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HomeMy WebLinkAboutSun Solutions Tint Inc; 2018-11-13; PWL19-626GSDOC# 2019-0019067 111111111111 lllll 11111111111111111111111111111111111111111111111111111 RECORDED REQUESTED BY CITY OF CARLSBAD Jan 17, 2019 11 :35 AM OFFICIAL RECORDS Ernest J Dronenburg, Jr , SAN DIEGO COUNTY RECORDER FEES $0 00 (SB2 Atkins. $0.00) AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 PAGES 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 209-050-26-00 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 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 December 14, 2018. 6. The name of the contractor for such work or improvement is Sun Solutions Window Tinting, Inc. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Project No. PWL19-626GS, Agreement for Solar Window Tint -Safety Training Center. 8. The street address of said property is 5750 Orion Street, Carlsbad, CA 92010. , City Manager VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on 0Cb(:"), ...,:3 , 2013_, accepted the above described work as completed and ordered that a Notice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on~zLJ, 7 , 2ofl_, at Carlsbad, California. ~ OF CARLSBAD , VYJ)C0A R-1r1cr-~ b-( ~ARBARA ENGLESON Uv ~ity Clerk \IFILES01V\Departments\Pubhc Works\General Services\Safety Training Center (STC)\2. Budget\2. Contracting\Sun Solutions Window Tinting\Contracts\NOCIPWL 19-626GS NOC Sun Solutions Wmdow Tint doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Sun Solutions Window Tinting, Inc., has completed the contract work required for PWL 19-626GS, Solar Window Tint -Safety Training Center. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS (City) Solar Window Tint -Safety Training Center VALUE $2,099.07 CERTIFICATION OF COMPLETION OF IMPROVEMENTS ~ 11lJ\A o~tl~I,~ ~gine riiianager~ 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. Date APPROVED AS TO FORM: CELIA BREWER, City Attorney I\FILES01V\Departments\Pubhc Works\General Services\Safety Training Center (STC)\2. Budget\2. Contracting\Sun Solutions Window Tinting\Contracts\NOCIPWL 19-626GS API Sun Solutions Window Tint doc CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT SOLAR WINDOW TINT • SAFETY TRAINING CENTER PWL19-626GS This letter will serve as an agreement between Sun Solutions Tint, Inc., a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material, and labor necessary to apply solar window tint at various locations at the Safety Training Center; per Exhibit "A", and City specifications, for a sum not to exceed two thousand ninety-nine dollars and seven cents ($2,099.07). This work is to be completed within thirty days (30) working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees, and volunteers from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers' Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Insurance is to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII",; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4 California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Go~rnment Code se-:2650, ~-, and Carlsbad Municipal Code Sections 3.32.025, et seq. ";;-/' init '15J...:...L. init 6. The Contractor hereby acknowledges that debarment by another jurisdictiosz:unds for tbfkity of Carlsbad to disqualify the Contractor from participating in contract bidding. init ~ init 7. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Solar Window Tint-Safety Training Center -1-City Attorney Approved 2/29/2016 PWL19-626GS 8. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in the execution of the work covered by this Letter of Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 9. City Contact: Jason Kennedy, 760-931-2236 Contractor Contact: Kerry Ceasar, 760-635-0484 CONTRACTOR Sun Solutions Tint, Inc., a California corporation 2009 Shadow Grove Way Encinitas, CA 92024 P: 760-635-0484 kerry@sunsolutionstint.com By ~ (sign here) 5cott:c~.--. p.-es:~ 1 (print name title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Dated: ~{1~ '~nhere) Kerryan n e... Ccre.sar &er e.favq (print name/title) / (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER, City Attorney Solar Window Tint-Safety Training Center - 2 -City Attorney Approved 2/29/2016 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 San Diego On ~ c__,-4 ,~ 18 before me A. Vasvani, Notary Public date ~-CJ . Here Insert Name and Title of the personally appeared(~ A~R.._¼-~ ~ Af\Jf\J~ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that 'hel'elw/they executed the same in ~r/their authorized capacity(ies), and that by hioAier/their signature(s} on the instrument the person(s), or the entity upon behalf of which the person(s) 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. ~---------=::,'-"--~ Signature_~--------------- Signature of Notary Public ---------------OPTIONAL-------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: __________________________ _ Document Date: __________________ Number of Pages: ____ _ Signer(s) Other Than Named Above: ______________________ _ Capacity{ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ___________ _ D Corporate Officer -Title{s): _____ _ D Corporate Officer -Title(s): ______ _ D Partner -D Limited D General D Partner - D Limited D General D Individual D Attorney in Fact D Individual D Attorney in Fact D Trustee D Guardian or Conservator D Trustee D Guardian or Conservator D Other: _____________ _ D Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ Item No. 1 2 3 4 5 6 EXHIBIT A SOLAR WINDOW TINT -SAFETY TRAINING CENTER JOB QUOTATION Description Qty. Unit of Unit Measure Price SunTek IDS 20 Window Tint at 1st and 2nd Floor Men's Restrooms. Window Dimensions: 1 LS $488.94 (2)-38" X 24" (2)-44" X 24" (2)-90" X 24" SunT ek IDS 20 Window Tint at Main Lobby-West Entrance. Window Dimensions: (5)-56" X 21" 1 LS $1020.03 (5)-36" X 21" (5)-21" X 21" (2)-67" X 24" (1)-18" X 70" SunTek IDS 20 Window Tint at Lobby Office Window. 1 LS $126.45 Window Dimensions: (2)-47" X 23" SunTek IDS 20 Window Tint at Fire Storage Garage. 1 LS $168.60 Window Dimensions: (1 )-140" X 20" SunTek IDS 20 Window Tint at 1st Floor Emergency Exit Door 1 LS $101.16 Window Dimensions (1) 68" X 24" SunTek IDS 20 Window Tint at 2nd Floor Hallway Window Window Dimensions: 1 LS $193.89 (1) 70" X 36" (1) 18" X 36" LUMP SUM TOTAL "Includes taxes, fees, expenses and all other costs. PWL19-626GS Unit Total $488.94 $1020.03 $126.45 $168.60 $101.16 $193.89 $2,099.07 Solar Window Tint-Safety Training Center - 3 -City Attorney Approved 2/29/2016 ACORD9 CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/00/YYYY) L__.,-10/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, 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 i::•tm,~• ienv waltz PACIFIC SOUTHWEST INSURANCE SERVICES r._~H.t .,_.,. 818-701-1033 If~ .. _ .. 818-701-5884 9036 Reseda Blvd Ste 105 i=~ ..... ierrvw@oswinsurance.com Norttvidge,CA 91324 NIUREIIIIS) AFFORDING COVERAGE NAIC# 1NSURERA: Liberty Mutual Insurance INSURED 1NSURER•: Liberty Mutua 1 Insurance Sun Solutions Tint Inc. 1NSURERc: State Compensation Insurance 2009 Shadow Grove Way INSURERD: Encinitas, CA 92024 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ~t: ,_ POUCYEl'F ~EXP TYPE OF INSURANCE ~-ft --""""'YNUMBER LIMITS GENERAL UA8UTY EACH OCCURRENCE $ 1,000,000 -✓ COMMERCIAL GENERAL LIABILITY LJAMAut: T?_,:t:N I= $ 1,000,000 -:J CLAIMS-MADE [l] OCCUR A y BKS 1757431591 6/20/18 6/20/19 MEO EXP (Any one person) $ 15,000 t-- PERSONAL & AI:N INJURY $ 1,000,000 ,__ GENERAL AGGREGATE $ 2,000,000 ,__ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG s 2,000,000 1/l POLICY n ~,Q;: n LOC s AUTOMOBILE LIAIIIUTY f.,~~.~INulE LIMt I ,__ s 1,000,00 L ANY AUTO BOOIL Y INJURY (Per person) s ALL OWNED ~ SCHEDULED BKS 1757431591 6/20/18 6/20/19 BOOIL Y INJURY (Per accident) s A ,__ AUTOS ,__ AUTOS NON-O'M,IED ~~.~E $ HIRED AUTOS AUTOS ~ ,__ s UMBRELLA UAII HOCCUR EACH OCCURRENCE s ~ EXCESSUAII CLAJMs-MADE AGGREGATE $ rn:n I I""~" s $ WORKERS COMPENSATION ✓ I T~§T~D!-;,, I 10~- AND EMPLOYERS' UAIIIUTY Y/N C fW'( PROPRIETOR/PARTNER/EXECUTIVE [YJ N/A 9225101-18 1/30/18 1/30/19 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUOED? (Mandatoly In NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 1t,rn, describe under D SCRIPTION OF OPFRATIONS below E.L. DISEASE • POLICY LIMIT $ 1,000,000 1,000,000 B BAS 1957431591 BAS 1957431591 6/20/18 6/20/19 $60,000 6/20/18 6/20/19 a DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Addltlonal Remarks Sct..dule, If men apace la reqund) The Certificate Holder is added as an additional insured. CERTIFICATE HOLDER CANCELLATION City of Cartsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668 -ECM #35050 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. New York, NY 10163-4668 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ----i!ii!li!iiii --!l!!!!!!!!!I!!! iiiiiiiiil --~ -== ~ ==-=== ~ ==== -!I!!!!!!!!!!!!! -!I!!!!!!!!!!!!! ~ lii!i!i!!!!iiii -8 iiii===il ~ -!I!!!!!!!!!!!!! 15 10/26/18 Coverage Is Provided In: Policy Number: ~LiberfY. '1ll Mutual. Ohio Security Insurance Company -a stock company BKS (19) 57 4315 91 INSURANCE Policy Period: From 06/20/2018 To 06/20/2019 Endorsement Period: Policy Change Endorsement From 10/23/2018 to 06/20/2019 12:01 am Standard Time Named Insured & Malling Address SUN SOLUTIONS TINT INC. 2009 SHADOW GROVE WAY ENCINITAS, CA 92024 CHANGES TO POLICY • TRANSACTION # 2 at Insured Mailing Location Agent Malling Address & Phone No. (800) 682-8476 NETWORKED INSURANCE AGENTS 443 CROWN POINT CIR STE A GRASS VALLEY, CA 95945-9557 This Policy Change Endorsement Results In A Change In The Charges As Follows: Additional Premium Description of Change(s) The following Additional Insured now applies to the policy per form CG2010 and General Endorsement form CG7002 attached: City of Carlsbad/CMWD, PO Box 4668 -ECM #3505, c/o EXIGIS Insurance Compliance Services, New York, NY 10163-4668. Issue Date 10/26/18 To report a claim, call your Agent or 1-800-362-0000 DS 70 27 01 08 57431591 N0060452 270 Total Additional Charges Authorized Representative NCAOPPNO INSURED COPY 002903 $78.00 $78.00 Note: This is not a bill PAGE 1 OF 10 ~ '5 10/26/18 ~Libertx ~ Mutual. INSURANCE Named Insured Coverage Is Provided In: Ohio Security Insurance Company -a stock company Policy Change Endorsement Agent Policy Number: BKS (19) 57 4315 91 Policy Period: From 06/20/2018 To 06/20/2019 Endorsement Period: From 10/23/2018 to 06/20/2019 12:01 am Standard Time at Insured Mailing Location SUN SOLUTIONS TINT INC. (800) 682-8476 NETWORKED INSURANCE AGENTS SUMMARY OF LOCATIONS 0001 2009 Shadow Grove Way, Encinitas, CA 92024 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER CG 00 01 04 13 ~G 20 10 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 21 70 01 15 CG 21 76 01 15 CG 21 96 03 05 CG 22 68 09 97 CG 24 26 04 13 ~G 70 02 01 01 CG 81 38 12 08 Issue Date 10/26/18 TmE Commercial General Liability Coverage Form -Occurrence Additional Insured -Owners, Lessees or Contractors -Scheduled Person or Organization Exclusion -Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability -With Limited Bodily Injury Exception Employment-Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Silica or Silica-Related Dust Exclusion Operation of Customers Autos On Particular Premises Amendment of Insured Contract Definition General Endorsement Lost Key Liability Coverage Authorized Representative To report a claim, call your Agent or 1-800-362-0000 DS 70 27 01 08 57431591 N0060452 270 NCAOPPNO INSURED COPY 002903 PAGE 2 OF 10 !!!!!!!!!!!!!!! ==-= = = ;;;;;;;;; !!!!!!!!!!!!!!! ~ ====--= ~ ==== -!!!!!!!!!!!!!!! ==-= !!!!!!!!!!!!!!! ~ -~ !!i!!!!!!!!!!ii 11!!!!!!!!!!!!1 8 iiiiiiiiiilliil ~ iiiiilailll !!!!!!!!!!!!!I! 10/26/18 ~Lihertx ~ Mutual. INSURANCE Named Insured Coverage Is Provided In: Ohio Security Insurance Company - a stock company Policy Change Endorsement Agent Policy Number: BKS (19) 57 4315 91 Policy Period: From 06/20/2018 To 06/20/2019 Endorsement Period: From 10/23/2018 to 06/20/2019 12:01 am Standard Time at Insured Mailing Location SUN SOLUTIONS TINT INC. (800) 682-8476 NETWORKED INSURANCE AGENTS POLICY FORMS AND ENDORSEMENTS · CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER CG 84 99 01 12 CG 88 10 04 13 CG 88 60 12 08 CG 88 65 12 08 CG 88 70 12 08 CG 88 72 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 90 41 01 13 IL 00 17 11 98 IL 00 21 09 08 IL 02 70 09 12 LC 87 10 05 00 *NP 74 26 04 13 Issue Date 10/26/18 TIRE Non-Cumulation Of Liability Limits Same Occurrence Commercial General Liability Extension Each Location General Aggregate Limit Voluntary Property Damage Extension Construction Project(s)-General Aggregate Limit (Per Project) Off Premises Property Damage Including Care, Custody or Control Medical Expense At Your Request Endorsement Exclusion -Asbestos Liability Amendment Of Coverage B Personal And Advertising Injury Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement (Broad Form) California Changes -Cancellation and NonRenewal Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements Authorized Representative To report a claim, call your Agent or 1-800-362-0000 DS 70 27 01 08 57431591 N0060452 270 NCAOPPNO INSURED COPY 002903 PAGE 3 OF 10 -!!!!!!!!!!!!!I! -== = == ;;;;;;;; !!!!!!!!!!!!!I! ~ == -==== ~ ===== -!!!!!!!!!!!!!I! iilliliiiiii 1!!1!!!1!!!!!11 ==== -~ !i!!i!i!!i!!i!i 1!!!111!!!!!!!! 8 ~ ~ -!!!!l!!!9!!! 0 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): CITY OF CARLSBAD/CMWD PO BOX 4668 -ECM 3505 C/O EXIGIS INSURANCE COMPLIANCE SER NEW YORK, NY 10163 Location(s) Of Covered Operations 2009 SHADOW GROVE WAY ENCINITAS, CA 92024 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who 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 in- jury", "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 operatons 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 permit- ted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, 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 addi- tional exclusions apply: This insurance does not apply to "bodily in- jury" or" property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed 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 or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 0 C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: 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 ap- plicable Limits of Insurance shown in the Dec- larations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 --== == == -~ ===== = ==== -!!!!!!!!!!!!!!! lliiiiliiiiiiii !!!!!!!!!!!!!!! ~ -----i ~ !!!!!!!!!!!!!!! 8 ==== - !!!!!!!!!!!!!!! 0 POLICY NUMBER BKS (19) 57 4315 91 Policy Period: General Endorsement From 06/20/2018 To 06/20/2019 12:01 am Standard Time at Insured Mailing Location This Endorsement Changes The Policy. Please Read it Carefully. THE COMPLETE ADDRESS OF ADDITIONAL INSURED, CITY OF CARLSBAD, PER CG2010 IS SHOWN TO READ AS FOLLOWS: PO BOX 4668 -ECM #3505 C/O EXIGIS INSURANCE COMPLIANCE SERVICES NEW YORK, NY 10163-4668 To report a claim, call your Agent or 1-800-362-0000 CG 70 02 01 01 Page 1 of 2 General Endorsement To report a claim, call your Agent or 1-800-362-0000 CG70 02 01 01 POLICY NUMBER BKS (19) 57 4315 91 Policy Period: From 06/20/2018 To 06/20/2019 12:01 am Standard Time at Insured Mailing Location Page 2 of 2 = = == -=--== = ;;;;;;; !!!!!!!!!!I!!!! ~ ~ == ~ ==== -!!!!!!!!!!I!!!! lliiililiiliiia -=== ~ !iiiii!!i!iE 1!111!!1!!!!!!! 8 ~ --!!!!!!!!!!I!!!! 0 IMPORTANT NOTICE NOTICE TO POLICYHOLDERS NP 74 26 0413 This explanation is not a part of your insurance policy, and it does not alter any of its prov1s1ons or conditions. No coverage is provided by this notice nor can it be construed to replace any provision in your policy or policies with us, or any forms attached to your policy or policies. The following information only gives a general explanation which may have occurred from your prior (or old) policy. Read your policy carefully to determine rights, duties, and what is and is not covered. Only the provisions of your policy determine the scope of your insurance protection. This notice has been prepared to provide you with information since one of the forms listed below maybe attached to your policy. Fully Earned and Minimum Premium Endorsements* CG 04 37 -Electronic Data Liability CG 20 03 -Additional Insured -Concessionaires Trading Under Your Name CG 20 10 -Additional Insured -Owners, Lessees Or Contractors -Scheduled Person Or Organization CG 89 79 -Additional Insured -Owners, Lessees Or Contractors -Completed Operations -Scheduled Person Or Organization -Arising Out Of Your Ongoing Operations CG 90 47 -Additional Insured -Owners, Lessees or Contractors -Scheduled Person Or Organization - Caused In Whole Or In Part CG 90 43 -Additional Insured -Owners, Lessees Or Organizations -Scheduled Person Or Organization - Including Primary/Non-Contributory And Waiver Of Subrogation CG 90 44 -Additional Insured -Owners, Lessees Or Contractors -Completed -Operations -Including Primary And Non Contributory And Waiver Of Subrogation CG 20 11 -Additional Insured -Managers Or Lessors Of Premises CG 20 15 -Additional Insured -Vendors CG 20 26 -Additional Insured -Designated Person Or Organization CG 20 28 -Additional Insured -Lessor Of Leased Equipment CG 20 29 -Additional Insured -Grantor Of Franchise CG 20 32 -Additional Insured -Engineers, Architects Or Surveyors Not Engaged By The Named Insured CG 20 34 -Additional Insured -Lessor Of Leased Equipment -Automatic Status When Required In Lease Agreement With You CG 20 37 -Additional Insured -Owners, Lessees Or Contractors -Completed Operations CG 89 80 -Additional Insured -Owners, Lessees Or Contractors -Completed Operations -Arising Out Of Your Work CG 84 56 -Additional Insured -Boat Shows CG 85 83 -Blanket Additional Insured Contractors -Products -Completed Operations CG 85 84 -Additional Insured Contractors Products -Completed Operations CG 86 11 -Additional Insured Automatic Status When Required In Construction Agreement With You - Contractors -Completed Operations CG 89 95 -Additional Insured -Automatic Status When Required In Construction Agreement With You -Products/Completed Operations CG 88 83 -Amendment of Other Insurance Condition -Designated Persons or Organizations CG 89 98 -Amendment of Other Insurance Condition One of the above endorsement(s) may be attached to your policy. With the attachment of the endorsement a premium charge has been made along with a fully earned or minimum premium amount which will be retained if the policy is cancelled or issued for less than a one year period. Please refer any questions you may have to your insurance agent. * Not applicable in Ohio. © 2013 Liberty Mutual Insurance NP 74 26 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 STATE ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BROKER COPY I COMPENS.O..TION INSURA ..... C..E FUND 9225101-18 NEW NA HOME OFFICE SAN FRANCISCO 5-05-09-90 PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EFFECTIVE OCTOBER 15, 2018 AT 12.01 A.M. AND EXPIRING JANUARY 30, 2019 AT 12.01 A.M. SUN SOLUTIONS TINT, INC. 2009 SHADOW GROVE WAY ENCINITAS, CA 92024 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF CARLSBAD WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, SUN SOLUTIONS TINT, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 037.. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: ~!!,~ OCTOBER 17, 2018 IL~~ .dl-L~~ PRESIDENT AND CEO SCIF FORM 10217 IREV.7·2014) 2570 OLD DP 217 Dear Policyholder: BROKER COPY PLEASE KEEP THIS ENDORSEMENT WITH YOUR POLICY These endorsements amend and are part of your policy. Please keep them with your documents for future reference. 9225101-18 NEW NA If you have any questions concerning these endorsements, Please contact your local State Fund office.