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HomeMy WebLinkAboutPleasant Line Corporation; 2019-03-04;CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT FABRICATION OF PUBLIC ARTWORK, OVERSIZE BEACH CHAIR PLEASANT LINE CORPORATION Tracking#: This agreement is made on the 1-/--fh day of _ __.__H::,J~-"-.,1,,../' 2018, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City") and Pleasant Line Corporation, whose principal place of business is a California Corporation, (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: Richard Schultz, Cultural Arts 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. NAME OF PROJECT; CONT. NO. NNNN Page 1 of 7 City Attorney Approved 9/27/2016 Tracking#: 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 subcont tor from participating in contract bidding. Signature: Print Name: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the 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. NAME OF PROJECT; CONT. NO. NNNN Page 2 of 7 City Attorney Approved 9/27/2016 Tracking#: INDEMNIFICATION, DEFENSE, HOLD HARMLESS. Contractor's Indemnity Obligations. Contractor shall indemnify, defend and hold harmless City and City's successors, assigns, officers, directors, shareholders, members, participants, partners, affiliates, beneficiaries, trustees, subsidiaries, employees, representatives and agents from and against any and all loss, damages, liability, claims, suits, costs and expenses, whatsoever, including reasonable attorney's fees, arising from or in any manner connected to: (i) the fabrication of the Art Work; (ii) negligent use of the Site by Contractor, Contractor's agents, employees, consultants, subcontractors and invitees; (iii) any damages to the Site or its improvements, and any injuries to persons-caused by-Contractor, Contractor's agents, employees, consultants, subcontractors and invitees; (iv) the activities, services or work conducted by Contractor and Contractor's agents, employees, consultants, subcontractors and invitees, and (v) the furnishing or supplying of work, labor, services, materials, equipment, or supplies by any persons, firms, corporations or other entities directed by Contractor in connection with the fabrication of the Art Work. Assignment to City. By the Completion Date, Contractor will assign to City any and all rights, claims or causes of action which may accrue to Contractor as the purchaser, recipient, consumer or user of any materials, supplies, products, or equipment (including rights, claims or causes of action arising due to any defects in the nature, quality or fabrication or design of any the materials, supplies, products or equipment) utilized in connection with the fabrication of the Art Work. If necessary City shall cooperate with Contractor in asserting any rights, claims or causes of action arising hereunder provided that such requirements are at no cost to City. 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. \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ \\\ NAME OF PROJECT; CONT. NO. NNNN Page 3 of 7 City Attorney Approved 9/27/2016 Tracking#: Start Work: Contractor agrees to start within thirty (30) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within ninety (90) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. (name of Contractor) (Contractor's license number) (license class. and exp. date) (DIR registration number) (DIR registration exp. date) (street address) Ftl//J/Q,?~ C::4. -?U7~~ (city/state/zip) S""f'?, 775""-?b o 2= (telephone no.) (fax no.) /Yefr/4fz.6! qn1 ~ ~ /-re? /J'1 (e..rtfu1 address) 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 (print name/title) :~ere) ~~N ,~lz. (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By· -~;f~;!,, P. u~ City Manager Ll.J.~ ·fC;,,. ~~ D, rec n..'L ~ ~ARBARA ENGLESON If _City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A 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: NAME OF PROJECT; CONT. NO. NNNN Page 4 of 7 City Attorney Approved 9/27/2016 Tracking#: 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 NONE Total % Subcontracted: _Q_ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. NAME OF PROJECT; CONT. NO. NNNN Page 5 of 7 City Attorney Approved 9/27/2016 Tracking#: EXHIBIT B The City is requesting Contractor to fabricate one oversize beach chair (chair) measuring 4'd x 4'w x 6'h, to be used as a prototype for future outdoor public art in the City. The creation of a prototype with the intended use of analysis and evaluation that will be assessed by a structural engineers and the City's public works engineering staff. The Contractor shall, to the best of his ability, fabricate, assembly, and prepare the chair's surface for an acrylic paint application. Chair Illustrations: NAME OF PROJECT; CONT. NO. NNNN Page 6 of 7 City Attorney Approved 9/27/2016 Tracking#: Chair materials: Marine grade¾" plywood, screws, paint, sand paper, roller etc. The Chair's material should consist of material recommended by beach chair designer, any variations to the Chair's materials should be discussed and preapproved by the City's Cultural Arts Manager or his designee. Contractor shall perform all services and furnish all supplies necessary to fabricate and assemble the chair. Fabrication: Fabricate a prototype oversized beach Chair based on schematic of the design, which will be painted with acrylic paint by another artist. Contractor agrees to complete work within ninety (90) working days after receipt of Notice to Proceed. Chair weight capacity: The Chair must be able to hold two (2) individuals with a total weight capacity of 500 lbs. Chair anchoring: The Chair must be constructed made ready to be securely anchored to a base. Finished product delivery: The Contractor shall notify the Cultural Arts Manager in writing when the fabrication of the Chair is complete and ready for pick-up. Upon receiving Contractor's notice of completion of fabrication, City will promptly inspect the Chair prior to pick-up and ensure it conforms with the approved prototype beach chair design. The City will pick up and transport the finished fabricated oversize beach chair directly from the Contractor's location, 1850 Camino Rainbow, Fallbrook, CA 92028. Warranty of product: Warranty of Quality and Condition. Contractor represents and warrants that: The fabrication of the Chair will be performed in a workman-like manner. The Chair, as fabricated, will be free of defects in materials and workmanship, including any defects consisting of "inherent vice" or qualities which cause or accelerate deterioration of the Chair, and barring any unusual conditions outside of normal use, shall be warranted for one (1) year after the date of final written acceptance by City. Fabrication materials: Contractor represents and warrants that the materials used for fabrication of the Chair are not currently known by Contractor to be harmful to public health and safety. Payment schedule: Description Cost Build Prototype Oversized Beach Chair $6,000 Contractor will be paid for the prototype chair one thousand dollars ($1,000) in materials and water jet cutting and 50 hours of labor at one hundred dollars ($100.00)/hr. = five thousand dollars ($5,000), for a total cost not-to-exceed six thousand dollars ($6,000). All costs must include taxes, fee's, expense and all other costs. All costs will be paid as specified above. Contractor's invoice will be submitted at the completion of the chair. Invoices shall be sufficiently detailed to include related activities for approval by the City. NAME OF PROJECT; CONT. NO. NNNN Page 7 of 7 City Attorney Approved 9/27/2016 PLEALIN-01 NGULA1 ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 08/06/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the 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 License # OL48969 CONTACT .,,..,,::. CJ Risk & Insurance Services fft8_NJo, Extl: (619) 233-8000 I r:i~. Nol:(619) 864-7106 404 Camino Del Rio S. STE 410 San Diego, CA 92108 ~:.M_AJ!,. ___ policy@c3insurance.com INSURER/SI AFFORDING COVERAGE NAIC# INSURER A: Sentinel Insurance Co. Limited 11000 INSURED INSURER B: Pleasant Line Corporation INSURERC: 1850 Camino Rainbow INSURER D: Fallbrook, CA 92028 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT \MTH 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. I~,: TYPE OF INSURANCE ~,.\1.,0~ ~u,.~~ POLICY NUMBER ,.i;s~~~~ POLl~YEXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 -D CLAIMS-MADE [R] OCCUR Qt~.f)9.U9c~ENTED 1,000,000 72SBA Tl2894 07/26/2018 07/26/2019 $ -MED EXP /Anv one oersonl $ 10,000 -PERSONAL & ADV INJURY $ 2,000,000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 ~ □PRO-□ 4,000,000 POLICY JECT LOC PRODUCTS -COMP/OP AGG $ OTHER $ A AUTOMOBILE LIABILITY -COMBINED SINGLE LIMIT /Co ac.cident\ $ 2,000,000 ANY AUTO 72SBATl2894 07/26/2017 07/26/2018 BODILY INJURY /Per oerson\ $ --OWNED SCHEDULED -AUTOS ONLY -AUTOS BODILY INJURY /Per accident\ $ X HIRED X ~8-l"o~"mJr.~ FP~7~&:~d~t?AMAGE $ -AUTOS ONLY $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I ~~fTIITF I I gJH-AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ N/A E.l. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If more space Is required) Certificate holder is included as additional Insured per written contract as respects to the General Liability but limited to the operations of the Insured under said contract, and always subject to all the policy terms, conditions and exclusions per endorsements attached. 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. P.O. Box 4668 -ECM #35050 New York, NY 10163-4668 AUTHORIZED REPRESENTATIVE I ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 72 SBA TI2894 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -PERSON-ORGANIZATION CITY OF CARLSBAD 1200 CARLSBAD VILLAGE DR CARLSBAD, CA 92008 THE CITY OF SACRAMENTO, ITS OFFICIALS, AND EMPLOYEES 1030 15TH ST STE 240 SACRAMENTO, CA 95814 Form IH 120011 85 T SEQ. NO. 002 Printed In U.S.A. Page 001 Process Date: o 4 / o 2 / 18 Expiration Date: o 7 / 2 6 / 1 9 0 N a, I LIENHOLDER NOTIFICATION NOTICE OF CHANGE IN POLICY TERMS: The Loss Payable Clause Endorsement providing coverage to lienholders has been revised. The revised Loss Payable Clause Endorsement for Assigned Risk Policies remains unchanged. Assigned Risk Policy numbers start with the following digits: 9 or 08. Please go to partners.geico.com to view a copy of the revised endorsement or request that a copy be sent to you. You may also contact us at 1-877-347-3281 to request a copy of the revised endorsement. We are open Monday through Friday 8:30 a.m. to 6:30 p.m. EST. CITY OF CARLSBAD CULTURAL ARTS OFFICE 1775 DOVE LN CARLSBAD CA 92011 l'OLICY NUMl1LR: OIS9%1'J08 f NllORSLMI NI INSURED NAML/ADDRFSS: RACHEL BISHOP M I CH At l S lll I / l fl: 12/16/18 (12:01 IXP: 06/16/llJ (l?:01 A.M. STANDARD IIMFllBSO CAMINO RAINBOW I OSS PAYLI: Cl IY 01 CARI 'iBAD Clll IURAI ARIS OFFICF 1 I I'> DOV I I N U\RLSBAD CA Y2011 A.M. STANDARD TIMf)FALLBROOK CA 9?018 9648 ADDITIONAi INSURED: CI IY Of CARL POLICY PIRIOD: 12/16/lB (17:01 A.M. SIANDAIW l lMI l IO: 06/16/l'J (12:01 A.M. STANDARD I IM! l GEICO ATTN: LIENHOLDER DEPARTMENT P.O. Box 9094 Macon, GA 31208-9094 1-877-347-3281 Page 1 I NSll RI R: GlICO GfNERAl INSllRANCl COMPANY PROClSS IJAIF: 1?/l'i/18 VIN: '>lBRl3411GS41419/ 06 IOYOIA COVLRAGl:S: COl I: 01100/DFD COMP: 0',00/DFD BI: 0100/0300 Pll:0100 II lfll POI ICY CANCIIS. Wf WIii NO!IIY YOU. lllf LIE_NHOI Ill R, Al LEASI 10 DAYS llllORI Wf lERMINAII YOUR lNlll{IST. CORRESPONDENCE OR INQUIRIES DIRECTED TO INSURER MUST INCLUDE A COPY OF THIS NOTIFICATION LHNOT (02-12) Visit us at partners.geico.com to enroll in our online Lienholder Coverage Verification Service. GEICO Washington DC MAILING ADDRESS RACHEL S BISHOP AND MICHAEL STUTZ 1850 CAMINO RAINBOW FALLBROOK CA 92028-9648 To whom it may concern: GEICO GENERAL INSURANCE COMPANY VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) Policy Number: 0759461908 Effective Date: 12-16-18 Expiration Date: 06-16-19 Registered State: CALIFORNIA This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy. Vehicle Year: 2006 Make: TOY OT A Model: TUNDRA VIN: 5TBRT34116S474797 COVERAGES Bodily Injury Liability Each Person/Each Occurrence State Minimum $15,000/$30,0000 Property Damage Liability State Minimum $5,000 Medical Payments Uninsured & Underinsured Motorists Each Person/Each Occurrence Comprehensive Collision Emergency Road Service Rental Reimbursement Lien holder CITY OF CARLSBAD X Additional Insured CULTURAL ARTS OFFICE 1775 DOVE LN CARLSBAD, CA 92011-0000 Additional Information: LIMITS $100,000/$300,000 $100,000 $5,000 $100,000/$300,000 Full $50 Per Day/ $1,500 Max Interested Party If you have any additional questions, please call 1-800-841-3000. DEDUCTIBLES $500 Ded $500 Ded/Waiver CAUTIONARY NOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS, AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER "ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN, THE DATE OF THIS FACSIMILE. U-33 10-07 CERTIFICATE OF EXEMPTION WORKERS' COMPENSATION/EMPLOYERS' LIABILITY INSURANCE I, $t/"/4e( \/4,b-- [insertname] , am the ___ {7; ___ .e;"""'v-'-, -0__._, _________ _ [title] of l(j#.f~I /_,If/",, r:;/1¥~' , . I hereby certify that ~$,tA,,/-Lar"s? &,y!tJrAh~/1/ \ [ name of company] [ name of company] has no employees and is not required by law to maintain workers' compensation or employers' liability insurance. Should -~-~-~-~-~ _ _,_/_~_'M_V_,,.._C:,_11-.~~,__-fi_~_~ __ P_4---_' __ employ any person during the term I [ name of company] of the Agreement with the City of Carlsbad for ~r1t~,+ tt/ ?IP-"'rf,r.;.-'tf?/Jrh t"/4",,-' [ description of project or work that is being contracted] then workers' compensation and employers' liability insurance will be obtained. [Title and name of company or corporation]' 06/15/2006 25