS 001-5310-7550 P.O. NO. P137268 CONTRACT NO. ACCOUNT NO. CONTRACTOR: ADDRESS: S&J Builders and Restoration Services, Inc. 10815 Wheatlands Ave. Suite J Santee, CA 92071 The Contractor is directed to make the following changes as described herein. Changes shall include all labor, materials, equipment, contract time extension, and all other goods and services required to implement this change. Payment stated on this change order includes all charges, direct or indirect, arising out of this additional work including charges for field overhead, extended home office overhead, delays, disruptions, cumulative impacts, loss of efficiency, extended equipment costs and overtime premium costs and is expressly agreed between the City and the Contractor to be the complete and final costs hereof. The requirements of the specifications, where pertinent and not in conflict with this change order, shall apply to these changes. Pursuant to the Standard Specifications for Public Works Construction, perform the following: Item 1: Contractor to provide all labor, equipment and materials to replace the previously installed kitchenette upper and lower cabinets. Cabinet laminate to be a standard option from the Wilsonart collection. Contractor to reinstall sink and light fixture from previous cabinets. Total cost not to exceed ..................................................................... $3,802.82 TOTAL INCREASE TO CONTRACT COST .................................................... $3,802.82 TIME FOR COMPLETION OF ALL WORK UNDER THIS CONTRACT SHALL BE INCREASED BY 30 WORKING DAYS AS A RESULT OF THIS CHANGE ORDER. ~{..,MUN PAL PROJECTS MANAGER (DATE) ~'-,~\rv\)\ /,+('7 ~@~ERING MANAGER (DATE) (DATE) AP~PROVED BY: ;.,.,,-_/✓ __,,..-c-~---,-.-~--"-~ ~---'----S--=· 3 /-/ (j c'"ONTR TO (DATE) -8tt-',Pttt1'1,l'leN-l-l::U::Ell.J (DATE) DeptA Cd-tj fYlttV?t r~t,,0/iC-vJuvk...s DISTRIBUTION: INSPECTION FILE (ORIGINAL), PURCHASING, CONTRACTOR CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT SENIOR CENTER MOLD REMEDIATION PWM 19-736GS This agreement is made on the // -Jh. day of {!]?;ill , 2019, by the City of Carlsbad, California, a municipal~corporation, (hereinaftrcalled "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. Senior Center Mold Remediation Page 1 of 8 City Attorney Approved 9/27/16 PWM19-736GS 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 subcontractor from participating in contract bidding. Signature: ~a o -e.::::) ~ -=--=-- Print Name: Gracie Wilson 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. Senior Center Mold Remediation Page 2 of 8 City Attorney Approved 9/27 /16 PWM19-736GS 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 thirty (30) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within sixty (60) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. S & J Builders and Restoration Services, Inc. (name of Contractor) Ill Ill Ill Ill Ill Ill Ill 689944 (Contractor's license number) B, C-36 2/29/2020 (license class. and exp. date) 1000018498 (DIR registration number) 6/30/2019 (DIR registration exp. date) Senior Center Mold Remediation Page 3 of 8 10815 Wheatlands Ave, Suite J (street address) Santee, CA 92071 (city/state/zip) 619-449-2014 (telephone no.) 619-449-0887 (fax no.) swilson@sandjbuild.com (e-mail address) City Attorney Approved 9/27 /16 PWM19-736GS 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: (sign here) Gracie Wilson, President/ Secretary (print name/title} By: --- CITY OF CARLSBAD, a municipal corporation of the State of California s-...~ I l.); J.s. J (.,t:"O ~ V ~ ------~~--~~~~-~------,,, (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. lL£ 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. BRrf ER, G,? Attorney BY: ----~-----'--.-,tlC---- Senior Center Mold Remediation Page 4 of 8 City Attorney Approved 9/27/16 PWM19-736GS 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: -JZS--=----- The Contractor must perform no less than fifty percent (50%) of the work with its own forces. Senior Center Mold Remediation Page 5 of 8 City Attorney Approved 9/27/16 PWM19-736GS EXHIBIT B SENIOR CENTER MOLD REMEDIATION JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 LS 1 Remediate mold in entry way, auditorium, refreshment $43,173.48 closet, storage room and ceiling area; Scope of work attached as Exhibit "D". Price includes Labor & Materials Bond TOTAL* $43,173.48 *Includes taxes, fees, expenses and all other costs. Senior Center Mold Remediation Page 6 of 8 City Attorney Approved 9/27/16 EXHIBIT C LABOR AND MATERIALS BOND PWM19-736GS Bond no. 100439077 Premium $863.00 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: SENIOR CENTER MOLD REMEDIATION 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 FORTY-THREE THOUSAND ONE HUNDRED SEVENTY-THREE DOLLARS FORTY-EIGHT CENTS ($43,173.48), 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. Senior Center Mold Remediation Page 7 of 8 City Attorney Approved 9/27/16 PWM19-736GS In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this ___ g_~_ct __ day of April , 20 19 . CONTRACTOR: S&J BUILDERS AND RESTORATION SERVICES, INC. By: ____ _..~""--...,....-(n_a_~___._-~_C_o_n_~-a-ct-r) ____ _ ~nhere) ~ 7':l,J1\~o\,) (print name here) CFO I V, "c-4t. P /<.i,'c/-,¼- (title and orga~za~ of ~a., By: ___ "'---,~---,~~--/"?~-------~nhere) 5~"' , lA,(~ o...; (print name here) CFc ~ v •""-' Pc«A tcl-r (title an~organization of signatory) Executed by SURETY this _.2.._n .... d ____ day of April , 20 19 . SURETY: American Contractors Indemnity Company (name of Surety) 801 S. Figueroa Street, Suite 205, Los Angeles, CA 90017 (address of Surety) 310-649-0990 (telepho e number of Surety) By: e of Attorney-in-Fact) 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: Senior Center Mold Remediation Page 8 of 8 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 Orange On Aft. IL Z. 1 2o I q before me, Angela K. Kim Notary Public _ . ·--·-···· Date Here Insert Name and Title of the Officer personally appeared _____________ A_r_ie_l _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(tq whose name(~ is~ subscribed to the within instrument and acknowledged to me that he/~~ executed the same in his~/ttumcauthorized capacity~). and that by hislNerttbe>r signature~) on the instrument the person(s.), or the entity upon behalf of which the person~) acted, executed the instrument. ANGELA K. KIM Notary Public -California Orange County commission# 2190918 My Comm. Expires Apr 11. 2021 Place Notary Seal Above z z :,. 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 ----------------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: _80nd11 I ODY '!>°t 0}-'3::: Document Date: ___ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: _A_,_i"I_T_ll,_'r_ed_ia _______ _ Signer's Name: ___________________ _ I I Corporate Officer -Title(s): ______ _ l Corporate Officer -Title(s): ______ _ I I Partner -I I Limited I I General ·· l Partner -r i Limited f ' General 1 I Individual XI Attorney in Fact ! Individual I Attorney in Fact I I Trustee I l Guardian or Conservator I J Trustee I i Guardian or Conservator f I Other: ______ _ .. ········--I I Other: Signer Is Representing: ______________ _ Signer Is Representing: ___ _ &,'C(,,,'<!.<;,,"C<;'<;;,<x,;:<;;~;,<;~'%'QC,"g;cVK;'C(,'C(,'C(,'C(,'C(,~'C(,'<--;;;,-..x,'C<;;'C<;;'G<;'G<;'C(;,'C{,"C<.,'C(;,~"C<.,-g,'<-'X,'G<>'C<,'C(,'G<,"C{;'<;<;,-g;,"<.~~"==¼>~ ©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_04_3_9_0_7_7 _________ _ issued in the course of its business and to bind the Company thereby, in an amount not to exceed Forty-four thousand and 00/100 ( $44,000.00 ). 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 1st day of June, 2018. ,,,,,,•~c'f0111,,,, ~~ ... ~,'-_ ......... fl$~~~ State of California County of Los Angeles f<J~--···· ···•.~~ §~! \1~ : !:! : NCORPORAlW : =l ::i %~\ SEPT.25,1990 f-<f \~6'\. . . .-:~; ~ •···· ····• ~ ;,,,,.,,,g4iiFOil"'~,,,"'"' 'l111111111n,,,\ By: AMERICAN CONi~;EMNITY COMPANY Ada S. Pessin, President 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 1st day of June, 2018, before me, Sonia 0. Carrejo, 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.. Slgnatuce ~ (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 ----~A=p~ri~I ___ _ Bond No. Agency No. 100439077 4046 \\\\\\ltllflll//J ,,,,, \\,t>-CTO~ ,,,,,. ~' ~'\ ····•···•··· 8 /.,;/;. ~ o .. •· ...... '<,~ $v_.. ··.<t'~ §~/ \t~ ; ~ 1 INCORPORATED l :::; ; ': u>: SEPT. 25. 1990 ;-< i; ~~·-. _:I").,; ~I,,.•.. ..-.0~ ~ •···· ····• ~ ~✓,✓,,,;.,,ii;;oi~'~,,,,~ 1/1111111111111\ visit tmhcc.com/surety for more information 2019 HCCSZZPOAACIC06/2018 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 -54 JI\/ '1) 1 ·,£ 6--0 ) On 4/J 1€.,/L '31 ,M/9 before me. (?IJTl/€/fL'N£ -L> • f?ak~ J...bmRy/2~/C Date Here Insert Name and Title of th Officer personally appeared ';§; €..A IV T (A.) 1 '; S 0/1/ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person~ whose name(~re subscribed to the within instrument and ackno~1~ged to me tha@she/they executed the same in @!her/their authorized capacity(ie&), and that by ~er/their signature~ on the instrument the person(~. or the entity upon behalf of which the person(~ acted, executed the instrument. Place Notary Sea/ Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signatu,&a,4/:(/.,,, J; ~,a...<--- Signature of Notary Public ------------..---oPTIONAL--------------- Though this section is optional, co fraudulent reattach leting this information can deter alteration of the document or nt of this form to an unintended document. Description of Attached Document Title or Type of Document: _____ __,_ _______ Document Date: _______ _ Number of Pages: ___ Signer(s) Other J"han Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ ; l Corporate Officer -Title(s): ______ _ _ Partner -·• ' Limited U General 1 i Individual 1-1 Trustee ~ Attorney in Fact r I Guardian or Conservator LJ Other: ______________ _ Signer Is Representing: ________ _ Signer's Name: ____________ _ I J Corporate Officer -Title(s): ______ _ 1 Partner - [ = Limited ! ' General • , Attorney in Fact l l Guardian or Conservator ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 PWM19-736GS Exhibit "D" S&J Builders and Restoration Services Inc Bultders&Restoratlon5ervlces.lnc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Insured: City of Carlsbad Property: 799 Pine Ave Carlsbad , CA 92008 Claim Rep.: NIA Estimator: Sean Wilson Position: Senior Estimator Company: S&J Builders Business: 10815 Wheatlands Ave Suite J Santee, CA 92071 Reference: Company: City of Carlsbad Contractor: Company: S&J Builders and Restoration Services Business: 10815 Wheatlands Ave Suite J Santee, CA 92071 Cellular: (760) 585-8076 Business: (619) 449-2014 x 106 E-mail: swilson@sandjbuild.com Business: (619) 449-2014 Claim Number: Policy Number: Type of Loss: Roof Leak Date Contacted: 2/13/2019 Date of Loss: 2/13/2019 Date Inspected: 2/15/2019 Price List: Estimate: CASD8X MARI 7 SJ PVW --- Restoration/Service/Remodel CITYOFCBD-SR-AUDITOl Date Received: 2/14/2019 Date Entered: 3/26/2019 Bullderl&Restorations.rvtces,lnc. S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 PWM 19-736GS Exhibit "D" Sean Wilson from S&J Builders inspected the property damage with Jim of City of Carlsbad. Upon our site walk Jim gave me access to Senior Center Auditorium. During my inspection I noted elevated moisture in several rooms. The line items are the request of the City for the emergency services and repairs by room. We would like to thank you for the opportunity to provide you with this COST PROPOSAL FOR ADDITIONAL EMS AND REP AIR PHASE. The total cost for the repairs detailed in the following proposal is $ 43,173.48 The attached estimate details the specific work to be completed. Additional work outside of that specified in this estimate will be through separate proposal(s) and/or change order(s) detailing the additional/changed scope of work as well as the terms and pricing of those changes. EMS and repairs will be scheduled after a signed contract is received by S&J Builders and a PO is issued by the city. Unless noted otherwise, the customer is required to provide heat, water and electricity on-site for the duration of this project. The customer is responsible for providing continuous access to the project area during normal business hours, Monday -Friday, 7:30 am -4:00 pm. Where an item is being replaced, we will be matching the existing item's quality, color, finish, texture or material as close as possible where applicable unless noted otherwise, there is no guaranty either specified or implied on exact matches. Estimate includes prevailing rates. This estimate does not include hazardous material testing, abatement or mold remediation unless specifically detailed in the following estimate. This estimate is valid for 60 days from 3/26/2019. If you have any questions about this estimate, please contact Sean Wilson to discuss those questions. Respectfully, Sean Wilson CITYOFCBD-SR-AUDITOl 3/26/2019 Page:2 S&J Builders and Restoration Services Inc Bullderl & Restoration Servtces, Inc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 CITYOFCBD-SR-AUDITOl Entry/Foyer DESCRIPTION Estimate excludes mold remediation. 1. Containment Barrier/ Airlock/Decon. Chamber 2. Floor protection -cloth -skid resistant, breathable 3. Peel & seal zipper 4. Remove Drinking fountain -Lower cover 5. Remove Security system -key pad -Detach 6. Tear out baseboard and bag for disposal -up to Cat 3 7. Tear out wet drywall, cleanup, bag for disposal 8. Tear out and bag wet insulation 9. HEP A Vacuuming -Detailed -(PER SF) 10. Apply anti-microbial agent Main Level 11. Dehumidifier (per 24 hour period) -Large -No monitoring 12. Air mover (per 24 hour period) -No monitoring 13. Neg. air fan/Air scrub.-Large (per 24 hr period)-No monit. 14. Equipment setup, take down, and monitoring (hourly charge) 15. Detach & Reset Light fixture -wall sconce 16. Install Security system -key pad 17. 5/8" drywall -hung, taped, ready for texture 18. Drywall tie in to existing -per LF 19. Texture drywall -Orange Peel 20. General Demolition -per hour Labor to remove containment 21. Seal the surface area w/latex based stain blocker -one coat 22. Paint the surface area -two coats Paint affected walls only. Cut off at outside and inside corners. 23. Baseboard - 4 1/4" 24. Paint baseboard -two coats 25. Install Drinking fountain -Lower cover 26. Clean floor -tile 27. Final cleaning -construction -Commercial Roof repair excluded from this estimate. Auditorium DESCRIPTION CITYOFCBD-SR-AUDITOl PWM 19-736GS Exhibit "D" 3/26/2019 Height: 16' 8" QTY 316.67 SF 76.00 SF 1.00 EA 0.50 EA 1.00 EA 16.67 LF 166.67 SF 166.67 SF 316.67 SF 166.67 SF 4.00 EA 8.00 EA 4.00 DA 3.00 HR 1.00 EA 1.00 EA 166.67 SF 36.67 LF 180.00 SF 1.50 HR 180.00 SF 581.39 SF 17.00 LF 17.00 LF 0.50 EA 150.00 SF 273.57 SF Height: 9' QTY Page:3 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 DESCRIPTION Estimate excludes mold remediation. 28. Containment Barrier/Airlock/Decon. Chamber 29. Peel & seal zipper CONTINUED -Auditorium 30. Tear out cove base and bag for disposal -up to Cat 3 31. Tear out non-salvageable vinyl plank, & bag for disposal 32. Tear out wet drywall, cleanup, bag, per LF -to 4' -Cat 3 33. Tear out and bag wet insulation -Category 3 water 34. HEPA Vacuuming -Detailed -(PER SF) 35. Apply anti-microbial agent 36. Dehumidifier (per 24 hour period) -Large -No monitoring 37. Ducting -lay-flat 38. Air mover (per 24 hour period) -No monitoring 39. Neg. air fan/Air scrub.-Large (per 24 hr period)-No monit. 40. Equipment setup, take down, and monitoring (hourly charge) 41. Batt insulation -6" -R19 -unfaced batt 42. 5/8" -drywall per LF -up to 4' tall 43. Texture drywall -Orange Peel 44. General Demolition -per hour Labor to remove containment 45. Seal the surface area w/latex based stain blocker -one coat 46. Paint the walls -two coats 47. Vinyl plank flooring 48. Vinyl Floor Covering Installer -per hour Additional labor to lace in replacement flooring 49. Cove base molding -rubber or vinyl, 4" high 50. Final cleaning -construction -Commercial Refreshment Closet DESCRIPTION Estimate excludes mold remediation. 51. Remove Sink -single -SA VE 52. Cabinet -upper (wall) unit -Detach -SA VE 53. Countertop -flat laid plastic laminate -Detach -SAVE 54. Cabinet -lower (base) unit -Detach -SAVE 55. Tear out wet drywall, cleanup, bag for disposal 56. Tear out and bag wet insulation 57. Containment Barrier/ Airlock/Decon. Chamber 58. Peel & seal zipper 59. Tear out cove base and bag for disposal -up to Cat 3 CITYOFCBD-SR-AUDITOl PWM19-736GS Exhibit "D" 3/26/2019 QTY 333.00 SF 1.00 EA 12.00 LF 96.00 SF 11.50 LF 46.00 SF 2,473.09 SF 46.00 SF 4.00 EA 12.00 LF 12.00 EA 4.00 DA 4.00 HR 46.00 SF 11.50 LF 78.00 SF 0.50 HR 78.00 SF 1,682.65 SF 96.00 SF 4.00 HR 12.00 LF 573.74 SF Height: 7' QTY 1.00 EA 8.17 LF 16.33 LF 8.17 LF 151.70 SF 151.70 SF 49.00 SF 1.00 EA 17.31 LF Page:4 S&J Builders and Restoration Services Inc Buflders&RestoratlonServlces,lnc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 DESCRIPTION CONTINUED -Refreshment Closet 60. Tear out non-salvageable vinyl plank, & bag for disposal 61. HEP A Vacuuming -Detailed -(PER SF) 62. Apply anti-microbial agent 63. Dehumidifier (per 24 hour period) -Large -No monitoring 64. Air mover (per 24 hour period) -No monitoring 65. Equipment setup, take down, and monitoring (hourly charge) 66. Batt insulation -6" -Rl 9 -unfaced batt 67. 5/8" drywall -hung, taped, ready for texture 68. Texture drywall -Orange Peel 69. General Demolition -per hour Labor to remove containment 70. Seal the walls and ceiling w/latex based stain blocker -one coat 71. Paint the walls and ceiling -two coats 72. Install Cabinetry -upper (wall) units 73. Install Cabinetry -lower (base) units -SAVE 74. Remove Countertop -flat laid plastic laminate 75. Install Sink -single 76. Install P-trap assembly -ABS (plastic) 77. R&R Angle stop valve 78. Plumbing fixture supply line 79. Vinyl plank flooring 80. Cove base molding -rubber or vinyl, 4" high 81. Final cleaning -construction -Commercial Storage Area/Room DESCRIPTION Estimate excludes mold remediation. 82. Containment Barrier/Airlock/Decon. Chamber 83. Peel & seal zipper 84. Remove Fluorescent -two tube -4' -fixture w/lens -SA VE 85. Cabinet -full height unit -Detach -SA VE 86. Remove Escutcheon only 87. Tear out cove base and bag for disposal -up to Cat 3 88. Tear out non-salvageable vinyl plank, & bag for disposal 89. Remove Fiberglass reinforced plastic (FRP) paneling w/trim 90. Tear out wet drywall, cleanup, bag, per LF -to 4' -Cat 3 91. Tear out wet drywall, cleanup, bag -Cat 3 92. Tear out and bag wet insulation -Category 3 water 93. HEPA Vacuuming -Detailed -(PER SF) CITYOFCBD-SR-AUDITOl PWM19-736GS Exhibit "D" 3/26/2019 QTY 14.28 SF 137.44 SF 137.44 SF 4.00 EA 8.00 EA 3.00 HR 151.70 SF 151.70 SF 151.70 SF 0.50 HR 151.70 SF 151.70 SF 8.17 LF 8.17 LF 16.33 LF 1.00 EA 1.00 EA 2.00 EA 2.00 EA 14.28 SF 17.31 LF 14.28 SF Height: 8' 6" QTY 49.00 SF 1.00 EA 3.00 EA 5.00 LF 1.00 EA 44.53 LF 147.63 SF 178.13 SF 44.53 LF 150.52 SF 146.67 SF 325.75 SF Page: 5 S&J Builders and Restoration Services Inc Bulklers & Restom1on Services, Inc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 CONTINUED -Storage Area/Room DESCRIPTION 94. Apply anti-microbial agent 95. Dehumidifier (per 24 hour period) -Large -No monitoring 96. Ducting -lay-flat 97. Air mover (per 24 hour period) -No monitoring 98. Neg. air fan/Air scrub.-Large (per 24 hr period)-No monit. 99. Equipment setup, take down, and monitoring (hourly charge) 100. Batt insulation -6" -Rl 9 -unfaced batt 101. 5/8" drywall -hung, taped, ready for texture 102. Drywall tie in to existing -per LF 103. Texture drywall -Orange Peel 104. General Demolition -per hour Labor to remove containment 105. Seal part of the walls and ceiling w/latex based stain blocker -one coat 106. Paint the walls and ceiling -two coats 107. Fiberglass reinforced plastic (FRP) paneling w/trim 108. Install Cabinetry -full height unit 109. Seal & paint full height cabinetry -inside and out 110. Vinyl plank flooring 111. Cove base molding -rubber or vinyl, 4" high 112. Install Cabinetry -full height unit 113. Install Escutcheon only 114. Install Fluorescent -two tube -4' -fixture w/lens 115. Final cleaning -construction -Commercial Ceiling Area DESCRIPTION Shear wall panels broken pre loss. 116. Water Extraction & Remediation Technician -per hour Ceiling Area Additional time to bag up and remove demoed drywall (Pre water damage) 117. Plastic bag -used for disposal of contaminated items 118. Tear out wet drywall, cleanup, bag -Cat 3 119. Tear out and bag wet insulation 120. HEPA Vacuuming -Detailed -(PER SF) 121. Apply anti-microbial agent 122. Water Extraction & Remediation Technician -per hour Additional labor due to confined space CITYOFCBD-SR-AUDITOl PWM19-736GS Exhibit "D" 3/26/2019 QTY 220.96 SF 4.00 EA 12.00 LF 12.00 EA 4.00 DA 4.00 HR 146.67 SF 223.85 SF 34.33 LF 271.94 SF 0.50 HR 271.94 SF 543.89 SF 178.13 SF 5.00 LF 5.00 LF 147.63 SF 44.53 LF 5.00 LF 1.00 EA 3.00 EA 147.63 SF Height: 3' 6" QTY 2.00 HR 6.00 EA 137.81 SF 80.06 SF 57.75 SF 297.94 SF 3.10 HR Page:6 S&J Builders and Restoration Services Inc BuUders & Restoration Servtces, tnc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 DESCRIPTION CONTINUED -Ceiling Area 123. Dehumidifier (per 24 hour period)-Large -No monitoring 124. Air mover (per 24 hour period) -No monitoring 125. Equipment setup, take down, and monitoring (hourly charge) 126. Batt insulation -Add-on for confined spaces 127. Batt insulation - 1 O" -R30 -unfaced batt 128. 5/8" drywall -hung & fire taped only 129. Drywall tie in to existing -per LF 130. Drywall Installer/ Finisher -per hour Additional labor to install 5/8 drywall above ceiling joist in confined space. Roof DESCRIPTION 131. Roofing (Repair) [EXCLUDED] City has contract with roofer General DESCRIPTION 132. Emergency service call -during business hours 133. Remediation -Supervisory -per hr 134. Equipment decontamination charge -per piece of equipment 135. Haul debris -per pickup truck load -including dump fees 136. Haul debris -per pickup truck load -including dump fees 13 7. Contamination -air or surface testing & lab analysis [ BY THE CITY ] 138. Asbestos test fee -full service survey -base fee [EXCLUDED] City to provide testing 139. Hazardous Material Remediation (Asbestos) [EXCLUDED] S&J Builders will provide and estimate for asbestos abatement if the test results come back positive. 140. Commercial Supervision/ Project Management -per hour 141. Bond, permits & fees [ AS INCURRED] 155. Bond 142. Repeat Customer Discount Labor Minimums Applied CITYOFCBD-SR-AUDITOl PWM 19-736GS Exhibit "D" 3/26/2019 QTY 4.00 EA 12.00 EA 4.00 HR 80.06 SF 80.06 SF 137.81 SF 25.50 LF 11.94 HR QTY 1.00 EA QTY 1.00 EA 3.00 HR 16.00 EA 3.00 EA 2.00 EA 6.00 EA 1.00 EA 1.00 EA 8.00 HR 1.00 EA 1.00 EA 1.00 EA Page: 7 S&J Builders and Restoration Services Inc Bullderl & Reltomlon Servlcel, Inc. 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 DESCRIPTION 143. Finish carpentry labor minimum Grand Total Senior Estimator Grand Total Areas: 4,459.33 3,164.15 0.00 3,164.15 3,255.86 0.00 0.00 Coverage Repairs EMS Total SF Walls SF Floor SF Long Wall Floor Area Exterior Wall Area Surface Area Total Ridge Length CITYOFCBD-SR-AUDITOl 3,185.16 SF Ceiling 351.57 SY Flooring 0.00 SF Short Wall 3,320.44 Total Area 320.02 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length Item Total % 18,679.08 16,813.17 35,492.25 52.63% 47.37% 100.00% PWM19-736GS Exhibit "D" QTY $43,173.48 7,644.49 SF Walls and Ceiling 412.60 LF Floor Perimeter 480.52 LF Ceil. Perimeter 4,459.33 Interior Wall Area 0.00 Total Perimeter Length ACV Total % 22,591.88 20,581.60 43,173.48 3/26/2019 52.33% 47.67% 100.00% 1.00 EA Page: 8 3 5 7 S&J Builders and Restoration Services Inc 108 15 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 2 4 6 8 CITYOFCBD-SR-AUDITO 1 PWM 19-736GS Exhibit "D" 3/26/2019 Page:9 - 9 11 13 15 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 6I9-449-2014 619-449-0887 fax Lie 689944 10 12 14 16 CITYOFCBD-SR-AUDITO I PWM 19-736GS Exhibit "D" 3/26/2019 Page: 10 - 17 19 21 23 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 18 20 22 24 CITYOFCBD-SR-AUDITOl PWM19-736GS Exhibit "D" 3/26/2019 Page: 11 - 25 27 29 31 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 26 28 30 32 CITYOFCBD-SR-AUDITOl PWM19-736GS Exhibit "D" 3/26/2019 Page: 12 - 33 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-201 4 6 19-449-0887 fax Lie 689944 CITYOFCBD-SR-AUDITO 1 PWM 19-736GS Exhibit "D" 3/26/20 19 Page: 13 8ulldffl & Reetoradon Semces, Inc. Image No. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Type 49-001 50-002 51-003 52-004 53-005 54-006 55-007 56-008 57-009 58-010 59-011 60-012 61-013 62-014 63-015 64-016 65-017 Image Detail Date Taken 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 2/15/2019 CITYOFCBD-SR-AUDITOl PWM 19-736GS Exhibit "D" Taken By 3/26/2019 Page: 14 -S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Bultderl & Restoration Services. Inc. Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 Continued -Image Detail Image No. Type Date Taken 18 66-018 2/15/2019 19 67-019 2/15/2019 20 68-020 2/15/2019 21 69-021 2/15/2019 22 70-022 2/15/2019 23 71-023 2/15/2019 24 72-024 2/15/2019 25 73-025 2/15/2019 26 74-026 2/15/2019 27 75-027 2/15/2019 28 76-028 2/15/2019 29 77-029 2/15/2019 30 78-030 2/15/2019 31 79-031 2/15/2019 32 80-032 2/15/2019 33 81-033 2/15/2019 CITYOFCBD-SR-AUDITOl PWM19-736GS Exhibit "D" Taken By 3/26/2019 Page: 15 Main Level t9 N Entry/Foyer \, I CITYOFCBD-SR-AUDITOl 39' 8" 39' Auditorium 48' 6" 49' 2" PWM19-736GS Exhibit "D" Main Level 3/26/2019 Page: 16 Ceiling Area 1----------11' 2"----------1 1----------10' 611 --------1-....t ('<) Ceiling Area l£) - CITYOFCBD-SR-AUDITO I = --l£) - PWM19-736GS Exhibit "D" Ceiling Area 3/26/2019 Page: 17 ~ S&JBU-1 op ID: A.1 ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 02/28/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer riahts to the certificate holder in lieu of such endorsement(s). PRODUCER 619-220-8014 ~l?HI~cT Steve Henkelman JPL Insurance Group, Inc PHONE 619-220-8014 [ rffc, No):619-220-8015 JPL Insurance Services (A/C, No, Ext): 3033 5th Avenue, Ste. 325 it'n1!!..,.,. StevelClllplmsurance.com San Diego, CA 92103 Steve Henkelman INSURERISl AFFORDING COVERAGE NAIC# INSURER A: Arch Specialtv Ins Co 21199 f'URi . INSURER B: Cypress Insurance Company 10855 J uilders And Restoration INSURER c: California Automobile Ins Co. 38342 erviceq Inc 0815 heatlands Ave. Ste. J INSURER D: Financial Pacific Insurance Co 31453 antee, CA 92071 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 ii,.DDL ~~ POLICY NUMBER POLICYEFF POLICY EXP LIMITS ITI> ,..,.,n A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE oo OCCUR ~i}~b~U9F~ENTED 100,000 X 12EMP9285806 10/15/2018 10/15/2019 $ X CPL 12EMP9285806 10/15/2018 10/15/2019 MED EXP IAnv one cersonl $ 5,000 X $SK deductible PERSONAL & ADV INJURY $ 1,000,000 -2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY 00 ft& D LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Pl(MBINED SINGLE LIMIT ~r_r_jrl .... nl\ $ 1,000,000 -X ANY AUTO X BA040000032483 03/01/2019 03/01/2020 BODILY INJURY /Per oersonl $ -OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY /Per accident\ $ --HIRED NON-OWNED iP~?~5c~d1;,;;t?AMAGE $ >---AUTOS ONLY r--AUTOS ONLY $ A X UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 2,000,000 -12EMX0523005 10/15/2018 10/15/2019 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ ./ OED I I RETENTION $ $ B WORKERS COMPENSATION x I nfT,,TF 1 InH-AND EMPLOYERS' LIABILITY Y/N X SJWC029784 01/01/2019 01/01/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Professional Liabi 12EMP9285806 10/15/2018 10/15/2019 Agg/Occ $2MIU$1MIL / D Bailees 60497187 10/10/2018 10/10/2019 Bailees 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 coverage is primaa; & non- contributory. 30-Day Notice of Cancellation applies per at ached endorsement As respects Auto Liability City of Carlsbad is additional insured. 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 7JP~~ 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 CARLSBA INSURED'S NAME S & J Builders And Restoration S&JBU-1 OP ID: AJ All Forms attached and a~ply when reguired by written contract. Umbrella extends General, Professional and Pollution liabiity, and workers' compensation only. PAGE 2 Date 02/28/2019 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 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: THE CITY OF CARLSBAD, ITS OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED HEREUNDER AS RESPECTS LIABILITY ARISING OUT OF ACTIVITIES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED. COVERAGE UNDER THIS POLICY SHALL BE PRIMARY AS RESPECTS THE CITY, ITS OFFICIALS, EMPLOYEES AND VOLUNTEERS All other terms and conditions of this Policy remain unchanged. Endorsement Number:18 Policy Number: 12 EMP 92858 06 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: 10/15/2018 00 EMP0101 00 01 14 1 of 1 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. Endorsement Number: 17 Policy Number: 12 EMP 92858 06 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: 10/15/2018 00 EMP0068 00 08 04 1 of 1 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 8810 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 0113 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 CA88100113 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 -= --- = ;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;; !!!!!!!!!!!!!!! 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 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 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 $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. BLANKET WAIVER Person/Organization Job Description All CA Operations SCHEDULE Blanket Waiver -Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium 1898.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective O 1/01/2019 Insured Policy No. SJWC029784 Endorsement No. Premium$ Insurance Company Cypress Insurance Company WC 99 0410B Countersigned by _______________ _ (Ed. 9-14)