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HomeMy WebLinkAboutCoastal Colors Painting Company Inc; 2020-01-02; PWM20-949GSDocuSign Envelope ID: 025E9543-03A4-42FB-A2A4-81A691E59A79 RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: DOC# 2020-0685813 1111111131111 I III 1111 IIII IIII IIII IlI It 11111411111111 Nov 04, 2020 10:00 AM OFFICIAL RECORDS Ernest J. Dronenburg, Jr., SAN DIEGO COUNTY RECORDER FEES: $0.00 (SB2 Atkins: $0.00) PAGES: 2 City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 Space above this line for Recorder's use. PARCEL NO: 215-050-70-00 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 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 Mar. 9, 2020. 6. The name of the contractor for such work or improvement is Coastal Colors Painting 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: Project No. PWM20-949GS, Project Name: Teak & Ipe Stain at Dove Library. 8. The street address of said property is 1775 Dove Lane, Carlsbad, CA 92011, in the City of Carlsbad. CITY OF CARLSBAD Geoff Patnoe, Assistant City Manager VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on c-2-(`) , , 20)L, 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 , 20 at Carlsbad, California. CITY OF CARLSBAD BARBARA ENGLESON City Clerk Q:\Public Works\General Services\Agreements & Contracts\Coastal Colors Painting\Teak & Ipe Stain at Dove Library - PWM20-949GS \ 5. NOC\2.NOC - Teak & Ipe Stain at Dove Library - PWM20-949GS.docx DocuSign Envelope ID: 025E9543-03A4-42FB-A2A4-81A691E59A79 CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Coastal Colors Painting Co., Inc. has completed the contract work required for PWM20-949GS - Teak & Ipe Stain at Dove Library. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE Refinish all teak tables and ipe wood trims at Dove $9,852 Library. CERTIFICATION OF COMPLETION OF IMPROVEMENTS John Maasho , Pub ic Works Manager 0\l'r-I'L Date 10/13/2020 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. - Geoff Patnoe, Assistant City Manager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By: Assistant City Attorney Q: \ Public Works \General Services \Agreements & Contracts \Coastal Colors Painting \Teak & Ipe Stain at Dove Library - PWM20-949GS \ 5. NOC13.API - Teak & lpe Stain at Dove Library - PWM20-949GS.docx CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT TEAK AND IPE STAIN AT DOVE LIBRARY PWM20-949GS This agreement is made on the j IJ(4_ day of~4-l,,<l.<-L~~.l(....l,~1-----' 2020, by the City of Carlsbad, California, a municipal corporation, (herein and Coastal Colors Painting Company, Inc., a California corporation, whose principal ace of business s 7668 El Camino Real -104- 737, Carlsbad, CA 92009 (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: Barney Dresman (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. Teak And lpe Stain At Dove Library Page 1 of 11 City Attorney Approved 1/25/2019 PWM20-949GS 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 tf/ ff Print Name: NI ~ /)q _ 7'--= (f/ IL It) I{ 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 "AX"; 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 corttract, 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. Teak And lpe Stain At Dove Library Page 2 of 11 City Attorney Approved 1/25/2019 PWM20-949GS 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 seven (7) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within thirty (30) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Coastal Colors Painting Company, Inc. (name of Contractor) 972518 (Contractor's license number) C33-Painting & Decorating 4/30/2020 (license class. and exp. date) 1000514160 (DIR registration number) 6/30/2020 (DIR registration exp. date) Teak And lpe Stain At Dove Library Page 3 of 11 7668 El Camino Real -104-737 (street address) Carlsbad.CA 92009 (city/state/zip) 760-27 4-5391 (telephone no.) N/A (fax no.) coastalcolors@gmail.com (e-mail address) City Attorney Approved 1/25/2019 PWM20-949GS 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 COASTAL COLORS PAINTING COMPANY, INC., a California corporation By: By: /L/.{l~ . (sigi'rn'e re) CITY OF CARLSBAD, a municipal corporation of the State of California By:~ /l/!( fl fi(L (JI Ii 10 JY -. St (l!_( T/1/<Y ' (print n~rfle/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: Teak And lpe Stain At Dove Library Page 4 of 11 City Attorney Approved 1/25/2019 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 Califom)a ? 2-: County_ o~ ~~/ -( ~ ...e_~ On I l [ L(o l2<J { q before me, -;...~.:...__c_.....:..._--,L...>,L.:...=_..=:._..L...:...!'=J..../....-1----+J'C.....V---=---,,£... Date personally appeared -+---\rL....>,,...,..~±::~----\--~b-l--~=-l___::::.--1------------- who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityQes), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ~LYONGUff C-.12297117 NotMy Public. c.ulomy s.n Diego County c-11,20ZJ Place Notary Seal Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoi aragraph is true and correct. Signatu ---------------OPTIONAL--------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ____________ Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name:-_. ___________ _ □ Corporate Officer -Trtle(s): ______ _ □ Corporate Officer -Title(s): _____ _ D Partner -D Limited D General D Partner -D Limited D General D Individual □ Attorney in Fact D Individual D Attorney in Fact □ Trustee □ Guardian or Conservator D Trustee D Guardian or Conservator □Other: _____________ _ D Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ ·~ ©2014 National Notary Association• www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 PWM20-949GS 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 No11 e Total% Subcontracted: The Contractor must perform no less than fifty percent (50%) of the work with its own forces. Teak And lpe Stain At Dove Library Page 5 of 11 City Attorney Approved 1/25/2019 PWM20-949GS EXHIBIT B Teak and lpe Stain at Dove Library Contractor to provide all material, tools and labor necessary to clean, sand and refinish teak tables and ipe wood trims at Dove Library, 1775 Dove Ln, Carlsbad, CA 92011. Scope of Work shall consist on all items mentioned in the contractor's proposal dated October 2, 2019. Locations of work to be performed are referenced in a drawing and pictures attached to this document as Exhibit "C". Cutsheet of material to be use is attached to this document as Exhibit "D". Additional Notes: QTY 2 Contractor shall power wash, sand, clean and stain 17 teak tables with Golden Care Teak Protector. Power wash, sand, clean and seal ipe benches in front and rear courtyards, exterior ipe trim in front courtyard, exterior light trims in front and rear courtyards, and decorative ipe at monument with Seal Once Premium Wood Sealer. Any runoff water shall be collected and disposed of properly, water shall not be permitted to run into drains, gutters, or offsite. Work to take place when library and cafe are closed. Schedule to be agreed with Project Manager Second application to take place within 12 months if needed. Notification will be given to the contractor 30 days prior for second application. JOB QUOTATION UNIT DESCRIPTION PRICE EA Prep and refinish all teak tables and ipe wood trims at Dove Library $8,410 TOTAL* $16,820 *Includes taxes, fees, expenses and all other costs. Teak And lpe Stain At Dove Library Page 6 of 11 City Attorney Approved 1/25/2019 . .. • EXHIBIT C Teak and lpe Stain at Dove Library -Site Plan □ [f ~,, ~w 1 ~ rs a n 13 t;, ··~ D ~ -~ □ D ~ J] D ~ @ 0 t 0 6 [b,13 "-" D □ 0 D f .o .o 0 Teak and lpe Stain at Dove Library Page 7 of 11 PWM20-949GS 11'1 a 11'1 LJ Light Enclosure ,'~ ~~'~ -" ' Rear Courtyard Ben ches Teak and lpe Stain at Dove Library -Pictures 3'x3' Table Front Courtyard Wood Trim Teak and lpe Stain at Dove Library Page 8 of 11 PWM20-949GS Exhibit C (continued) . t Dove Library d lpe Stain a Teak an Page 9 of 11 PWM20-949GS Exhibit C (continued) EXHIBIT D Teak and lpe Stain at Dove Library -lpe Product Information Saf e & easy protection for exotic wood. SEAL-ONCE~ EXOTIC Premium Wood Sealer deep v oe·,c•ro'l.'!S 'he ~urface 10 i.;rOlt.!Ct, p,eserv•: und e,,1101•,c.t: o l 1,1pes oi CH,t c v,ooo, inc u<l ng oe. Tcuk unti Mor-ogony ;->-opr eru•1, Pt:ncrerhnology pcnelr:ire~ •rl: oens,'S' of orov.01.XJS, UCO! ng O fle)(1ble. l.lrCClhOble t.>o<r,er •or IO·\g t:s11ng. durot.J'e pro•ec,,on. SEAL-ONCE EXOTIC 1~ a•so .,ale !or !he 1_•1wironn;enJ. Ul1ro lu-' VOC :-;on-101,c ,--.1 not !torn oels, pla-·ll~ 01 p<:oµlc NOOJO• One c.oor uppl:co11c·' w,tt1 dern 1orrnu,o Water bused 'or,nuto flro, cfos UV µrotect en og:J.rh' fo:J ng Soop & v.o•e: c ccn-.,p Su!2 & t:o~y opplic.01,on & mo1r•enon~e For more information, visit www.seal-once.com. Teak and lpe Stain at Dove Library Page 10 of 11 PWM20-949GS Teak and lpe Stain at Dove Library -Teak Product Information Teak Cleaner •. )' <.Jm,: :~r; C'<'tra .d ... ~'. .!~,)1/; ,Jr ..,e, m::;-,s~ :/-t (, other ~t!a:.-: C CfFt"'S1 OJ"S ,:, •iQS!'..dieJ a~, --en Teak Protector -/ Simply belier 11 f!CS. :o ~it'~ 'i ;)f e-:~:::r rn~;p\~1rv. Cf:" .J : ~r.-·•, ,o ,..,JI ; t...: .. k i-:.,,. .:.i. v," t me • ~ 11 Teak and lpe Stain at Dove Library why i~ 1t t,O moch hf':ft~r than tcak·oH/'tf"aler: • rt. ···a ·tu,1·!i :·he ~;.,Je' z.ro-,'\r <:<.':v~r f t.:-,.,h. •·:-r j r ;_1r :1, <-. (,yr ;;r--,tt::cto1 .,vrr·:.; ete < .,...,.~•;;:> ... . based ;,,nd :.,) v1.•r:t-'ree· thr.,t 1:. -,._ ... ! ..... ,.., _ _ ... Page 11 of 11 PWM20-949GS Exhibit D (continued) ·¥E:~ CERTIFIOAT:E OF LIABILITY INSURANCE I I);;~:~ tHlS CERTIFICArE·lfflSSUED AS,AMAtTER QF'tNFORMATION ONLY AND CONFERS NO RIGHTS• UflONi'HECERTIFICATE l'IOLDER. 'rHIS CERTIFICATE DOES-NOTAFFlltMATIVELY OR.'NEGATIVELY AMEIIID, 'EXT'ENO OR ALTER THe·coVERAGEi4'FFORDED BY THE POLl~IES BEt.OW.: THIS CERJIF!CATE qr:. •INSURANCE Di:>!;:S NOT CONSllTUTE A CONTRACt BETWEEN THE ISSUING lNSURER(S), AUTHORizED REPRESENTATIVE~R'.~ODUCE~ ~Q THE 9~1iffCAJE fiOLQER,.. . IMPORjANT: If '"1 ~rtifl~ hQl~Hs; !ln.ADOITIONAL,JNSUREO, thff pollcy{ti,s) muet h!IV~ APDlllON~ INSlJ_RED ptovlsl1;ms or be endorsed. H SUBROG~ ft~ IS WAIVED, 15µbjectio thUermsl11nct. ~ndltlons of the. pollqy, .~iQ ~lcle• may ·requli;e· an eJKlor5$"1Qflt. A ataitment on this ctrtifl~ doe, not; confer rigbte ~•.'the· certificate hot~ .In neu '9t J\lch ,ndol'!Mlme11f(•). INIURER A: Ataln Specla1ty Insurance company iNsiJFtER e ,A11ttawlnfSuran~e uompany INSURERE ~ .. --,-,,--,.,--------,.-----,..----11------1 -lNSURl!!R'F.: COVERAGES CERTIFICATE NUMBER: REVl$ION NUMBER! THIS.IS tO.CEffTIF't' TftAT 'THE PCLJC!f:,$'.Qf. l~UAANCE .t:1$TEP 8ELOW HAVE aeeN issoeo JO THE INSUl'U:CL~ AIID\'E i=OR 1HE POLICY PERIOD , INDICATED. N01'v.rlri:'IST/\NDl!-IG AN'Y.~EClUIREMEf'ff, TE~M OR CONDrr:100 Of''ANY comRACT OR OTHER ciOCUMEJ\IT wm:i ·RESPE'CT ro WHICH Tl:IIS CERTIFicATE MA.Y 13E.1$$UED OR MA'l PERTAIN, 'tHE INSUAANCE. AFF~. BY, THE POLiC!ES · DESCRIBED HEREIN IS SUSJE'CT' TO ALL THE TERMS, EXCLUSIONS.AND CONOITIONS OF suq::1 PQUCIE~; LIMITS SHOWN MAY HAVEl3EEN ftEOl,iCED ~v f'AID CLAIMS, ' --------~-- B CERT1FICATE HOUJER IY I t64q73463 I I □jg. nt I .City <1f Carlsbact/CMWD . . c/o E;)Q~ ln:SU~rice:¢QtT1pllance .S~r:.vlce$ P.O. Bdx 466'1hECM #35050 New Yori:t. NY 10163;4.s I PERSONAl&ADVINJUF\Y $1,000,000 GENERAL AGGREGATE $2,000,000 ~" COt,11"/0P,AG(, . s 2;000,000 $ =w,BI S 11000,000 ·r~~i.;.'r"""'"e · s s: :$ .AGGREGATE .:$ 1:1,EACHAceloENt s 1;000,000 ·e,L.b!SEASe-EAEMP.Lo'i'EI= s 1,000;000 .~··. .ACORD 25{2016/03) © 1~88,,2015 ACORD CORPORATION, Alf rights reserved. The ACORD·name and logo are reglsteredmarks·ofACORD . . WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC0403 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. Work performed by Coastal Colors Painting Company Inc at: 7768 El Camino Real #104-737 CARLSBAD, CA 92009 Subrogant Information City of Carlsbad/CMWD C/O EXIGIS Ins. Compliance Servcies PO BOX 4668 NY, NY 10163 7768 El Camino Real Carlsbad , CA 92009 Class Code 5482 Schedule Description I PAINTING &#8212; water, oil or gasoline storage tanks &#8212; Including shop operations &#8212; employees whose regular hourly wage equals or exceeds $26.00 per hour 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 12/12/2019 Insured: Coastal Colors Painting Company Inc Policy No. MWC0072198-06 Endorsement No. Premium (See Attached) Insurance Company: Markel Insurance Company Countersigned by __________ _ WC040306 (Ed. 04-84) © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual© 2001 9 of 11 Payroll $500.00 POLICY NUMBER: CIP377847 COMMERCIAL GENERAL LIABILITY CG 2404 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- com pleted operations hazard". This waiver applies only to the person or organization shown in the schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 33 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured 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 i nsured on your policy. Such person or organization is an additional insured 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any Insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; 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. Page 2 of2 © Insurance Services Office, Inc., 2012 CG 20 33 0413 ENOORSEMENT This Endorsement Changes the Policy-Please Read it Carefully PRIMARY AND NON-CONTRIBUTING INSURANCE (Sole Negligence) This endorsement modifies CO\erage provided under the following: OOMMERCIAL GENERAL LIABILITY OOVERAGE PART OWNERS AND OONTRACTORS PROTECTIVE LIABIUTY OOVERAGE PART PRODUCTS OOMPLETED OPERATIONS LIABLllY CDVERAGE PART The following· is added to Section IV -Commercial General Liability Conditions, Paragraph 4: Section IV: Commercial General Liability Conditions 4. other Insurance: d. Specifically and solely for the Third-Party shown below, notwithstanding the pro\1sions of sub-paragraphs a, b, and c of this paragraph, it is hereby agreed that in the e\ent of any " suit" where the damages are caused by the insured's sole negligence, this insurance sh.all be primary and any other insurance maintained by the additional insured named as the Third Party below shall be excess and non-contributory. The Third-Party to whom this endorsement applies is: ANY PARTY FOR WHOM THE INSURED IS PERFORMING SERVICES, AT A SPECIFIED PROJECT SET FORTH IN A WRITTEN CONTRACT, THAT: (1) HAS BEEN SIGNED BY ALL PARTIES, INCLUDING THE NAMED INSURED AND THE PARTY SEEKING COVERAGE UNDER THIS ENDORSEMENT; AND (2) HAS BEEN ENTERED INTO BEFORE ANY LOSS HAS OCCURRED Any CO'.erage provided pursuant to this endorsement shall be subject to all other terms, conditions, exclusions and endorsements of the policy to which this form is attached. The endorsement is e1fecti-ve on the inception date of the policy unless otherwise stated below. Policy Number: CIP377847 Named Insured: COASTAL COLORS Endorsement Effective Date: 05/17/2019 AF001397 07/16 Page 1 of 1