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Home My WebLink AboutGoforth and Marti DBA G/M Business Interiors; 2021-11-30; PWLCA-22050LIBPWLCA-22050LIB PW Letter of Agreement: Carlsbad City Library 2nd Floor Exploration HUB Height Adjustable Desk City Attorney Approved 2/29/2016 -- 1 -- CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT CARLSBAD CITY LIBRARY 2nd FLOOR EXPLORATION HUB HEIGHT ADJUSTABLE DESK This letter will serve as an agreement between Goforth & Marti DBA G/M Business Interiors, a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to assemble and install a height adjustable desk, per the Contractor’s proposal dated July 2, 2021 and City specifications, for a sum not to exceed two thousand three hundred eight and forty-two cents ($) 2,308.42. This work is to be completed within 90 working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees and volunteers, 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 this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers’ Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said 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. Insurance is 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. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4, California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. ________ init ________ init 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. ______ init ______ init 7. 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. DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 PWLCA-22050LIB PW Letter of Agreement: Carlsbad City Library 2nd Floor Exploration HUB Height Adjustable Desk City Attorney Approved 2/29/2016 -- 2 -- 8. 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 the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of 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 the execution of the work covered by this Letter of Agreement. 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. 9. City Contact: Senior Management Analyst, Fiona Everett, 760-602-2014 Contractor Contact: Michelle Philbin, 619-236-0500 CONTRACTOR - GOFORTH & MARTI DBA G/M BUSINESS INTERIORS CITY OF CARLSBAD, a municipal corporation of the State of California 110 W. A Street, Suite 140 San Diego, CA 92101 619-236-0500 mphilbin@gmbi.net By: By: (sign here) SUZANNE SMITHSON Library & Cultural Arts Director as authorized by the City Manager Laurinda P. Easley, President & Secretary By: Dated: (sign here) For FAVIOLA MEDINA City Clerk Services Manager (print name/title) (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. 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: For CELIA A. BREWER, City Attorney BY: _______________________________ Deputy/Assistant City Attorney DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 11/30/2021 Project ID / Who & Where DOVE LIBRARY HUB 1927997/2/2021 SHIP TO: CARLSBAD (DOVE) DOVE LIBRARY 1775 DOVE LANE CARLSBAD CA 92009 Phone: Fax: (760)602-2014 BILL TO:3845 CITY OF CARLSBAD 1635 FARADAY AVE CARLSBAD CA 92008 Phone: Fax: FIONA EVERETTFIONA EVERETT (760)602-2014 Systems Desk Units Tables Files Chairs Ancillary10001 0Product Counts: QuotationDate: Storage 0 Scope of Work Narrative Project Overview: ADD ON UNIT TO DOVE LIBRARY HUB Design Specifics: HEIGHT ADJUSTABLE DESK WITH LOWER CREDENZA Invoicing (Phases/MegaSIF Construction): STANDARD 9301_01 PREVAILING WAGE ***FINISHES ARE TO MATCH EXISTING FURNITURE IN HUB*** QUOTE FOR: HERMAN MILLER HEIGHT ADJUSTABLE TABLE FOR: CARLSBAD DOVE LIBRARY HUB LEAD-TIME: 6-8 WEEKS SCOPE OF WORK: 1) G/M TO RECEIVE AND INSPECT PRODUCT AT OUR SD WAREHOUSE Product Summary / Scope of Work GRAND TOTAL $2,308.42 Account Executive: Michelle Philbin Project PAS: Yesenia Figueroa 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 1 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Samantha Estrada (sestrada@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101 G/M Business Interiors DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 2) G/M TO SET (1) HEIGHT ADJUSTABLE TABLE IN PLACE PER ATTACHED DRAWINGS. 3) PLEASE CONTACT ANDREA HILLIARD @ (760) 602-2041 TO SCHEDULE SERVICES. 4) G/M WILL HOLD PRODUCT FOR UP TO (2) WEEKS AT OUR WAREHOUSE FREE OF CHARGE. ANY PRODUCT REMAINING IN OUR WAREHOUSE AFTER THIS PERIOD WILL INCUR STORAGE FEES **NOTE: QUOTE WILL NEED TO BE ADJUSTED IF SERVICES TO TAKE PLACE AFTER BUSINESS HOURS, OR DURING THE WEEKEND Quotation # 192799G/M 1 4,463.60 4,463.60 1,569.91 Sell ExtSellList ExtList LOT TECH LAB Who/What/Where 1,569.91 BOM A BOM: See Attached Bill of Materials 6Piece Count: .00.00.00.00 FreightTaxable Srvcs.Non-Tax Srvcs.Description: (01) EA HERMAN MILLER RENEW HEIGHT ADJUSTABLE TABLE WITH MODESTY PANEL, 30"X72" WITH CONVENIENCE POWER Design Fee Account Executive: Michelle Philbin Project PAS: Yesenia Figueroa 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 2 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Samantha Estrada (sestrada@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101 G/M Business Interiors DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 Quotation # 192799G/M 0 .00 .00 .00 Sell ExtSellList ExtList LOT Z G/M Services Who/What/Where .00 BOM B BOM: See Attached Bill of Materials Piece Count: 325.00.0085.56199.65 FreightTaxable Srvcs.Non-Tax Srvcs.Description: G/M Furniture Planning Services, if applicable, include field measurements, drawing AutoCAD building shells, developing typical workstations and private office standards, space planning typicals into the floorplan, developing furniture color schemes, order specifications and receiving client approvals for all drawings and color schemes for order entry. G/M Project Management Services include drawings and field measure checks, order scheduling & routing, electrical consulting with contractors,field checks,monitoring construction progress along with delivery, assembly, punchlist coordination through final completion. G/M Project Services include receiving and inspecting of each product, shipping damage adjudication with vendors, transporting product if applicable, staging of products, delivery, setting in place of all furniture, level clean and polishing of all items, vacuum floors and recycling of all waste products associated with the furniture project. G/M Punchlist Services include formulation of the project punchlist, ordering and receiving of punchlist products, and delivery and assembly to finalize the punchlist and project. G/M Warranty Services Department is provided to offer clients our no-charge warranty service work for all furniture protected under valid factory warranties. G/M maintains electronic copies of our Client's invoices for warranty enforcement. For service requests, our Warranty Department may be contacted via e-mail at warranty@gmbi.net Design Fee Account Executive: Michelle Philbin Project PAS: Yesenia Figueroa 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 3 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Samantha Estrada (sestrada@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101 G/M Business Interiors DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 Quotation # 192799G/M Product Subtotal: Services (Non-Taxable) Services (Taxable) Freight (Taxable) Design Services (Non-Taxable) Sales Tax (7.750%) $1,569.91 $199.65 $85.56 $0.00 $325.00 $128.30 $2,308.42Total: Taxable Subtotal: Non-Taxable Subtotal: $1,655.47 $524.65 Terms: Net 30 Days 100%$2,308.42 Signer Title I have reviewed the quote, the bill of materials, the drawings (if applicable), the color cards (if applicable), and other associated exhibits for my order. I approve the colors, fabrics, and finishes as previously selected and correct as shown on the attached exhibit. I am satisfied that the product I have selected is the correct size and is suitable and will perform for its intended purpose. I am aware this product is manufactured to order and is not returnable to G/M or to the manufacturer. I understand that legal title to the product will transfer upon delivery to my commercial or residential location and all associated labor is taxable until title transfers. I am aware additional costs charged for inside delivery, staging, setting in place, assembly, leveling, cleaning, polishing, recycling of waste materials are separately stated and are elected as an additional contract option. I am aware of the grand total price of this contract as shown on this quote. Approved by:Signature Print Name Signed Date G/M is ordering your furniture from a variety of manufacturers to be aggregated and received into our G/M operated warehouse. Once the final portion of your order has been received, a “ready to deliver” notification will be sent to you. G/M, at this point, will graciously, store your complete order for up to two weeks at no charge. If for some reason you cannot accept a timely delivery within two weeks, a quote for one month’s handling and storage shall be calculated and forwarded to you. Title Account Executive: Michelle Philbin Project PAS: Yesenia Figueroa 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 4 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Samantha Estrada (sestrada@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101 G/M Business Interiors DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 DOVE LIBRARY HUB CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 6/28/2021 7:14:04 PMAQuote #192799 TECH LABDepartment: Contract TECH LAB ELEVATE GM IN-STOCK- EASSET # 1 15.60 15.60 14.57 14.571 %GMSPB Elevate™ Surge Protector BLACK TECH LABTag: HERMANMILLER ~ 1 315.00 315.00 144.90 144.90 54.002 %Y1113.66NL +Modesty Panel,w/o added cable trough,Lam Top/TP Edge 66W HM Finish +natural maple HM Edge Finish +natural maple TECH LABTag: 1 3,617.00 3,617.00 1,193.61 1,193.61 67.003 %DU6ACS.3072LD Renew Rect Tbl, C-Foot,Sq-Edge,Lam Top/Thermo Edge,Elec Ext Range, 30D 72W NNP no power access SUD simple up down HM natural maple HM natural maple G2 graphite satin leg with graphite satin foot PSC simple cable NNN no cutout 57 glides TECH LABTag: 1 22.00 22.00 6.49 6.49 70.504 %G1331. Cord Cleat 2/Pkg TECH LABTag: 1 130.00 130.00 42.90 42.90 67.005 %DU15S.D Height-Adjustable Vertical Cable Manager (1) PER TABLE BK black TECH LABTag: 1 364.00 364.00 167.44 167.44 54.006 %Y1414.L06S +Logic Mini,1 simplex receptacles, 1 pwr USB A/C Combo,6' cord/conduit,surf clamp G1 Finish @graphite TECH LABTag: Project DesignerAccount Executive:Yesenia FigueroaMichelle Philbin Page: 1 Job Captain Samantha Estrada DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 DOVE LIBRARY HUB CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 6/28/2021 7:14:04 PMAQuote #192799 TECH LABDepartment: Contract Product Subtotal: $1,569.91 Project DesignerAccount Executive:Yesenia FigueroaMichelle Philbin Page: 2 Job Captain Samantha Estrada DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 PO-4PO-5PO-7PO-6APO-84'-4"COMBO (2)LATERALFILE BELOW, 2H IBOOKCASE ABOVE3'-2"24/48/72P 24/4868/48J68/48J57/24NG11/2457/48JG11/4831268/48N2H 30WLAMINATETOPC003ADA CLEARADA CLEARPER CUSTOMEROK TO BLOCKDOOREXISTING 42"ADA CLEARADA CLEARADA CLEAR38"H/36"WBOOKCASE65"HSTORAGECABINET/WARDROBECOMBO24/72/482A12A/60 P24/30ADA CLEARADA CLEAR30/6024/78PP A12A/483'-1"PO-6BCOMBO (2)LATERALFILE BELOW, 2H IBOOKCASE ABOVE43'-1"3'-1"COMBO (2)LATERALFILE BELOW, 2HIBOOKCASE ABOVEEXISTING PRODUCTTO BE VERIFIED 4'-078"2 24/42SPX24D/48L/84R38"H/36"WBOOKCASE65"HSTORAGECABINET/WARDROBECOMBOGM DOES NOTRECOMMEND THISCLEARANCE4'3'-6"3'-8"30/6630/663320/3620/3642/36J20/3630/3642/30J42/30J42/36J42/36J42/30J42/30J42/36J22PPPP3H 30W3H 30W ?A12A/484 SSSS222H 42W4 30/6024/78PP A12A/48C004220/36/38COMMON TOP220/36/384'-9"ADA C L EARANCE EXISTING METAL STORAGEC0019'-7"FURN. DIM. P AM P AM 24/5424/54 68/24J68/30J46/24N68/24J68/30J46/24N2 3 1'-8"30/6024/78PP MEASUREMENT TOFIELD D IMS EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASEEXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE EXISTING BOOKCASE 4'-1"4'-3"5'-9"GM RECOMMENDSCAPPING EX IS TING FMGM RECOMMENDSCAPPING EX IS TING FM 42/48J 4'WALL START22/48 2H 36WADA CLEARANCEADA CLEARANCEADA CLEARANCET24/66EXISTING COMMONTOP5514'12'-1"AA2036/2036/2028/48/72/N553'-6"3'-3"3'-7"5'5'-5"4'-4"DOORFABRIC INTER IOR WALL PERFORATED METAL EXTERIOR WALLLAMINATE MOUNT WALLFABRIC INTERIOR WALL LAMINATE EXTERIOR WALLFABRIC INTERIOR WALLGLASS MOUNT WALL ANANAN ANANAN T14/FNPT14/FNP 0614/FNP14/FNP3'7'10'-7"6'-9"FURNITUREDIMENSION9'-5"68/36JA35/24NA35B BF35/24NASTS/F15/42A68/42J1A2/35B3/332"A6AAA 68WALL START24/72D 2/68B2AA68/36J68/30JAA68/48J 68BWALL START2/68B2A68/36XA 68/36NA3'-6"4'-11"A68/24N68B A68/36CCA68B 24/66 30/60E 2/68B2A 2/68B 2A 2/68B2AFFFF CPUHFLO/SSM Y7240.10Y7240.10Y7240.10Y7240.10FD/B30A68/24X68/18NA 68/36NA 68BAA 68/30JAA SHEET #:DRAWING TITLE:SCALE:REVISIONSDWG:PAS:DRC:PROJ #001002003004005DATE:AE:006007008009010CITY OF CARLSBAD DOVE LIBRARY 17775 DOVE LANE CARLSBAD, CA 92011 FLOOR 219279905.21.2021MICHELLE PHILBINKANSADA GILDERSLEEVE--FILE PATHIF1023/32"=1'-0"OVERALL PLANwww.gmbi.netDIGITAL TECHNOLOGY LABAREA OF WORK06.16.2021 (YF)06.16.2021 05.21.2021DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 DIGITAL TECHNOLOGY LAB NOTICE TO THE CORPORATION, PERSON &/OR PERSONS REGARDING THIS DOCUMENT: THE DESIGN, DRAWING, & CONCEPTUAL INFORMATION PRESENTED HERE ARE THE PROPERTY OF G/M BUSINESS INTERIORS. THIS DOCUMENT CONTAINS CONFIDENTIAL & PROPRIETARY INFORMATION THAT CANNOT BE REPRODUCED OR DIVULGED, IN WHOLE OR IN PART, WITHOUT AUTHORIZATION FROM G/M BUSINESS INTERIORS. BY ACCEPTANCE OF THIS DATA, THE USER AGREES NOT TO TRANSMIT THIS DATA OR PROVIDE ACCESS TO ANY PART OF IT TO ANOTHER PARTY. THIS DOCUMENT & THE INFORMATION WITH IN IT ARE NOT TO BE DISTRIBUTED TO ANY OUTSIDE PARTIES.CITY OF CARLSBAD DOVE LIBRARY 1775 DOVE LANE CARLSBAD, CA 92011 EXISTING Preorder: 192799 Designer: Kansada Gilderlseeve DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 6'-2"ZCELA2'-6" TIGHT FIT 24/60 OFO15OFO15 AB AM EXISTING 42W TACKBOARDEXISTING WHITEBOARD 4'-3" 54W/20D 30/7230/722'-8"PDIGITAL TECHNOLOGY LAB NOTICE TO THE CORPORATION, PERSON &/OR PERSONS REGARDING THIS DOCUMENT: THE DESIGN, DRAWING, & CONCEPTUAL INFORMATION PRESENTED HERE ARE THE PROPERTY OF G/M BUSINESS INTERIORS. THIS DOCUMENT CONTAINS CONFIDENTIAL & PROPRIETARY INFORMATION THAT CANNOT BE REPRODUCED OR DIVULGED, IN WHOLE OR IN PART, WITHOUT AUTHORIZATION FROM G/M BUSINESS INTERIORS. BY ACCEPTANCE OF THIS DATA, THE USER AGREES NOT TO TRANSMIT THIS DATA OR PROVIDE ACCESS TO ANY PART OF IT TO ANOTHER PARTY. THIS DOCUMENT & THE INFORMATION WITH IN IT ARE NOT TO BE DISTRIBUTED TO ANY OUTSIDE PARTIES.CITY OF CARLSBAD DOVE LIBRARY 1775 DOVE LANE CARLSBAD, CA 92011 NEW Preorder: 192799 Designer: Kansada Gilderlseeve New furniture to be added to existing OPTIONAL MOBILE BOX/FILE DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 2'-6"TIGHT FIT24/60ABFM2'-2"3'-11"6'-7"8'-1"FMEXISTING 42W TACKBOARDEXISTING WHITEBOARD3'-3"3'-9"54W/20D30/7230/72 P SHEET #:DRAWING TITLE:SCALE:REVISIONSDWG:PAS:DRC:PROJ #001002003004005DATE:AE:006007008009010CITY OF CARLSBADDOVE LIBRARY 17775 DOVE LANE CARLSBAD, CA 92011 FLOOR 219279906.16.2021MICHELLE PHILBINKANSADA GILDERSLEEVE--FILE PATH05.21.202106.16.2021 (YF)IF102E3/4"=1'-0”ELECTRICAL PLANwww.gmbi.netStations Using "A" Recept.Stations Using "B" Recept.Stations Using "C" Recept.Stations Using "D" Recept.Electrical Power BreakELECTRICAL LEGEND - SYSTEMS FURNITURETile Height Data/Comm PortAvailable on Ethospace & Vivo SystemsCable Mgmt Panel Data/Comm PortDATA/COMM CONDITIONS - SYSTEMS FURNITURE Available on Action Office System- SWITCH- DATA- RECEPTACLE- FIRE EXTINGUISHER- THERMOSTATELECT / MECH SYMBOLS(Can be located above or below the Wksf)(Can be located above or below the Wksf)= Floor Monument= Power Pole= Wall J-BoxPPFMWJELECTRICAL CONDITIONS - SYSTEMS FURNITUREMin. Circuits RequiredReceptacle UsedFMX#Min. Circuits RequiredReceptacle UsedPPX#Min. Circuits RequiredReceptacle UsedWJX#Power & Data Pole EntryAvailable on End of Run or In-LineFloor Entry Locations for Power & Data(Full Enclosure Suggested for Data Integrity)Wall Entry Locations for Power & Data(Open Panel Suggested for Access)Base Data/Comm PortAvailable on All Systems(Located at the base of frame or panel)DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 02/10/2021 Jenna La FondVan Wyk Risk Solutions150 Ottawa Ave NWSuite 1000Grand Rapids, MI 49503 (616) 942-5070 (616) 942-8199 JennaL@vanwykcorp.com National Union Fire Insurance 19445 GOFORTH & MARTIdba: G/M Business Interiors 110 West A StreetSte 140San Diego, CA 2101 Hiscox Insurance Company 10200 2021/2022 A Y A Medical Payments 5,000 NA A Y City of Carlsbad is included as Additional Insured with respects to General Liability as required by contract or written agreement. A waiver of subrogation is included for Workers Compensation as required by contract or written agreement. 30 days notice of cancellation. Email: City of Carlsbad1635 Faraday AveCarlsbad, CA 92008 GL 518-01-77 3/1/2021 3/1/2022 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 CA 296-16-06 3/1/2021 3/1/2022 1,000,000 WC 080-75-6387 3/1/2021 3/1/2022 1,000,000 1,000,000 1,000,000 B Professional Liability ANE4053725.19 3/1/2021 3/1/2022 $2,000,000 $1,000,000Aggregate Limit Each Occurrence ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDLSUBRLTRINSDWVD 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 AUTOSHIREDNON-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 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. 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 DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 —˙ ¸˛ ˝¸˛ ˛˝ ˝˝˝ ˛ ˛˛˝ ˝¸ —˛˝ ˛ ˛˘ ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ –“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˛ ˛ ˙ ˚˛ —˛ ˝¸ ¿‡» ” ……•‹•–†¿· †›«ﬁ»… —»ﬁ›–†ł› ﬁ ﬁ„¿†•ƒ¿‹•–†ł›–‰¿‹•–†ł› ” –“»ﬁ»… »ﬁ¿‹•–†› ˛ ˛ ˙ ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ †”–ﬁ‡¿‹•–† ﬁ»ﬂ«•ﬁ»… ‹– ‰–‡·»‹» ‹‚•› ˝‰‚»…«·» •” †–‹ ›‚–'† ¿–“» '•·· » ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ —¿„» –” ˝»‰‹•–† ‚– › † †›«ﬁ»… •› ¿‡»†…»… ‹– •†‰·«…» ¿› ¿† ¿……•‹•–†¿· •†›«ﬁ»… ‹‚» »ﬁ›–†ł› –ﬁ –ﬁ„¿†•ƒ¿‹•–†ł› ›‚–'† •† ‹‚» ˝‰‚»…«·» «‹ –†·§ '•‹‚ ﬁ»›»‰‹ ‹– ·•¿•·•‹§ ”–ﬁ –…•·§ •†¶«ﬁ§ ﬁ–»ﬁ‹§ …¿‡¿„» –ﬁ »ﬁ›–†¿· ¿†… ¿…“»ﬁ‹•›•†„ •†¶«ﬁ§ ‰¿«›»… •† '‚–·» –ﬁ •† ¿ﬁ‹ § ˙–«ﬁ ¿‰‹› –ﬁ –‡•››•–†› –ﬁ ‚» ¿‰‹› –ﬁ –‡•››•–†› –” ‹‚–›» ¿‰‹•†„ –† §–«ﬁ »‚¿·” •† ‹‚» »ﬁ”–ﬁ‡¿†‰» –” §–«ﬁ –†„–•†„ –»ﬁ¿‹•–†› ”–ﬁ ‹‚» ¿……•‹•–†¿· •†›«ﬁ»…ł› ¿‹ ‹‚» ·–‰¿‹•–†ł› …»›•„†¿‹»… ¿–“» –'»“»ﬁ ‚» •†›«ﬁ¿†‰» ¿””–ﬁ…»… ‹– ›«‰‚ ¿……•‹•–†¿· •†›«ﬁ»… –†·§ ¿·•»› ‹– ‹‚» »¤‹»†‹ »ﬁ‡•‹‹»… § ·¿' ¿†… ” ‰–“»ﬁ¿„» ﬁ–“•…»… ‹– ‹‚» ¿……•‹•–†¿· •†›«ﬁ»… •› ﬁ»ﬂ«•ﬁ»… § ¿ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ‹‚» •†›«ﬁ¿†‰» ¿””–ﬁ…»… ‹– ›«‰‚ ¿……•‹•–†¿· •†›«ﬁ»… '•·· †–‹ » ﬁ–¿…»ﬁ ‹‚¿† ‹‚¿‹ '‚•‰‚ §–« ¿ﬁ» ﬁ»ﬂ«•ﬁ»… § ‹‚» ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ‹– ﬁ–“•…» ”–ﬁ ›«‰‚ ¿……•‹•–†¿· •†›«ﬁ»… •‹‚ ﬁ»›»‰‹ ‹– ‹‚» •†›«ﬁ¿†‰» ¿””–ﬁ…»… ‹– ‹‚»›» ¿……•‹•–†¿· •†›«ﬁ»…› ‹‚» ”–··–'•†„ ¿……•‹•–†¿· »¤‰·«›•–†› ¿·§ ‚•› •†›«ﬁ¿†‰» …–»› †–‹ ¿·§ ‹– –…•·§ •†¶«ﬁ§ –ﬁ ﬁ –»ﬁ‹§ …¿‡¿„» –‰‰«ﬁﬁ•†„ ¿”‹»ﬁ ·· '–ﬁ •†‰·«…•†„ ‡¿‹»ﬁ•¿·› ¿ﬁ‹› –ﬁ »ﬂ«•‡»†‹ ”«ﬁ†•›‚»… •† ‰–††»‰‹•–† '•‹‚ ›«‰‚ '–ﬁ –† ‹‚» ﬁ–¶»‰‹ ł–‹‚»ﬁ ‹‚¿† ›»ﬁ“•‰» ‡¿•†‹»†¿†‰» –ﬁ ﬁ»¿•ﬁ› ‹– » »ﬁ”–ﬁ‡»… § –ﬁ –† »‚¿·” –” ‹‚» ¿……•‹•–†¿· •†›«ﬁ»…ł› ¿‹ ‹‚» ·–‰¿‹•–† –” ‹‚» ‰–“»ﬁ»… –»ﬁ¿‹•–†› ‚¿› »»† ‰–‡·»‹»… –ﬁ ‚¿‹ –ﬁ‹•–† –” §–«ﬁ '–ﬁ –«‹ –” '‚•‰‚ ‹‚» •†¶«ﬁ§ –ﬁ …¿‡¿„» ¿ﬁ•›»› ‚¿› »»† «‹ ‹– •‹› •†‹»†…»… «›» § ¿†§ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† –‹‚»ﬁ ‹‚¿† ¿†–‹‚»ﬁ ‰–†‹ﬁ¿‰‹–ﬁ –ﬁ ›«‰–†‹ﬁ¿‰‹–ﬁ »†„¿„»… •† »ﬁ”–ﬁ‡•†„ –»ﬁ¿‹•–†› ”–ﬁ ¿ ﬁ•†‰•¿· ¿› ¿ ¿ﬁ‹ –” ‹‚» ›¿‡» ﬁ–¶»‰‹ ˙ —˛˝ ˛ ˛˘ ˙¸ ¸ ˝ —˛ ˛ ˛ ˛ ˝¸˛ ˝ ˛˝¸ ˙ ˛ ˛ ˛ ˙¸ ˚ ˛ ºŁØØ DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ —¿„» –” •‹‚ ﬁ»›»‰‹ ‹– ‹‚» •†›«ﬁ¿†‰» ¿””–ﬁ…»… ‹– ‹‚»›» ¿……•‹•–†¿· •†›«ﬁ»…› ‹‚» ”–··–'•†„ •› ¿……»… ‹– ˝»‰‹•–† •‡•‹› ” †›«ﬁ¿†‰» ” ‰–“»ﬁ¿„» ﬁ–“•…»… ‹– ‹‚» ¿……•‹•–†¿· •†›«ﬁ»… •› ﬁ»ﬂ«•ﬁ»… § ¿ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ‹‚» ‡–›‹ '» '•·· ¿§ –† »‚¿·” –” ‹‚» ¿……•‹•–†¿· •†›«ﬁ»… •› ‹‚» ¿‡–«†‹ –” •†›«ﬁ¿†‰» ˛»ﬂ«•ﬁ»… § ‹‚» ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ –ﬁ “¿•·¿·» «†…»ﬁ ‹‚» ¿·•‰¿·» •‡•‹› –” †›«ﬁ¿†‰» ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› '‚•‰‚»“»ﬁ •› ·»›› ‚•› »†…–ﬁ›»‡»†‹ ›‚¿·· †–‹ •†‰ﬁ»¿›» ‹‚» ¿·•‰¿·» •‡•‹› –” †›«ﬁ¿†‰» ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 ‚•› »†…–ﬁ›»‡»†‹ »””»‰‹•“» ”–ﬁ‡› ¿ ¿ﬁ‹ –” –·•‰§ –•››«»… ‹– § ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ˝¸˛ ˛ ˛ˇ¸˛ ¸˛ ˛ ˛ ˛ ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ–“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ¸˝˝˝ ¸ ˚˛ ˛ ˝¸ ˝¸˛ ŁØº łæº «‹‚–ﬁ•ƒ»… ˛»ﬁ»›»†‹¿‹•“» –ﬁ–«†‹»ﬁ›•„†¿‹«ﬁ » ł•† ˝‹¿‹»› ‚»ﬁ»·•‰¿·» —¿„» –” ˝ ˙ ˚˛ –“»ﬁ¿„» ‚– › †›«ﬁ»… •› ¿‡»†…»… ‹– ¿…… …†§ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ›‚–'† •† ‹‚» ›‰‚»…«·» ¿–“» ‹– '‚–‡ §–« »‰–‡» –·•„¿‹»… ‹– •†‰·«…» ¿› ¿† ¿……•‹•–†¿· •†›«ﬁ»… «†…»ﬁ ‹‚•› –·•‰§ ¿› ¿ ﬁ»›«·‹ –” ¿†§ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ §–« »†‹»ﬁ •†‹– '‚•‰‚ ﬁ»ﬂ«•ﬁ»› §–« ‹– ”«ﬁ†•›‚ •†›«ﬁ¿†‰» ‹– ‹‚¿‹ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† –” ‹‚» ‹§» ﬁ–“•…»… § ‹‚•› –·•‰§ «‹ –†·§ '•‹‚ ﬁ»›»‰‹ ‹– ·•¿•·•‹§ ¿ﬁ•›•†„ –«‹ –” «›» –” ¿ ‰–“»ﬁ»… ¿«‹– –'»“»ﬁ ‹‚» •†›«ﬁ¿†‰» ﬁ –“•…»… '•·· †–‹ »¤‰»»… ‹‚» ·»››»ﬁ –” ł‚» ‰–“»ﬁ¿„» ¿†…æ–ﬁ ·•‡•‹› –” ‹‚•› –·•‰§ –ﬁ ł‚» ‰–“»ﬁ¿„» ¿†…æ–ﬁ ·•‡•‹› ﬁ»ﬂ«•ﬁ»… § ›¿•… ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ˛˝ ææ 21 2961606 ˛ œ ˛ ¸˝˝˝ ˛˛˝ ¸ ˛ ˝¸˛ —˙ —˝¸˛ — ˙ —˛˝ ˛ ˛˘ ˛ ˙¸ ˛ ˛¸˙ ¸ —˛˚ ˝¸˛ ˝¸˝ ¸ ˙ ¨ ˝¸—˛˝ ˛ ˛˘˝ ˙ ˛˝ ¸ ¸˝ ˚˛¸ DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ¸˝˝˝ ¸ ˚˛ ˛ ŒŁØ łŒ æº ¸˛˘ ˛—˛˝˚ ˛˝ ‚•› »†…–ﬁ›»‡»†‹ »””»‰‹•“» ”–ﬁ‡› ¿ ¿ﬁ‹ –” –·•‰§ –•››«»… ‹– § ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ–“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˚˛ ˛˝˛ ˛˝ ˛˚˛˙ ˝ ˛˝ ¸˝ ł ł ‚» ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ '¿› »†‹»ﬁ»… •†‹– ﬁ•–ﬁ ‹– ¿†§ ¿‰‰•…»†‹ –ﬁ ·–›› – '¿•“»ﬁ –” ‹‚» ﬁ•„‚‹ –” ﬁ»‰–“»ﬁ§ '•·· …•ﬁ»‰‹·§ –ﬁ •†…•ﬁ»‰‹·§ ¿·§ ‹– §–«ﬁ »‡·–§»»› –ﬁ »‡·–§»»› –” ‹‚» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ¿†… '» ﬁ»›»ﬁ“» –«ﬁ ﬁ•„‚‹› –ﬁ ·•»† ‹– » ﬁ»•‡«ﬁ›»… ”ﬁ–‡ ¿†§ ﬁ»‰–“»ﬁ§ ”«†…› –‹¿•†»… § ¿†§ •†¶«ﬁ»… »‡·–§»» ˝»‰‹•–† ˚ «›•†»›› «‹– –†…•‹•–†› –›› –†…•‹•–†› º ﬁ¿†›”»ﬁ –” ˛•„‚‹› –” ˛»‰–“»ﬁ§ „¿•†›‹ ‹‚»ﬁ› ‹– ¸› •› ¿‡»†…»… ‹– ¿…… ‚» ¿‰‰•…»†‹ –ﬁ ·–›› •› …«» ‹– –»ﬁ¿‹•–†› «†…»ﬁ‹¿»† •† ¿‰‰–ﬁ…¿†‰» '•‹‚ ‹‚» ‰–†‹ﬁ¿‰‹ »¤•›‹•†„ »‹'»»† §–« ¿†… ›«‰‚ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ¿†… –'»“»ﬁ '» '•·· '¿•“» ¿†§ ﬁ•„‚‹ –” ﬁ»‰–“»ﬁ '» ‚¿“» ¿„¿•†›‹ ¿†§ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† '•‹‚ '‚–‡ §–« ‚¿“» »†‹»ﬁ»… •†‹– ¿ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ »‰¿«›» –” ¿§‡»†‹› '» ‡¿» «†…»ﬁ ‹‚•› –“»ﬁ¿„» –ﬁ‡ ¿ﬁ•›•†„ –«‹ –” ¿† ¿‰‰•…»†‹ –ﬁ ·–›› •” ææ 21 ŒŒŒ ˛ œ ˛ ¸˝˝˝ ˛˛˝ ¸ ˛ ˝¸˛ —˙ —˝¸˛ — PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 POLICY NUMBER: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 04 13 Page 1 of 1Insurance Services Office, Inc., 2012 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" 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 that 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 agree- ment,theinsuranceaffordedtosuchaddi- tional 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 Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of Insurance shown in the Decla- rations. GL518-01-77 ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR PER THE CONTRACT OR AGREEMENT. AGREEMENT YOU HAVE ENTERED INTO. PDF created with pdfFactory Pro trial version www.pdffactory.com PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 —˙¸˛˛˛˙ ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ –“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˛ ˛ ˙ ˚˛ —˛ —¿„»–” —˛˛˙ ˛¸˛˙ ˛ ˝¸˛ †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ —˛¸˝æ— —˛˝ ˙ ˚˛ —˛ ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ‚» ”–··–'•†„ •› ¿……»… ‹– ‹‚» ‹‚»ﬁ †›«ﬁ¿†‰» –†…•‹•–† ¿†… ›«»ﬁ›»…»› ¿†§ ﬁ–“•›•–† ‹– ‹‚» ‰–†‹ﬁ¿ﬁ§ —ﬁ•‡¿ﬁ§ †… –†‰–†‹ﬁ•«‹–ﬁ§ †›«ﬁ¿†‰» ‚•› •†›«ﬁ¿†‰» •› ﬁ•‡¿ﬁ§ ‹– ¿†… '•·· †–‹ ›»» ‰–†‹ﬁ•«‹•–† ”ﬁ–‡ ¿†§ –‹‚»ﬁ •†›«ﬁ¿†‰» ¿“¿•·¿·» ‹– ¿† ¿……•‹•–†¿· •†›«ﬁ»… «†…»ﬁ §–«ﬁ –·•‰§ ﬁ –“•…»… ‹‚¿‹ ł ‚» ¿……•‹•–†¿· •†›«ﬁ»… •› ¿ ¿‡»… †›«ﬁ»… «†…»ﬁ ›«‰‚ –‹‚»ﬁ •†›«ﬁ¿†‰» ¿†… ł ˙–« ‚¿“» ¿„ﬁ»»… •† 'ﬁ•‹•†„ •† ¿ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ‹‚¿‹ ‹‚•› •†›«ﬁ¿†‰» '–«·… » ﬁ•‡¿ﬁ§ ¿†… '–«·… †–‹ ›»» ‰–†‹ﬁ•« ‹•–† ”ﬁ–‡ ¿†§ –‹‚»ﬁ •†›«ﬁ¿†‰» ¿“¿•·¿·» ‹– ‹‚» ¿……•‹•–†¿· •†›«ﬁ»… ºŁØØ DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 —˙ ¸˛ †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ Ł —¿„» –” ˚˛ ˛˝˛ ˛˝ ˛˚˛˙ ˝ ˛˝ ¸˝ ˛ ˛ ˙ º ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ –“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˛ ˛ ˙ ˚˛ —˛ —˛¸˝æ— —˛˝ ˙ ˚˛ —˛ ˝¸ ¿‡» ” —»ﬁ›–† ﬁ ﬁ„¿†•ƒ¿‹•–† †”–ﬁ‡¿‹•–† ﬁ»ﬂ«•ﬁ»… ‹– ‰–‡·»‹» ‹‚•› ˝‰‚»…«·» •” †–‹ ›‚–'† ¿–“» '•·· » ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› º ‚» ”–··–'•†„ •› ¿……»… ‹– —¿ﬁ¿„ﬁ¿‚ Ł ﬁ¿†›”»ﬁ ” ˛•„‚‹› ” ˛»‰–“»ﬁ§ „¿•†›‹ ‹‚»ﬁ› – ¸› –” ˝»‰ ‹•–† ˚ –†…•‹•–†› » '¿•“» ¿†§ ﬁ•„‚‹ –” ﬁ»‰–“»ﬁ§ '» ‡¿§ ‚¿“» ¿„¿•†›‹ ‹‚» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ›‚–'† •† ‹‚» ˝‰‚»…«·» ¿–“» »‰¿«›» –” ¿§‡»†‹› '» ‡¿» ”–ﬁ •†¶«ﬁ§ –ﬁ …¿‡¿„» ¿ﬁ•›•†„ –«‹ –” §–«ﬁ –†„–•†„ –»ﬁ¿ ‹•–†› –ﬁ §–«ﬁ '–ﬁ …–†» «†…»ﬁ ¿ ‰–†‹ﬁ¿‰‹ '•‹‚ ‹‚¿‹ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ¿†… •†‰·«…»… •† ‹‚» ﬁ–…«‰‹›‰–‡·»‹»… –»ﬁ¿‹•–†› ‚¿ƒ¿ﬁ… ‚•› '¿•“»ﬁ ¿·•»› –†·§ ‹– ‹‚» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ›‚–'† •† ‹‚» ˝‰‚»…«·» ¿–“» ºŁØØ —¸˛˝¸ —— ˛ ˛ ˛ ˛ ˙¸ ˛ DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087 03/01/2021 WC 080-75-6387 GOFORTH & MARTI - DBA: GM BUSINESS INTERIORS NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. DocuSign Envelope ID: 3F5BBA8E-DB78-4500-AE70-0DAFB1631087