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Statewide Stripes Inc; 2018-09-11; PWM19-494GS
RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2018-0497570 I IIIIII IIIII IIIII IIIII IIII IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII Dec 03, 2018 01 ·48 PM OFFICIAL RECORDS Ernest J. Dronenbur SAN DIEGO COUNTY 9, Jr., FEES $0. 00 (SB2 RECORDER Atkins: $0.00) PAGES: 1 Space above this line for Recorder's use. PARCEL NO: N/A -~--------- 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 10/25/2018. 6. The name of the contractor for such work or improvement is Statewide Stripes, 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. PWM19-494GS, Project Name: Thermoplastic Crosswalk Installation at Various City Locations. 8. The street address of said property is City Wiele, in the City of Carlsbad. ,n yo,.r, -:.,,.1 '.:> s~~ 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 Q otJ . 9 , 20JX, 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 Dou 1--2> I 201.i{, at Carlsbad, California. Cl~ OF CARLSBAD • "'c~ K 171c7f!VKN~ b."'1;1)"'\... BARBARA ENGLESON City Clerk Q \Public Works\PW Common\Agreements & Contracts\Contracts\2019 ContractslMINOR PUBLIC WORKSIStatewide\6.NOC -Thermoplastic crosswalk installations.doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Statewide Stripes, Inc has completed the contract work required for PWM19-494GS - Thermoplastic Crosswalk Installation at various City Locations. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE City Wide --r~uM,o~\~ .. s he... c.,,o<;swa..\ ~ $36,400 CERTIFICATION OF COMPLETION OF IMPROVEMENTS ~ ~ ---=-'"'"-+-ll l &-=--+--'---[ I t( - ~gin.Q~ 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 improvements. i4~1{df, Scott Chadwic ~ty Manag APPROVED AS TO FORM: CELIA BREWER, City Attorney directed to commence maintaining the above described Date Q \Public Works\PW Common\Agreements & Contracts\Contracts\2019 Contracts\MINOR PUBLIC WORKS\Statewide\7.API -Thermoplastic Crosswalk Installations.doc PWM 19-494GS CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT THERMOPLASTIC CROSSWALK INSTALLATION AT VARIOUS CITY LOCATIONS This agreement is made on the //"-/!-day of ~ )-lJL , 2018, by the City of Carlsbad, California, a municipal corporation, (hereinaftercaieci"City"), and Statewide Stripes, Inc, a California corporation, whose principal place of business is P.O. Box 600710, San Diego, CA 92160-0710 (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: Terry Ennis (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. Thermoplastic Crosswalk Installation Page 1 of 8 City Attorney Approved 9/27/16 PWM 19-494GS 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 th tdebamABflH>y another jurisdiction is grounds for the City of Carlsbad to disqualify the Contract c r from participating in contract bidding. / Signature: Print Name: VICE PRESIDENT 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. Thermoplastic Crosswalk Installation Page 2 of 8 City Attorney Approved 9/27/16 PWM 19-494GS 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 five (5) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within forty-five (45) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Statewide Stripes, Inc. (name of Contractor) 788286 (Contractor's license number) C32 12/31/18 (license class. and exp. date) 1000001334 (DIR registration number) 6/30/19 (DIR registration exp. date) Thermoplastic Crosswalk Installation Page 3 of 8 P.O. Box 600710 (street address) San Diego, CA 92160-0710 (city/state/zip) 858-560-6887 (telephone no.) 858-560-0158 (fax no.) adam@statewidestripes.com (e-mail address) City Attorney Approved 9/27/16 PWM 19-494GS 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 STATEWIDE STRIPES C., a California ~oL (sign here) 1?\V \ d t>v-, \ Y\oJI\~ (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: ti ./) Paz G ez / Public Wo!:ls.s--E:'irector as au rized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !i...§ 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: rib~ Deputy City Attorney Thermoplastic Crosswalk Installation Page 4 of 8 City Attorney Approved 9/27/16 PWM 19-494GS 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 NONE NONE NONE NONE Total% Subcontracted: -P--- The Contractor must perform no less than fifty percent (50%) of the work with its own forces Thermoplastic Crosswalk Installation Page 5 of 8 City Attorney Approved 9/27/16 PWM 19-494GS EXHIBIT B Thermoplastic Crosswalk Installation Installation of 13,000 linear feet of themoplastic crosswalks at various locations throughout Carlsbad. JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 lnft 13,000 Thermoplastic installation, including all traffic control; $36,400 City will provide no fee right of away permit. TOTAL* $36,400 *Includes taxes, fees, expenses and all other costs. Thermoplastic Crosswalk Installation Page 6 of 8 City Attorney Approved 9/27/16 Thermoplastic Crosswalk Installation Locations -Exhibit "B" Item# Location Notes Color Linear feet 1 Jefferson @ Marron White 385 2 Tram a rack Ave @ 1-5 Freeway N/B and 5/B Yellow 443 3 Marron @ Mall From ECR White 360 4 El Camino Real @ Marron White 724 5 El Camino Real @ Plaza Dr White 587 6 Carlsbad Village Dr@ El Camino Real White 780 7 Tamarack@ Adams Yellow 443 8 Pio Pico @ Tamarack Yellow 439 9 Tamarack @ 5 Freeway N/B and 5/B White 290 10 Cypress @ Carlsbad Blvd Yellow 102 11 Beech @ Carlsbad Blvd White 447 12 Madison @ Carlsbad Villade Dr White 500 13 Carlsbad Village Dr @ Jefferson White 471 14 Harding@ Carlsbad Village Dr White 502 15 Carlsbad Village Dr @ 5 ? White 80 16 Pio Pico @ Carlsbad Village Dr White 446 17 Carlsbad Village Dr @ Monroe White 417 18 Los Flores @ Buena Vista Way Yellow 233 19 Grand @ Jefferson 422 20 Harding @ Chestnut White 328 21 Chestnut @ Pio Pico N/B and 5/B White 360 22 Chestnut @ Celinda Stop Bar White 40 23 Poinsettia @ El Fuerte White 667 24 Unicornio @ El Fuerte White 345 25 Melrose @ Alga White 782 26 Melrose @ Carrillo Way White 666 27 Poinsettia @ Alicante Rd White 603 28 Poinsettia @ Estra Del Mar E/B Lines White 358 Total Estimate of Linear Feet 12,220 Total Linear Feet Not -to-Exceed 13,000 STATEWIDE ST!llPES, INC P.O. BOX 600710 ESTIMATE SAN DIEGO, CA 92160-0710 « « (( (( « « « « « « « (( « (( « «)))) )) »)))))))))))))))) »)))) » 858.560.6887 858.560.0158 FAX TAX ID #33-0915254 I I DATE· . ', a,,,,, 5/18/2018 I .· NO. . I 17176 CLASS: C32 SLBE # I0SS0008 MB/SB# 40421 DBE# 32232 Exhibit "B" rw CONT!lACTO!l llEG# 1000001334 City of Carlsbad Purchasing Dept. 1635 Faraday ave Carlsbad CA 92008 ~ PROJEOi'J:' .. Thermoplastic around city CA Lie. #788286 Signatory Local 1184 Exp' 12/31/2018 Since 1990 sws·No TBm:18 Net30 QTY DESORIPTION 13,000 Thermoplastic Includes: Item listed, Prevailing wages, Traffic control for our work, Labor and Materials bond Excludes: Traffic control plans and permits *Note: Traffic control plans are not needed. Statewide Stripes performs work in a moving mobile work zone OOST TOTAL 2.80 36,400.00 II ··TOTAL I $36,400.00 EXCLUDE: Adjust Cancellation Clause@ $250.00 ea Ce11., Additional Insured Endorsements on Auto Liability @ $75.00 ea., bonds, notary services, night work, prevailing wages (unless included above). Not responsible for A.D.A. Compliance. Items not specifically included are excluded and require an Additional Bid. Acceptance of Estimate and Agreement. The undersigned hereby contracts for the services noted above and agrees to pay for the services upon completion and receipt ofan invoice. The undersigned agrees to pay reasonable attorney's fees and costs ifincuned in the enforcement of this contract. STATEWIDE STRIPES, INC. REQUIRES TWO WEEKS ADVANCE WRITTEN NOTICE PRIOR TO SCHEDULING. STATEWIDE STRIPES WILL NOT BE RESPONSIBLE FOR LIQUIDATED DAMAGES UNLESS MUTUALLY AGREED TO IN WRITING Co. Name: Date: ------------- By: Signature ___________ _ I Bond No. CAC 712759 Premium: $342.00 Premium will be adjusted based on final contract price EXHIBITC LABOR AND MATERIALS BOND PWM 19-494GS Issued in Duplicate WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Statewide Stripes, Inc. (hereinafter designated as the "Principal"), a Contract for: THERMOPLASTIC CROSSWALK INSTALLATION AT VARIOUS CITY LOCATIONS in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Statewide Stripes Inc., as Principal, (hereinafter designated as the "Contractor"), and Merchants Bonding Company (Mutual} as Surety, are held firmly bound unto the City of Carlsbad in the sum of THIRTY-SIX THOUSAND FOUR HUNDRED Dollars ($36,400), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Deve!opment Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. Thermoplastic Crosswalk Installation Page 7 of 8 City Attorney Approved 9/27/16 PWM 19-494GS In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this-~-=-~-- day of ~ 20\r. Executed by SURETY this 27th day CONTRACTOR: By: -s here) ~~ ~ M ctL,v'.6Nt (print name here) \l\u(Pe£8~ (sign here) Do.\) ic\ By-\ \~ ..\,e_, (print name here) Vf.es,ocnt (title and organization of signatory) of ___ A_u_..gu_s_t _______ , 20JL. SURETY: Merchants Bonding Company (Mutual) (name of Surety) 6700 Westown Parkway, West Des Moines, IA 50266 (address of Surety) 515-243-8171 (telephone number of Surety) s1::3 ~~--- (signature of Attorney-in-Fact) Cyndi Beilman, Attorney-in-Fact (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney} (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.} APPROVED AS TO FORM: CELIA A. BREWER City Attorney , / By:~ Deputy City Attorney Thermoplastic Crosswalk Installation Page 8 of 8 City Attorney Approved 9/27/16 ' . CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of San Diego } On August 27, 2018 before me, Pam Davis , Notary Public, ---><-----'--------------------------Date Insert Name of Notary exactly as it appears on the official seal personally appeared ____ C~y_nd_i_B_e_i_lm_a_n _____ ---,-,---,-,--:-=-.,....,..--------------- Name(s) of Signer(s) Place Notary Seal Above 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 capacity(ies), 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. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and o~icial seal. ! Signature , . / «.1w:-t< -£1----u- Signature of Notary Public Pam Davis OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of the form to another 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: _____________ _ D Individual D Corporate Officer -Title(s): ________ _ D Partner D Limited D General ~ Attorney in Fact D Trustee D Guardian or Conservator D Other: ______ _ Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here Signer's Name: --------------D Individual D Corporate Officer -Title(s): ________ _ D Partner D Limited D General D Attorney in Fact D Trustee D Guardian or Conservator D Other: -------- Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here . - MERCHANTS Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Anne Wright; Cyndi Beilman; Dana Michaelis their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 6th day of April , 2017 , ........ . • ••'~\ON,4 '•,,, •• ··~~-.:;·p··o··.i.·~ tl··· .., c, .··a~ ""_, ... o •• :~:"Cl ~·.~\ -~:~ o c,~O• :c:--- -:-: :s:. _:2: \ c., .._ 2003 _.-//): ---~~·.... . ... ·~,.-· ··"'"1 ········ .,:,~.· ST A TE OF IOWA COUNTY OF DALLAS ss. •••• f:r •••• ······ ······• . ...... . .• \lG Co• • ··~~\ ....... ~_;. .·~.·~ Y. PO If_,; .• "f; • . • • (.) "7,..4·.;..t.• •c-.>:~ (1\• • :~:--o-o:-.• :,:. 1933 :~: . '{,·· : -:-.: •• ~·. ..·"..,.<:::, • • ~1t······· \:'\'.· ••• -¢, •• ······· MERCHANTS BONDING COMPANY (MUTUAL) MERCHANT NATIONAL BONDING, INC. By 7~ President On this this 6th day of April 2017 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. "£}~\Alu"~ ~ ,:.:I.'.'., ~ . . 1owt>- ALICIA K. GRAM Commission Number 767 430 My Commission Expires April 1, 2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 27th day of August , 2018 . POA 0018 (3/17) .. "' ... " .. •• • :-,.1'G COk"• • ~~······•.·>?,!)•. •"<Q~• • ~ \\ p O ,9_:;. ·"'~ • • : "":!;t ,..4·. ;.L • ..... :_ -o-~:_: ·~: :3:. : ~ ·. 1933 : c::-• .~..... _:-::,y: • VL•, ,.•J,.C:::,~ •."'~IV· ...... ':'\'.· ~..,. "'¢! ,.~ ······· .t:/~~~- Secretary CALIFORNIA CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of -~--+=,=..<..:.V)__.___0-""'--------'u'--------¼~--'D~_ On 0\i0\10 before me, . tws1"W1 personally appeared -J---+--ui~S~UV\ ___ M_G,_8_\ ~----<~----------- who proved to me on the basis of satisfactory evidence to be the person{.81' whose name,(.81 is/ar;e' subscribed to the within instrument and acknowledged to me that he/sQ,e'/t~y executed the same in his/~r/u<e"ir authorized capacity(i~, and that by his/l)er/t-/{eir signature~on the instrument the perso~), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ~ • ~ 5!-----~------------------- Optional Information . HOUSTON COMM. #2139254 7 Notary Public · California 3 San Diego County ,j Comm. Ex ires Feb. 2 202r (Seal) Although the in rmation in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized docu nt and may prove useful to persons relying on the attached docurn('nt ledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: lndividual(s) i , Attorney-in-Fact ] Corporate Officer(s) Guardian/Conservator Partner· Limited/General i Trustee(s) ! ! Other representing: r1tle(s} Name('>) ol Person(s) or Ent1ty(1es) Signer 1s Repre,Pr1t1nq Proved to me on the basis of satisfactory evidence forrn(s) of 1der1t1!1c_dt1cm credible w1tr1c·11(es) Notarial event is detailed in notary journal on Page # Entry# Notary contact: Other 1 I Additional Signer(s) i S1gner(s) Thumbprrnt(s) ( opyr1ght 2007 )01) '\Jotary Rotary, Inc PO Box ,,I 1400, Des Mo1rw<,, IA )03 l l-0S07 All R1qhts Reserved Item Number 101777 PIPcl~t' contact your Author11l'd Reseller to purchase copies of this form ACKNOWLEDGMENT 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 Cali~n~a County of _____.~""'-----''-'--n-~-"------'=---l)~D----) On __ Q-1-4\---==c;c...+\ _,_\ CO=-----before me, --'---'---'-------'---'--=--=-..:.~-=~'----------'-'-/--'----""----""-"-.:.......=..,~_____.:_:_....:..::\o--"l ~ (insert name and title of the offic personally appeared Pt1t\J\d tbv\ \ha n 1JL? 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 capacity(ies), 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. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature\~ ti:IBA ~ (Seal) M. HOUSTON COMM. #2139254 z Notary Public • California ~ San Diego County - Comm. Ex ires Feb. 2, 2020 300423 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) ~ 4/11/2018 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 CONTACT NAME: PHONE _____ __ _ _ I tffc, No): IA/C. No. Ext):_ - -USI Insurance Services National, Inc. E-MAIL ADDRESS: 10940 White Rock road, 2nd Floor INSURER(S) AFFORDING COVERAGE NAIC# Rancho Cordova, CA 95670 INSURER A: Travelers Property Casualty Insurance Company 36161 INSURED INSURERS: Cypress Insurance Company 10855 Statewide Stripes Inc. INSURERC: P.O. Box 600710 INSURERD: INSURERE: San Diego CA 92190 INSURERF: COVERAGES CERTIFICATE NUMBER: 12946943 REVISION NUMBER: See below 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. 1r::; -------ADDL SUBR ----POLICY EFF POLICY EXP ------- TYPE OF INSURANCE l"'cn W\/n POLICY NUMBER IMMIDD/YYYYI IMM/DD/YYYYl LIMITS A i X COMMERCIAL GENERAL LIABILITY X DT22-C0-6K540018-TCT-18 03/01/2018 03/01/2019 EACH OCCURRENCE s 1,000,000 ~- CLAIMS-MADE [~ i OCCUR DAMAGE TO RENTED ----- ' PREMISES !Ea occurrence) $ 300,000 ' - - ' M_ED_E:XP (Any one person) $ 5,000 ,_ ---------- PERSONAL & ADV INJURY s 1,000,000 --------- GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2,000,000 . -~ PRO-=:]Loe ------- ~-POLICY JECT PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: s A , AUTOMOBILE LIABILITY X DT-810-6K540018-TCT-03/01/2018 03/01/2019 COMBINED SINGLE LIMIT s 1,000,000 /Ea accident1 -X ANY AUTO BODILY INJURY (Per person) s -OWNED SCHEDULED BODILY INJURY (Per accidenl) s ~---AUTOS ONLY ·-----AUTOS --HIRED X NON-OWNED iP~~~~c~~~AMAGE $ ~ AUTOS ONLY -AUTOS ONLY ! s UMBRELLA LIAB H OCCUR EACH OCCURRENCE s -EXCESS LIAB CLAIMS-MADE AGGREGATE s OED I I I RETENTION $ s WORKERS COMPENSATION 01/01/2018 01/01/2019 I PER I I OTH-B I AND EMPLOYERS" LIABILITY X STWC922397 X STATUTE ER Y/N 1,000,000 'ANYPROPRIETOR/PARTNER/EXECUTIVE IT E.L. EACH ACCIDENT s ; OFFICER/MEMBER EXCLUDED? NIA ' (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 I If yes, describe under 1,000,000 , DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) WC99 04 1 OB.CG D3 16 11 11,CG 02 46 08 05 Blkt AI/Contractors,CAT3530310 Forms attached. RE: Project Name: BLUEWATER PARKING BIKE LANE Agreement #: PWL 18-27CED CITY OF CARLSBAD/CMWD is named as additional insured as it relates to general liability and auto liability in accordance with the terms and conditions of the policies. Waiver of subrogation is granted as it relates to workers' compensation in accordance with the terms and conditions of the policies. The above general liability coverage is primary and noncontributory as respects general liability where required by written contract. ~ ' .... .-..-.Ii.-..-. !:IC .. ----CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE c/o EXIGIS Insurance Compliance Services THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4668 -ECM #35050 New York, NY 10163-4668 AUTHORIZED REPRESENTATIVE I 9r~- The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) {This certificate replaces certificate# 12946925 issued on 4/11/2018) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any Injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsemenl to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age descrlpllon only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what Is and Is not covered. A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. Increased Suppfementary Payments D. Incidental Medical Malpractice E. Who Is An Insured -Newly Acquired Or Formed Organizations F. Who Is An Insured -Broadened Named Insured -Unnamed Subsidiaries G. Blanket Additional Insured -Owners, Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following Is added to Exclusion g., Aircraft, Auto Or Watercraft, In Paragraph 2. of SECTION I -COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Nol owned by any Insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph or the exceptions in Ex- clusion J., Damage To Property, in Para- graph 2. of SECTION I -COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY Is deleted. 2. The following replaces the last paragraph of Paragraph 2., Excluslons, of SECTION I - COVERAGES -COVERAGE A. BODILY H. Blanket Additional Insured -Lessors Of Leased Equipment I. Blanket Additional Insured -Stales Or Political Subdivisions -Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unlntentional Omission L. Blanke! Waiver Of Subrogation M. Amended Bodily Injury Definition N. Contractual Liability -Railroads INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water; unless Exclusion f. of Section t -Coverage A -Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion -All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in Its title. A separate limll of insurance applies to "premises damage" as described In Para- graph 6. of SECTION Ill -LIMITS OF IN- SURANCE. CGD3161111 © 2011 The Travelers Indemnity Company. AU rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- TION Ill -LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit Is the most we will pay under Coverage A for damages because of "premises damage" lo any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limfl will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 If no amount Is shown for the Damage To Premises Rented To You Limit on the Declaralions of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease or premises. How- ever, that portion of the contract for a lease of premises that Indemnifies any person or organization for "premises damage" Is not an "Insured contract"; 5. The following ls added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage"; or 7. Paragraph 4.b.(1)(c) of SECTION IV - COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS -COVER- AGES A AND B of SECTION I -COVER· AGE: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have lo fur- nish these bonds. · 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS -COVER· AGES A AND B of SECTION I -COVER· AGES: d. AU reasonable expenses incurred by the insured al our request to assist us in the investigation or defense of the claim or "suit", includfng actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission committed in providing or falling to provide "incidental medical services", first aid or "Good Samaritan services" lo a person. 2. The following is added to Paragraph 2.a.(1) of SECTION II -WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodUy injury" arising out of providing or fail- ing to provide: (I) "Incidental medical services" by any of your "employees" who is a nurse pracli- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (II) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or falling to provide first aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 161111 3. The following Is added to Paragraph 5. of SECTION Ill -LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence llmfl, all 'related acts or omissions committed in providing or failing to provide "incldenlal medical services", first aid or "Good Samaritan services" to any one per- son will be deemed lo be one "occurrence". 4. The followlng exclusion ls added to Para- graph 2., Excluslons, of SECTION I -COV- ERAGES -COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "properly damage" arising out of the willful violation of a penal statute or ordinance relating lo the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or lrealment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV -COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and collectible other Insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that Is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1) of Section fl -Who Is An Insured. E. WHO IS AN INSURED -NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II -WHO IS AN INSURED: COMMERCIAL GENERAL LIABILITY 4. Any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, of which you are the sole owner or in which you maintain the ma- jority ownership interest, will qualify as a Named Insured if there Is no other Insurance which provides similar coverage to that or- ganization. However: a. Coverage under this provision is afforded only: (1) Untif the 180th day after you acquire or form the organization or the end of the poUcy period, whichever is earlier, if you do not report such organization in writing lo us within 180 days after you acquire or form it; or (2) Untll the end of the policy period, when that date Is later than 180 days after you acquire or form such organization, if you report such organization In writing to us within 180 days after you acquire or form it, and we agree in wr!Ung that ii will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily Injury" or "property damage" that occurred before you acquired or formed the organizalion; and c. Coverage B does not apply lo "personal in- jury" or "advertising injury• arising out of an offense committed before you acquired or formed the organization. F. WHO IS AN INSURED -BROADENED NAMED INSURED -UNNAMED SUBSIDIARIES The following is added lo SECTION II -WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declara- tions is a Named Insured if you maintain an own- ership interest of more than 50% In such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily Injury" or "properly damage" that occurred, or "personal injury" or "advertising Injury" caused by an of- fense committed after the dale, If any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG 0316 1111 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED -OWNERS, MANAGERS OR LESSORS OF PREMISES The following Is added to SECTION II -WHO IS AN INSURED: Any person or organization that Is a premises owner, manager or lessor and thal you have agreed In a written contract or agreement lo in- clude as an additfonal Insured on this Coverage Part Is an insured, but only with respect to llability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreementj and b. Arises oul of the ownership, maintenance or use of that part of any premises leased lo you. The insurance provided to such premises owner, manager or lessor is subject lo the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor wlll be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarallons, which- ever are less. b. The Insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c. The Insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance mus! be primary to, or non- contributory wilh, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance. H. BLANKET ADDITIONAL INSURED -LESSORS OF LEASED EQUIPMENT The following is added lo SECTION II -WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age''. "personal injury" or "advertising injury" that: a. Is "bodily Injury" or "property damage" that occurs, or Is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Is caused, in whole or In part, by your acts or omissions In the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided lo such equipment lessor Is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on lhe Declarations, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily Injury" or "property damage" that occurs, or "personal injury" or "advertising Injury· caused by an of- fense that is committed, after the equipment tease expires. c. The insurance provided lo such equipment lessor is excess over any valid and collectible other Insurance available to such equipment lessor, whether primary, excess, conlingent or on any other basis, unless you have agreed In the written contract or agreement that !his insurance must be primary to, or non-contributory with, such other insurance, In which case this insurance will be primary to, and non-contributory with, such other in- surance. I. BLANKET ADDITIONAL INSURED -STATES OR POLITICAL SUBDIVISIONS -PERMITS The following Is added to SECTION II -WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 6 ©2011 The Travelers Indemnity Company. All rights reserved. CGD3161111 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to llabillly for "bodlly injury", "property damage", "personal In- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or politfcal subdivision does not apply to: a. Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that slate or po- l!llcal subdivision; or b. Any "bodily injury" or "property damage" In- cluded in lhe "products-completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added lo Paragraph 2., Duties In The Event of Occurrence, Offense, Clalm or Sult, of SECTION IV -COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of lhe in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II -Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited llablllty company), any of your "executive offi- cers" or directors (If you are an organiza- lion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) lf you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are Individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: (a) Any individual who is: (I) A partner or member of any part- nership or Jolnl venture; COMMERCIAL GENERAL LIABILITY (II) A manager of any limited llabllity company; or (Ill) An execulive officer or director of any other organizalion; that Is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if ii is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only If you subsequently give notice lo us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part Includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following Is added to Paragraph 6., Repre• sentatlons, of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice your rights under !his insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION The following Is added to Paragraph 8., Transfer Of Rights Of Recovery Against others To Us, of SECTION IV -COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CGD3161111 © 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a conlract or agree- ment to waive thal insured's righl of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily Injury" or "property damage" that oc- curs; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. M, AMENDED BODILY INJURY DEFINITION The followlng replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY -RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Secllon: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CGD3161111 POLICY NUMBER: DT-810-6K540018-TCT-COMMERCIAL AUTO · THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any Injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or llmlted by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage Is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE -LOSS B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS F. HIRED AUTO LIMITED WORLDWIDE COVERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -LIABILITY COV- ERAGE: · Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that Is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following Is added to Paragraph c. In A.1., Who Is An Insured, of SECTION II -LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and OF USE -INCREASED LIMIT I. PHYSICAL DAMAGE·-TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "Insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. CAT3 53 0310 © 2010 The Travelers Indemnity Company, Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. wlth Its permission. COMMERCIAL AUTO 2, The following replaces Paragraph b. In B.5., Other Insurance, of SECTION IV -BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract In that _ individual "employee's" name, with your perrnission, while perform- ing duties related to the conduct of your business. However, any "auto" that Is leased, hired, rented or borrowed with a driver is not a covered "auto".. · D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -LIABILITY COV- ERAGE: Any "employee" of yours Is an "insured" while us- Ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2}, of SECTION II -LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to fu'rnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II -LIABILITY COVERAGE: (4) All reasonable expenses Incurred by the "insured" at our request, including actual loss of earnings up -to $500 a day be- cause of time off from work. F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS The following replaces Subparagraph (5) In Para- graph B.7., Polley Period, Coverage Territory, of SECTION IV -BUSINESS AUTO CONDI- TIONS: (5) Anywhere In the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their house- holds. (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United ·states of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate-or set- tle any such claim or "suit" and keep us advised of ail proceedings and ac- tions. (II) Neither you nor any other involved "Insured" will make any settlement without our consent. (Ill) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (Iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limit Of Insurance, of SEC- TION II-LIABILITY COVERAGE. {v) We will reimburse the "insured" for the reasonable expenses Incurred with our consent for your Investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limit Of Insurance, of SECTION II -LIABILITY COVER- AGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the ap- plicable limit of insurance In pay- ments for damages, settlements or defense expenses. (b) This insurance Is exce$s over any valld and collectible other Insurance available Page 2 of4 © 2010 The Travelers Indemnity Company. CAT3 53 0310 Includes copyrighted material of Insurance Services Office, Inc. with I.ts permission. to the "insured" whether primary, excess contingent or on any other basis. (c) This Insurance Is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. You agree to maintain all required or compulsory insurance In any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will' only be liable to the same extent we would have been liable had you complied with the compulsory In- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, Its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of Insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE -GLASS The following is added to Paragraph D., Deduct!• ble, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than ·replaced. H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC· TION 111-PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I.· PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence In Para- graph A.4.a., Transportation Expenses, of SECTION Ill -PHYSICAL DAMAGE COVER• AGE: We will pay up to $50 per day to a maximum of $.1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. COMMERCIAL AUTO J. PERSONALEFFECTS The following Is added to Paragraph A.4., Cover- age Extensions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Personal Effects We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies only In the event of a total theft of your covered "auto". No deductibles apply to this Personal Effects coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags In a covered "auto" you own that In- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV -BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You {If you are an Individual); (b) A partner (if you are a partnership); (c) A member (If you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or · (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". CA T3 53 0310 © 2010 The Travelers Indemnity Company. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -BUSINESS AUTO CONDI· TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written .contract signed and executed prior to any "accident" or "loss", provided that the "accident''. or "loss" arises out of operations contemplated by such contract. The waiver applles only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV -BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any Information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. Page 4 of 4 © 2010 The Travelers Indemnity Company. CA T3 53 0310 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED -(Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section Ill -Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. -DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10B (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. BLANKET WAIVER Person/Organization Job Description All CA Operations SCHEDULE Blanket Waiver -Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium 4547.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2018 Insured Insurance Company WC 99 0410B (Ed. 9-14) Cypress Insurance Company Policy No. S TWC 922397 Endorsement No. Premium$ Countersigned by _________________ _