Loading...
HomeMy WebLinkAboutUrban Corps of San Diego; 2018-12-13; PWM19-684GSRECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2019-0163533 111111111111 lllll 111111111111111111111111111111 IIIII IIIII IIIII IIII IIII May 02, 2019 11 :02 AM OFFICIAL RECORDS Ernest J Dronenburg, Jr., SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins $0 00) PAGES Space above this line for Recorder's use. PARCEL NO: 156-180-46-00 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. 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 Feb. 20, 2018. 6. The name of the contractor for such work or improvement is Urban Corps of San Diego. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Project No. PWM19-684GS, Project Name: Parks Maintenance Admin Remodel. 8. The street address of said property is 1166 Carlsbad Village Drive, Carlsbad, CA 92008, in the City of Carlsbad. ~....L...L-,_______,,;:_+-----"'--+L-6.J~ -e. Lu.. Ku..., , City Manager / VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Car bad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on ------1..-"'-lli""""'""""'.,._........,c....w~----' 20J.9__, 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 _t./ __ --~~~{)-~ 20 1 C,, at Carlsbad, California. Q:\Public Works\General Services\Agreements & Contracts\Urban Corp\Parks Maintenance Ad min Remodel -PWM19-684GS\NOC\2.NOC -Parks Maintenance Ad min Remodel -PWM1 9-684GS.docx CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Urban Corps of San Diego has completed the contract work required for PWM19-684GS -Parks Maintenance Admin Remodel. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS Remodel admin offices. $6,800 CERTIFICATION OF COMPLETION OF IMPROVEMENTS , Public Works Mar\ager VALUE 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. , City Manager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By: ( , ~1 '>._ / Deputy City Attorney,\ Q \Public Works\General Services\Agreements & Contracts\Urban Corp\Parks Maintenance Adm in Remodel -PWM19-684GSINOC\3.API -Parks Maintenance Admin Remodel -PWM19-684GS.docx Tracking #: PWM19-684GS Parks Maintenance Admin Office Remodel Page 1 of 7 City Attorney Approved 9/27/16 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT PARKS MAINTENANCE ADMIN OFFICE REMODEL This agreement is made on the ______________ day of _________________________, 2018, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Urban Corps Of San Diego, a non-profit corporation whose principal place of business is 3127 Jefferson St., San Diego, CA 92110 (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor’s proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Brian Bacardi (City Project Manager) WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 13th December Tracking #: PWM19-684GS Parks Maintenance Admin Office Remodel Page 2 of 7 City Attorney Approved 9/27/16 FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: ____Anne Bernstein___________________ 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. DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 Tracking #: PWM19-684GS Parks Maintenance Admin Office Remodel Page 3 of 7 City Attorney Approved 9/27/16 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 thirty (30) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Urban Corps of San Diego 3127 Jefferson St. (name of Contractor) 972059 (street address) San Diego, CA 92110 (Contractor’s license number) B, C27, C-61/D49, C-61/D63 - 4/30/18 (city/state/zip) 619-235-6884 (license class. and exp. date) N/A (telephone no.) 619-235-5425 (DIR registration number) N/A (fax no.) dperez@urbancorps.org (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 Tracking #: PWM19-684GS Parks Maintenance Admin Office Remodel Page 4 of 7 City Attorney Approved 9/27/16 AUTHORITY. The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR URBAN CORPS OF SAN DIEGO, a non-profit corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Anne Bernstein, Acting CEO Paz Gomez, Public Works Director as authorized by the City Manager (print name/title) By: (sign here) Kyle Kennedy, CFO (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 Tracking #: PWM19-684GS Parks Maintenance Admin Office Remodel Page 5 of 7 City Attorney Approved 9/27/16 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 0% Tracking #: PWM19-684GS Parks Maintenance Admin Office Remodel Page 6 of 7 City Attorney Approved 9/27/16 EXHIBIT B Parks Maintenance Admin Office Remodel Contractor to provide all materials, tools and labor to necessary to complete the scope of work as outined in Exhibit C and the specifications as listed: - Frame, drywall and texture approximately 19 linear feet of wall in three locations in the facility. One section of wall to be approximately 11’ 4” which will include framing in a 36” door. The second section of wall to be framed in will be approximately 7’5”. The third to be an existing 30” X 36” window. - Remove two (2) existing doors. - Furnish and install two (2) new 32” doors. - Furnish and install one (1) new 36” door. - Cut in and finish new pass through window. - Paint new work with one (1) coat of primer and two (2) coats of finish paint. Paint to match existing in the locations of work. - Matching baseboard to be installed in all locations of new work. - Insulation to be installed in all newly framed walls. - All construction material and debris to be hauled off. JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LS 1 Remodel Parks Maintenance Admin Office per Exhibit C. $6,800 TOTAL* $6,800 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 Parks Maintenance Admin Office Remodel Page 7 of 7 City Attorney Approved 9/27/16 EXHIBIT C DocuSign Envelope ID: 71B0143C-3762-455A-A100-AF73035F2854 DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificate holder in lieu of such endorsement(s). CONTACTPRODUCERNAME:FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED. NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSDWVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT $OTHER: COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) BODILY INJURY (Per person) $ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS $ UMBRELLA LIAB EACH OCCURRENCE $OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $ $DED RETENTION$ PER OTH-WORKERS COMPENSATION STATUTE ERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / AOFFICER/MEMBER EXCLUDED?(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE$If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) URBAN-7 OP ID: KV 12/11/2018 Keri VogtFaith Insurance ServicesBrakke Schafnitz Ins. Brokers28202 Cabot Rd. Suite 600Laguna Niguel, CA 92677Charles A. Faith 949-365-5144 949-313-3288 keri.vogt@sig.us American States Insurance 19704 General Ins. Co. of AmericaUrban Corps of San DiegoCountyPO Box 80156 San Diego, CA 92138 B X 1,000,000 X Y 24CC28766290 10/25/201810/25/2019 200,000 10,000 1,000,000 3,000,000 X 3,000,000 1,000,000 B X 24CC32284220 10/25/201810/25/2019 X X X X Comp 1,000 X Coll 1,000 XX 6,000,000 A 01SU43636620 10/25/201810/25/2019 6,000,000 B Professional Liab LP7745020K 10/25/201810/25/2019 Per Incid 1,000,000 Aggregate 3,000,000 Agreement Name: UTIL895 City of Carlsbad is named as additional insured as required by written agreement per the attached endorsement COCEXIG City of Carlsbad/CMWD c/o Exigis Insurance Compliance Services P.O. Box 488-ECM#35050 New York, NY 10163-4668 Policy No. 24CC28766290 City of Carlsbad The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED HIRED NON-OWNEDAUTOS ONLY AUTOS AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 THISCERTIFICATE 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. INSDADDL WVDSUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12/15/2017 Arthur J. Gallagher & Co.Insurance Brokers of California, Inc. LIC# 07262931255 Battery Street #450San Francisco CA 94111 Urban Corps of San Diego CountyP.O. Box 80156San Diego, CA 92138 NonProfits' United Workers' Compensation Safety National Casualty Corporation 15105NONPUNI-01 1473950847 A NPU - WCG 001-2018 1/1/2018 1/1/2019 X 500,000 500,000 500,000 B Excess Wokers' Comp SP4057827 1/1/2018 1/1/2019 Limit Per OccurenceE.L. Per Occ & AggXS of 500,000 Statutory2,000,000 Re: All California operations of the named insured City of CarlsbadPublic Works/General Services405 Oak AvenueCarlsbad CA 92008