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HomeMy WebLinkAboutXylem Dewatering Solutions Inc; 2018-12-06; PWM18-469UTILRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2019-0354198 111111111111 lllll 11111111111111111111111111111111111111111111111111111 Aug 21, 2019 08:12 AM OFFICIAL RECORDS Ernest J. Dronenburg. Jr, SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins $0 00) PAGES 2 Space above this line for Recorder's use. PARCEL NO: 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 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 June 30, 2019. 6. The name of the contractor for such work or improvement is Xylem Dewatering Solutions, 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. PWM18-469UTIL, Project No. 38401, Project Name Cannon Sewer Lift Station Pump Multismart Control Panel Installation. 8. The street address of said property is 2197 Cannon Road, in the City of Carlsbad. I, the undersigned, say: ~f Scott Chadwick, VERIFICATION OF CITY CLERK I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on Au~l/5 f ;}np(, , 2019, accepted the above described work as completed and ordered that a otice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on Avju.S+ 5th, 2019_, at Carlsbad, California. J-l~cfo, Gorn~ 2. r-+-~~~==::::=-.µLJe.P.IJ:bl-c, j c Jet>,(' City Clerk Q:\Public Works\Utilities\ADMINISTRATIONIAGREEMENTS & CONTRACTSIAGREEMENTS & CONTRACTS\Xylem -Multismart Control Panel\NTP, NOC, API & Cover\NOC (Public and Private) -revised 2019-02-07.doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Xylem Dewatering Solutions, Inc. has completed the contract work required for Contract No. PWM18-469UTIL, Project No. 38401 for Cannon Sewer Lift Station Pump Multismart Control Panel Installation. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS City Installation of a new pump control panel technology at Cannon sewer lift station CERTIFICATION OF COMPLETION OF IMPROVEMENTS VALUE $19,629.42 ~rL-1-21-11 Don Wasko, Utilities Manager 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 improvements. anager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By C.A~ Deputy City Attorney Q:\Public Works\Utilities\ADMINISTRATIONIAGREEMENTS & CONTRACTS\AGREEMENTS & CONTRACTS\Xylem -Multismart Control Panel\NTP, NOC, API & Cover\API (Public Works) -revised 2019-02-07.doc PWM18-469UTIL CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT CANNON SEWER LIFT STATION PUMP MULTISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 This agreement is made on the (o~ day of <v~ W , 2018, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Xylem Dewatering Solutions, Inc., a New Jersey corporation, whose principal place of business is 11161 Harrel Street, Mira Loma, CA 91752 (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: Jesse Castaneda (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. CANNON SEWER LIFT STATION PUMP MULTISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 Page 1 of 6 City Attorney Approved 9/27 /16 PWM18-469UTIL 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~or the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contra.ct~,~ _ , • Signature: _ ~~--/U£ei: ~ _ Print Name: Graham Hackett-Regional Sales Manager:$:•--, "jf--(k 5 / / .,7/t,(,.f_ ~-~ --' REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification t:A/1/1.£.t:?y~ of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' f 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. 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. CANNON SEWER LIFT STATION PUMP MUL TISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 Page 2 of 6 City Attorney Approved 9/27/16 PWM 18-469UTI L 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 ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within five (5) working days after commencing work. CONTRACTOR'S INFORMATION. Xylem Dewatering Solutions, Inc. (name of Contractor) 826400 (Contractor's license number) C-61 I D21 -Machinery and Pumps 10/31/19 (license class. and exp. date) 1000004522 (DIR registration number) 6/30/19 (DIR registration exp. date) /II /II Ill /II /II /II Ill /II Ill Ill Ill CANNON SEWER LIFT STATION PUMP MUL TISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 Page 3 of 6 11161 Harrel Street (street address) Mira Loma, CA 91752 (city/state/zip) 951-332-3668 (telephone no.) 951-332-3679 (fax no.) Alan.Dahlgvist@xyleminc.com (e-mail address) City Attorney Approved 9/27/16 PWM 18-469UTI L 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 XYLEM DEWATERING SOLUTIONS, INC., a New Jersey corporation "~¥~ ( n her /JJ;V/ftcL ,/. LJ£L2-IA/tVJgj) CITY OF CARLSBAD, a municipal corporation of the State of California By: Vicki V. Quiram, Utilities Director as authorized by the City Manager (print name/title) Vie£ ,/7,eE.$/.tJC.111T l!N.& By: L}1J!Et:Tt:J/J_ Or &t4J (sign here) (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !f..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: CANNON SEWER LIFT STATION PUMP MUL TISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 Page 4 of 6 City Attorney Approved 9/27/16 PWM18-469UTIL 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 CITY OF CARLSBAD, a municipal corporation XYLEM DEWATERING SOLUTIONS, INC., of the State of California :;;;•~~lo~o'/Clk By /4 /)Jl~ ·~, Vick;V. Quiram, Utilities Director as fe . ~ 1/ fl authorized by the City Manager t..LJl&II/E& 0. IS.8/22a!J r 1cer~rn (print name/title) 4 /1itJ c[}; ff(! Tt1£.. tJ/ t/ilr:1-//,/ce~?!__.. By: (sign here) (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. ~ 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 jnQ.2 ~ ..z." Deputy CityAflorney CANNON SEWER LIFT STATION PUMP MULTISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 Page 4 of 6 City Attorney Approved 9/27/16 ,, XYLEM DEWATERING SOLTUTIONS, INC, ii<"'*** UNANIMOUS CONSENT 01r THilDJ)J\RD OP DIRECTORS WHEREAS: The undersignedJ constituting oll of th!} of Direot01·s of Xylem Dewate1·i11g Solutions. lnc .• a co1·po1'alio11 fo1med pursuant to the ln.ws of the State of Now Jersey (the ''Col'poration")> hereby take the f(?llowiug actions and consents to. approves and adopts tl1e. followlng re.solutions. without a meeting, p\lrsuant to the provisions of New Jors¢y Cotpol'ation Act, Section ~4A:6~7. l Qfthe New Jersey Statutes, with the same effect as if tntoh aotions wero taken pursuant to 1·esoluUons prc;sented to1 and ndoptcd nt a duly called mooting of the Directors of the Corporation. RESOLVElJ: That the acts and oontt·i,.cts of tbe cut·root and past officers of tho Col"poradon are het'eby adopted, ratifioo and approved. RESOLVED FORTH.ER: That the following no.med porsons are appointed as officers of Um CoJ'poration in tho onpaoities indicated oppoiiile 1hl)ir respective names, to serve as officers from this date forward until their resignation, removal 01· death or until theit sncoessors are duJy appointed, hujjyllfi!iJlS David Flinton AnooDellllY J1111ePobsoJl Keith Richey Linda Ly11oh SonluHollles Theresa Gladstein ±obcrtLY?fll 'l'lmGla1.m· Dan Hollategge Karen Lutz .1~ .. -, .. , i ~ I -.,.. Officers Pt(I.Sldcnt Vice Pr(l,,'lldent. Treasul'er & Controller Vice Pri:isidont, Seorotary & Oenernl Counsol Vfco Prosldont & Assistant Secretnry Vice Prosldont & Assiatant'fteasul'ct Vloo President&; Allllsteut 'freasul·er Vfoe Pro11ltlont & Asslstant 1'roo!uror Vice Prosident 8,, Assistant Tusauter Vkc Prosldent Vice President Vfoe Pr03ident Vice President Viet Prealdent ' RESOLVED FURTHER~ That 11ny previous appointment of officers for the Corpomtion is hereby revoked. ' RESOLVED FURTHER! That this Unn.11imuuN Written Consent may be exeout~d In any number of counterparts, each of which wl1en so executed shall be ~eemed to be an original and all of which when taken togethor shall constitute one and th') same document, and that the different Dil'ectol'S of the Col'pmmion need not be signatories to tho same counterpart, IN WITNESS WHEREOF~ the -undendgned have ex.eo'Uted tJtis U: 30, 2016. ·--···-----------------------------------~-------J PWM 18-469UTI L 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 ,.._\'C'{\P, Total % Subcontracted: __ C-'--,__,'~--0 __ _ The Contractor must perform no less than fifty percent (50%) of the work with its own forces CANNON SEWER LIFT STATION PUMP MUL TISMART CONTROL PANEL INSTALLATION CONT. NO. 38401 Page 5 of 6 City Attorney Approved 9/27/16 PWM18-469UTIL EXHIBIT B CANNON SEWER LIFT STATION PUMP MULTISMART CONTROL PANEL INSTALLATION Install multitrode multismart control panel on pump at Cannon sewer lift station. JOB QUOTATION ITEM UNIT QTY DESCRIPTION NO. 1 EA JOB #84-80 01 59, MUL TISMART MSM 3MP2PLUS+ 3 PUMP W/MTR PROT PLUS SOFT 1 EA JOB #14-60 30 09, SUPPLY, BATTERY POWER, 55W, 12V TRICKLE CHARGE, DIN RAIL KIT 2 EA JOB #14-60 30 26, BATTERY, PM 12120, 12V 12AMP ($97 EA) #14-69 97 65S, PUMPVIEW AGREEMENT SILVER 1 EA JOB PPD ONE YEAR AGREEMENT (NO TAX) First One (1) Year of monitoring will be included with the agreed purchase Multismart systems. 1 EA JOB #14-40 02 56, KIT, SURGE PROTECTION 240V 1PH+ STRIKESORB 1 EA JOB #14-60 30 84, KIT, PUMPVIEW CLOUDGATE MODEM+ VERIZON/ATT HIGH GAIN ANTENNA 1 EA JOB #83 77 80, PROBE, LEVEL 2.5/10-30FS 30M 1 EA JOB #83 78 20, BARRIER, SAFETY 10-CHANNEL 9 EA JOB #14-40 41 28, TRANSFORMER, CURRENT 150:5 ($40.50 EA) SUBTOTAL 1 EA JOB TAX 48 EA JOB #14-69 00 04A, LABOR, MOBILE FL YGT, NO TAX ($164 EA) 1 EA JOB FREIGHT CHARGE TOTAL* *Includes taxes, fees, expenses and all other costs. CANNON SEWER LIFT STATION PUMP MULTISMART CONTROL PANEL INSTALLATION PRICE $6,136.24 $209.00 $194.00 $0.00 $484.50 $1,318.85 $897.30 $872.10 $364.50 $10,476.49 $811.93 $7,872.00 $469.00 $19,629.42 CONT. NO. 38401 Page 6 of 6 City Attorney Approved 9/27 /16 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 11/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marsh USA, Inc. PHONE I rffc Nol: 1166 Avenue of the Americas ,.,,,._ No Extl: New York, NY 10036 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# CN108453421-STND-GAWUe-18-19 INSURER A : ACE American Insurance Company 22667 INSURED INSURER B : ACE Fire Underwriters Ins. Co. 20702 Xylem Water Solutions USA, INC 35300 14125 South Bridge Circle INSURER c : Allianz Global Risks US Insurance Comoanv Charlotte, NC 28273 INSURER o : lndemnitv Insurance Comoanv of North America 43575 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: NYC-010338181--06 REVISION NUMBER: 17 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR ,:~Mi~ POLICY EXP LIMITS LTR •••~n ~,n POLICY NUMBER IMM/DD/YYYYI C X COMMERCIAL GENERAL LIABILITY USL00107118 10/31/2018 10/31/2019 EACH OCCURRENCE $ 1,000,000 -~ CLAIMS-MADE 0 OCCUR DAMA<3E i;yE RENTED PREMISES Ea occurrence\ $ 1,000,000 MED EXP (Any one person) $ 10,000 - PERSONAL & ADV INJURY $ 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 ~ •PRO-DLoc $ 6,000,000 POLICY JECT PRODUCTS -COMP/OP AGG OTHER: SIR: $1,000,000 $ A AUTOMOBILE LIABILITY ISA H25272754 10/31/2018 10/31/2019 COMBINED SINGLE LIMIT $ 3,000,000 /Ea accident\ X ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ f--HIRED -NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY /Per accident\ $ f--- $ (.; X UMBRELLA LIAB M OCCUR USL00109918 10/31/2018 10/31/2019 EACH OCCURRENCE $ 5,000,000 f-- EXCESSLIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 $ D WORKERS COMPENSATION WLR C65437065 (AOS) IU/J I/LU 10 10/31/2019 X I ~ffTUTE I I OTH- AND EMPLOYERS" LIABILITY ER B Y/N SCF C65437107 (WI) 10/31/2018 10/31/2019 2,000,000 ANYPROPRIETOR/PARTNERIEXECUTIVE 0 E.L. EACH ACCIDENT $ A OFFICER/MEMBER EXCLUDED? NIA 10/31/2019 (Mandatory in NH) WLR C65437028 (CA, MA, OR) 10/31/2018 E.L. DISEASE -EA EMPLOYEE $ 2,000,000 If yes, describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE· POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is required) City of Carlsbad and its officials and employees are included as Additional Insured (except Workers' Compensation) where required by written contract. This insurance is primary over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of Subrogation is applicable where required by written contract and as permissible by law. CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1635 Faraday Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Carlsbad, CA 92008 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I Lauren Giagrande ~ ~~~ © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: USL00107118 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILlTY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): As required by Contract. Information reauired 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the perfom,ance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.B.With respect to the insurance afforded to these additional insureds, the following Is added to Section 111-Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number XYLEM INC. 1133 WESTCHESTER AVENUE Policy Number WHITE PLAINS NY 10604 Symbol: WLR Number: C65437065 Policy Period Effective Date of Endorsement 10-31.2015 TO 10-31-2019 10-31-2018 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the oclicv number. The remainder cf the information is to be comoleled onfv when this endorsement is lBSued subseauent to !he 11raMralicn of the oo'""'. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Representative -WC 00 03 13 (11/05) Ptd. U.S.A. Copyright 1982-83, National Council on Compensation Workers' Compensation and Employers' Liability Policy Named Insured i Endorsement Number XYLEM INC. I 1 INTERNATIONAL DRIVE Policy Number RYE BROOK NY 10573 Symbol: WLR Number: C65437065 Policy Period Effective Dale of Endorsement 10-31.2018 TO 10-31.2019 10-31-2018 Issued By {Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the oolicv number, The remainder of the infannatiori is to be com Dieted onlv when this endorsa,nent is isaued subseauent to the oreoaralion of tho oolicv. POLICY INFORMATION PAGE ENDORSEMENT The following item(s) 1. • lnsured's Name 11. 0 Item 3.8. Limits 2.0 Policy Number 12.• Item 3.C. States 3.0 Effective Date 13.• Item 3.D. Endorsement Numbers 4.0 Expiration Date 14.• Item 4. *Class, Rate, Other 5. 00 lnsured's Mailing Address 15. 0 Interim Adrustment of Premium 6. • Experience Modification 16.• Carrier Servicing Office 7, • Producer's Name 17.• Interstate/Intrastate Risk ID Number a.• Change in Workplace(s) of Insured 18.0 Carrier Number 9.0 lnsured's Legal Status 19.• Issuing Agency/Producer Office Address 10.0 Item 3.A. States is changed to read: THE INSURED'S MAILING ADDRESS HAS BEEN REVISED TO READ: XYLEM INC. 1 INTERNATIONAL DRIVS RYE BROOK,NY 10573 WC 99 06 00B (08114) Authorized Representative © Includes copyright material of the National Council on Compensation Insurance, Inc. used with it.s permission. 11-09-2018 NYU INSURED COPY CKE-1U76A Page 1 ot 1