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HomeMy WebLinkAboutUrban Corps of San Diego; 2019-10-11; PWM20-907GSr RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2019-0586253 111111111111 lllll 111111111111111111111111111111 IIIII IIIII IIIII IIII IIII Dec 16, 2019 01 :46 PM OFFICIAL RECORDS Ernest J Dronen burg, Jr., SAN DIEGO COUNTY RECORDER FEES $0 00 (SB2 Atkins. $0.00) PAGES 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 203-353-06-00 1. The undersigned is owner ofthe 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 November 5, 2019. 6. The name of the contractor for such work or improvement is Urban Corps of San Diego. 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. PW -907GS; Project Name: Harding Center Office Reconfiguration. 8. The street address of said property is 3096 Harding Street, C rlsba , CA 92008 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; the City Manager of said City on h/ortmbt[ a,tA , 201!1_, 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 DtceMhd qJb , 20J.i, at Carlsbad, California. CITVOFCAR~ {,/~;= BARBARAENGlESON City Clerk /../ecior G(J~tz I D~pu!,j c,tJ CJer✓ Q:\Public Works\General Services\Agreements & Contracts\Urban Corp\Harding Center Office Reconfiguration -PWM20-907GS\5. NOC\2. NOC -Harding Center Office Reconfiguration -PWM20-907GS.docx ' CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Urban Corps of San Diego has completed the contract work required for PWM20-907GS -Harding Center Office Reconfiguration. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS Demolish cabinetry, construct new walls to create new office space. VALUE $12,957.00 CERTIFICATION OF COMPLETION OF IMPROVEMENTS ~ r[-(<,'13 John ~YublicWorksri.¼nager Date CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Cl is hereby authorized to record the Notice of Completion and release the bonds in accor nc with State Law and City Ordinances. The is hereby directed to commence maintaining the above described APPROVED AS TO FORM: CELIA BREWER, City Attorney Q \Public Works\General Services\Agreements & Contracts\Urban Corp\Hard,ng Center Office Reconfiguration -PWM20-907GS\5. NOC\3. API -Harding Center Office Reconfiguration -PWM20-907GS docx ... ProjeGt: Harding Center Office Reconfiguration Change Order No. 01 CONTRACT CHANGE ORDER NO.01 PROJECT: Harding Center Office Reconfiguration CONTRACT NO. PWM20-907GS ACCOUNT NO. 3707000 9060 47231 9083 CONTRACTOR: Urban Corps of San Diego ADDRESS: 3127 Jefferson St. San Diego, CA 92110 P.O. NO. P138018 The Contractor is directed to make the following changes as described herein. Changes shall include all labor, materials, equipment, contract time extension, and all other goods and services required to implement this change. Payment stated on this change order includes all charges, direct or indirect, arising out of this additional work including charges for field overhead, extended home office overhead, delays, disruptions, cumulative impacts, loss of efficiency, extended equipment costs and overtime premium costs and is expressly agreed between the City and the Contractor to be the complete and final costs hereof. The requirements of the specifications, where pertinent and not in conflict with this change order, shall apply to these changes. Pursuant to the Standard Specifications for Public Works Construction, perform the following: Item 1 : During construction it was determined that installation of a new office door and relocation of electrical outlets and lighting fixtures were required. Contractor to provide all labor, equipment and materials necessary to complete the office reconfiguration as intended and depicted on the contract drawings. Total cost not to exceed ................................................................... $1,970.00 TOTAL INCREASE TO CONTRACT COST .................................................... $1,970.00 TIME FOR COMPLETION OF ALL WORK UNDER THIS CONTRACT SHALL BE INCREASED BY 02 WORKING DAYS AS A RESULT OF THIS CHANGE ORDER. RECOMMENDEDB\ l I\ ~\,J\J \ ,,/, MUNICIPPROJECTS MANAGER (DATE) ~GINE~iN</Mii~~J\ l~wg,l APPROVED AS TO FORM: DISTRIBUTION: INSPECTION FILE (ORIGINAL), PURCHASING, CONTRACTOR --2-<li' (DATE) ll ( q l C"t PWM20-907GS Harding Center Office Reconfiguration Page 1 of 6 City Attorney Approved 1/25/2019 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT HARDING CENTER OFFICE RECONFIGURATION This agreement is made on the ______________ day of _________________________, 2019, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Urban Corps of San Diego, a non-profit corporation whose principal place of business is 3127 Jefferson St., San Diego, CA 92110 (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor’s proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Brian Bacardi (City Project Manager). WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB October11th PWM20-907GS Harding Center Office Reconfiguration Page 2 of 6 City Attorney Approved 1/25/2019 FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: __Kyle Kennedy______________________ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers’ Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than……..$1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ….…$1,000,000 Property damage insurance in an amount of not less than……..$1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for “any auto” and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY. Workers’ Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. 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 DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB PWM20-907GS Harding Center Office Reconfiguration Page 3 of 6 City Attorney Approved 1/25/2019 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 ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within twenty (20) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Urban Corps of San Diego 3127 Jefferson St. (name of Contractor) 972059 (street address) San Diego, CA 92110 (Contractor’s license number) B – General Building, 04/30/2020 (city/state/zip) 619-235-6884 (license class. and exp. date) N/A (telephone no.) 619-235-5425 (DIR registration number) N/A (fax no.) dperez@urbancorps.org (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// /// /// DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB PWM20-907GS Harding Center Office Reconfiguration Page 4 of 6 City Attorney Approved 1/25/2019 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, URBAN CORPS OF SAN DIEGO, a non-profit corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Kyle Kennedy / CEO Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: (sign here) (print name/title) 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 Group B Chairman, President, or Vice-President 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: _____________________________ Deputy City Attorney DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB PWM20-907GS Harding Center Office Reconfiguration Page 5 of 6 City Attorney Approved 1/25/2019 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 be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB NA 0 NA NANA NA NA NA NA NA NA PWM20-907GS Harding Center Office Reconfiguration Page 6 of 6 City Attorney Approved 1/25/2019 EXHIBIT B Contractor to provide all labor, equipment and materials necessary to demolish cabinets and walls and construct new walls to create a new office space, as generally shown on the attached proposal (Exhibit “C”) dated August 30, 2019. JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LS EA Demolish cabinetry and construct new walls creating new office space as shown on the attachment to the attached proposal. $10,987.00 TOTAL* $10,987.00 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB URBAN CORPS OF SAN DIEGO COUNTY - Certified Local Conservation Corps & Charter School 3127 Jefferson Street, San Diego, CA 92110, Mailing Address: P.O. Box 80156, San Diego, CA 92138 Telephone (619) 235-6884, Fax (619) 235-5425, www.urbancorpssd.org State Contractors License # 972059 PROPOSAL DATE: August 30, 2019 TO: John Maashoff, Assistant to the City Manager, City of Carlsbad FROM: Steve Poppert, General Contractor, Urban Corps of San Diego County PROJECT: 3096 Harding Street, Interior Partitions SUBJECT: Urban Corps Construction Proposal _________________________________________________________________________________________ Dear Mr. Maashoff, Thank you for the opportunity to provide pricing for the 3096 Harding Street, Interior Partitions. Our pricing includes the following scopes of work per the site visit on 8/19/2019. SCOPE OF WORK AND PROPOSAL: 1.Demo and remove existing interior partition as indicated on drawings and as required to accomplishnew work.2.Protect existing utilities to remain from damage.3.Install new framing and gypsum wallboard sheathing. 4.New top set rubber base to be installed at all new wall locations.5.Patch and repair existing carpet as required.6.Paint to match existing.7. Throughout the construction period, maintain the buildings and site in a standard of cleanliness. TOTAL LUMP SUM BASE BID = $10,987.00 ten thousand nine hundred eighty-seven NOTE: Please see the following for proposal clarifications, and exclusions. PROPOSAL CLARIFICATIONS: Please note the following clarifications regarding our proposal: 1.Owner intends to continue to occupy adjacent existing building during the entire constructionperiod.2.Owner intends to occupy the Project upon Substantial Completion.3.Cooperate with Owner to minimize conflict and to facilitate Owner's operations.4.Schedule the Work to accommodate Owner occupancy.5.Specific work time restrictions to be provided by client to Urban Corps.6.Work to be completed in 10 working days.7.Proposal is valid for ninety (90) days8.All work to be performed during normal business hours9.Ample parking for construction vehicles at no cost shall be made available for Urban Corps.10.Space for disposal of trash and debris to be provided for Urban Corps.11.Urban Corps is exempt from State of California prevailing wage. PROPOSAL EXCLUSIONS: The following items are specifically excluded from our proposal: 1.Carpet Materials2.Plumbing systems and Underground Utilities, such as storm drainage.3.All electrical work PWM20-907GS Exhibit "C" DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB URBAN CORPS OF SAN DIEGO COUNTY - Certified Local Conservation Corps & Charter School 3127 Jefferson Street, San Diego, CA 92110, Mailing Address: P.O. Box 80156, San Diego, CA 92138 Telephone (619) 235-6884, Fax (619) 235-5425, www.urbancorpssd.org Page 2 of 2 State Contractors License # 972059 4.Fixtures, Furnishings and equipment.5.Staking & Engineering of entire site area.6.Permits and Fees. 7.Construction Water.8.Compaction Testing.9.Repair of un-marked Utilities.10.Design / engineering11.Testing and inspection services, costs, and fees.12.Environmental Fees. 13.Overtime and schedule acceleration costs.14.Prevailing Wage Labor Rates.15. Security.16.CAD as-built drawings. 17.Additional insurance in excess of Contractor’s existing policies. We welcome the opportunity to meet with you to review our proposal and its conditions and please feel free to contact me if you have any questions. Respectfully submitted, Urban Corps of San Diego County Steve Poppert General Contractor PWM20-907GSExhibit "C" DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB PWM20-907GS - Exhibit "C" DocuSign Envelope ID: C19F67D0-0CBF-4226-B752-7CAD6E1821CB DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificate holder in lieu of such endorsement(s). CONTACTPRODUCERNAME:FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED. NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSDWVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT $OTHER: COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) BODILY INJURY (Per person) $ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS $ UMBRELLA LIAB EACH OCCURRENCE $OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $ $DED RETENTION$ PER OTH-WORKERS COMPENSATION STATUTE ERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / AOFFICER/MEMBER EXCLUDED?(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE$If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) URBAN-7 OP ID: KV 12/11/2018 Keri VogtFaith Insurance ServicesBrakke Schafnitz Ins. Brokers28202 Cabot Rd. Suite 600Laguna Niguel, CA 92677Charles A. Faith 949-365-5144 949-313-3288 keri.vogt@sig.us American States Insurance 19704 General Ins. Co. of AmericaUrban Corps of San DiegoCountyPO Box 80156 San Diego, CA 92138 B X 1,000,000 X Y 24CC28766290 10/25/201810/25/2019 200,000 10,000 1,000,000 3,000,000 X 3,000,000 1,000,000 B X 24CC32284220 10/25/201810/25/2019 X X X X Comp 1,000 X Coll 1,000 XX 6,000,000 A 01SU43636620 10/25/201810/25/2019 6,000,000 B Professional Liab LP7745020K 10/25/201810/25/2019 Per Incid 1,000,000 Aggregate 3,000,000 Agreement Name: UTIL895 City of Carlsbad is named as additional insured as required by written agreement per the attached endorsement COCEXIG City of Carlsbad/CMWD c/o Exigis Insurance Compliance Services P.O. Box 488-ECM#35050 New York, NY 10163-4668 Policy No. 24CC28766290 City of Carlsbad CERTIFICATE OF WORKERS’COMPENSATION COVERAGE Dec 13,2018 PRODUCER NonProfits’United Workers’Compensation Group610FultonAvenue,Suite 200 Sacramento,CA 95825 Arthur J.Gallagher&Co Insurance Brokers ofCalifornia,Inc 1255 Battery Street #450 San Francisco,CA 94111 Phone:(916)868-6231 Fax:(916)880-5251 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THECOVERAGEAFFORDEDBYTHEPOLICIESBELOW. INSURERS AFFORDING COVERAGE INSURED Urban Corps of San Diego CountyPOBox80156 San Diego,CA 92138 INSURERA:NonProfits’United Workers’Compensation Group INSURERB:Safety National Casualty Corp [NAIC #15105] INSURERC: INSURERD: INSURERE: COVERAGESThis Certificate is not intended to specify all endorsements,coverages,terms,conditions and exclusions ofthe policies shown. THE POLICIES OF COVERAGELISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICYPERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM,OR CONDITION OF ANY CONTRACT OR OTHERDOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED ORMAY PERTAIN,THE COVERAGEAFFORDEDBYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCEDBYPAID CLAIMS. POLICYINSRPOLICYtte.TYPE OF COVERAGE POLICY NUMBER EFFECTIVE DATE EXPIRATION LIMITS GENERALLIABILITY EACH OCCURRENCE $ COMMERCIALGENERALLIABILITY FIRE DAMAGE(Anyonefire)$ [ctamsmave |[occur MED EXPENSE(Anyoneperson)$ GENERAL AGGREGATELIMIT APPLIESPER:PERSONAL&ADV INJURY $ Jpoucy ||pRoJect ||Loc GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ANY AUTO (Each accident)$ ALLOWNED AUTOS BODILY INJURY $SCHEDULED AUTOS (Perperson)$ HIRED AUTOS BODILYINJURY $NON-OWNED AUTOS (Peraccident)$ PROPERTYDAMAGE $(Peraccident)$ PERxX OTHERSTATUTEWORKERS’COMPENSATIONAAND NPU-WCG001-2019 1/1/19 1/1/20 [ELEACHACCIDENT $500,000EMPLOYERSLIABILITYE.L.DISEASE —EA EMPLOYEE $500,000 E.L.DISEASE —COVERAGELIMIT $500,000 OTHER .Limit Per Occurrence -Statutory B_EXCESS Workers’Compensation SP 40579671 1/1/19 1/1/20 EL Per Occ &Agg $2,000,000 xsof$500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS Evidence ofWorkers’Compensation Coverage:Waiver ofSubrogation included by Endorsment NPUWCG-URBAN-079 CERTIFICATE HOLDER |CANCELLATION City of.Carlsbad/CMWDc/o EXIGIS Insurance ComplianceServices PO Box 488-ECM #35050 New York,NY 10163 4668 NPUWCG-URBAN-079 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORETHEEXPIRATIONDATETHEREOFNOTICEWILLBEDELIVEREDINACCORDANCEWITHTHEPOLICYPROVISIONS. Based on ACORD25 (2014/01) NONPROFITS}UNTITED!EReeenFP THIS ENDORSEMENT CHANGES THE MEMORANDUM OF COVERAGE PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US NonProfits’United Workers’Compensation Group Memorandum of Coverage:NPU-WCG 001-2019 This endorsement modifies the coverage provided underthe following: Memorandum of Coverage:PART ONE:WORKERS’COMPENSATION COVERAGE Paragraph H.RECOVERY FROM OTHERSis amendedwith respect to the following:Name and Addressof Person or Organization: City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services PO Box 4668 -ECM #35050 New York,NY 10163-4668 DESCRIPTION OF OPERATIONS/LOCATIONS ADDED BY ENDORSEMENT: -The City of Carlsbad,its officers,officials,employees,agents and volunteers. NPU-WCGwaivesanyright of recovery it may have against the person or organization shown above because of payments made by NPU-WCGfor injury or damagearising out of the Members’operations done undera contract with that person or organization shown above and included in the coverage provided by the Memorandum of Coverage.This waiver applies only to the person or organization shownon the Schedule Above. This endorsementis part of the Memorandum of Coverage and is effective on the date shown below. All other terms and conditions remain unchanged. Effective Date:January 1,2019 Expiration Date:January 1,2020 Member:Urban Corps of San Diego County Endorsement No:NPUWCG-URBAN-079 Date Issued:Dec 13,2018 kegs LE 7 Authorized Representative for NPU-WCG -MOC:NPU-WCG 001-2019NPU-WCG Page 1