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S. R. Bray LLC DBA Power Plus; 2021-04-26; PWM21-1446FAC
PWM21-1446FAC Police & Fire HQ Temporary Power - Cont. No. 4715 Page 1 of 9 City Attorney Approved 1/20/2020 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT POLICE & FIRE HQ TEMPORARY POWER; CONT. NO. 4715 This agreement is made on the ______________ day of _________________________, 2021, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and S. R. Bray LLC, a Delaware limited liability company d.b.a. Power Plus whose principal place of business is 5500 E. La Palma Ave., Anaheim, CA 92807 (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: Steven Stewart (City Project Manager). PAYMENT. The 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 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 26th April DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract procE;lss 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 partici · @ in contract bidding. Signature: Mc Print Name: Steven R Bray 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. Police & Fire HQ Temporary Power -Cont. No. 4715 Page 2 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC 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 five hundred twenty (520) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill S. R. Bray LLC, d.b.a. Power Plus (name of Contractor) 980589 (Contractor's license number) B C10 C61/D31 1/31/2023 (license class. and exp. date) PW-LR-1000624421 (DIR registration number) 6/30/2023 (DIR registration exp. date) Police & Fire HQ Temporary Power -Cont. No. 4715 Page 3 of 9 5500 E. La Palma Ave. (street address) Anaheim, CA 92807 (city/state/zip) 760-839-9430 (telephone no.) 760-839-9436 (fax no.) scerny@powerplus.com (e-mail address) City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC 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 S. R. BRAY LLC, a Delaware limited liability ~~~pany £1£E~ (sign here) Steven R. Bray, President (print name/title) (sign hefe} Steven Nameroff, CFO (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: _·_,,_-jf,_J--1_1o/',..,=--.------ Assistant City Attorney Police & Fire HQ Temporary Power -Cont. No. 4715 Page 4 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to Business Name and Address DIR Registration License No., % of be Subcontracted No. Classification & Total Expiration Date Contract NONE Total % Subcontracted: ______ _ The Contractor must perform no less than fifty percent (50%) of the work with its own forces Police & Fire HQ Temporary Power -Cont. No. 4715 Page 5 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC EXHIBIT B Police & Fire Headquarters Temporary Power Contractor shall meet and coordinate all work with SDG&E, obtain city building permits, deliver and install power equipment, obtain approvals from city and SDG&E to energize, lease power equipment to city for contract duration and then remove equipment at end of lease. JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE NO. 1 Lot 3 Contact SDG&E and coordinate field work $1,200 2 Lot 1 Obtain city building permit for temp power install $300 3 Lot 1 Deliver temp electrical materials $8,200 4 Lot 1 Install temp electrical materials $28,540 5 Lot 1 Obtain building inspection approval of temp setup $170 6 month 16 Lease electrical materials for up to an additional 16 $11 ,616 month contract duration and remove at direction of city TOTAL" $50,026 *Includes taxes, fees, expenses and all other costs. Police & Fire HQ Temporary Power -Cont. No. 4 715 Page 6 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC Scope Of Work: Quote applies to setting a 400 amp 480 volt three phase service for trailers. Prevailing wages are included in price. Carlsbad will be responsible for private dig alert (CPL). A separte price will be issued for trailer hook-up. Remarks: Monthly' rental charges will be $726.00 per month' after the first 22 months'. •Months will be calculated in 28-day periods. Quantity Equipment/Service 1 Meter. 3 Ph 400A 480V Meter with CT Provisions 1 Dlstro Pnl -3 Ph 400a 277/480v Mn Bkr -Tac-On 1 Disconnect - 1/3 Ph 400a 480v Tac -On 2 Wire -0/H 2/0 Grulllo (1 Span) 3 Pole • Black Diamond (30 feet) 1 Meter -Utility Trench -18 x 32 x 72 (SD Reg) 1 Meter I City County Permit. San Diego 1 Runners Fees 5 Ground Rod -8 Foot 1 Flex• 3 Wire 250 MCM AL -Over 8 feet 1 Transformer -100 KVA Single Phase Step Down (Includes load center) 14 Breaker -100 amp 2 Pole 120/240v 1 Receptacle -50 Amp Twist Lock 2 Riser· 3 Wire 250 MCM Flex 8 foot 200A 1 Ph 1 Transformer • 45 KVA Three Phase Step Down (includes load center) 2 Transformer -75 KVA Three Ph Step Down (Includes load center) 1 Flex • 3 Wire 250 MCM AL. 8 ft. and under 1 Riser -2 Wire 1 /0 1 1/2" Flex 6 foot 1 00A 1 Wire -0/H #2 (1 Span) 1 Breaker -100 amp 3 pole 120/208v 1 Concrete -Per Yard 1 Meter • Plywood Backboard 1 Pole -8 Foot Bare 1 Prevalllng Wage Included Total: $50,026.00 Police & Fire HQ Temporary Power -Cont. No. 4 715 Page 7 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 EXHIBIT C LABOR AND MATERIALS BOND PWM21-1446FAC Bond No. 0235516 Premium: $2,001.00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to S. R. Bray LLC, a Delaware limited liability company d.b.a Power Plus (hereinafter designated as the "Principal"), a Contract for: POLICE & FIRE HQ TEMPORARY POWER CONTRACT NO. 4715 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. S. R. Bray LLC d.b.a. Power Plus, as Principal, (hereinafter designated as the "Contractor"), and Berkley Insurance Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of fifty thousand twenty-six dollars ($50,026), 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 Development 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. Police & Fire HQ Temporary Power -Cont. No. 4 715 Page 8 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 PWM21-1446FAC 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. SIGNED AND SEALED, this )0(1-X 8th day of_A~p~r_il _________ , 20_2_1_ S.R. Bray LLC dba Power Plus Steven R. Bray (SEAL) Berkley Insurance Company By: __ .. My....__(P-r-in-ci_p...,al ... ) ....... _____ _ (Signature) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY -ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CELIA A. BREWER City Attorney By: -1<~ Assistant City Attorney (SEAL) Police & Fire HQ Temporary Power -Cont. No. 4715 Page 9 of 9 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 CALIFORNIA ALL-PURPOSE 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 . tlc-anw On ~IJ/j 1 / 2__D-Z-/ before me, \J ' I ~ pers-:tl1y appeared --~____: __ -..:...._ __ Q--=--_· ---=-_:_---=--4-1,-re-,n-•e_rt 0 _________ _ who proved to me on the basis of satisfactory eviden e to be the person whose nRmeft.~bscribed to thew· in instrument and acknowledged to me that ~cuted the same in er e1r authorized capacity(iJ5), and that by Qii§/11eJ/tl 1ei1 sig1rature,e£) on the instrument the person(;)('or the entity upon behalf of which the person~acted , executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of Californ ia that the foregoing paragraph is true and correct. WITNESS my hand and official seal. <;/{l{t~' r ♦ 0 ♦ 0 0 0 D ft ft ft ft ~ V. 0£LARIVA f ~ ~~~ Notary Public • California : z \~. Oranie County ~ ~ Commission• 2310770 - ""'1 Co.rrrr • E.x;,ir~ Nov 2•, 2023 Notary Public Signature (Notary Public Seal) INSTRUCTIONS FOR COMPLETING THIS FORM ADDITIONAL OPTIONAL IN FORMATION This form complies with current California statutes regarding notary wording and, DESCRI PTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknowledgments from other states may be completed/or documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) (Title or description of attached document continued) Number of Pages __ Document Date. ___ _ CAPACITY CLAIMED BY THE SIGNER □ Individual (s) □ Corporate Officer (Title) □ Partner(s) □ Attorney-in-Fact □ Trustee(s) □ Other __________ _ 2015 Version 1.wm.NotaryClasses.com 800-873-9865 • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. lle/she/il,ey;-is /are) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form • Signature of the notary public must match the signature on file with the office of the county clerk. ❖ Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. ❖ Indicate title or type of attached document, number of pages and date. ❖ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 POWER OF ATTORNEY BERKLEY INSURANCE COMPANY WILMINGTON, DELAWARE No. Bl-7667a-el NOTICE: The warning found elsewhere in this Power or Attorney affects the validity thereor. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the ·'Company"), a corporation duly organized and existing under the laws orthe State of Delaware, having its principal office in Greenwich, CT, has made, constituted and appointed, and does by these presents make, constitute and appoint: Paul Boucher; De1111is E. l"11ger; Timothy J. Noo11a11; Adri(lna Valenzuel"; or Jennifer Ochs of Lockton Comp(l11ies, LLC of Los Angeles, CA its true and lawful Attorney-in-Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws or the State of Delaware, without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following resolutions which were duly and validly adopted at a meeting of the Board or Directors of the Company held on January 25, 20 I 0: RESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief Executive Officer, President or any Vice President of the Company, in coqjunction with the Secretary or any Assistant Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and revoke any power of attorney previously granted; and further RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and further RESO L v-Efi;-thatthe-signatur e of any aathorized-officerand-the-seai-of-the-eompany may be-affixt::d by fac:.imtfrle~t1ru.--a"'n"'y,-------- power of attorney or ce11ification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimi le signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, the Company has caused these presents _!:Q . .be signed and attested by its appropriate officer$ and its corporate seal hereunto affixed this 26th day of March 2020 . I S "'o~o..,,.., o~ B t ~ ~· ~ y_~~,_..µ. _________ _ ,~.\)~Nq~ Attest: ~, \~ ~l-.i\l, ! fra . edermar1 cP 1~, .. Executive Vice Presidcut & Secretary ' Oru,wr,i\.~ STATE OF CONKECTICUT ) ) ss: COUNTY OF FAIRFIELD ) CERTIFICATE I, the undersigned, Assisrnnt Secretary of BERKLEY INSURA.i"l'CE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct and complete copy of the ciriginal Power of Attorney; that said Power of Atromey has not been revoked or rescinded and that rh.~authority of the Anorney-in-Fac[ set fortb therein, who executed lhe bond or undertaking to wl1ich this Power of Att~i""' · ched, is in full force and effect lls oftbis date. ~ If~, ~•.Re_,,l't ,, under my band and seal of the Company, th.is ~ day of Aril. . , 2021 . . ~ SL\L ., .--:...,__;;::.... ~--- \ dl 1,tJ7\ ~ ". /~l i\. · _ _,_ ____ _ , Aw~ -' Vmccn.t P. Fo1tc DocuSign Envelope ID: 1EF99E1D-9B94-4382-B0E0-FB1C3362CD67 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the. identity of the individual who signed the document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document State of California County of LOS ANGELES On ApW. 0, 1J) Zd before me, RHONDA LARSON, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ________ A_D_R_IA_N_A_V_A_L_E_N_Z_U_E_L_A ___________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the persontfv whose name~) is/~~ subscribed to the within instrument and acknowledged to me that !S©(she/1)(~ executed the same in Ji(i~her/t,)(~ authorized capacity~)l. and that by .XOC'her/~Mr signatureOO on the instrument the personOO, or the entity upon behalf of which the person~) acted, executed the instrument. ········1 RHONDA LARSON Noury Public • Californi,1 z Los Angeles County ~ Commission # 2329998 - y Comm. Expires Jun 27, 2024 Place Notary Seal Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Signature of Notary Public RHONDA LARSON, NOTARY PUBLIC ---------------oPnONAL--------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: _____________ Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ___________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ___________ _ □ Corporate Officer -Title(s): ______ _ D Corporate Officer -Title(s): ______ _ □ Partner -□ Limited □ General D Partner -D Limited D General □ Individual □ Attorney in Fact D Individual D Attorney in Fact D Trustee D Guardian or Conservator D Trustee D Guardian or Conservator 0 Other: _____________ _ D Other: _____________ _ Signer Is Representing: _________ _ Signer Is Representing: ________ _ ©2014 National Notary Association • www .National Notary .org • 1-800-US NOTARY (1-800-876-6827) Item #5907 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Lockton Insurance Brokers, LLC 777 S. Figueroa Street, 52nd Fl. CA License #0F15767 Los Angeles CA 90017 (213) 689-0065 SR Bray, LLC dba Power Plus! 5500 E. La Palma Ave Anaheim CA 92807 SRBRA01 Chubb National Insurance Company 10052 Executive Risk Indemnity Inc.35181 Federal Insurance Company 20281 Starr Indemnity & Liability Company 38318 X X 2,000,000 100,000 5,000 2,000,000 4,000,000 4,000,000 X 2,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X 5,000,000 5,000,000 XXXXXXX Y X 1,000,000 1,000,000 1,000,000 B 54309649 3/31/2021 3/31/2022 A 54309650 03 (AOS)3/31/2021 3/31/2022 D 54309651 03 (CT)3/31/2021 3/31/2022 C 1000585672211 3/31/2021 3/31/2022 B 54309652 03 3/31/2021 3/31/2022 3/31/2022 1476559 Y Y Y Y Y Y Y 4/7/2021 17472625 17472625 XXXXXXX CITY OF CARLSBAD 1635 Faraday Carlsbad CA 92008 Certificate Holder(s) are Additional Insured(s) as per the attached endorsement or policy language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached endorsements or policy language. Waiver of subrogation applies as per the attached endorsements or policy language, where allowed by law. RE: POLICE & FIRE HQ TEMPORARY POWER. Additional Insured: CITY OF CARLSBAD. X See Attachments _____, ACORD® ~ I I -~ □ -- Fl □ □ --------H I I I I I □ Named Insured:SR Bray, LLC dba Power Plus! CITY OF CARLSBAD 1635 Faraday Carlsbad, CA 92008 To whom it may concern: In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance, thus this is your final hard-copy delivery. To ensure electronic delivery for future renewals of this certificate, we need your email address. Please contact us via one of the methods below, referencing Certificate ID 17472625 Email: LACertseDelivery@lockton.com Phone: (213) 334- 4669 If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. In the event your mailing address has changed, will change in the future, or you no longer require this certificate, please let us know using one of the methods above. The above inbox and phone number is for automating electronic delivery of certificates only. Please do NOT send future certificate requests to this inbox or contact the phone number below with email updates. Thank you for your cooperation and willingness in reducing our environmental footprint. Lockton Companies Lockton Companies 777 South Figueroa Street Los Angeles, CA 90017 Attachment Code: D568466 Master ID: 1476559, Certificate ID: 17472625 0 LOCXTON' POLICY NUMBER: 54309650 03 (AOS) and 54309651 03 (CT)COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does apply to “bodily injury” or “property damage” occurring after: 1. All work, including material, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of “your work” out of which the injury or damage arising has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 Insurance Services Office, Inc., 2012 Page 1 of 2 Attachment Code: D519166 Master ID: 1476559, Certificate ID: 17472625 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 Insurance Services Office, Inc., 2012 Page 2 of 2 Attachment Code: D519166 Master ID: 1476559, Certificate ID: 17472625 POLICY NUMBER: 54309650 03 (AOS) and 54309651 03 (CT)COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY WHERE THE CONTRACT SPECIFIES COVERAGE FOR COMPLETED OPERATIONS. ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II – Who Is Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by “your work” at the location designated and described in the Schedule of this endorsement performed for the additional insured and included in the “products-completed operations hazard”. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code: D519168 Master ID: 1476559, Certificate ID: 17472625 POLICY NUMBER :54309650 03 (AOS) & 54309651 03 (CT)COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE FOR SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Additional Insured:Location Of Covered Operations: WHERE REQUIRED BY WRITTEN CONTRACT.ALL LOCATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at the Location Of Covered Operations shown in the Schedule, the following is added to SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance and supersedes any provision to the contrary; Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under this policy provided that: (1) The Additional Insured is a named insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. 10-02-2461 (Ed. 7-15)Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Miscellaneous Attachment: M498919 Master ID: 1476559, Certificate ID: 17472625 Policy Number: 54309650 03 (AOS) & 54309651 03 (CT) COMMERCIAL GENERAL LIABILITY Form 10-02-1800 (Rev. 09-17) COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS 8. Transfer Or Waiver Of Rights Of Recovery Against Others To Us We will waive the right of recovery we would otherwise have had against another person or organization, for loss to which this insurance applies, provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured’s rights to recover all or part of any payment made under this Coverage Part have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Coverage C. Form 10-02-1800 (Rev. 09- 17) Miscellaneous Attachment: M71149 Master ID: 1476559, Certificate ID: 17472625 Policy Number: 54309649 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: This endorsement modifies the Business Auto Coverage Form. 1. EXTENDED CANCELLATION CONDITION Paragraph A.2.b. – CANCELLATION - of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an “insured” under any other automobile policy or would be an “insured” under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is an “insured” under any other automobile policy; (b) That has exhausted its Limit of Insurance under any other policy; or (c) 180 days or more after its acquisition or formation by you, unless you have given us written notice of the acquisition or formation. Coverage does not apply to “bodily injury” or “property damage” that results from an “accident” that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A.1. – WHO IS AN INSURED – of SECTION II – LIABILITY COVERAGE is amended to add the following: d. Any “employee” of yours while using a covered “auto” you don’t own, hire or borrow in your business or your personal affairs. C. Lessors as Insureds Paragraph A.1. – WHO IS AN INSURED – of SECTION II – LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered “auto” while the “auto” is leased to you under a written agreement if: (1) The agreement requires you to provide direct primary insurance for the lessor; and (2) The “auto” is leased without a driver. Such leased “auto” will be considered a covered “auto” you own and not a covered “auto” you hire. However, the lessor is an “insured” only for “bodily injury” or “property damage” resulting from the acts or omissions by: 1. You; 2. Any of your “employees” or agents; or 3. Any person, except the lessor or any “employee” or agent of the lessor, operating an “auto” with the permission of any of 1. and/or 2. above. D. Persons And Organizations As Insureds Under A Written Insured Contract Paragraph A.1 – WHO IS AN INSURED – of SECTION II – LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered “auto”, provided that you and such person or organization have agreed under an express provision in a written “insured contract”, written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an “insured”. However, such person or organization is an “insured” only: Form: 16-02-0292 (Rev. 11-16)Page 1 of 3 “Includes copyrighted material of Insurance Services Office, Inc. with its permission” Miscellaneous Attachment: M464290 Master ID: 1476559, Certificate ID: 17472625 (1) with respect to the operation, maintenance or use of a covered “auto”; and (2) for “bodily injury” or “property damage” caused by an “accident” which takes place after: (a) You executed the “insured contract” or written agreement; or (b) The permit has been issued to you. 3. FELLOW EMPLOYEE COVERAGE EXCLUSION B.5. - FELLOW EMPLOYEE – of SECTION II – LIABILITY COVERAGE does not apply. 4. PHYSICAL DAMAGE – ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. – TRANSPORTATION EXPENSES – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day for temporary transportation expense, subject to a maximum limit of $1,000. 5. AUTO LOAN/LEASE GAP COVERAGE Paragraph A. 4. – COVERAGE EXTENSIONS - of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following: c. Unpaid Loan or Lease Amounts In the event of a total “loss” to a covered “auto”, we will pay any unpaid amount due on the loan or lease for a covered “auto” minus: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue loan/lease payments at the time of the “loss”; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor: d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. We will pay for any unpaid amount due on the loan or lease if caused by: 1. Other than Collision Coverage only if the Declarations indicate that Comprehensive Coverage is provided for any covered “auto”; 2. Specified Causes of Loss Coverage only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered “auto”; or 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any covered “auto. 6. RENTAL AGENCY EXPENSE Paragraph A. 4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following: d. Rental Expense We will pay the following expenses that you or any of your “employees” are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business: MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT: 1. $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or “loss” of, that vehicle, including income lost due to absence of that vehicle for use as a replacement; 2. $2,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered “loss”; and 3. $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement. 4. $7,500 maximum total amount for paragraphs 1., 2. and 3. combined. 7. EXTRA EXPENSE – BROADENED COVERAGE Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following: e. Recovery Expense We will pay for the expense of returning a stolen covered “auto” to you. 8. AIRBAG COVERAGE Paragraph B.3.a. - EXCLUSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage. 9. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - BROADENED COVERAGE Paragraph C.2. – LIMIT OF INSURACE - of SECTION III - PHYSICAL DAMAGE is deleted and replaced with the following: b. $2,000 is the most we will pay for "loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is: (1) Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; (2) Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or (3) An integral part of such equipment. Form: 16-02-0292 (Rev. 11-16)Page 2 of 3 “Includes copyrighted material of Insurance Services Office, Inc. with its permission” Miscellaneous Attachment: M464290 Master ID: 1476559, Certificate ID: 17472625 10. GLASS REPAIR – WAIVER OF DEDUCTIBLE Under Paragraph D. - DEDUCTIBLE – of SECTION III – PHYSICAL DAMAGE COVERAGE the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Paragraph D.- DEDUCTIBLE – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following: If this Coverage Form and any other Coverage Form or policy issued to you by us that is not an automobile policy or Coverage Form applies to the same “accident”, the following applies: 1. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Paragraph A.2.a. - DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV - BUSINESS AUTO CONDITIONS is deleted and replaced with the following: a. In the event of “accident”, claim, “suit” or “loss”, you must promptly notify us when the “accident” is known to: (1) You or your authorized representative, if you are an individual; (2) A partner, or any authorized representative, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company. Knowledge of an “accident”, claim, “suit” or “loss” by other persons does not imply that the persons listed above have such knowledge. Notice to us should include: (1) How, when and where the “accident” or “loss” occurred; (2) The “insured’s” name and address; and (3) To the extent possible, the names and addresses of any injured persons or witnesses. 13. WAIVER OF SUBROGATION Paragraph A.5. - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV – BUSINESS AUTO CONDITIONS is deleted and replaced with the following: We will waive the right of recovery we would otherwise have against another person or organization for “loss” to which this insurance applies, provided the “insured” has waived their rights of recovery against such person or organization under a contract or agreement that is entered into before such “loss”. To the extent that the “insured’s” rights to recover damages for all or part of any payment made under this insurance has not been waived, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after “accident” or “loss” to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. – CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV – BUSINESS AUTO CONDITIONS - is deleted and replaced with the following: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Form because of such failure. 15. AUTOS RENTED BY EMPLOYEES Paragraph B.5. - OTHER INSURANCE of SECTION IV – BUSINESS AUTO CONDITIONS - is amended to add the following: e. Any “auto” hired or rented by your “employee” on your behalf and at your direction will be considered an “auto” you hire. If an “employee’s” personal insurance also applies on an excess basis to a covered “auto” hired or rented by your “employee” on your behalf and at your direction, this insurance will be primary to the “employee’s” personal insurance. 16. HIRED AUTO – COVERAGE TERRITORY Paragraph B.7.b.(5).(a) - POLICY PERIOD, COVERAGE TERRITORY of SECTION IV – BUSINESS AUTO CONDITIONS is deleted and replaced with the following: (5) A covered “auto” of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and 17. RESULTANT MENTAL ANGUISH COVERAGE Paragraph C. of - SECTION V – DEFINITIONS is deleted and replaced by the following: “Bodily injury” means bodily injury, sickness or disease sustained by any person, including mental anguish or death as a result of the “bodily injury” sustained by that person. Form: 16-02-0292 (Rev. 11-16)Page 3 of 3 “Includes copyrighted material of Insurance Services Office, Inc. with its permission” Miscellaneous Attachment: M464290 Master ID: 1476559, Certificate ID: 17472625 WORKERS’ COMPENSATION AND EMPLOYERS’ LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7-08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMNET – CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following “attaching clause” need to be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 3/31/2021 at 12:01 A.M. standard time, forms a part Policy No.: 54309652 03 of the Federal Insurance Company Issued to: S.R. Bray LLC dba Power Plus! Endorsement No. 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. The additional premium for the blanket waiver offered by this endorsement shall be 0.00 % of the total California premium. Schedule Person or Organization Job Description WHERE REQUIRED BY WRITTEN CONTRACT. WC 99 03 04 (Ed. 7-08) Miscellaneous Attachment: M474997 Master ID: 1476559, Certificate ID: 17472625 WORKERS COMPENSATION AND EMPLOYERS LIABLITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN CONTRACT IN STATES WHERE APPLICABLE. This endorsement changes the policy to which it is attached and is effective on date issued unless otherwise stated. (This Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 3/31/2021 Policy No. 54309652 03 Endorsement No. Insured: S.R. Bray LLC dba Power Plus Premium Insurance Company: Federal Insurance Company WC 00 03 13 (Ed. 4-84)Copyright 1983 National Council on Compensation Insurance. Miscellaneous Attachment: M71147 Master ID: 1476559, Certificate ID: 17472625 Policy Number: 54309650 03(AOS) & 54309651 03 (CT)COMMERCIAL GENERAL LIABILITY 10-02-2494 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS This endorsement modifies the following: COMMON POLICY CONDITONS SCHEDULE Names(s) and Address(es) ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH US. The following Condition is added: Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non-renewal to any Person(s) or Organization(s) shown in the Schedule Thirty (30) days prior to the effective date of the cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver notice of cancellation to any Person(s) or Organization(s) shown in the Schedule TEN (10) days prior to the effective date of cancellation. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). 10-02-2494 (Ed.7-15)Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 Miscellaneous Attachment: M464789 Master ID: 1476559, Certificate ID: 17472625