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HomeMy WebLinkAboutIntegra Reality Resources-San Diego; 2021-07-20;City Attorney Approved Version 9/27/17 1 AGREEMENT FOR ON-CALL APPRAISAL SERVICES INTEGRA REALTY RESOURCES – SAN DIEGO THIS AGREEMENT is made and entered into as of the ______________ day of July, 2021, by and between the CITY OF CARLSBAD, a municipal corporation, ("City"), and INTEGRA REALTY RESOURCES – SAN DIEGO, a California corporation, ("Contractor"). RECITALS A. City requires the professional services of an appraiser that is experienced in appraisal of open space. B. Contractor has the necessary experience in providing professional services and advice related to appraisal of open space acquisitions. C. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", which is incorporated by this reference in accordance with this Agreement’s terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective for a period of one hundred and eighty (180) days from the date first above written. The City Manager may amend the Agreement to extend it for one (1) additional one (1) year period(s) or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term will be “Not to Exceed” Five Thousand Three Hundred and Twenty dollars ($5,320). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. Invoices for completed appraisals shall be paid by the City within 30 days of receiving each completed task or appraisal report and an itemized invoice, subject to Exhibit “A.” DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B 7/20/2021 City Attorney Approved Version 9/27/17 2 6. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City’s election, City may deduct the indemnification amount from any balance owing to Contractor. 7. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 8. OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorney’s fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney’s fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor’s agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to 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 DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 3 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. 10.1 Coverage and Limits. Contractor will maintain the types of coverage and minimum limits indicated below, unless the Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 10.1.1 Commercial General Liability Insurance. $2,000,000 combined single-limit per occurrence for bodily injury, personal injury and property damage. If the submitted policies contain aggregate limits, general aggregate limits will apply separately to the work under this Agreement or the general aggregate will be twice the required per occurrence limit. 10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $1,000,000 combined single-limit per accident for bodily injury and property damage. 10.1.3 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. 10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor’s profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 4 10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy of the work product for Contractor’s records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City. 15. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City For Contractor Name Curtis Jackson Name Jeff Greenwald Title Real Estate Manager Title Executive Director Department City Manager’s Office Address 2775 Via De La Valle, Suite 206 City of Carlsbad Del Mar, CA 92014 Address 1200 Carlsbad Village Dr. Phone No. 858-259-4900 Carlsbad, CA 92008 Email jgreenwald@irr.com Phone No. 760-434-2836 Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 5 16. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. Yes No X 17. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 18. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 20. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services within 30 days of the promised work product, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. Upon notification of termination of this Agreement, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will work with Contractor to determine what percentage of work that Contractor has Performed prior to the termination of the Agreement. Based upon that finding City will determine the final payment of the Agreement. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. City will compensate Contractor within 30 days of receiving an invoice and accounting of the unpaid hours expended on behalf of the City prior to receiving notice of termination. Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 6 upon request of City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. 21. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, 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 information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement. 23. JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 24. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld. 25. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 7 26. 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. INTEGRA REALTY RESOURCES – SAN DIEGO CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) (sign here) Jeff Greenwald, Executive Director Kyle Lancaster, Parks & Recreation Director (print name/title) (print name/title) ATTEST: By: (sign here) BARBARA ENGLESON City Clerk (print name/title) If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups. Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 8 DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B City Attorney Approved Version 9/27/17 9 EXHIBIT “A” SCOPE OF SERVICES On-Call Appraisal Valuation Services: “On-call” valuations shall be conducted at $250/hour or on a fixed project fee basis, payable upon completion of each deliverable task • Full Appraisal, completed to Uniform Standard of Professional Appraisal Practice (USPAP) standards, of the market value of the 100% fee simple interest of Assessor Parcel No: 209-060-61, a 43.58-acre parcel near the corner of College Boulevard and El Camino Real, in the City of Carlsbad. The Fee for this appraisal shall be $5,320.00 DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B 1001486 132849.12 03-16-2016 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBRWVDADDLINSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION$ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 07/12/2021 Mynderse Insurance and Financial Services Inc. 2775 Via De La Valle Ste 105 Del Mar CA 92014 Nick Mynderse (858) 481-1410 (858) 481-1420 Nick@SFDelMar.com Limbach & Greenwald Company Inc dba Integra Realty Resources 2775 Via de la Valle Suite 206 Del Mar CA 92014 25151 25178 A Y 2,000,000 1,000,000 5,000 2,000,000 4,000,000 4,000,000 Business Property 151,100 B Y 498 7000-D03-55A 04/03/2021 04/03/2022 1,000,000 A Y 90-ER-A559-0 04/03/2021 04/03/2022 1,000,000 The City of Carlsbad, its officials, employees and volunteers are named as additional insured The City of Carlsbad 1200 Carlsbad Village Drive Carlsbad CA 92008 State Farm General Insurance Company State Farm Mutual Automobile Insurance Company 90-ER-A557-6 04/03/2021 04/03/2022 Nick Mynderse DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B ACORD® I ~ State Farm I A ® lX □ [Z] ~ ~ rl □ □ [Z ~ ~ ~ ~ ~ lX f1 I I I I I □ I DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B E9YM Policy No.: 90-ER-A557-6 SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 90-ER-A557-6 Named Insured: Limbach & Greenwald Company Inc dba lntegra Realty Resources 2775 Via de la Valle Suite 206 Del Mar CA 92014 Additional Insured (include address): The City of Carlsbad 1200 Carlsbad Village Drive Carlsbad CA 92008 FE-6609 INIUIAM<t The City of Carlsbad, (or if applicable -the City of Carlsbad Redevelopment Agency, Housing Authority or Carlsbad Municipal Water District) its officials, employees and volunteers must be named as an additional insured with respect to liability arising out of activities performed by or on behalf of the Named Insured (General Liability only). The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Coverage under this policy shall be primary insurance as respects the City, its officials, employees and volunteers. This policy will not be canceled, materially changed nor the amount of coverage reduced until thirty (30) days after receipt of written notice of cancellation or reduction in coverage by the Housing Services Department of the City of Carlsbad, California. All rights of subrogation are waived as respects all additional insureds hereunder. WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ~ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Prtnted in U.S.A. DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B THIS ENDORSEMENT 1C HAN GES THE POUCY PLEASE READ IT CA REFU LL Y. WAIVER OF OURRJGHT TO RECOVER ROM OTHERS EN DORSEMEN T · CALIFORNIA Poli cy Nun1b0r; 76 WEG JW0009 Endorsement Nmnber: Effective D te: 02/16/21 -rfc(;tivo hom is the same fl,S. r.l;:iled on the lnfo,mati n Page of lhe polic.:y. N~med Insured and Addross: IMBACH & GREEN\' ALD COMPANY I ~CE 2775 VIA DE LA VALLE ST 206 DEL MAR CA 92014 We have th .· rig ht to reoovei om p·; yrnenls from ~rn yone Hable for an inj ury covered by thl:s policy. We wiil not eI force our ri-JJl1l. Hge1i11st thei person or organizotion 11.1m0l1 in the S(:heduhai . (This arw:iElrncnt OIJ(Jlies only t0 lhc uxtent tha1 yOIJ p□Jfurrn w rk mder a wrHteo r;0nlrnct lhut requ ire s you to obtr-ifn this ;::igreem@I1l fr rn u ·.) You inu ·t nu iint~i11 payroll re cor c~ i:icctu.'llely seqregating t11 ~ remu11P.1·.ition of yo1 r erri plo~1lms while en~anac.J in the work (l,~$Cl'iood i11 Lhe Schedule. _ TtlQ-~11'.ldition J premium fo r this endorsorno11 t st1flll be 5 % of th ei Cali forn ia workers' cornpe11s~1tion premil1m otherwise du~ = 0 11 such remuneralron . SCHEDULE ~ Person or Organization :;::,=;: ous1, G SERVlCES D IVISiON ·1200 CARLSBAD =;; VILLAGE DRIVE CARLSBAD. CA 92008 ~ = ~ Counterstr.med Dy __ Form WC 04 03 06 ( 1) PrtllhJd in U.S A Job De•script1o n 003 Autlrn ri ed eprcso ntativ Procoss Date: 0 1/08t21 Polic y Expiration Oat : 02/1 G/22 DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B -....,., -- INFORMATION PAGE WORKERS COMPENSATION ANO EMPLOYERS UA.BlLITY PO ICY IN SUR ER~ Ha rH o r(I Insura nce Co mpariy of the Mklwosl ONE HARTFO f{D PLAZA HARTFORD CT 06 ·1 f5fi. NCCI Company Number: Company Code: G llot..lCY NUMB Previous Polley Nurnbe : 76 WEG JW0009---_, . 76 WEG JW0O D9 l 1. Named Insured i1111d Mailing .Acidress: (No., Street, Town, Slalo1 Ztp C odG) FEIN Number: 20-1473623 State ldentlfica Ion Nt fl1b(}r(s): The Nnmed Insured is: Corpori:.1tion UMBACH & GR -ENWALD COMPM,IY INC E 2775 VJA D U~ VAt.LE STE 206 DEL rv1AH CA 920 4 Busin~s of Named h':1$Ured: All Other Business Support Scrv1c051 Otiher workplaces not shown above: = = 2. Polley Poriod: From 02/16.121 To 02/16/22 ANNUAL 12:01 a.m., Slandard limo m the ins1.1red's nrnillnt1 w.idr~s s. ~ Producer's Name: A TOMA TIC DAT A PROCESSING 'INS AGCY 71 HANOVER ROAD FLORHAM PARK NJ 07932 Produc r's Code: 76 250717 tss fn9 Office: TH E HARTFORD BUSINESS SERVICE CENT J::rl. 3600 WISEt' AN iBL VO SA N ANTO 10 TX 70 251 (877) 287-1~ I§______ Tota!I EsUmatocl Annu 1 Prnmium: $6 288 Daposit Promium: Po!icy Minhnmn Premimn: $600 CA Au(lit Period: A NUAL lnsl llmenl Term: M pol'lcy i & no l binding unless cou nlcrs.i~J nod y our <'Ju h 01·i ze cl re pres o II l,.:i tive . -~Y 1HE. l-L RTFORD Sruffll[ LA.RS RENEWAL C ··11 01108121 -----.~--- Form WC 00 00 01 A (·I) P 1ntcd in U .SA Pl' ~oss D lo: 0 i/Ofl/2 1 Dalo P,190 1 (Cc.ui mrnd on 110xt pag~) Policy Exp I ration Oiite: 02116/' :> DocuSign Envelope ID: 78099DD1-B8D1-41C9-8F14-D9E3CD7B1B0B INt--Ul<MA ·"ION PAGE; (Contin ued) Policy Number: 7b W "(3 JWO OO 3. A. Wo,rkers Compensation Insur nee-: Part one of lhe poli~y ar,pli0s to lhe \JVorkers Compensi:1Jior1 U:iw ul lbo stales Ii t .d here: CA 8, Employo,·s Liability In surai,ce: Peirt T o of tho policy applies to wnrl< in each state listed in Item 3 A ThA limlts of om liabilUy under Part Two ar : lfodily Injury by Accfdent Bodil y inJu ry by Disease Bocllly inJu r:y by Diseaso ~; 'I • 000 ,000 $1 ,,000,000 ,fi 1 ,000,000 oa ch ~c cl d<H'tt poHcy llm1t eac employo C. Other States lnsuran,co: Part hr©e of the po licy c.1 pplies lu t w st1~tes. if any . listed here. All ',ATES EXCEPT NORTH DAKO A, OHIO, WAS HINGTON, WYO 11NG, U.S.TERRITORIES AND STATES DESIGNATED IN IT EM 3.A. OF THE IN FOR Mt~TION PAGE . D. Thisi policy Includes th0so endorsements and schedu e: SEE ENDORSEMENT-WC 99 03 68 4. 11le promium tor this poUcy will be determined by our !trnUlllS of Rules, C,lassifications, Rilt s and Rating Plal'ls. AH :information rnquir0d be~?~ 'is ~ubJ~~.l tg_yeri ,eation and •chang·e by audit. CJ a S.S I ficatT eris. Code Numbe·r tlnci Description ---"-----------·· Totn! S!~mdard Premium Premium or~count EXp&nse Constant Premium Bnsl · Total· E im, tod Annua'I Remlin rntlon --....--.. ........... R,ates Per $100 of Rem u n e rat Ion errorl~m Risk lnsurn nr.e Progr m R a1.1lhorirntiur1 Act Di.sclosu e Endors~menl Estimated Annual Premium (be.or St.1 c1Hil ffl0S) Tola! Estimated Surcharges Suo tile attochud Schooule(s) at Operations for Location ctml Slate level Premium Inform, ton TotM Estl tnat~d Annual Pra miun1: $6,288 Depo : PoliC:1' Ml nlint : $600 Cl\ lntorst to/lt1trastr1to Iden ification Numbe : Re er lo S .. h doh~ or Operations NAICS: G6149 9 Labor Contractors Polley Number: SIC: 731)~) r-orm WC Oil 00 01 A (1) Printed :n U.S.A. P.ig 2 Estimated Annual Premium $!:i,678 ·$23 $200 S192 $6,047 $241 Process Date: 01(0812 1 Policy Ex pirntion Dato: 02/1 6/2:-?