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HomeMy WebLinkAboutSame Day Express LLC dba Signature Sculpture; 2020-02-26;AGREEMENT FOR SCULPTURE RESTORATIOIN AND MAINTENANCE SERVICES SAME DAY EXPRESS, LLC OBA SIGNATURE SCULPTURE THIS AGREEMENT is made and entered into as of the ,;}(pf/1 day of __ ,,,1--,i""""-.-!.<.l.........,"""-"-,i.:::;.---• 2020. by and between the CITY OF CARLSBAD, a municipal corporation, ("City" , nd Same Day Express, LLC d.b.a Signature Sculpture, a California limited liability company, (" ontractor''). RECITALS City requires the professional services of a contractor that is experienced in sculpture restoration and conservation in providing services for the City's public art inventory. Contractor has the necessary experience in providing these professional services, has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in Exhibit "A", attached and incorporated by this reference in accordance with the terms and conditions set forth in this Agreement. 2. TERM This Agreement will be effective for a period of one (1) year from the date first above written. The City Manager may amend the Agreement to extend it for three (3) additional one (1) year periods or parts thereof in an amount not to exceed three thousand, eight hundred dollars ($3,800) per Agreement year. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended agreement. 3. COMPENSATION The total fee payable for the Services to be performed shall not exceed three thousand eight hundred dollars ($3,800) per Agreement year. No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or the Services specified in Exhibit "A." 4. PREVAILING WAGE RATES Any construction, alteration, demolition, repair, and maintenance work, including work performed during design and preconstruction such as inspection and land surveying work, cumulatively exceeding $1,000 and performed under this Agreement are subject to state prevailing wage laws. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all such workers employed by him or her in the execution of the Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. City Attorney Approved Version 6/12/18 5. STATUS OF CONTRACTOR Contractor will perform the Services as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under the control of City only as to the results to be accomplished. 6. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City's self-administered workers' compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 7. INSURANCE Contractor will obtain and maintain policies of commercial general liability insurance, automobile liability insurance, a combined policy of workers' compensation, employers liability insurance, and professional liability insurance from an insurance company authorized to transact the business of insurance in the State of California which has 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, in an amount of not less than one million dollars ($1,000,000) each, unless otherwise authorized and approved by the Risk Manager or the City Manager. Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims- made coverage. The insurance will be in force during the life of this Agreement and will not be canceled without thirty (30) days prior written notice to the City by certified mail. City will be named as an additional insured on General Liability which shall provide primary coverage to the City. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Contractor will furnish certificates of insurance to the Contract Department, with endorsements to City prior to City's execution of this Agreement. 8. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City Name Karen McGuire Title Programs & Venue Coordinator Department Library & Cultural Art City of Carlsbad Address 1775 Dove Lane Carlsbad, CA 92011 Phone No. 760-602-2022 2 For Contractor Name Brett Fiore Title Owner -------------- Address P.O. Box 920 Palm Desert, CA 92260 Phone No. 760-275-2779 Email signaturesculpturepd@yahoo.com City Attorney Approved Version 6/12/18 Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. 9. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. YesD No ■ 10. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. 11. TERMINATION City or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. City will pay Contractor's costs for services delivered up to the time of termination, if the services have been delivered in accordance with the Agreement. 12. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees it may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. Contractor further acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to terminate this Agreement. 13. JURISDICTIONS AND VENUE Contractor agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Agreement is the State Superior Court, San Diego County, California. 14. ASSIGNMENT Contractor may assign neither this Agreement nor any part of it, nor any monies due or to become due under it, without the prior written consent of City. 15. AMENDMENTS This Agreement may be amended by mutual consent of City and Contractor. Any amendment will be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. City Attorney Approved Version 6/12/18 3 16. 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 By: Brett Fiore, Owner (print name/title) By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California rkwuvf\ HEATHER PIZZUT&2~ Library & Cultural Arts Director ATTEST: If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a 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 !!!.!:!.!! 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 !ket~tt;~ City Attorney Approved Version 6/12/18 4 EXHIBIT "A" SCOPE OF SERVICES Full restoration and maintenance of the Coastal Helix, a sculpture created by artist Roger Stoller. The sculpture is located at the Coastal Trail Roundabout, at the north entrance to Carlsbad within the area encompassed by the corner of Carlsbad Blvd. and State Street. The Coastal Helix requires restoration and ongoing maintenance to retain and preserve the sculpture. Task 1 -Restoration Image of Site Location Photo of Roundabout Sculpture Clean/remove rust and oxidation from the outdoor metal sculpture. Apply a protective coat of clear metal oil and wax as a preventative measure for future protection of the sculpture from the environment and contaminants, such as the marine environment. All work will be conducted on-site at the Coastal Helix Roundabout. Restoration Cost: $2,600 Task 2 -Maintenance Perform follow up maintenance at 6-month intervals after the completion of the initial restoration. Maintenance costs will be billed at an hourly rate of One hundred fifty dollars per hour ($150/hour). Annual Maintenance Cost Not-to Exceed: $1,200 The Contractor shall perform to the standards required in this jurisdiction and will be expected to work closely with Cultural Arts Manager or designee throughout the duration of this Agreement. The Contractor bears the sole burden for ensuring that all legally required licenses and permits are obtained and renewed as specified by the regulating agency. This information is provided as a guide only. The Contractor must verify and comply with all Federal, State, and Local requirements, whether listed here or not. City Attorney Approved Version 6/12/18 5 Payment Schedule: Task 1 -Restoration of Metal Sculpture $2,600 1. An amount of $1,200 will be paid upon the execution of the Agreement and upon annual renewal of this Agreement, if any. 2. An amount of $1,200 will be paid upon the completion of the initial maintenance (and subsequent annual maintenance, if any) of the sculpture, in a manner acceptable to the Cultural Arts Manager or Designee. 3. Per the Contractor's request to assure that the work performed provided sufficient restoration of the damage caused by environmental conditions, an amount of $200 will be paid after the three (3) month interval evaluation conducted by the Contractor and in a manner acceptable to the Cultural Arts Manager or Designee. Task 2 -Maintenance Not-to-exceed $1,200 Perform ongoing maintenance as needed and requested by Cultural Arts Manager or designee. Maintenance costs will be billed at an hourly rate of One hundred fifty dollars per hour ($150/hour). All invoices shall be submitted at the conclusion of each required maintenance session to the Cultural Arts Manager or designee. Invoicing / Payment All invoices shall be submitted to City's Cultural Arts Manager Richard Schultz or designee and shall be sufficiently detailed to include related activities and costs. Final invoice approval will be completed by City's Library & Cultural Arts Director or designee. City Attorney Approved Version 6/12/18 6 A~D• CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 01/09/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tina Eads NAME: Desert Cornerstone Insurance Service, Inc. r:,gNJ0 Extl: (760) 347-7723 I FAX (A/C, No): (760) 347-7725 CA License #OF 15709 E-MAIL lina@desertcornerstoneins.com ADDRESS: 81713 Hwy 111, Ste E INSURER($) AFFORDING COVERAGE NAIC# Indio CA 92201 INSURER A: United Specialty Ins Co. 12537 INSURED INSURERS: Same Day Express, LLC, dba: Same Day Express; INSURERC: dba: Signature Sculpture Restoration INSURERD: P.O. Box 920 INSURERE: Palm Desert CA 92261 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 GL 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 ,;~}6g~, POLl<;YEXP LIMITS LTR INSD WVD POLICY NUMBER !MM/DD/YYYYl X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 >--=:J CLAIMS-MADE [81 OCCUR Uf"\IVIAbC I u l"\C:l'I c:u PREMISES /Ea occurrence\ $ 100,000 >-- MED EXP (Any one person) $ 5,000 >--A y CCP850370 07/01/2019 >-- 07/01/2020 PERSONAL &ADV INJURY $ 1,000,000 ~'LAGGRE□ L~~l~_APP□ER GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS -COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ >--(Ea accident\ ANY AUTO BODILY INJURY (Per person) $ >--OWNED -SCHEDULED BODILY INJURY (Per accident) $ -AUTOS ONLY -AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY !Per accident! --$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS" LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE □ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Carlsbad, its agents, officers, directors and employees are named as additional insured per form CGL 1816 0216 when required by a written contract. CERTIFICATE HOLDER CANCELLATION City of Carlsbad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1200 Carlsbad Village Drive AUTHORIZED REPRESENTATIVE Carlsbad CA 92008 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy #CCP8503 70 CGL 1816 0216 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY . ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION, PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: CONTRACTORS LIMITED CLAIMS MADE GENERAL LIABILITY COVERAGE FORM CONTRACTORS LIMITED CLAIMS MADE AND REPORTED GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Additional Insured Person(s) or Organization Location(s) of Covered Operations Any Person or Organization as Required by Written Various Locations as per contract with the named Contract to be named as Additional Insured insured A. Section II -VVho is an Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury• caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CGL 1816 0216 Includes copyrighted material of Insurance Seivlces Office, Inc., used with Its pennlsslon. Page 1 of 2 CGL 1816 0216 C. The insurance provided for the benefit of the above scheduled additional insured(s) shall be primary and non- contributory, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated in the Schedule above. D. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits of Insurance and Deductible: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. CGL 1816 0216 Includes copyrighted material of Insurance Services Office, Inc., used with Its permission. Page 1 of 2 ACORDe CERTIFICATE OF LIABiLITY INSURANCE I DATE (MM/DDIYYYY) ~ 01/09/2020 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 poUcy(les) must 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 Heu of such endorsement(s). PRODUCER ~ LUIS EDUARDO PEREZ PERFECT BALANCE INSURANCE SERVICES INC ...... 7fln_773...11ni:i~ I fffc Mo\• ?an.770_1921 73867 FREb WARING DRIVE ---· PALM DESERT CA 92260 DDRESS• INSURERISl AFFORDING COVERAGE NAICf INSURER A: STATE COMPENSATION FUND INSURED INSURERS: SAME DAY EXPRESS OBA: SIGNATURE SCULPTURE INSURERC: POBOX920 INSURERD: - PALM DESERT CA 92260 INSURERE: 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 CONDffiONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE LTR m••n ,uA~ POLICY NUMBER ,,tOU1.TEfF M--'"'DIYYYY 1,l:8~~%~1 LIMITS GENERAL LIABILITY EACH OCCURRENCE s -~!!""!_!',_ ! U "'"' , ,au -COMMERCIAL GENERAL LIABILITY I I PREMISES IE• occurr•ncel $ :] ClAIMS-MADE □ OCCUR MEO EXP (Any one pt/SOil) $ -PERSONAL & ADV INJURY $ ~ ·---GENERAL AGGREGATE $ ~ n'L AGGREGATE LIMIT APPLIES PER: PROOUCTS-COMP/OPAGG $ POLICY n ~ff,: n LOC $ AUTOMOBILE LIABILITY r:-r lfi:1~1/i~~lflNGLE LIMIT s r-- ANY AUTO BODILY INJURY (P•r pe11on) s r--Al.LOWNED -SCHEDULED BOOIL y INJURY (Per accident) $ r--AUTOS -AUTOS -- HIRED AUTOS NON-O'MIED rp~';':~~~AGc $ --AUTOS $ UMBRELLA LIAB HOCCUR r r EACH OCCURRENCE $ ·-EXCESSUAB ClAIMS·MADE AGGREGATE s OED I I RETENTION s $ WORKERS COMPENSATION IT~,rMNsl 10:.tt· AND EMPLOYERS' LIABILITY y / N A ANY PROPRIETOR/PARTNER/EXECUTIVE m NIA l. 1960987-2019 07/01/2019 07/01/2020 E.L. EACH ACCIDENT s1ooonnn OFFICE/MEMBER EXCLUDED? (Mandatory In NH) .E.L. DISEASE• EA EMPLOYEE s 1000000 II yu, desClfbe '"1d■r · '"~ E.L. DISEASE -POLICY LIMIT s 1,000,000 I ' DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, AddlUon1I Remork, Schedule, Ir more apace le required) ... 10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM. 30 DAY NOTICE OF CANCELLATION FOR OTHER THEN NON-PAYMENT OF PREMIUM. ANY AND ALL OPERATIONS BY THE NAMED INSURED ON BEHALF OF THE CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION CITY OF CARLSBAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1200 CARLSBAD VILLAGE DRIVE ACCORDANCE WITH THE POLICY PROVISIONS, CARLSBAD CA 92008 AUTHORIZED REPRESENTATIVE t; 5~~ LUISE PEREZ I --© 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD® VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE I DATE (MM/00/YYYY) ~· 01/20/2020 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. This form is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose. PRODUCER CONIA\,T Karen Schroeder NAME: State Farm JOHN FORD PHONE 760-564-0011 I rM Nol: 760-564-0221 IA/C No Extl: 79440 CORPORATE CENTRE DR STE 104 E-MAIL karen.schroeder.itgu@statefarm.com ADDRESS: ' LA QUINTA, CA 92253 PRODUCER CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A, State Farm Mutual Automobile Insurance Company 25178 BRETT FIORE INSURER B: DBA: SAME DAY EXPRESS & SIGNATURE SCULPTURE INSURERC: PO BOX 920 INSURER □: PALM DESERT, CA 92261-0920 INSURER E: DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR I MAKE/ MANUFACTURER I MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 2008 CHEVROLET EXPRESS VAN 1GCGG29C581158598 DESCRIPTION VEHICLE/EQUIPMENT VALUE SERIAL NUMBER $ COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S) 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 POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR AOD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYYYY) DATE (MM/DDIYYYY) LIMITS lXJ VEHICLE LIABILITY COMBINED SINGLE LIMIT $ A y 2148 782-C24-55 09/24/2019 BODILY INJURY (Per person) $ 1,000,000 09/24/2020 BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE $ 1,000,000 GENERAL LIABILITY EACH OCCURENCE $ R OCCURRENCE GENERAL AGGREGATE $ CLAIMS MADE $ INSR LOSS POLICY EFFECTIVE POLICY EXPIRATION LTR PAYEE TYPE OF INSURANCE POLICY NUMBER DA 11: IMM/DD/YYYY) DATE (MM/00/YYYY) LIMITS / DEDUCTIBLE VEH COLLISION LOSS 0 ACV 0 AGREEOAMT $ LIMIT ~ □ 0 STATED AMT $ OED VEH COMP LJ VEH OTC 0ACV 0 AGREED AMT $ LIMIT -□ 0 STATED AMT $ DED EQUIPMENT 0ACV 0 AGREEOAMT = BASIC Fl BROAD $ LIMIT □RC 0 STATEDAMT $ DED SPECIAL □ - REMARKS (INCLUDING SPECIAL CONDITIONS/ OTHER COVERAGES) (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) ADDITIONAL INTEREST CANCELLATION Select one of the following: The additional interest described below has been added to !he policy(ies) listed herein by policy number(s). A request has been submitted to add the additional interest described below to the policyues) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. listed herein b olic nymbe s VEHICLE/ EQUIPMENT INTEREST: LEASED FINANCED NAME AND ADDRESS OF ADDITIONAL INTEREST CITY OF CARLSBAD LIBRARY & CULTURAL ARTS DEPARTMENT ATTN: KAREN MCGUIRE 1775 DOVE LANE CARLSBAD, CA 92011 DESCRIPTION OF THE ADDITIONAL INTEREST X ADDITIONAL INSURED LENDER'S LOSS PAYEE LOAN/ LEASE NUMBER LOSS PAYEE @1997-2015 ACORD CORPORATION. All rights reserved. ACORD 23 (2016/03) The ACORD name and logo are registered marks of ACORD 1004361 142987.3 01-26-2016