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Exact Construction; 2021-01-29; PKRC21-0127
Tracking #: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS; CONT. NO. PKRC21-0127 This agreement is made on the L91-4 day of ..7—euvx_04---pi , 20'2.4 by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Exact Construction whose principal place of business is 1195 Angelus Ave., San Diego, CA 92114 (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: Tennujin Matsubara (City Project Manager) PAYMENT. I ho City shall withhold retention as required by Public Contract Code Section 9203. 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 1.773.1 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 I abor 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. STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS; CONT. NO. PKRC21-0127 Page 1 of 9 City Attorney Approved 1/22/2020 Signature: Print Name: 167.-r-C34 /1117/7 /71-- Tracking #: 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. 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 participatjacontract bidding. 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-A/II"; 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. STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS; CONT. NO. PKRC21-0127 Page 2 of 9 City Attorney Approved 1/22/2020 Tracking #: 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. 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 14 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 21 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Exact Construction (name of Contractor) 896546 (Contractor's license number) General Builder (license class, and exp. date) 1 000064292 (DIR registration number) 6/30/2021 (DI R registration exp. date) 1195 Angelus Ave. (street address) San Diego/CA/92114 (city/state/zip) 619-254-5497 (telephone no.) N/A (fax no.) exactconstructiongyahoo.com (e-mail address) STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS; CONT. NO, PKRC21-0127 Page 3 of 9 City Attorney Approved 1/22/2020 By: (sign here) City Manager 04)Y1/4.94--- (print name/title) By: ATTEST: BARBARA ENGLESON City Clerk Depoj 09- tver.c (sign here) DputLCity Attorney Tracking #: AUTHORITY. The individuals executing this Agreement and struments referenced in it on behalf of Contractor each represent and warrant that they have the gal po or, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR CITY SARLSBAD, a municipal corporation of the Stat a fornia (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, Secretary, President, or Assistant Secretary, Vice-President 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: STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS; CONT. NO. PKRC21-0127 Page 4 of 9 City Attorney Approved 1/22/2020 Tracking #: EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: STAGFCOACH COMMUNITY PARK; CONCRETE SIDEWAI K AND DRINKING FOUNTAIN IMPROVEMENT S; CON-I. NO. PKRC21-0127 Page 5 of 9 City Attorney Approved 1/22/2020 Tracking #: EXHIBIT B SCOPE OF WORK Location: Sta ecoach Community Park 1. Between Field 2 and 3: demolish and remove existing concrete and pour new concrete for drinking fountain. Remove •63 square feet of concrete; 7' x 9' existing drinking fountain pad Install •Basoplato for now drinking fountain (provided by City of Carlsbad) •63 square feet of concrete sidewalk; 7' x 9' existing drinking fountain pad 63 square feet: $1,890.00 2. Community Center: demolish and remove existing concrete, pour new concrete, and install root barrier on the perimeter edge of concrete. Remove •516 square feet of concrete; 24' x 21.5', 8' x 16.5', 8' x 12.75' Install •516 square feet of concrete; 24' x 21.5', 8' x 16.5', 8' x 12.75' •25 lineal feet of bio barrier root barrier Root Barrier: $1,500.00 516 square feet: $10,320.00 3. Tennis court perimeter sidewalk and drinking fountain: demolish and remove existing concrete and pour new concrete. Remove •2,204 square feet of concrete sections; 5' x 29', 20' x 24', 103' x 9', 5' x 60', 12' x 16', 8 x 20' Install •2,204 square feet of concrete sections; 5' x 29', 20' x 24', 103' x 9', 5' x 60', 12' x 16', 8 x 20' •103 lineal feet of 6" curb •Baseplate for new drinking fountain (provided by City of Carlsbad) 103 lineal feet of 6" curb: $4,200.00 2,204 square feet: $41,876.00 S I AGECOACH COMMUNITY PARK: CONCRFTF SIDFWAI K AND DRINKING FOUNTAIN IMPROVEMENTS; CONT. NO. PKRC21-0127 Page 6 of 9 City Attorney Approved 1/22/2020 Tracking #: Total cost for materials: $23,914.00 Total cost for labor: $35,872.00 Grand Total: $59,786.00 Exclusions and Notes •The contractor will not be responsible for any damages incurred by unmarked service lines (irrigation mainlines, lateral pipes, wires, etc.). City staff will repair all damages incurred during this project that have not been marked by means of paint, feathers, flags, etc. during the start to completion of this project. •Drinking fountain, drinking fountain hardware, installation of point of connection devices and connecting of water service line to existing plumbing will be provided and completed by city staff. This will be coordinated jointly by city staff and the contractor during the start and completion of each project. Total contract amount not to exceed $59,786.00. STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS: CONT. NO. PKRC21-0127 Page 7 of 9 City Attorney Approved 1/22/2020 Premium Subject to Adjustment Tracking (4: Based on Final Contract Price Bond No. 100544008 EXHIBIT C LABOR AND MATERIALS BOND Premium: $1,196.00 ,.'VH( lAS. the f`.:i!y C.;ouric I of the Cty of Carlsbad. State of Catilornia. has awarder) 'i's.st Exact Construction and Concrete chfyr•inciftcy designated t-is the "f)rin(;ipai"), a Contract For: STAGECOACH COMMUNITY PARK; CONCRETE SIDEWALK AND DRINKING FOUNTAIN IMPROVEMENTS CONTRACT4401PKRC?1-0127 City of Carlsbad. in strict conformity with the drawings and specifications, and other Conlinct Documents, now on file in the Office of the City Clerk of the City Qf CadSbad and alror which are iricorpun:ed hotein by this f eference. *W:11,4,CAS. Principal ha$ 6Xeduted or is about to execute said Contract and thellWrnis thereof req;iire thp. .1„if(fli.q.hirig of a bond, prOVigingthol If Principal or any of its subcontractors shall fail to pay for arly Provisions, prOvencler or olAer supplies or teams used in, upon of about the performance or the work Ogrer.?if dOne or for any wor,k or labor done thereon of any kind. the Surety on,h,ls'Op.,nd will pay the Salt1V till:extent hereinafter set forth. NOW, THEREFORE. WE. Exact, Constructign. as PrihriPal..(hereinafter itrksig'nated as the "contraMet mid American Contractors Indemnity Company as Surety, are hcId firmly bound unto thftir.M. or Carlst:14.!.d in the sum rif .11114p4,ine thousand iitven hundred •elighly•six ,DOilprs ($59-.786). said sio! tti ani aEnount actual to: One I-kindred percc-Int (10,0*0) of the total amount payable under the term::: a 1-N, Cdntracl by the City of Cartgac.L and for which payment well and truly-lobe made we bind ourselves. our nefr5; executors and admirlOrbibra, successors, ora.ssigna;. jointly on* sever.. fiemly by these presents tHE CONDITION or riis OBLIGATION IS SUCH that lithe Contractor or his/her subContractors: fait to •—,y104 any materials; urOvistons. provender. suppi10..:Or Walt tiSed in, uportAtorebout the per-km.400, .01 tiv ?ivork contracted to be:' done, or for any other Wk or labor thereon:of:any )(Ind. cOnSistemt •tQ.10111Vnin Civil Cede sF..ction 0.00 or kir amounts due under RV Unemployment Insurance Code Cliv, til4p01 to, the work or labor performed under MIS Contract. or for any amounts required to be dedw;f:'10. 4iithkeik.;4nd paid over to the EMployment Development Depoitment from the wages of employees a! tt .cOurractio.i! and subcontractors ptirsuant to section 13020 of the Unemployment Insurance Code vvit . 13,))4441.4).1ho work end labbr, that•the Surety will pay for the,Sarne, and also in case :30 is brought Orlon. rensonahle nttorney's f4es. to be fixed by the court consistent with ColiforlUa Civil Code section. f455.1,, This b 0 shall inure to tne benefit of any of the persons•narned in California Civil otie section 9100. so .12. to g*. 'a-rich& of action to those'persons or their osSighs in any sUit brought upoiphe bond. f•;:.1/43f.f;14.0014:”..; :VW tIcr.it:T3 that 4.1e aliinge. Oilension 0! time..atteration or additipn to th: cl! Cont14-1, ,or o ft r iurr c be pOarrned hereunder or trio specifications bcco!nponyinil ;he Satfre :;r1;)!; OaeGt e)Oi; gat ronli o' ihrf:; 001144, VI)d it coos hereby waive notice of any change,. extension ol addition to the torfris otthe contract or tO-tneskor,,ht or to (ho specifications. AGEcOACitcOmmuNITY PARK: rE SIDEWALK AND OR/NK/NG ,.1.;N Art4 MI; Y.4:DvE wrs; Ha 21 o12: Page 8 of 0 Cily Allot ney Apf.rove.,1 of Con Ofb (print name, herd) Tracking 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 2--. day Executed by SURETY this 18th day of Fe-6 - , 202- f. of February 20 21 ' CONTRACTOR: Exact Construction and Concrete (title and organization: of signatory) By; isignitere)' (print name here) (title and organization .a signatory) SURETY: American Contractors Indemnity Company (name of Surety) 625 The City Drive S., Suite 205. Orange, CA 92868 (address of Surety) 714-740-7000 (telepte: umber of Surety) By: (sign reio Attorney-in-Fact) Ariel T. Heredia (Printed name of Attorney-In-Fact) (attach scprpOrate resolution showing current poWer of attorney) (Proper notarial acknowledgment of execution,by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretaryor 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 Attorney C.C)MMVNITY PARK; !;,.ONCRETE: 3iDEWALK AND DRINKING AIN IMPROVEMENTS: '.:ONT NO PKI1C21.0127 Page 9 of 9 City Attorney Approved 1)22.7021.i Notary PuXbilcH?Ca:7 1, Oraile County k Commiss!on 4 2262101 Conrn. Exoires Nov 7. 29411 4.1§6.4jorgar.4.11,weit •CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE §1189 a(-&K.,10'.A192L 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 Olartat__ 0 n fi-r7,1t),4-01. 181 /2„) 1- before me, Date personally appeared K. Ho, Notary Public Here Insert Name and Title of the Officer Ariel T. Heredia Name(s) of Signer(s) who proved td me on the basis of satisfactory evidence to be the person% whose name* isfe04 subscribed to the within instrument and acknowledged to me that he/al-W*1w executed the same in his/he/t& authorized capacity(Mx), and that by hisibeCittelt signature M on the instrument the person*, or the entity upon behalf of which the .person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of thei atate of California that the foregoing paragraph i$ bile: and correct. WITNESS my hand and official seal. Signature Signature of Wotary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter.alteittion .of:the document or fraudulent reattachment of this form to: an unintended d.6cuinent, Description of Attached Document Title or Type of Document Bond * I 00,54( Document Date: Number of Pages: Signer(s). Other. Than Named Above: Ca.pacity(ies) Claimed by Mytiork :SighWe. Name: Ariel T. Heredia Signer's Name: 0 Corporate Officer — Title(): Corporate Officer — Title(s): Partner — 1171 Limited 171.6eneral Partner — Li Limited Li General individual K.] .Attorney in Fact LI Individual i7lAttorney in Fact LI Trustee 171 Guardian or Conservator Trustee 1:1*Guardian or Conservator E.1 Other: L.:1 Other: Signer Is Representing: Signer Is Representing: e&V.f...,I_X"MMTM.Y001;A:WW:AxixStRz<IMMX.:x L'A.X :;<:x x::"c4.4"."?',:‹53,%:',.."%64WW,>,,Vggggfre'OgraWMT 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-878.•6827) Item #5907 (seal) WITNESS my hand and official seal Signature „t ...,,, , 5:y. Pt 1?ii:C4.t''CtEifTvniz . vst 1=42‘20Z oiz Kio Lo, As nt Secretary TOKIO MARINE H C C POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, ARIEL T. HEREDIA its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number 100544008 issued in the course of its business and to bind the Company thereby, in an amount not to exceed Fifty-nine thousand, seven hundred eighty-six and 00/100 $59,786.00 ). This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1st day of September, 2011. "Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attomey-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 1st day of June, 2018. Iss-t04.T2R,sf.",- •- ...,*,c,„ ...,-... r ., .:.--,c,, AMERICAN CONT.KTO S INDEMNITY COMPANY l ittt State of California County of Los Angeles :Z 01CO)WORATED =4= Tit\ SEPt 25,1*90 1. ... .... `4g.gFOVO,S, .7071,1,51,0%. By: Ada S. Pessin. President 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. On this 1st day of June, 2018, before me, Sonia 0. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity. and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. I, Kb o Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of February 2021 004101111110, Bond No. Agency No. 100544008 •`'o'?••• ..... -• 4 , -",- -. cos .3.-- -' '...:L• - z...-.: =,...) INCORPORATED =4 = ...a SEPT. 25, 1990 -< = 4046 ; S 0. • ...., *..,:•.., 4.,.* ,::.: .. 4'44 i ............ 14//iiim101% visit tmhcc.com/surety for more information HCCSZZPOAACIC061201 8 --- i 0 ACCPRE) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYTY) 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 StateFarm State Farm Insurance Jack Dale Agency 0 1001 B ave #213 CONTACT Jordanne Lordson NAME: PHONE Est): 619 7438481 rikilcc , No): iA/C. No, ADDRESS: jordanne@jackdale.net 0'0 Coronado Ca 92118 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: State Farm General Insurance Company 25151 INSURED AHARON MILLET DBA EXACT CONSTRUCTION 1195 ANGELUS AVE SAN DIEGO,CA92114-3106 INSURER B : INSURER C: INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POUCY NUMBER POLICY EFF (mmlooryyyy) POLICY EXP (MWDD/TYYTI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES - ; JPRECOT 1 PER: LOC GENERAL AGGREGATE s PRODUCTS - COMP/OP AGO $ $ AUTOMOBILE UABILITY ANY AUTO OVVNED AUTOS ONLY HIRED AUTOS ONLY r'• •sf I SCHEDULED AUTOS NON-OWNED AUTOS ONLY Y 460 9984-C21-55B 296 4514-D11-55H 03/03/2021 04/11/2021 09/21/2021 e armEerrs)t?INGLE LIMIT $ 10/11/2021 BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE (Per accident) $ 1,000,000 $ — UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS-MADE • EACH OCCURRENCE $ AGGREGATE $ DED i . RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y /N N / A STATUTE ER PER 1 ; 0TH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) 79 INTERNATL 1824 DUMP DMP SGL VIN: AA182JHA29770 12 FREIGHTLNR M2 106V FLTBDTRK FLTBD TR VIN: 1FVACXDT4CDBJ5715 • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF CARLSBAD 799 PINE AVE STE 200 AUTHORIZED REPRESENTATIVE CARLSBAD CA 92008-2428 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent. © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020 ---- 1 ® A C CPR EP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 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 Target Financial & Insurance Services, Inc. 3250 Grey Hawk Ct Carlsbad CA 92010 CONTACT Customer Service Department NAME: (800) 450-8013 FAX (800) 434-8053 PHONNo, Ext) E , No): (A/C, E-MAIL Certificates@tgfis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC it INSURER A : Associated Industries Ins Co Inc 23140 INSURED Exact Construction 1195 Angelus Avenue San Diego CA 92114 INSURER B : INSURER C: INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: GL 20-21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN: THE INSURANCE AFFORDED BY THE POLIO ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLJCY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY AES104135604 08/02/2020 08/02/2021 EACH OCCURRENCE $ 1i 000i 000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100 000 $ . CLAIMS-MADE X OCCUR ma) EXP (Any one person) $ 5.000 PERSONAL &ADV INJURY 1 000 000 GEN'L AGGREGATE POLICY OTHER: ..•—• LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE 000 000 $ 2 ' ' PRODUCTS - COMP/OP AGG $ 2.00 0,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-CANNED AUTOS ONLY COMBINED SINGLE LIMIT tEa accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE /Per accident) $ _ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION S WORKERS COMPENSATION ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below YIN N /A AND EMPLOYERS' LIABILITY STA.TUTE ER I PER l I 0TH- I I E.L. EACH ACCIDENT $ E.L. DISEASE-BA EMPLOYEE $ E.L. DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Verification of Coverage *Subject to all policy terms, exclusions and conditions* CERTIFICATE HOLDER CANCELLATION The City of Carlsbad Parks and Recreation Dept 799 Pine Ave Carlsbad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CA 92008 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS COMPENSATION INSURANCE STATE C.:ONIPNSATION INS.URANCE FUND SP CERTH OLDER COPY ISSUE DATE: 08-01-2020 GROUP: POLICY NUMBER: 1974447-2020 CERTIFICATE ID: 48 CERTIFICATE EXPIRES: 08-01-2021 08-01-2020/08-01-2021 CITY OF CARLSBAD PARKS & RECREATION ADMIN SP 799 PINE AVE STE 200 CARLSBAD CA 92008-2428 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. 11611. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-08-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CARLSBAD PARKS & RECREATION ADMIN ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2014 IS --- ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER MILLET, DONWYN AHARON EXACT CONSTRUCTION SP 1195 ANGELUS AVE SAN DIEGO CA 92114 [KDA.ON] (REV.7-2014) PRINTED : 03-02-2021 POLICYHOLDER COPY STATE P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE COMPENSATION INS'URANCE FUND ISSUE DATE: 08-01-2020 GROUP: POLICY NUMBER: 1974447-2020 CERTIFICATE ID: 48 CERTIFICATE EXPIRES: 08-01-2021 08-01-2020/08-01-2021 CITY OF CARLSBAD PARKS & RECREATION ADMIN SP 799 PINE AVE STE 200 CARLSBAD CA 92008-2428 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. .,..4......77,,,-", Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-08-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CARLSBAD PARKS & RECREATION ADMIN ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2014 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER MILLET, DONWYN AHARON EXACT CONSTRUCTION SP 1195 ANGELUS AVE SAN DIEGO CA 92114 [KDA,CN] ME11.7-M14) PRINTED : 03-02-2021 ..--- 7 0 ACCPRO CERTIFICATE OF LIABILITY INSURANCE kPar---' DATE (MM/DD/YYYY) 03/02/2021 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 po icy, 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 Target Financial & Insurance Services, Inc. 3250 Grey Hawk Ct Carlsbad CA 92010 CONTACT Customer Service Department NAME: PHONE (800) 450-8013 FAX (800) 434-8053 (AlC, Nor Ext) WC, No, : E-AIL Certificates@tgfis.com MRESS: ADD INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Associated Industries Ins Co Inc 23140 INSURED Exact Construction 1195 Angelus Avenue San Diego CA 92114 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: GL 20-21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MMIDDITYYY) POLICY EXP (MM/DDIVYYY) LIMITS A X COMMERCIAL GENERAL UABILITY Y AES1041 35604 08/02/2020 08/02/2021 EACH OCCURRENCE $ 1'' 000 000 CLAIMS-MADE X OCCUR DAMAGE 10 RENTED PREMISES (Ea occurrence) 10a a 00 $ ' MED EXP (Any one person) , $ 5000 PERSONAL & ADV INJURY $ 1, 000, 000 GEN'L R AGGREGATE LIMIT APPLIES PER: POLICY X m CT e- OTHER: JE LOC GENERAL AGGREGATE $, 2 000, 000 PRODUCTS • COMP/OP AGG 0 $ 2,0 CO00 $ - - AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY - SCHEDULED AUTOS NON-OWNED AUTOS ONLY COMBINED SINGLE LIMIT {Ea accident) S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB - OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION 3 $ WORKERS COMPENSATION Y AND EMPLOYERS' LIABILITY / N ANY PROPRIETOR/PARTNER:EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA PER STATUTE 0TH. ER Et EACH ACCIDENT S EL. DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate Holder is named as Additional Insured, to the extent provided in the attached form(s). *Additional Insured status is subject to all policy terms, exclusions and conditionsk CERTIFICATE HOLDER CANCELLATION The City of Carlsbad Parks and Recreation Dept 799 Pine Ave Carlsbad I CA 92008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE —12---fruZZA-sre W.-1-Aciocr."-E (D 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying servic- es, including: a.The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opi- nions, reports, surveys, field orders, change orders or drawings and specifications; or b.Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 CERTHOLDER COPY SP STATE COMPNSATION INSURANGG FUND P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-01-2020 GROUP: POLICY NUMBER: 1974447-2020 CERTIFICATE ID: 48 CERTIFICATE EXPIRES: 08-01-2021 08-01-2020/08-01-2021 CITY OF CARLSBAD PARKS & RECREATION ADMIN SP 799 PINE AVE STE 200 CARLSBAD CA 92008-2428 This is to certify that we have issued a valid Workers Compensation insurance policy in a form apprbved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. 1 /.1) d .v1,--7,,-,--, Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-08-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CARLSBAD PARKS & RECREATION ADMIN ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2014 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER MILLET, DONWYN AHARON EXACT CONSTRUCTION SP 1195 ANGELUS AVE SAN DIEGO CA 92114 [KDA,ON] (REV.7-2014) PRINTED : 03-02-2021 P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE STATE COMPENSATION INSURANCE FUND SP POLICYHOLDER COPY ISSUE DATE: 08-01-2020 GROUP: POLICY NUMBER: 1974447-2020 CERTIFICATE ID: 48 CERTIFICATE EXPIRES: 08-01-2021 08-01-2020/08-01-2021 CITY OF CARLSBAD PARKS & RECREATION ADMIN SP 799 PINE AVE STE 200 CARLSBAD CA 92008-2428 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein, Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AF FORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-08-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CARLSBAD PARKS & RECREATION ADMIN ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2014 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER M/LLET, DONWYN AHARON EXACT CONSTRUCTION SP 1195 ANGELUS AVE SAN DIEGO CA 92114 [KDA,CN] (REV.7-20141 PRINTED : 03-02-2021 PRODUCER StateFann State Farm Insurance Jack Dale Agency 1001 B ave #213 Coronado Ca 92118 0'0 INSURED AHARON MILLET DBA EXACT CONSTRUCTION 1195 ANGELUS AVE SAN DIEGO,CA92114-3106 PHONE 619 7438481 4ALC-No Ex0. FAX INC. No)* E-MAIL jordanne@jackdale.net ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A : State Farm General Insurance Company NAIC # 25151 INSURER B INSURER C INSURER 13 • INSURER E - INSURER F: CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/03/2021 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). CNAMONTEA: CT Jordanne Lordson COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INS!) SUER WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _. I- 7 CLAIMS-MAUE OCCUR _ . DAMAGE TO RENTED PREMISES (Ea occurrence) S MED EXP (Any one person) S PERSONAL & ADV INJURY $ GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES I JECPRO-T 1 PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ — _ _ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ V' i'. SCHEDULED AUTOS NON-OWNED AUTOS ONLY Y 460 9984-C21-55B 03/03/2021 09/21/2021 COMBINED SINGLE LIMIT • $ 296 4514-D11-55H 04/11/2021 10/11/2021 BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE ,_(12ffiLacck_lev $ 1,000,000 S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE s AGGREGATE s CEO RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N IA PER 0TH- STATUTE ER E.L. EACH ACCIDENT $ El. DISEASE - EA EMPLOYEE $ EL. DISEASE - POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 79 INTERNATL 1824 DUMP DMP SGL VIN: AA182JHA29770 12 FREIGHTLNR M2 106V FLTBDTRK FLTBD TR VIN: 1FVACXDT4CDBJ5715 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF CARLSBAD 799 PINE AVE STE 200 AUTHORIZED REPRESENTATIVE CARLSBAD CA 92008-2428 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent. ACORD 25 (2016/03) 0 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020