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HomeMy WebLinkAboutWestern State Builders; 2021-04-23; PKRC20-1221Tracking #: CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT CANNON PARK PLAYGROUND REFRESH; PKRC20-1221 Al) This agreement is made on the , day of LA , 20.2/, by the City of Carlsbad, California, a municipal corporation, (hereinaft r called "City"), and Western State Builders whose principal place of business is 2141 Orange Ave., Escondido, CA 92029 (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: Phil Christman (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. CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 1 of 15 City Attorney Approved 1/22/2020 Tracking #: FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractqscorbcontractor from participating in contract bidding. Signature: Print Name: 3o 1 k0-1"_ tA0 itV1 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. 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 CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 2 of 15 City Attorney Approved 1/22/2020 Tracking 44: 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; arid 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 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Western State Builders :A 2141 Orange Ave (name of Contractor) 10015'38 /CAo -7 1 (street address) Escondido, CA 92029 (Contractor's license number) General Building Contractor; exp. 2/28/21 (license class, and exp. date) 4000039078- I 0000-1004i 0 (city/state/zip) 760-703-6024 (telephone no.) 760-270-8639 (DIR registration number) (fax no.) 640124. 40 1 :39j Z_o -1) westernstatebuildersagmail.com (DIR registration exp. date) (e-mail address) CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 3 of 15 City Attorney Approved 1/22/2020 By: By: CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California (R6Tok (sign here) v ic e ices .0-c. 4-- LI-Ukko.teN HO,ttel Arv.," (print name/title) By: ATTEST: ity Manager Tracking #: 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. (sign here) slutine Moefi (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a car oration, 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: , Deputy/Assistant Cit Attorney (Lemci.A e irgARBARA ENGLESON peregi evyppny Clerk CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 4 of 15 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 k/ 1 itCk Total % Subcontracted: 0 (96 CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 5 of 15 City Attorney Approved 1/22/2020 Tracking #: EXHIBIT B Scope of Work Cannon Park Playground Refresh Western State Builders Western State Builders will furnish all materials, labor and equipment necessary to rehabilitate the playground at Cannon Park according to Miracle Playground Manufacturer specs and ASTM/CPSC standards. Play Structure •Receive and Unload Miracle Refresh Equipment •Follow manufacturer's specs to repaint existing posts o Manufacturer's specs provided as exhibit •Erect and build Miracle equipment per manufacturer's specs O Installation manual provided by Miracle •Install all compliant stickers and signage (material provided by others) •Ensure Structure Meets CPSI Standards O Inspected by CPSI •Layout, drill and Install (2) Spring Riders Demo •Provide and install security fencing for duration of project •Demo and remove old structure keeping main support post in place •Dispose of old equipment properly off site •Repair any damaged surfacing or adjacent equipment caused by this project Equipment Furnish Equipment Listed: •Replacement components for entire structure except center stage columns; O Parts list attached •ATV "C" Spring Rider •Buzzy Bee "C" Spring Rider Item Number Description Price "I Materials and Equipment $29,989.41 2 Labor $13,500.00 3 Bond $1,600.00 4 Temporary fencing $2,800.00 Agreement shall not exceed $47,890.00 CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 6 of 15 City Attorney Approved 1/22/2020 Tracking #: Scope of Work Continued Procedure for Painting posts for Miracle Refresh Preparation •Inspect metal for corrosion or rust. •Wash with TSP to remove dirt, grease, oil, mildew, and other contaminants. Scrape and sand smooth all rusted, peeled, or blistered areas. •Remove heavy rust deposits with a wire brush or power sander. •Sand glossy surfaces to provide a roughened surface or "tooth" for better adhesion. A 3M scrubby works for this step. •Wipe off dust and metal particles before painting, •Remove all hardware, if necessary. •Mask and protect areas not being painted. Mixing •Mix only the amount of paint you can apply within 30 minutes •Each 6' post is about 4 SQ. FT of surface. •A gallon of paint should cover 25ea. 6' posts •You should be able to paint 6 posts every 30 minutes so only mix up a maximum of 1 quart of paint at a time. •Purchase some plastic measuring cups, you cannot guess at the formula. It is 3 parts paint to 1 part catalyst. •Do not put catalyzed paint back into the container. Once catalyzed usethe paint within 30 minutes or dispose of it properly. Applying Paint •Use a 4" brush •Start at the top of the post and work down •Properly catalyzed and applied paint should flow into a smooth finish. •Avoid painting warm metal surfaces in direct sunlight to prevent lap or brush marks and heat blisters. •Paint within the ideal temperature range of 50° to 90° F. •Paint should dry to the touch within 2 hours Clean up •Use paint thinner to clean the brushes between batches. •Use new brushes each day so the fibers are soft and pliable and won't leave brush marks. •Dispose of rags, mixing tools and brushes properly at the end of the day. CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 7 of 15 City Attorney Approved 1/22/2020 Tracking #: Scope of Work Continued Drawing Name: Cannon Park • Refresh Project Number: R0036_43910475844 Generated by PlayCreator - PartsList This price list is provided as a design aid only. Actual pricing to customer and the accuracy of that pricing is the sole responsibility of the Sales Representative. Model Description Qty 71453859 5' DECK FOR ROOF (DECKS ONLY - NO POST 0 CENTER COLUMN) 1 7146085 WAVY WEDGE WALL WALKER 1 7146155 MONSTER PIPE STRAIGHT 1 7146385U GROOVE II SLIDE VORTEX 1 71468251 AVALANCHE SLIDE W/MESH 1 ENCLOSURE 71471520 KC INTERACTIVE PANEL FRAME ONLY 1 714715205 FOUR-THE-VVIN INSERT 1 71474959U 405 TYPHOON SLIDE DOMED WAVE 1 714782 CRUNCH STATION 1 71496559C TRANSFER POINT W/SINGLE STEP 1 7149746 WIGGLY WORM CLIMBER 1 953 ATV SPRING RIDER 1 961 BUZZY BEE SPRING RIDER 1 CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 8 of 15 City Attorney Approved 1/22/2020 TIVitatEt gtett W.110211 STIP :4,1111t: • 5...4 [44.40 wan?. TY/P4.7:44 k Glt47..1 g S.C1( ..4517.t 14011V StR.40.ti :244111 titre 6tZGI / 714421 intKVIkt tut): 7 tat/41 sw.. net: SN.A.14:0111c404 WIL4/114Itte..".., * ?MUM Miracle . -------- MIRACLE PLAYGROUND SALES, INC. POO Pau.* 0.. 54.0 1442,11.: el)) 2014225 Corem.CA FAX.: atIttiMOIPACC,rer 41s4r titttiettriftNik tiro* .1t.te 1.14.4t4,10 Plelt SOW.. R0036_43910475844 CONIRJES TO ASTM/CPSC comPuEs ADA P lAWCP S314e RECO S ASTM NAM SOSIMPAute.m.,. ;., 1,41.1,z • te.,,,af..,4 At.ffCj ,3 Cannon Park Refresh City of Carlsbad, CA CVaCiri: 55 ) Tracking #: Scope of Work Continued CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 9 of 15 City Attorney Approved 1/22/2020 Tracking #: Scope of Work Continued CANNON PARK PLAYGROUND REFRESH PKRC20.1221 Page 10 of 15 City Attorney Approved 1/22/2020 Tracking #: Scope of Work Continued CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 11 of 15 City Attorney Approved 1/22/2020 Tracking #: Scope of Work Continued CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 12 of 15 City Attorney Approved 1/22/2020 Tracking #: Scope of Work Continued CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 13 of 15 City Attorney Approved 1/2212020 BOND NO. 2314415 PREMIUM: $1,197.00 PREMIUM IS FOR CONTRACT TERM AND IS SUBJECT TO ADJUSTMENT BASED ON FINAL CONTRACT PRICE Tracking #: EXHIBIT C LABOR AND MATERIALS BOND WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Western State Builders (hereinafter designated as the "Principal"), a Contract for: CANNON PARK PLAYGROUND REFRESH CONTRACT NO. PKCR20-1221 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, Western State Builders, as Principal, (hereinafter designated as the "Contractor"), and NORTH AMERICAN SPECIALTY INSURANCE COMPANY as Surety, are held firmly bound unto the City of Carlsbad in the sum of forty-seven thousand eight hundred ninety Dollars ($47,890), 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. CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 14 of 15 City Attorney Approved 1/22/2020 WESTERN ST TE BUILDERS, INC. of Contractor) (sign here) JUL P. DILLAVOU-MOEN orney-in-Fact) CELIA A. BREWER City Attor y By: 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 25TH day Executed by SURETY this 25TH day of JANUARY 20 21 CONTRACTOR: (print name here) VICE PRESIDENT (title and organization of signatory) By: (sign here) JAMES J. MOEN S -Cf•Al i V1097\ (print name here) SECRETARY (title and organization of signatory) of JANUARY 20 21 . SURETY: NORTH AMERICAN SPECIALTY INSURANCE COMPANY (name of Surety) 777 SOUTH FIGUEROA STREET, SUITE 3700 LOS ANGELES, CA 90017 (address of Surety) 213/337-3078 (te e hone number of Surety) TRACY LYNN RODRIGUEZ, ATTORNEY-IN-FACT (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.) APPROVED AS TO FORM: Deputy City Attorney CANNON PARK PLAYGROUND REFRESH PKRC20-1221 Page 15 of 15 City Attorney Approved 1/22/2020 OFFICIAL SEAL K ler Notary Publit - State crl My Corninission 121042021 M. Kenny. Notary Public SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire. and having its principal office in the City of Kansas City. Missouri and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and haying its principal office in the City of Kansas City. Missouri, and Westport Insurance Corporation. organized under the laws of the State of Missouri. and having its principal office in the City of Kansas City. Missouri does hereby make, constitute and appoint: JOHN G. MALONEY, HELEN MALONEY, SANDRA FIGUEROA, MARK D. 1ATAROLA, JESSICA SCHMAL AND TRACY LYNN RODRIGUEZ JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact. to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies. as surety. on contracts of suretyship as are or may be required or permitted by law, regulation. contract or otherwise. provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: ONE HUNDRED TWENTY FIVE MILLION (S125.000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24, 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 2011. "RESOLVED. that any two of the President. any Senior Vice President, any Vice President, any Assistant Vice President. the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds. undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the finure with regard to any bond. undertaking or contract of surety to which it is attached.- NO11111140 *JC0171.1.12 01/p 4..-6SPOP 4.16 .tal SEAL ion 4,,f6g A/%741.P.Ar•••• 4,ko 0 4, I By ▪ •.1 EA 0.4 't Steven P. And Senior NacePresidena IS ashington -International Insurance Compam L S, ff 0: & Senior Vice President or North American Specialt? Insurance Company & Senior Vice President or Westport Insurance Corporation Q4 '▪ "Atisk99°/11.' ul:'•• .... By 4.45„41 • . . /•• toe :tribe A. Ito, Senior Vice President of Wasbington International Insurance Company '°'''iliennottfannt0 Senior Vice President of North American Specialty Insurance Company & Senior Vice President of Westport Insurance Corporation IN WITNESS WHEREOF, North American Specialty Insurance Company. Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed. and these presents to be signed by their authorized officers this this 19TH day of JUNE .20 i. North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook ss: On this 19THday of JUNE . 20 19. before me. a Notary Public personally appeared Steven P. Anderson • Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation. personally known to me. who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. I. Jeffrey Goldberg the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company. Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company. Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF. I have set my hand and affixed the seals of the Companies this 25th day of JANUARY .20 21 . Jelin:: Goldberg. Vice President & Assistant Secretary or Washington International Insurance Compam North American Specialty Insurance Company & Vice President & Assistant Secretor). or Westport insurance Corporation Place Notary Seal and/or Stamp Above (1— Signature of N aiy Public Signature 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 SAN DIEGO on Date before me, SANDRA FIGUEROA, NOTARY PUBLIC Here Insert Name and Title of the Officer personally appeared JULIAN P. DILLAVOU-MOEN Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(e) whose name(s) istare- subscribed to the within instrument and acknowledged to me that hetalieithey executed the same in hisittetAlieif authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(*) acted, executed the instrument. — _— SANDRA FIGUEROA COMM. #2334108 • - . SAN DIEGO COUNTY NOTARY PUBLIC-CALIFORNIAZ > --- MY COMMISSION EXPIRESS SEPTEMBER 22, 2024 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. 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: JULIAN P. DILLAVOU-MOEN 171 Corporate Officer — Title(s): VICE PRESIDENT O Partner — 0 Limited 0 General O Individual 0 Attorney in Fact O Trustee 0 Guardian of Conservator O Other: Signer is Representing: Signer's Name: 0 Corporate Officer — Title(s): O Partner — 0 Limited 0 General O Individual 0 Attorney in Fact o Trustee 0 Guardian of Conservator O Other: Signer is Representing: ©2017 National Notary Association 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 SAN DIEGO On .21/ /42-- before me, SANDRA FIGUEROA, NOTARY PUBLIC Dote Here Insert Name and Title of the Officer personally appeared JULIAN P. DILLAVOU-MOEN Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isfar-ssubscribed to the within instrument and acknowledged to me that he/ohelthey executed the same in hisifie1414eif authorized capacity(ies), and that by his/liefitheir signatUre(s) on the instrument the person(6), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signature of N my Public SANDRA FIGUEROA comm.# 2334108 1, SAN DIEGO COUNTY > NOTARY PUBLIC-CALIFORNIAZ MY COMMISSION EXPIRES SEPTEMBER 22, 2024 Place Notary Seal and/or Stamp Above 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(les) Claimed by Signer(s) Signer's Name: JULIAN P. DILLAVOU-MOEN (4 Corporate Officer — Title(s): VICE PRESIDENT O Partner 0 Limited 0 General O Individual 0 Attorney in Fact O Trustee o Guardian of Conservator o Other: Signer is Representing: Signer's Name: 0 Corporate Officer — Title(s): O Partner — 0 Limited 0 General O Individual 0 Attorney in Fact O Trustee 0 Guardian of Conservator O Other: Signer is Representing: ©2017 National Notary Association 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: TRACY LYNN RODRIGUEZ 0 Corporate Officer — Title(s): O Partner 0 Limited 0 General o Individual tgl Attorney in Fact o Trustee 0 Guardian of Conservator O Other: Signer is Representing: Signer's Name: 0 Corporate Officer — Title(s): o Partner — 0 Limited 0 General O Individual 0 Attorney in Fact O Trustee 0 Guardian of Conservator 0 Other: Signer is Representing: 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 SAN DIEGO On 1/25/2021 before me, SANDRA FIGUEROA, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared TRACY LYNN RODRIGUEZ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name( r4 is/ape- subscribed to the within instrument and acknowledged to me that -he/she/they executed the same in 4e/her/their authorized capacity(les), and that by-his/herAtirteif signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. SANDRA FIGUEROA 1 COMM. #2334108 11,. SAN DIEGO COUNTY > NOTARY PUBLIC-CALIFORNIAZ MY COMMISSION EXPRESS SEPTEMBER 22, 2024 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Place Notary Seal and/or Stamp Above Signature of °tory Public ©2017 National Notary Association ACC3RIOr CERTIFICATE OF LIABILITY INSURANCE illare...-- DATE (MM/DD/YYYY) 01/28/2021 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). PRODUCER Statewide Commercial Ins Brokers 2406 N Lake Avenue Altadena, CA 91001 Phone (877) 207-7900 Fax (626) 340-4807 CONTACT Customer Service Department NAMF. FAX IPAIHcOLE F i. (877) 207-7900 (AIC Not: (626) 340-4807 E-MAIL AnnRFR R. mail@stSwide.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Kinsale Insurance Company 38920 INSURED Western State Builders 2141 Orange Ave Escondido CA 92029 INSURERS: INSURER c: INSURER 0: 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 JP4SR SUBR WVT) poLicY NUMBER POLICY EFF DAM/DO/WM POLICY EXP IMM/coolYYYY1 LIMITS A VI COMMERCIAL GENERAL LIABILITY 0 CLAIMS-MADE ,Rei OCCUR Li Y 0100094629-1 08/26/2020 08/26/2021 EACH OCCURRENCE $ 1,000,000.00 $ 100,000.00 DAMAGE TO RENTED PRFMISES lEa occorrencel MED EXP (Any one person) $ 0.00 PERSONAL & ADV INJURY $ 1 000 000.00 GEN'L AGGREGATE LIMIT APPLIES PER: Z POLICY Li 78,, El LOC 0 OTHER GENERAL AGGREGATE $ 2 000 000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY 0 ANY AUTO FT1 SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ m OWNED m AUTOS ONLY .—I AUTOS BODILY INJURY (Per accident) $ —1 NON-OWNED •MSS ONLY — AUTOS ONLY PROPERTY DAMAGE jeer accident) $ Ti Ti $ El UMBRELLA LIAB 0 OCCUR D EXCESS LIAB n CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ PI DEO n RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVED OFFICER/MEMBER EXCLUDED? N / A r--1 PER 1-1 0TH- ! i RTAT(ITE 1 1 ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Carlsbad is named as additional insured. CERTIFICATE HOLDER CANCELLATION City of Carlsbad 799 Pine Avenue, Suite 200 Carlsbad, CA 92008 I 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) QF The ACORD name and logo are registered marks of ACORD WESTSTA-02 CERTIFICATE OF LIABILITY INSURANCE ASCOTT "ACC3R1::7, DATE (MM/DONYYY) 1129/2021 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). PRODUCER JPL Insurance Group, Inc. 3033 Fifth Ave. #325 San Diego, CA 92103 INSURED Western State Builders c/o Julian Moen 2141 Orange Ave Escondido, CA 92029 uktra Matthew Welty Ins. Agency inc. (A/G, No, Ext): 121_10:(888) 795-2247 PHONE 0016s, weltyinsurance@gmailcom INSURERJRAFFORDING COVERAGE NAIC # INSURER A :AmGuard 42390 INSURER B: Insurance Co of the West 27847 INSURER C : INSURER D : INSURER E : INSURER F: COVERAGES E TIFI ATE NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. IITISR I 'ADDL cut 1 TYPE OF INSURANCE INSD INSURANCE LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN SUER WVD POLICY NUMBER ISSUED CONTRACT THE POLICIES REDUCED BY POLICY EFF _thournronry) TO THE INSURED NAMED ABOVE FOR THE OR OTHER DOCUMENT WITH RESPECT DESCRIBED HEREIN IS SUBJECT TO PAID CLAIMS. POLICY PERIOD TO WHICH THIS ALL THE TERMS, POLICY EXP (MIWODIVYYY) LIMITS , ..cgvi. l ---I I ______.--1 ---------. COMMERCIAL GENERAL LIABILITY 1 CLAIMS-MADE 1 1 OCCUR AGGREGATE LIMIT APPLIES PER: POLICY I LOC . JECT .. . EACH OCCURRENCE $ ..... _., ....._____ DAMAGE TO RENTED PREMISES (Ea occgEreace.)_.. „ MED EXP (Any one person) ___$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ I OTHER. I $ AUTOMOBILE LIABILITY ANY AUTO OWNED y : SCHEDULED AUTOS ONLY ?_.; AUTOS FAIN 'S ONLY _ XI rkToTT ONLY I X WEAU1 67978 12/21/2020 12/21/2021 COMBINED SINGLE LIMIT 1,000,000 I BODILY INJURY (PeLperson) $ --- X_ BODILY INJURL(Per accidenD $ 11,Re?FLEMYntliiAMAGE_._.. $ . OCCUR UMBRELLA LIAB ___... EXCESS LIAR : CLAIMS-MADE DEC)-T I RETENTION $ EACH OCCURRENCE AGGREGATE . S.. $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY . ANY PROPRIETOPJPARTNER/EXECUTIVE IY . 1.11 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I ••• • If yes, describe under i DESCRIPTION OF OPERATIONS below N / A WSD5057820-00 11/1012020 X PER I I 0TH. ...____STAILIIE. I I ER.. 11/10/2021 EL. EACH ACCIDENT EX,OISEASE.- EA EMPLOYEE EL. DISEASE - POLICY LIMIT $_ 1,000,000 $ __ $ 1 ,000, 00 .° 1, (foTI, tig ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: CANNON PARK PLAYGROUND REFRESH; PKRC20-1221 As respects Auto Liability the certificate holder is additional insured when required by written contract per attached endorsement. CERTIFICATE HOLDER NCEL City of Carlsbad 799 Pine Avenue, Suite 200 Carlsbad, 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 ;V ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO BA 99 04 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This provision does not apply in regard to any ownership, Additional Insured When Required by Contract (1) Paragraph Al. — WHO IS AN INSURED — of Section 11 — Liability Coverage is amended to add: d. When you have agreed, in a written contract or written agreement, that a person or organization be added as an additional insured on your business auto policy, such person or organization is an "insured", but only to the extent such person or organization is liable for "bodily injury" or "property damage" caused by the conduct of an "insured" under paragraphs a, or b. of Who Is An Insured with regard to the ownership, maintenance or use of a covered "auto." The insurance afforded to any such additional insured applies only if the "bodily injury" or "property damage" occurs: (1)During the policy period, and (2)Subsequent to the execution of such written contract, and (3)Prior to the expiration of the period of time that the written contract requires such insurance be provided to the additional insured. (2) How Limits Apply If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of: maintenance or use of the additional insured's "autos." (a)The limits of insurance specified in the written contract or written agreement; or (b)The Limits of Insurance shown in the Declarations. Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and described in this Section. (3)Additional Insureds Other Insurance If we cover a claim or "suit" under this Coverage Part that may also be covered by other insurance available to an additional insured, such additional insured must submit such claim or "suit" to the other insurer for defense and indem nity. However, this provision does not apply to the extent that you have agreed in a written contract or written agreement that the insurance is primary and non- contributory with the additional insured's own insurance. (4)Duties in The Event Of Accident, Claim, Suit or Loss If another person or organization is added as an additional insured on your policy, the additional insured shall be required to comply with the provisions in A. Loss Conditions 2. — Duties In The Event Of Accident, Claim, Suit Or Loss — of SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured, BA 99 04 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1