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Home My WebLink AboutThe Door Company; 2018-02-26; PWM18-113GSRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2018-0283030 111111111111 lllll 111111111111111111111111111111 IIIII 111111111111111111 Jul 11, 2018 04:59 PM OFFICIAL RECORDS Ernest J. Dronenburg, Jr., SAN DIEGO COUNTY RECORDER FEES: $0.00 (8B2 Atkins $0.00) PAGES 2 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 213-110-04-00 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 May 20, 2018. 6. The name of the contractor for such work or improvement is The Door Company. 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: Alga Norte Aquatic Center Gate Replacement Agreement PWM18-113GS. 8. The street address of said property is 6565 Alicante Road, in the City of Carlsbad. 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; of said City on \-31 bf'-...SL. I ) , 20li, 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 VU--£1,...Q, J ;b, 20 ! 51, at Carlsbad, California. err; OF CARLSBAD , \ r,/,f)'la),o, f!uLllk,___, /Jut_ BARBARA ENGLESON City Clerk Q \Public Works\PW Common\Agreements & Contracts\Contracts\2018 Contracts\MINOR PUBLIC WORKS\The Door Company\CONTRACTS -Alga Norte Aquatic Center Gate Replacement\CONSTRUCTION -Alga Exit Gates\NOC (Public and Private) -revised 2018-02-27.doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS The Door Company has completed the contract work required for PWM18-113GS Alga Norte Aquatic Center Gate Replacement. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS (Specify if City or CMWD) Fabrication and Installation of 4 Exit Gates VALUE $22,595 CERTIFICATION OF COMPLETION OF IMPROVEMENTS Date 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 imp9:7Wu 6/11/;_s 7'1'::rcra;li:City Manager __,D=-a_t_e~-------- ../ APPROVED AS TO FORM: CELIA BREWER, City Attorney By:C/k~ Deputy City Attorney Q \Public Works\PW Common\Agreements & Contracts\Contracts\2018 Contracts\MINOR PUBLIC WORKS\The Door Company\CONTRACTS . Alga Norte Aquatic Center Gate Replacement\CONSTRUCTION -Alga Exit Gates\API (Public Works) -revised 2018-02-15.doc Tracking#: PWM18-113GS CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 This agreement is made on the d lo +..h. day of --L-""""'L...?:=---'-----¥----' 2018, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), a The Door Company, a sole proprietorship, whose principal place of business is 2345 Alta Vista Drive, Ista, CA 92084 (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: Ron Haugland (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. ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 Page 1 of 6 City Attorney Approved 9/27/16 Tracking#: PWM18-113GS 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 subcontr r from particip ·/ in contract bidding. Signature: Print Name: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the Califomia 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. ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 Page 2 of 6 City Attorney Approved 9/27/16 Tracking#: PWM18-113GS 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 fifteen (15) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within forty five (45) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. THE DOOR COMPANY, a Sole Proprietorship Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill (name of Contractor) 740956 (Contractor's license number) C-61 / D28: B 9/30/19 (license class. and exp. date) 1000023636 (DIR registration number) 6/30/18 (DIR registration exp. date) ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 Page 3 of 6 2345 Alta Vista Drive (street address) Vista, CA 92084 (city/state/zip) 760-917-5194 (telephone no.) NA (fax no.) joe@innovationdoors.com (e-mail address) City Attorney Approved 9127116 Tracking#: PWM18-113GS 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 THE DOOR COMPANY, ::ole Propri/~hip_ ,-~/ ~ /2 ~-,, ~ sign re) CITY OF CARLSBAD, a municipal corporation of the State of California By: Elaine Lukey/P orks Director as authorized by the City Manager ~ ' ,--,11 \A;y p '-V \ J E'Z i $ t'l~ u u 11'\,QJ-' ~ (prinThame/title) By: (sign here) (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. 1f..E_ corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: ~LL~ Deputy City Attorney ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 Page 4 of 6 City Attorney Approved 9/27/16 Tracking#: PWM18-113GS 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 ,#D1vc2,.,, Total % Subcontracted: The Contractor must perform no less than fifty percent (50%) of the work with its own forces ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 Page 5 of 6 City Attorney Approved 9/27 /16 Tracking#: PWM18-113GS EXHIBIT B Alga Norte Aquatic Center Gate Replacement Contractor will provide all labor, equipment and materials necessary to remove four existing steel gates and furnish and install four new powder coated aluminum gates, with Mag locks, and one ADA assist automatic low energy operator at Alga Norte Aquatic Park located at 6565 Alicante Road, Carlsbad, CA 92009. This contract includes the following: • New Custom Manufactured Aluminum Gates powder coated to customer specs and matching existing steel gates currently installed • New Low Energy automatic opener with power boost to close • New Weather proof Mag locks with 1200 pound pull electro magnet • New Continuous Hinges • New Touch Bar Panics to release Mag locks • New Wireless push button activation switch mounted near gate • New battery back-up power supply • New LCN closers on 3 gates • Labor needed to install • All parts and labor guaranteed for 1 year JOB QUOTATION DESCBIPTION··. •· • :}L: y '¼Y• 1:. ·· .• ,?P'RtC.E .. ITEM UNIT QTY NO. i• 1• ti;~ ). '• ,,/ . 1 EAC 1 Four Custom Manufactured Aluminum Gates powder $22,595 H coated and aesthetically matching existing steel gates TOTAL* $22,595 *Includes taxes, fees, expenses and all other costs. ALGA NORTE AQUATIC CENTER GATE REPLACEMENT; CONT. NO. 4733 Page 6 of 6 City Attorney Approved 9/27 /16 ACORD9 CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY) ~ 01/18/2018 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 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 1..UNIAI..I Eric Bock NAME: ACWGROUP, LLC dba: AKAMINE CHRISTMAN WALL INSURANCE rA~g,o Ertl: 760-625-7816 I rt~ Nol: 760-262-3673 79-220 Corporate Center Drive Suite 102F E-MAIL ebock@acwgroup.com ADDRESS: La Quinta, CA 92253 INSURER(S) AFFORDING COVERAGE NAICIII 1NSURERA: Securitv National Insurance Comoanv 19879 INSURED INSURERB: JOSEPH VEL TON JEZISEK INSURERC: 2345 ALTA VISTA DRIVE INSURERD: INSURERE: Vista CA 92084 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. NOlWITHSTANDING 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 ~-1..':~/o'W~ ..':~liF~ LTR TYPE OF INSURANCE ,., .. .., W\lr, POLICY NJMBER LIMITS A COMMERCIAL GENERAL LIABILITY NA 105898404 05/20/17 05/20/18 EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE CR] OCCUR LJAMAGI:: TO 1--11::N 11::LJ PREMISES iEa occurrence! $ 100,000 MED EXP (Any one person) $ 5,000 -PERSONAL & ADV INJ.JRY $ 1,000,000 c---2,000,000 GEN"L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ ~ POLICY O :':8i DLoc PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILrrY i1,~~~~~ INGCE LIMIT $ -ANY AUTO BODILY INJURY (Per person) $ -ALL O1/vNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ --NON-OVINED ;p~~~~~gAMAGE HIRED AUTOS AUTOS $ --$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ c--- EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N Ar-N PROPRIETOR/PARTNER/EXECUTIVE D EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE -EA EMPLOYEE $ grs~~ftfi8~ ~~~PERATIONS below EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The following entity is listed as an additional insured with respects to general liability insurance per attached company blanket form 49-0108 07 11 Project Description: Door installation, service and repair Project Location: Various locations through out San Diego County CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE c/o EXIGIS Insurance Compliance Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 4668 -ECM #35050 ACCORDANCE WITH THE POLICY PROVISIONS. New York, NY 10163-4668 AUTHORIZED REPRESENTATIVE s:;-~ I @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number: NA105898404 Endorsement Effective: 5/20/2017 12:01 a.m. Named Insured JOSEPH VEL TON JEZISEK, DBA: JOSEPH VEL TON JEZISEK Counteraigned r:t h~ SCHEDULE Name of Person or Oraanlzation:t th d . d . bl" t d b ·rt f itt t t · A"ny person or orgamzatIon tna e name msure Is o Iga e y vI ue o a wr en con rac or agreement to provide insurance such as is afforded by this policy. Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II -Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions 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 site 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. C. The words "you" and "your" refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. Primary Wording If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self-insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49-0108 07 11 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 Used with permission ACSC To: Company: Fax Number: Voice Phone: From: Subject: CAA77174270 1/5/2018 2:10:25 PM PAGE 1/010 Fax Server Automobile Club of Southern California P.0.Box 25001, Santa Ana, CA. 92799-5001 BRIAN DO 7147542165 INTERINSURANCE EXCHANGE OF THE ACSC -MILA Dateandtimeoftransmission: Friday, January 5, 2018 2:10:14 PM Number of pages including this cover sheet: 10 ACSC ACSC 1/5/2018 2:10:25 PM PAGE 2/010 Fax Server • Automobile Club of Southern Callfornla P.O. Box 25001, Santa Ana CA 92799-50D1 AAA.com (844) 380-5959 September 22, 2017 AUTO INSURANCE RENEWAL OFFER Policy Number: CAA 077174270 JEZ!SEK, KERRY AND JEZISEK, JOSEPH :2345 ALTA VISTA OR. VISTA CA 92084-7026 Thank you for your 4 years of membership with the Auto Club. We are pleased to offer renewal of your auto policy for another year. We are also pleased to announce that valued policyholders like you will again receive a return of premium through a Policyholder Savings Dividend. This is one of the advantages of having auto insurance through the Auto Club. As a convenience, we have applied your $461 Policyholder Savings Dividend to your renewal premium to reduce your premium balance. This renewal package includes the follo'Mng documents: • Your Policy Coverages and Limits pages (Renewal Declarations) • Billing Statement • Proof of Insurance Cards • Other important insurance documents Thank you again for choosing us. Sincerely, 1~r.~ Robert T. Bouttier Chief Executive Officer YOUR POLICYHOLDE~ SAVINGS DIVIDEND IS: $481 YOUR DISCOUNTS The following discounts have been applied to your auto policy premium: • Multl-Vehlcle • Loyalty • Good Driver POLICYHOLDER SAVINGS OlVIOENO STATEMENT on reverse= CIiek AAA.com/myaccount to access your I Visit or call your local Auto Club branch I Call (844) 380-5959 policy and pay your bill onllne AAA.com/branches Insurance provided to quallfted Auto Club members by the lnter/nsurance Exctiange of the Automobile Club. ACSC 1/5/2018 2:10:25 PM PAGE 3/010 Fax Server AUTO POLICY NUMBER: CAA 077174270 POLICYHOLDER SAVINGS DIVIDEND STATEMENT We are pleased to announce that our auto policyholders will once again receive money back through the payment of a POLICYHOLDER SAVINGS DIVIDEND. While auto dividends are not guaranteed, qualifying auto policyholders have received a Policyholder Savings Dividend in each year since 1990 and now you have the opportunity to get money back just for insuring your car with us. For years our auto policyholders have enjoyed the benefit of quality insurance, caring customer service, great discounts and also the opportunity to receive money back through a Policyholder Savings Dividend. Not all Insurance companies can say that. Giving money back to our auto policyholders through dividends is another way we're always with you. The amount of the Policyholder Savings Dividend that you w!II receive upon completion of your current policy period is displayed below. Your dividend amount is based on your current policy premium. Since dividends are paid at the end of your current policy term, the good news is we have applied your dividend to your renewal premium to reduce your premium balance and your minimum due. This means less money coming out of your pocket to renew your policy. YOUR POLICYHOLDER SAVINGS DIVIDEND THIS YEAR Policyholder Savings Dividend Amount: $461 Dividend applied to renewal premium for auto policy period: (Refer to the enolosed Renewal Bllflng Statement for your premium balance) 11-02-17 to 11-02-18 YOUR POLICYHOLDER SAVINGS DIVIDEND HISTORY Total savings received from dividends within the last five years: $1,777 Call {844) 380-5959 I Click AAA.eomtmyaccount to access your I Visit or calf your local Auto Club branch policy and pay your bill onllne AAA.com/branches lnsuranoe provided to quelif/et:i Auto Ck.lb m~rs by the lnterlnsuranoe Exchange of the Automobile Club. ACSC • 1/5/2018 2:10:25 PM PAGE 4/010 Fax Server lnterinsurance Exchange of the Automobile Club Automobile Insurance Polley Coverages and Limits Renewal Declarations Ve are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or ,efore the due date. Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as set forth , the lnaurance polloy and endorsements. These declarations, together with the contract and the endorsements In effect, complete your polloy. If .ny change to your policy or to the Information we have on file results In a premium decrease during the policy period, the lnterinsuranee txchange rG$erves the right to apply any refund due to your outstanding balanc;e. NAMED INSUREO(ltem 1.) AUTO POLICY NUMBER: CAA on174270 POLICY PERIOD (PACIFIC STANDARD TIME) JEZISEK, KERRY AND JEZISEK, JOSEPH 2345 ALTA VISTA DR POLICY EFFECTNE DATE: 11-02-17 12:01 AM. VISTA CA 92084-7026 POLICY EXPIRATION DATE: 11.02-18 12:01 AM VEHICLES I/EH. YE:.A.R WI.KE MODEl. IOENTIFICA TION NO. NUMBER 1 2007 TYTA TUNDRA LN ve 5TFLV52127X005140 2 1925 FORD MODEL T 14673114 6 2011 FORD RANGER SUPER 1FTLR4FE8BPA18799 7 2013 NSSN QUEST JN8AE2KP1DS068177 COVERAGES AND LIMITS Cov•l'll9• la not In 9ffect un!NS a premium 0r the word "Included" le ehown. ::OVERAGES LIMITS OF LIABILITY .leblllty lodlly Injury $1,000,000 each person/ $1,000,000 each occurrence •roperty Damage $500,000 each occurrence ladles/ 1hy$/cal Damage (AOl~II Cult \11lu1 unl•n al!itrWIH 1t11•d. lH1 d1du0lible) Vehl<:16 1 V6hlcl6 2 Ve/'ilcle 6 Vlhlefl 7 ~prehenslve _ess Deductible) Xllllslcn ACV No Coverage AC\/ ACV $1000 No Coverage $1000 $1000 ACV No Coverage AC\/ ACV ..ess Deduatlble) :ar Rental Expense $1000 No Coverage $1000 $1000 ::>er Day) No Coverage No Coverage No Coverage No Coverage lnln•ured Motorist lodily Injury· $30,000 each person/ $60,000 Uninsured & Underlnsured Vehloles Jntnsured DeducllbleWeMJr lnineured Collision ·otal Premium each accident Vehicle VEHICLE GARAGE ANNUAL" VERIFIED USE ZIPCOOE MILES MILEAGE COMMUTE: 92084 10,001 -12,500 NO PLEASURE 92084 1 -500 NO BUSINESS 92084 7,501 • 10,000 NO PLEASURE 92084 7,501 -10,000 NO ANNUAL PREMIUMS Vehicle 1 Vehicle 2 Vehicle 6 Vehlele 7 $322 $190 $ 239 $142 $ 330 $182 S 261) $141 I I I t I I I I • I :No Coverage:No Covarage:No Coverage:No Coverage: I I I I I I I I 1 I I I I t I ' ' I I . ' ! I $ 58 :No Coverage: $ 64 $ S4 1 ' ' ' $ 2!14 :No Coverage: $ 271 $ 274 ' ' ' ' ' ' . ' ' /No CoverageiNo Coverage/No CoveragejNo Coverage! I I I I I I t I $ 55 : S 53 ' $45 ' $45 : I 1 l I ' ' ' , Included [No Covarage: Included , Included ! ;No CovaragaiNo Covan1aeiNo Coverage/No Coveragei : $879 : $434 : 1892 S 774 SALVAGE NO NO NO Vehicle '.REMIUM Dl$COUNT8 "No Coverage• Indicates coverage not purchased, lease refertcthe enclosed document entitled "Premium DiE;counts Applied to Ycor Automobile Polley." • If .at any time you choose to pay less than the full balance outstanding, finance charges of up to 1.6%. per month of the balance outstanding wlll apply , as explained in your billing statements, which are part of these declarations. .. To see the annual mileage for your expiring policy, pleue refer to the ''Notice of Annual MIieage" page contained In your renewal package. PROCESS DATE 09w22-17 Pl.EASE ATTACH TO YOUR POLICY Total Annual Premium" $ 2979 (lnci.Jdes 111 applcable dlscounto,) Less Pollcyholder Savings Dividend $ 461 Net Premium" $2618 (SEE REVERSE) ACSC 1/5/2018 2:10:25 PM PAGE 5/010 Fax Server 1 2 3 DRIVER NUMBER 1 2 3 lnterinsurance Exchange of the Automobile Club Automobile Insurance Polley Coverages and Limits Renewal Declarations (continued) POLICY EFFECTIVE DATE: 11-02-2017 11111 differ tor each drfvtlf'. Plea&e 11ee eacll 11oollon of the ic contract for the def/nit/On of 'Peraon.s ln&Ured'. NAME JEZISEK, KERRY A JEZISEK, JOSEPH V JEZISEK, PETER J NUMBER OF PR~CIPALLY AT-FAULT ACCIDENTS I I MINOR ORIVINC3 RECORD NUMBER OF TRAFFIC CONVICTIONS I SERIOIJS I MAJOR I SEVERE I GENDER FEMALE MALE MALE SUSPENSIONS MARITAL STATUS MARRIED MARRIED SINGLE DRIVER STATUS PRIMARY PRIMARY ADDITIONAL RATED VEHICLE NUMBER 2 1 ENDORSEMENTS ANO CERTIFICATES SPECIAL EQUIPMENT"" SOUND EQUIPMENT'"' NUMBER 2011 2052 2231 2298 2367 I TITLE MEMBER'S AUTOMOBILE POLICY -POLICY NUMBER CHANGE LOSS PAYABLE-NOTICE TO LIENHOLDER GUARANTEED RENEWAL SELECTION OF UMIUIM COVERAGE ENDORSEMENT AMENDATORY ENDORSEMENT \/EH, CAMPER/ OTHER Z.WAY TELE-RADIO 011'1ER NO. VANCONV. RADIO PHONE 1 2 6 7 -Coverage is indicated by a "YES' in the appropriate equipment column. Co.terage limilallcris apply unless oo.-erage was purchased specifically for certain equipm&'"lt. AKY PHYSICAL DAMAGE LOSS MAY BE MADE PAY ABLE TO YOU AND AWf INTEREST LISTED BEiLOW: 'EH NO. 6 .OAN NO. 8151760818 \/ELLS FARGO DEALER SERVlCES >o BOX 5075 ~ORAOPOLIS PA 15108 PERSON DESIGNATED TO RECEIVE NONPAYMENT OF PREMIUM NOTICES: An individuel de8igne!ed by e ,:clicyholder lo receive notice of lepse, lermin&Uon, explral/on, nonf!J!HIW&I, or cancslJal/on of rile policy fer nonpayment or p,wm/um doe.t nal have any rights, whether aa 1111 additlonal Jn,ullfd or Olh1HWlt4, to eny t,enerlb unr:Jer the policy, ather than the r/gllf to 1$cewe noliCfl. CIiek AAA.com/myaccount to access your polley Information onllne, pay your blll or print additional proof of insurance cards ACSC 1/5/2018 2:10:25 PM PAGE 6/010 Fax Server • lnterinsurance Exchange of the Automobile Club P.O. Box 25-448, santa Ana, CA 92799-5448 AAA.com 1-677-422-2100 AUTOMOBILE RENEWAL BILLING STATEMENT THIS BILLINO STATEMENT AND lHE INFOMIATION IT CONTAINS ARE PART OF YOUR INSURANCE POLICY DECLARATIONS INSURANCE BILLING STATEMENT JEZISEK, KERRY AND JEZISEK, JOSEPH 2346 ALTA VISTA DR POLICY NUMBER: CAA 077174270 POLICY EFFECTIVE DATE: 11-02-2017 BILLING DATE: 09-22-2017 VISTA CA 92084 1. 2. 3, 4, 5. 6. RENEWAL PREMIUM; $ 2979.00 LESS PRIOR PAYMENT: $ 0.00 er PREVIOUS BALANCE: $ 0.00 AMOUNT FINANCED: $ 2978.00 LESS POLICYHOLDER SAVINGS OIVIOENC: $ 461.00 er TOTAL BALANCE: 2518.00 DUE DATE: 11-02-2017 Your Policyholder Savings 01Vldend has been used to reduce th• minimum du• m1caury to r•naw your policy: Minimum Amount Due: $ 330.96 Less Policyholder Savings Dividend: $ 461.00 er $ 130.04 er Your adjusted minimum due is $10.00, the minimum payment required to renew your policy. The balance Of the credit wilt be spread over your rematnlng Installments which wlll vary from . Your Minimum Due or I $10.00 I will be deducted from your bank account with the last four digits of 0807 on the Due Date ! 11-02-2017 J *A/fer the (nit/al renewal Installment each subsequent mtalment wiff Include a f/nanoe charge. Thank you for selecting our AAA Auto Pay plan, This convenient plan allows your monthly payments to be withdrawn automatlcally from your bank account. Your bank account with the last four digits of 0807 wlll be debited with the Minimum Due on the Due Date Indicated above. For quutlons on this bill please call (877) 422·2100 (option 1} 00 NOT PAY THIS BILL -YOUR AUTOMATIC PAYMENT HAS BEEN SCHEDULED -See reverse for details - ACSC Number Df Pe')menls 09 PHI\IUAI. PERCENTAGE RAT£ The cost otyour credit aa a yearly rate. 16.37% 1/5/2018 2:10:25 PM PAGE 7/010 SEND ANY QUESTIONS REGARDING THIS BILL TO: ACSC Attn: CORPORATE RECEIVABLES A313 P.O. Box 25001, Santa Ana, CA 92799-5001 Phone: 1-877-422-2100 ru in en In! 1 n orma 10n or 0 IC' : Tth'L d" If t' f P r CAA 077174270 First Pa~em r:ue Date Rra1 Pa:,ment Amount Other Pa','ll'Wlt$ lll't tile ••ch succeeding monlh on 1hls date 11-2-17 $10.00 2ND FINANCE CHARGE Amount Financed T otJII cf Pa;rn ents The dollar amount the The amount of cred1 pravlded to The amoun! you will nave paid credit WIii cclil you. ycu or oo )Cur behelf. after IJOlJ ha...a made ell pa~ents as $Cheduled. $147.27 $2,979.00 $3,126.27 Tl'lere Is no prepayment pen~ty. Fax Server Olher Pa~ents wlll vary trom $318.20 to $343-58 Total 841& F'rlce The total cost of your purchase on credit. $3. 12.6.27 The full balance or et least the Minimum Due Is payable by the due date. You must pay the outstanding balance In full to avoid paying any finance charges. After the first renewal payment, each subsequent bllllng will Include a finance charge. Paymenb received will be applied fl/'$t to any fees or charges due. The remainder of your payment will be applied to the premium due. AU returned payments, whether by check, electronic transaction, or other form of payment, may be re•pl'8$ented electronlc:ally for payment. Each late payment is subject to a $7 fee and each returned payment is subject to a $15 fee. Installment payment plans and all fees are subject to change without notice. An advel'$9 payment record (suoh as a late payment, a returned payment, or a nonpayment) may reduce the number of remaining Installments and Increase the minimum due, or result in a request to pay the entire balance of the policy bill In full. Whenever a payment is returned by your flnanclal Institution, we may, at our option, notify you In writing that the entire outstanding premium balance Is Immediately clue and payable In eash or by cashier's check or bank money order at one of the Auto Club's district offices, In addition, the payment record during the current policy period wtll determine the payment terms offered at the next policy renewal. The finance charge periodic rate will be 1 % per month (12% ANNUAL PERCENTAGE RATE) on that portion of the Balance exceeding $1,000 and 1.5% (18% ANNUAL PERCENTAGE RATE) on that portion of the Balance that Is $1,000 or less. ACSC 1/5/2018 2:10:25 PM PAGE 8/010 Fax Server • lnterinsurance Exchange of the Automobile Club Premium Discounts Applied to Your Automobile Policy Auto Policy Number: CAA 077174270 The following automobile premium discounts are available from the lnterinsurance Exchange. If you meet the discount requirements, an "X" will appear in the box next to the discount name and you will receive a premium reduction on all coverages that qualify for the discount. D MUL Tl-POLICY [X1 MUL Tl•VEHICLE D SELECT PROFESSIONALS & GROUPS IX] LOYALTY D DRMNQ COURSE D MATURE DRIVER D STUDENT AWAY D GOOD STUDENT [X] GOOD DRIVER JEZISEK. JOSEPH V D VERIFIED MILEAGE If you need additional information about any of the above discounts, please refer to the Available Automobile Premium Discounts Insert lnoluded with your renewal offer (or the Insert provided with your applloatlon). If you have additional questions about premium discounts or your auto policy, please call us at 1-877-422-2100. ACSC 1/5/2018 2:10:25 PM PAGE 9/010 Fax Server • lnterinsurance Exchange of the Automobile Club Polley Number: CAA 077174270 NOTICE OF ANNUAL MILEAGE Pursuant to section 2632.5 (c) or the California Insurance Code of Regulations, we are providing you with the annual mileage figures for your vehtcle(s). Vehicle Vehicle Vehicle No. Year Make 1 2007 TYTA 2 1925 FORD 6 2011 FORD 7 2013 NSSN Vehicle ldentlfioatlon No. 5TFLV52127X005140 14673114 1FTLR4FE8BPA18799 JN8AE2KP1D9068177 Annual Miles Expiring Polley 12,1501 -111,000 1 -600 7,501 -10.000 7.601 -10,000 8217 Ed. 09-2008 ACSC • 1/5/2018 2:10:25 PM PAGE 10/010 Fax Server lnterinsurance Exchange of the Automobile Club GUARANTEED RENEWAL ENDORSEMENT Effective 11-02-2017 12:01 A.M. Pacific Standard Time Forming a part of Policy No. CAA 077174270 issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB. We agree not to cancel or refuse to renew your policy, provided the premium Is paid when due. However, this agreement shall become void upon the occurrence of any of the events listed below, and we may then canoe! or refuse to renew your policy for any reason not prohibited by law. This agreement shall become void If: 1. Fraud or material misrepresentation has been committed affecting the pollcy or insured. 2. Arrt vehicle insured under your policy is used for commercial purposes. 3. You do not have a valid membership in the Automobile Club of Southern California. 4. Your primary residence Is outside the state of California. 5. You have failed to provide to us, within 30 days of our reasonable written request, Information necessary to accurately underwrite your policy or determine your premium. 6. During the 36 months before the expiration date of the policy period shown on your most recent deolarattons, you or any other primary or additional driver insured under your policy has had: a. a driver's license suspended or revoked for any reason; or b. any of the foUow!ng: (1) one or more convictions for: {a) any felony arising out of the ownership, maintenance or use or a motor vehicle; or (b) homicide or assault arising out of the ownership, matntenance or use of a motor vehicle; or (c) any drug or narcotics-related traffic violations; or (d) any speed contest; or (2) two or more conv!ctlons for any alcohol-related traffic violations; or (3) three or more convictions for any traffic violatlons we classify as "major" for additional premium purposes; or (4) two or more at-fault automobile accidents which result In bodily Injury; or (5) three or more at-fault automobile accidents which result In physloal damage only; or (6) three or more convictions for minor traffic violations. 7. Any primary or addltlonal driver is added to your policy who is not a statutory good driver because of his/her driving record. All provisions or your policy not affected by this endorsement remain unchanged, ACSC Management SetvlcM, Inc. ATTORNEY-IN-FACT 2231 E200li)Q Janean Hawney From: Sent: To: Subject: Sent from my iPhone Joe <joe@innovationdoors.com> Monday, February 19, 2018 4:38 PM Janean Hawney Workers comp exemption 1