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Vaughns Industrial Repair Co Inc; 2019-04-16; PWM19-725UTIL
DocuSign Envelope ID: FD966A99-60D8-4E7A-8F70-1DE194B602F7 DOC# 2020-0585692 1111111111111111111111111111111111111111111111111111 Sep 30, 2020 11:09 AM OFFICIAL RECORDS Ernest J. Dronenburg, Jr., SAN DIEGO COUNTY RECORDER FEES: $0.00 (Se2 Atkins: $0.00) PAGES: 2 Space above this line for Recorder's use. PARCEL NO: 168-331-91-00 NOTICE OF COMPLETION Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full name of the undersigned is Carlsbad Municipal Water District (CMWD), 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 19, 2019. 6. The name of the contractor for such work or improvement is Vaughan's Industrial Repair Co., 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: Contract No. PWM19-725UTIL. 8. The street address of said property is 4764 Rift Road, in the City of Carlsbad. CARLSBAD MUNICIPAL WATER DISTRICT Geoff Patnoe, Assistant Executive Manager VERIFICATION OF SECRETARY I, the undersigned, say: I am the Secretary of the Carlsbad Municipal Water District, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the Assistant Executive Manager of said Board on , 2020, accepted the above described work as completed and ordered tkat a Kiotice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on d- d- 3 , 2020, at Carlsbad, California. CARLSBAD MUNICIPAL WATER DISTRICT BA BARA ENGLESON Secretary Q: \ Public Works \PW Common \Agreements & Contracts \Contracts\2019 Contracts\MINOR PUBLIC VVORKS \Vaughan's Industrial Repair\PVVM19-725UTIL CALAVERA 3 Pumps \NOC API \NOC (Vaughans) Sanders 2020-09-02.doc RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DocuSign Envelope ID: FD966A99-60D8-4E7A-8F70-1DE1946602F7 CARLSBAD MUNICIPAL WATER DISTRICT ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Vaughan's Industrial Repair Co., Inc. has completed the contract work required for (PWM19- 725UTIL) the rebuild of three Calavera recycled water pumps and motors. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE Rebuild of three Calavera recycled water pumps and $55,583.91 Motors (CMWD) CERTIFICATION OF COMPLETION OF IMPROVEMENTS 6AA, Ken Knat2 District Engineer Date 9/3/2020 EXECUTIVE MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The Secretary to the Board of Directors is hereby authorized to record the Notice of Completion and release the bonds in accordance with State Law and City Ordinances. The Carlsbad Municipal Water District is hereby directed to commence maintaining the above described improvements. 5-- /---L,0 Geoff Patnoe, Assistant Executive Manager Date APPROVED AS TO FORM: CELIA BREWER, General Counsel By: As istant General Counsel Q:\PubIic Works\PW CommorMgreements & Contracts%Contracts ‘2019 Contracts1MINOR PUBLIC WORKSWaughan's Industrial Repair1PWW119-7251JTIL CALAVERA 3 Pumps INOC API API (Vaughans) Sanders 2020-09-02.doc Project: 19-725UTIL, Rebuild Three Calavera PS Recycled Water Pumps Change Order No. 1 CONTRACT CHANGE ORDER NO. 1 PROJECT: Rebuild Three Calavera Recycled Water Pumps and Motors CONTRACT NO. ACCOUNT NO. CONTRACTOR: ADDRESS: PWM 19-725UTIL 5026310-7550 Vaughn Industrial Repair, Inc. 16224 Garfield Avenue Paramount, CA 90723 PO No. P137248 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 : Motor Stator Rewind x3 cost not to exceed ................................................................... $2,535.00 Pump outer column replacement x 3 Item 2: cost not to exceed ................................................................... $1,364.13 TOTAL INCREASE TO CONTRACT COST ................................................... $3,899.13 TIME FOR COMPLETION OF ALL WORK UNDER THIS CONTRACT SHALL BE INCREASED BY O WORKING DAYS AS A RESULT OF THIS CHANGE ORDER. RECOMMENDED BY: APPROVED AS TO FORM: (:, /~1~/,.! (DATE} APPROVED BY: DISTRIBUTION: INSPECTION FILE (ORIGINAL), PURCHASING, CONTRACTOR ~//9~;7 (DATE) {DATE} Tracking#: PWM19-725UTIL CARLSBAD MUNICIPAL WATER DISTRICT MINOR PUBLIC WORKS CONTRACT REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS This agreement is made on the \(o~ day of t¾'y./\ \ , 2019, by the CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, hereinafter referred to as "CMWD", and VAUGHAN'S INDUSTRIAL REPAIR CO., INC., a California corporation, whose principal place of business is 16224 Garfield Avenue, Paramount, CA 90723 (hereinafter called "Contractor"). CMWD 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: Mark Biskup (CMWD 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 CMWD'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. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 1 of 10 General Counsel Approved 9/27/16 Tracking#: PWM19-725UTIL FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to CMWD 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 CMWD to disqualify the Contractor or subcontra/•rticipating in contract bidding. Signature: -~ ? ~ PrintName: ~ENT. @Nt;,1#(4.,/ REQUIRED INSURANCE. The successful contractor shall provide to CMWD, 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 CMWD 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 CMWD prior to such cancellation. The policies shall name CMWD as additional insured. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. WORKERS COMPENSATION AND EMPLOYER'S LIABILITY. Worker's 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. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 2 of 10 General Counsel Approved 9/27/16 Tracking#: PWM19-725UTIL 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. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless CMWD and the City of Carlsbad, and its 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 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 CMWD or City of Carlsbad. 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 five (5) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within six (6) months after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. /II /II Ill /II Ill Ill /II Ill Ill Vaughan's Industrial Repair Co., Inc. (name of Contractor) 535078 (Contractor's license number) C61 / D21 Machinery and Pumps 7/31/20 (license class. and exp. date) 1000013667 (DIR registration number) 6/30/19 (DIR registration exp. date) REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 3 of 10 16224 Garfield Avenue (street address) Paramount, CA 90723 (city/state/zip) 562-633-2660 x16 (telephone no.) 562-531-1204 (fax no.) jack@virc1.com (e-mail address) General Counsel Approved 9127116 Tracking#: PWM19-725UTIL 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 VAUGHAN'S INDUSTRIAL REPAIR CO., INC., a California corporation CARLSBAD MUNICIPAL WATER DISTRICT By: ~ (sign here) /1,1~ lr6$"~~UU:f4k~ (print na /title) Vicki V. Quiram, General Manager as authorized by the Executive Manager By;o/~gnr (print name/title) If required by CMWD, proper notarial acknowledgment of execution by Contractor must be attached . .!f...§. corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President 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. BR;~ER,~ne_.ral Counsel BY l__A_.,,~ Deputy General cl?usei REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 4 of 10 General Counsel Approved 9/27/16 Tracking#: PWM19-725UTIL 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 Business Name and DIR License No., %of Project to be Address Registration Classification & Total Subcontracted No. Expiration Date Contract Motor Repair Superior Electric Motor Svcs. 1000035656 N/A 12% 4622 Alcoa Ave Vernon, CA 90058 Total % Subcontracted: 12% The Contractor must perform no less than fifty percent (50%) of the work with its own forces. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 5 of 10 General Counsel Approved 9/27/16 Tracking#: PWM19-725UTIL EXHIBIT B REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS JOB QUOTATION ITEM UNIT QTY UNIT DESCRIPTION TOTAL NO. PRICE AMOUNT 1 EA 3 $15,886.43 Rebuild Pump as Described in Exhibit D $47,659.29 2 EA 3 $2,241.54 Rebuild Motor as Described in Exhibit D $6,724.62 3 EA 1 $1,200.00 Bond $1,200.00 TOTAL $55,583.91 *Includes taxes, fees, expenses and all other costs. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 6 of 10 General Counsel Approved 9/27/16 Premium subject to adjustment based on final contract price. EXHIBITC LABOR AND MATERIALS BONO Bond No. 100435390 Premium: $1,112.00 Tracking#: PWM19-725UTIL WHEREAS. the Board of Directors of the Carlsbad Municipal Water District has awarded to Vaughan's Industrial Repair Co., Inc. (hereinafter designated as the "Principar'}, a Contract for: REBUILD THREE CALAVERA RECYCLED WATER PUMPS ANO MOTORS CONTRACT NO. in the City of Carlsbad, in strict conformity with the drawings and specifications. and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incori:>orated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond. providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW. THEREFORE, WE, Vaughan's Industrial Repai( Co., Inc., as Principal, (hereinafter des.ignated as the "Contractor"}, and American Contractors Indemnity Company _______________ as Surety. are held firmly bound unto CMWD in the sum of fifty- five thousand five hundred eighty-three Dollars and ninety-0ne Cents ($55.583.91). said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns. jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplles, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract. or to the work to be performed hereunder or the specifications accompanymg the same shall affect its obligations on thi$ bond, and it does hereby waive notice of any change, extension of time. alterations or addition to the terms of the contract or to the work or to the specifications. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 7 of 10 General Counsel Approved 9127116 Tracking#: PWM19-725UTJL In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this '2,tJ 1'1-Executed by SURETY this 20th day day of tf/l/1'l"f: , 20J!l of March . 20~. CONTRACTOR: ~HvN111+1s kl/HsTn:tt (name of Contractor) a,:z(_ ~ /4 ~ (signheJ (print name here) V'~&G~e&vL (title and organization of signatory) (print name here) .$E.. C /<£ mtel (title and organization of signatory) SURETY: American Contractors Indemnity Company (name of Surety) 625 The City Drive So., Suite 205, Orange, CA 928 {address of Surety) (714)740-7000 (signature of Attorney-in-Fact) Freddy Anvari (printed name of Attorney-in-Fact) ( attach corporate resolution showing current power of attorney) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) {President or vice-president and secretary or assistant secretary must sign for corporations. If only one offtcer signs. the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporat10n.) APPROVED AS TO FORM: CELlA A BREWER General Counsel ~ JL_ By: j) Deputy General Coons~ REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 8 of 10 General Counsel Approved 9127/16 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange on 03/2ofao11 ~ I before me, ________ K_._H_o_,_N_o_t_a-'-ry_P_u_b_l_ic _______ _, Date Here Insert Name and Title of the Officer personally appeared ---------------'F---'r---=e--=d--=d_,_y-'--A-'-'--n'---'-v--=a-'-'ri ____________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(,I) whose name(s) is/ane subscribed to the within instrument and acknowledged to me that he/~/t~ executed the same in his/oot/~ authorized capacity(~). and that by his/heel~ signature()sj on the instrument the person(I), 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 ---------------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 11 --za Title or Type of Document: Bond II I OO, 3 5 J 1 () Document Date; _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ___________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: Freddy Anvari Signer's Name: ____________ _ 0 Corporate Officer -Title{s): _______ U Corporate Officer -Title(s): ___________________ _ [l Partner -[ l Limited U General LJ Partner -0 Limited D General C Individual KJ Attorney in Fact I ] Individual LJ Attorney in Fact [] Trustee C Guardian or Conservator ~I Trustee C Guardian or Conservator LJ Other:------------~-~ LJ Other: ______________ _ Signer Is Representing: Ai«6l!./lAN ~ Signer Is Representing: ________ _ ~ ~~~~~~~:1,'§1:$~~~~~~~~~ ©2014 National Notary Association• www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 TOKIO MARINE HCC KNOW ALL MEN BY THESE PRESENTS: POWER OF ATTORNEY That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, FREDDY ANVARI its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number _1_0_0_4_3_5_3_9_0 __________ _ issued in the course of its business and to bind the Company thereby, in an amount not to exceed ____________ O~n~e~h~u~n~d~re~d_t~h~o~u~s~a_nd~a_n~d~0~0~/~10~0~-----------<~--~$~1~0~0~,0~0~0~-~0~0 ___ ). This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the pt day of September, 2011. "Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed President on this pt day of June 2018. ,,,""""""'''' , ~~'~-(_~~~~~~s:/,,,..,, ~ 0 .. ', ~ ~ t:r:···WCORPORATE0·.1~\ ~ U,,I,~. SEPT, 25, 1990 :' "'(' ~ \~·;... ,.{o'f '-',,,,,,,.,~4t·;F·oR~'~,,--~----,,,,,r,1,11n\\' State of California County of Los Angeles By: Ada AMERICAN CONT by its A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accurac , or validit of that document. On this pt day of June, 2018, before me, Sonia 0. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS my hand and official seal. • s;gnatuce ~ (seal) I e e e e e ~:o~u.;R~ e e .. Not.try Pl.lb-lit • Ca!tfr1rni4 f i lZ1At1if>it-1-Co1.!1ty f Cemmh~lon, 2239◄ 7; -My C01"1l"I, ExpltH•ps 23, 202' I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this ____l_0th ___ day of ____ M_a_rc_h ___ _ 2019 Bond No. 100435390 Agency No. 6770 HCCSZZPOAACIC06/2018 EXHIBIT D SCOPE OF WORK FOR CALAVERA HILLS RECYCLED WATER PUMP REHABILITATION PROJECT DISCRIPTON: The work includes refurbishment of both the motor and pump assembly of three (3), 4-stage vertical turbine pumps with 60 hp. vertical electric motors as described below. Repair components and material shall be of equal or greater quality than original equipment and approved by CMWD. Relevant record drawings and existing equipment details for the pump/motor and the station is included as part of Exhibit "E" of this contract. The Contractor shall be familiar with the pump station site and the existing equipment by inspecting the site and the equipment prior to entering this contract. CMWD will coordinate with the Contractor for the removal and reinstallation of the equipment as described below. Scheduling of the work requires two (2) pumps to remain operational at the pump station while a single pump assembly is removed and refurbished. LOCATION: 4758 Rift Road, Carlsbad, CA. WORK AND MATERIALS PROVIDED BY CONTRACTOR: ITEM NO. 1: PUMPS, 3 -EA. 1) Contractor personnel will arrive on site and verify proper isolation of equipment. 2) Uncouple pump, remove drive motor and set aside. 3) Remove pump, load pump and motor onto Contractor provided flatbed and transport to Contractor repair facility. Crane and crane operation provided by CMWD see below. 4) Disassemble pump, clean, measure /record disassembly data, and advise.** 5) Fabricate all new line and lower bowl shafts from 416 SS material. 6) Straighten all shafting to .002" TIR maximum per API specification. 7) Fabricate all new bowl, suction eye and stuffing box bushings from 660 bronze material. 8) Machine impeller wear rings minimum clean; Fabricate and install new bowl wear rings. 9) Sandblast bowls, columns and head and apply 2-part epoxy coating to all wetted areas. 10) Dynamically balance impeller/shaft assembly to ISO 1940, quality grade G-2.5. 11) Assemble with SS shaft couplings/fasteners, rubber line shaft bearings and reconditioned mechanical seal. 12) Apply 2nd coat of epoxy exterior protective coating to complete assembly, matching existing exterior colors of pumps and motors. 13) Deliver to site, and VIRC personnel will install pump, motor and mechanical seal. * 14) VIRC will verify rotation, set impeller lift, test run pump and provide overhaul data report. ITEM NO. 2: MOTORS, 3 -EA. 1) Remove, load along with pump as described above. 2) Disassemble, clean, inspect and advise. 3) Test, clean, reinsulate, hi-pot, dip and bake stator. 4) Clean, dip and bake, re-insulate rotor. 5) Dynamically balance rotor assembly. 6) Install all new radial and thrust bearings and sight glass. 7) Reassemble, apply exterior protective coating/paint, 8) Deliver to site and reinstall along with associated pump, coordinating with CMWD and CMWD provided crane. SUPPORTING WORK PROVIDED BY CMWD: 1) LockouUtagout electrical switchgear, connecUdisconnect motor leads and hydraulically isolate pump(s). 2) Provide crane and crane services for the removal and installation of the pump(s) and motor(s) at the pump station site. CMWD provided crane will provide for loading and unloading to Contractor's truck at the pump station site only. 3) Disconnection and reconnection of pump from pump suction and discharge manifolds. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 9 of 10 General Counsel Approved 9/27/16 COORDINATION: Contractor and CMWD shall coordinate removal and reinstallation of pumps and motors. The schedule of the removal in reinstallation shall be agreeable and coordinated between CMWD and the Contractor. Contractor is responsible for transporting equipment to the location for repairs and returning to the pump station. CMWD will provide the crane and operator to remove the pump and motors and then to reinstall the pump and motors when returned from the Contractor. WARRANTY: Contractor shall provide written warranty for all workmanship and material provided in the rehabilitation in addition to any required warranty stipulated in the contract. * CMWD personnel to lockout/tagout electrical switchgear, connect/disconnect motor leads, hydraulically isolate pump for service and provide crane services as required. ** If additional repairs are required, CMWD will be notified before work is performed. REBUILD THREE CALAVERA RECYCLED WATER PUMPS AND MOTORS Page 10 of 10 General Counsel Approved 9/27/16 Exhibit E Mechanical Floor Plan T -' T I ;,, --, I I I I I I I I ..,I -I 01 ,s1 _, I I I .l. 8'-0" 200.60 ~lfMW!l'f"' w/;~;; DWG. No.58 '( / I / r/ I I I I I I I I I I I I I I I I I I I ~I I I I I I I l· I I I I I I I I I I Ao PUIIPING 1.1111' PERFORMANCE aJllllllllN INSCIWlGE TOTH. -er~ OYN.IMIC HYllR.\IJUC ~ T 1 440 217t15 75.0 2(1) 620 250 ai.s 3 800 195*15 n.o 111N111U11 SHUT-Off t£All 315 FT. SEl.fCTID MOTOR SIZE 60 HI'. TELEMETRY (O.F.0.1.) MCP 32•-o· VfO 1 7'-o· MECHANICAL FLOOR PLAN SCALE: 3/8"a1·-o· r ! -i:, _J VfO 2 s•-4• --, l 5'-3" 12" LUGS MCC MAJN 4'-10" 3• -o• CONCRETE WALK (TYP.) 1 C.O.T.G. P£R -CIIWO STD. DWG. No.SB CG @ PUMP STATION NORTH EXHIBIT E MA'TERJAL ANO WORK DESCRIPTIONS (DWGS. 11-1. 11-21 <l 11-3); 0 8" RESILIENT WEDGE GATE VALVE WlTH HANO WHEEL OPERATOR, FLG. X Fl.G. @ 8" VICTAUUC COUPLING, STYI..E 77. @ 8" PRESSURE REUEF VALVE (SUITABLE FOR 300 LB. WORKING PRESSURE). S<1" AT 200 P.S.L 0 12"X12"X6" TEE (PI..AIN X PlAIN X Fl.G.). @ 12"X8" ECCENTRIC REDUCER. TOP LEVEL (Fl.G. X PLAIN). @ FLOOR DRAIN WITH CAST IRON GRATE ANO BRONZE STRAINER {ZURN 2415 OR EQUAL). 0 60 HP VERTICAL T\JRBINE PUMPING UNIT. @ TWO (2) 1" HAI.F COUPLINGS WITH 1" CORPORATION STOPS PER CMWO STANDARD DRAWINGS W9 AND WI 0. SET ONE AT 45• OFF TOP OF PIPE. @ 8" FLG. SILENT CHECK VALVE. @ 8' VICTAUUC COUPLING. (u) 8" FLG. RESILIENT WEDGE GATE VALVE WITH HAND WHEEL OPERATOR ANO CLASS 2SO FLANGES. @ 12"X12"X8" TEE (PI..AIN X PLAIN X FLG.). @ CORE DRILL MASONRY WALL FOR 8" RWD. PROVIDE 1" ANNUi.AR SPACE BETWEEN OUTSIDE OF PIPE AND BLOCK WALL FILL ANNUi.AR SPACE WlTH NON-SHRINK GROUT. PROVIDE 1/2" DEEP SEAV,NT AT OUTSIDE FACE OF WALL (j] 8" FLG. MAGNETIC FLOW METER. @) 12"X8" REDUCING 90' aeow (PLAIN X FLG.). @ 12" STD. WT. CML. WSP DISCHARGE HEADER. @ 8" STD. WT. CML. WSP PUMP DISCHARGE. @ FABRICATED STEa. DISCHARGE HEAD PER SPECIFICATIONS. @ 12" RESILIENT WEDGE GATE VALVE (Fl.G. X Fl.G.) W1TH VALVE CAN ASS£M0LY PER CMWO STANDARD ORAWlNG W18. VALVE SHALL BE SUITABLE FOR A WORKING PRESSURE OF 250 P.S.I. AND SHALL BE EQUIPPED WITH 250 LB. FLANGES. @ 1/2" VOLUTE DRAIN FROM PUMP HEAD TO DRAIN. 1/2" TYPE K COPPER TUBING. @) PROVIDE A 2" GAP BETWEEN END OF COPPER TUBING AND DRAIN PIPE. @ 18"X18"X12" TEE (PLAIN X PI..AIN X FLG.). @ 12" RESILIENT WEDGE GATE VALVE WlTH VALVE CAN ASSEMBLY PER CMWD STANDARD DRAWING W18. ® 12"X8" LONG RADIUS REDUCING ELBOW (Fl.G. X FLG.). @ 12" 90' ELBOW {PLAIN X PLAIN). @ ~ ~rr~t'J ~ ~~l~~E~mRE~~ ~is°i'.~JO~G. ii ~~iP~1i1iHALL 250 LB. FLANGES. @ 12" BUTT STRAP. @ 18" STD. WT. CML & TC, WSP SUCTION HEADER. @ RUNNING TRAP WITH AOJUSTABLE CLEAN OUT TO GRADE. 2URN. JOSHAM. OR EQUAL ® AIR COMPRESSOR AND 60 GALLON RECENER. @) 18" 90' ELBOW (PIAIN X Fl.G.). @ 18"X12" CONCENTRIC REDUCER (PLAIN X Fl.G.). @ 12" LONG RADIUS SMOOTH BEND 90' EUlOW. TRIMMED TO 83"± (FLG. X fLG.). ® 12" 90' ELBCW (PIAIN X Fl.G.). @ 12"X12"X12" TEE (PLAIN X Fl.G. X FLG.). @ 12"X12"X12" TEE (PIAIN X PIAIN X PIAIN). @ 8" RESILIENT WEDGE GATE VALVE WITH CLASS 2SO FLANGES AND VN..VE CAN ASSEM0LY PER CMWO STANDARD DRAWING W18. @ 12"x6" CONCENTRIC REDUCER (FLG. x PIAIN) @ 8" SHORT RADIUS 90' ELBOW (PLAIN X FLG.). @ a• STD. WT. CUL. WSP DISCHARGE HEADER @) FIRE EXTINGUISHER UOONTEO TO MASONRY WALL CONFIRM LOCATIONS WITH OWNER PRIOR TO INST-'I.IATION. FIRE EXTINOLISHER SHALL BE PROVIDED IN ACCORDANCE WITH SPEClflCATIOH SECTION 10520. M-1 "AS BUILT" A?P/4·,~ .?IB-r,, P.E. UJ.1/, EXII ,.)-3 (• (2..... DATE. 8·/.1•(77 INSPECTOR DA TE fsirull CITY OF CARI.SBAD 1~ t====t===t==========================:::====t===:1====t===! L!.!J. ENGINEERING DEPARTMENT . LlU l----l----+-------------+--+--1---1-~ IIIPROVEllEIIT PLA!l3 FOR: ENCINA IIASIN WAltR RECI.AMATIOH PROGRAM, PHASE I CIILA\/ERA RECYCl.ED WAltR PUMP STATION EOUl'l,Sff BUI.DINCI LECIWICAl. Pl.AN L' . ) . . -___ _1__ __ -....; _ __L __ __J,_ ,--------------------------------------------------~-- ' ' ' ROOF MOUNTED i ROOF MOUNTED EXHAUST FAN ' EXHAUST FAN (Efl) ' (Ef2) w:-~-~-:~1 n--~-7 --=--~;,1 1! '·x-/ :1 i! '-x,/ ;1 ::_/, -,,:: ::/ ·,.·l Lll:'..::.--=.-..::..-..::..~J ~11:'~--=---=---=-",j.J ' : BB B R BB " _/ <= '-/ I ' /, ', ' / ·,_i r= ROOF ACCESS HATCH J AND LADDER DOUBLE LEAF ROOF HATCH WITH SKYl/GHTS (TYP.) i : i ~---------+-----32•-o· -,--------~-j PUMP STATION NORTH ROOF PLAN SCALE: 3/8"=1'-0" ,ii 196.0 _C_G __ 218.67 lw"- OUT-OF-SECTION ---------- ASPHALT PAVEMENT DOUBLE LEAF ROOF HATCH WITH SKYLIGHTS EXHAUST FAN ---..,----------~ 10·-1· 10'-7" EL 19+.50 (BOTTOM OF SUCTION BELL) EL 193.00 (BOTTOM or SUCTION CAN) SECTION BOOSTER PUMP SCALE: J/8"=1'-0" , A.!J rt M-2 "AS BUILT" s-19~,o P.E. UflJ, EXP.~ DATE REV1El'£D BY: Joe ,1/,:,.f/,rAc,n 6'·/-'•t7? INSPECTOR DATE fSHEET] CITY OF CARL'3BAD ISHEETSI ~====t===j============================1====1===jt===jt==j LJ1_J ENGINEERING DEPARTMENT 29 l----+-------1--------------+---+---jl--+--l IMPROVEMENT PLANS FOR: ENCINA BASIN WATER REC\J\MATION PROGRAM. PHASE I CAL.AVERA RECYCLED WATER PUMP STATION EOUf'Ll;NT IM.OtlCl MECHANICAL ROOF PLAN AfO SECTION it· ' ) ! - ll ) . ' I , • I ! I ..• , ''.i t ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) ~ 2/25/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 vV,.OMv Catherine Montoya NAME: Milestone Risk Management & Insurance Services PHONE (949)852-0909 I r..e~.No): (949) 852-1131 IAlr Nn C-·"· License No. 0B72766 ~t1cf~~ss: cmontoya@milestonepromise.com 8 Corporate Park, Suite 130 INSURER/SI AFFORDING COVERAGE NAIC # Irvine CA 92606 INSURER A: Liberty Surolus Insurance Coro 10725 INSURED INSURER B: American Fire & Casualty Insurance 24066 v.s.s. Sales, Inc. INSURER C : Underwriters at Lloyds 15792 16224 Garfield Avenue INSURER D : Insurance Company of the West 027847 INSURER E: Ohio Casualty Insurance Co. 24074 Paramount CA 90723-0000 INSURER F: COVERAGES CERTIFICATE NUMBER: 19/20 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE •••~n ,.n,n POLICY NUMBER IM M/DD/YYYYI IMMIDD/YYYY\ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE W OCCUR DAMAGE TO RENTED A PREMISES rEa occurrence\ $ 100,000 -X 100033067301 2/23/2019 2/23/2020 MED EXP (Any one person) $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 - GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Fl 0PRO-□LOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 fEa accident\ -X ANY AUTO BODILY INJURY (Per person) $ B >--ALL OWNED ~ SCHEDULED BAA(20) 56755498 2/23/2019 2/23/2020 BODILY INJURY (Per accident) $ >--AUTOS >--AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS t Per accident' >-->-- Comp/Coll Deductibles $ $1000/$1000 UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 5 000,000 - C X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION $ 0 CAS000040601 2/23/2019 2/23/2020 $ WORKERS COMPENSATION I PER I I UTH- AND EMPLOYERS' LIABILITY X STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA D (Mandatory in NH) y WSA504410800 11/1/2018 11/1/2019 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS below E Leased/Rented Equipment BKO (19) 56755498 2/23/2019 2/23/2020 Limit/Ded $50k/$lk DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Agreement No. PWM18-13UTIL -Repair 500 HP US Electrick Motor for Encina Vertical Pump and Rebuild Three Valmatic Valve Dampener Controls. Where required by written contract, The City of Carlsbad/CMWD is included as an additional insured as respects General Liability per the attached endorsements. Workers' Compensation waiver of subrogation applies per the attached endorsement. *30 days written notice of cancellation to the certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad/CMWD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o EXIGIS Insurance Compliance Services ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4668 New York, NY I ACORD 25 (2014/01) INS025 c201401J -ECM #35050 10163-4668 AUTHORIZED REPRESENTATIVE Catherine Montoya/CAM C--1.:1:l. ii.f..'r_c. ;Ii£_ ~y }lth' CZ7')•Ljc.L-' © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD / I _,._...,,, ..... Libcrh' ,I Commercial General Liability Surplu~ lnsurann· Corporation . LIBERTY SURPLUS INSURANCE CORPORATION (,\ New I lampshirc Stock Insurance Company, hereinafter the "Company11) ENDORSEl\IENT NO. 1 Effective Date: 2/23/19 to 2/23/20 Policy Number: 100033067301 Issued To: \T.S.S. Sales, Inc. 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) . -\ny person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; .-\ny other person or organization you are required to add as an additional insured under the contract or agreement described in the paragraph above. Location(s) Of Covered Operations .\11 locations of covered operations . (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 injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. .-\11 work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or © IS() Properties, Inc., 2004 Commercial General Liability _,.-__._..., Liberty ., Surplus lnsuram:e Corporation . 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. © ISO Properties, Inc., 2004 Commercial General Liability Liberty Surplu~ lnsurann· Corporation . LIBERTY SURPLUS INSURANCE CORPORATION (A New I lampshire Stock Insurance Company, hereinafter the "Company") ENDORSEJ\IENT NO. 2 Effective Date: 2/23/19 to 2/23/20 Policy Number: 100033067301 Issued To: V.S.S. Sales, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERA TIO NS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; "\ny other person or organization you are required to add as an additional insured under the contract or agreement described in the paragraph above. Location and Description Of Covered Operations All Locations and Description of Covered Operations (Information required to complete this Schedule, if not shown above, will be shown in the Declarations) 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 injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". © ISO Properties, Inc., 2004 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT· BLANKET WC 990634 (Ed. 8-00) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be 3 % of the total California Workers' Compensation premium otherwise due. Person or Organization ANY PERSON/ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT Schedule Job Description ALL CALIFORNIA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 11/01/2018 Policy No. WSA 5044108 00 Insured VS S Sales Insurance Company INSURANCE COMPANY OF THE WEST Endorsement No. Premium $ INCL . Countersigned By ____________ _ WC 9906 34 (Ed. 8-00) INSURED