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HomeMy WebLinkAboutPBA LTD South; 2021-12-21; PWM22-1731TRANPWM22-1731TRAN Kelly Channel Maintenance Page 1 of 8 City Attorney Approved 1/20/2020 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT KELLY CHANNEL MAINTENANCE This agreement is made on the ______________ day of _________________________, 2021, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and PBA, LTD South, a California corporation whose principal place of business is 4135 Park Drive, Carlsbad, CA 92008 (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: Clayton Dobbs (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. DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 December 21st PWM22-1731TRAN Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontract fr m pa 'cipating in contract bidding. Signature: Print Name: 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. Kelly Channel Maintenance Page 2 of 8 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 PWM22-1731TRAN Kelly Channel Maintenance Page 3 of 8 City Attorney Approved 1/20/2020 WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY. Workers’ Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys’ fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within thirty (30) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. PBA, LTD South 4135 Park Drive (name of Contractor) 1081694 (street address) Carlsbad, CA 92008 (Contractor’s license number) A & B 9/30/2023 (city/state/zip) 760-801-5238 (license class. and exp. date) 1000834464 (telephone no.) N/A (DIR registration number) 06/30/23 (fax no.) kevin.pbalimited@gmail.com (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// /// DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 PWM22-1731 TRAN AUTHORITY. The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. ,,CONTRACTOR . / ::;;_S 1 0. H, a California corporation \'__~ Kevin James Doherty, President & Secretary (print name/title) By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: __________ _ Assistant City Attorney Kelly Channel Maintenance Page 4of 8 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 PWM22-1731 TRAN 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 cQnstituting 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 Total % Subcontracted: _____Q_J6_ DIR Registration No. License No., Classification & Ex iration Date The Contractor must perform no less than fifty percent (50%) of the work with its own forces. %of Total Contract Kelly Channel Maintenance Page 5 of 8 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 PWM22-1731TRAN Kelly Channel Maintenance Page 6 of 8 City Attorney Approved 1/20/2020 EXHIBIT B Kelly Channel Maintenance The Contractor will remove all debris and sediments from top of concrete lined trapezoid channel, about 900 linear feet from end to end excluding area beyond the start of the dual box culverts. Trucks hauling debris shall have dump beds lined with visqueen or equivalent to prevent seepage. Debris shall be hauled to Carlsbad Tamarack storage yard to dry prior to Contractor hauling to landfill. The City right of way shall be clean at all times and Contractor will maintain appropriate traffic control during maintenance efforts. All traffic control will be in accordance with the latest edition of the California Manual on Uniform Traffic Control Devices (CAMUTCD). JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LS 1 Remove all debris, vegetation and sediments from Kelly Drive trapezoid channel with long reach excavator. Work shall be clean excavation (no equipment in channel) per the Army Corps of Engineers permits and specifications, and meet all standards and specifications for non-blue line, concrete channel maintenance. $36,400 TOTAL* $36,400 *Includes taxes, fees, expenses, and all other costs. DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 Bond Number:UCSX372X4431 Premium: $1,183.00 EXHIBITC LABOR AND MATERIALS BOND PWM 22-1731 TRAN WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to PBA, LTD South (hereinafter designated as the "Principal"), a Contract for: KELLY CHANNEL MAINTENANCE 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, PBA, LTD South, as Principal, (hereinafter designated as the "Contractor''), and United Surety Insurance Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of thirty-six thousand four hundred dollars ($36,400), 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 Gontract, 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. Kelly Channel Maintenance Page 7 of 8 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 / I I I \ PWM22-1731TRAN In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. SIGNED AND SEALED, this ___ 29_t_h ___ day of _____ N_o_v_e_m_b_er _____ , 20~ -PBA, LTD South (SEAL) ..-..:..-.,.,-~--.;__ ______ _ __ u_n_i_te_d_S_u_re_ty_ln_su_r_a_nc_e_C_o_m_p_a_n_y _(SEAL) (Surety) (Principal) By: ----,.j~£;~A --+l --=Q....._,Pr,.,..._/J ___ _ ' (Signat ref' Kelly A. Specht, Attorney-in-Fact (Name/Title) 1 (Name/Title) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY -ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CELIA A. BREWER City Attorney By: Assistant City Attorney Kelly Channel Maintenance Page 8 of 8 City Attorney Approved 1/20/2020 DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 California All-Purpose Certificate of Acknowledgment A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of _...;o;.;.ra=n=9.;;.e __________ _ } S.S. On November 29, 2021 before me, _______ B_e_th_a_n--"y_M_e_r_ce_r_, _N_ot_a---'ry'--P_ub_l_ic ____ _ ----------Name of Notary Public, Tille . personally appeared ___________ K_e~(l~y A_._S~p_ec_h_t _________ _ Name of Signer ("I) Name of Signer (2) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their 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(s) acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoi g paragraph is true and correct. ········~ BETHANY MERCER Notary Public -California z Orange County ! . Commission /I 2369740 y Comm. Expires A.;g 4, 2025 Seal Although the informatb n in this section i · not I quired by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized ocument and may prove useful to persons relying on the attached document. document titled/for the containing _2_ pages, and dated ___ N_o_ve_m_be_r_2_9_, _20_2_1_ r The signer(s) capacity or authority is/are as: D lndividual(s) IX! Attorney-in-fact D Corporate Officer(s) ______________ _ D Guardian/Conservator D Partner -Limited/General D Trustee(s) Title(s) D other: _________________ _ representing: United Surety Insurance Company Name(s)of Person{s) Entity(ies) Signer 1s Representing Method of Signer Identification Proved to me on the basis of satisfactory evidence: D form(s) of identification D credible witness(es) Notarial event is detailed in notary journal on: Page#__ Entry# __ Notary contact: _________ _ Other D Additional Signer D Signer(s) Thumbprints(s) □ -------------- © 2009-2015 Notary Learning Center -All Rights Reserved You can purchase copies of this form from our web site at www.TheNotarysStore.co111 DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 II UNITED CASUALTY AND SURETY INSURANCE CO MPANY US Casualty and Surety Insurance Company United Surety Insurance Company POWER OF ATTORNEY Agency No. 171372 KNOW ALL MEN BY THESE PRESENTS: That United Casualty and Surety Insurance Company, a corporation of the State of Nebraska, and US Casualty and Surety Insurance Company and United Surety Insurance Company, assumed names of United Casualty and Surety Insurance Company (collectively, the Companies), do by these presents make, constitute and appoint: Kelly A. Specht, Kandis Gregory, Richard P. Ford, Thomas C. Buckner, Michael Herranen, Bethany Mercer, William Belpedio its true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety. This Power of Attorney shall expire without further action on December 31", 2023. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Board of Directors of the Companies at a meeting duly called and held on the 1" day of July, 1993: Resolved that the President, Treasurer, or Secretary be and they are hereby authorized and empowered to appoint Attorneys-in-Fact of the Company, in its name and as its acts to execute and acknowledge for and on its behalf as Surety any and all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so executed by such Attorneys-in-Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected Officers of the Company in their own proper persons. That the signature of any officer authorized by Resolutions of this Board and the Company seal may be affixed by facsimile to any power of attorney or special power of attorney or certification of either given for the execution of any bond, undertaking, recognizance or other written obligation in the nature thereof; such signature and seal, when so used being hereby adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereunto affixed, this 15th day of February, 2021. Corporate Seals Commonwealth of Massachusetts County of Suffolk ss: UNITED CASUALTY AND SURETY INSURANCE COMPANY US Casualty and Surety Insurance Company United Surety Insurance Company On this 15th day of February, 2021, before me, Thomas P. Carrigan, Jr., a notary public, personally appeared Joel R. Chachkes, Treasurer of United Casualty and Surety Insurance Company, US Casualty and Surety Insurance Company and United Surety Insurance Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person(s), or the entity on behalf of which the person(s) acted, executed the instrument. I, Robert F. Thomas, Chief Operating Officer of United Casualty and Surety Insurance Company, US Casualty and Surety Insurance Company and United Surety Insurance Company do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. Robert F. Thomas, Chief Operating Officer TO CONFIRM AUTHENTICITY OF THIS BONO OR DOCUMENT EMAIL: CONFIRMBONO@UNITEOCASUALTY.COM DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 TO: FROM: Clayton Dobbs Kevin Doherty COMPANY: DATE: City of Carlsbad OCTOBER 4, 2021 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 2 PHONE NUMBER: RE: (760) 801-5238 Kelly Channel Clear & grub Scope: 1. Remove all Debris, vegetation & sediments from top of trapezoid channel to park street bridge. 2. Loads on trucks to be lined with visqueen 3. Haul debris to Carlsbad service yard on Tamarach4. All Prevailing wages 5. RW permit no fees6. RW to be cleaned every day until finished 7.All work to be completed within 5 working days of start8. This proposal includes a bobcat running in the bottom of channel pushing vegetation to excavator. 9. 22 loads plus or minus on Trucking Total Labor, Equipment and materials ---- $28,000.00 Alternate: No support equipment in channel, manual labor only with long reach Excavator reaching into channel Kelly Street: Total Labor & Materials ------- $36,400.00 SOUTH PROPOSAL PBA LTD SOUTH 4135PARK DR, CARLSBAD CA 92008-3636 PH: 760/801-5238 LICENSE 1081694 PWM22-1731TRAN Exhibit D LTD DocuSign Envelope ID: 18FA006F-2557-43B2-9C80-FE0260B42D18 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 on this 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), AUTHORIZED REPRESENTATIVE 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 PERIOD INDICATED. 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 12/02/2021 E360 INSURANCE SERVICES 16542 Ventura Blvd #300 Encino CA 91436 Sonia Castellon (888) 862-6750 (888) 256-0809 Sonia@e360insurance.com PBA, LTD South 4135 Park Drive Carlsbad CA 92008 KINSALE INSURANCE COMPANY 38920 State national Insurance Company Inc.12831 STATE COMPENSATION INSURANCE FUND 35076 A Y Y 0100163944-0 09/23/2021 09/23/2022 1,000,000 100,000 1,000,000 2,000,000 2,000,000 B Y NXTKWDRVCW-00-CA 11/16/2021 11/16/2022 1,000,000 A 0100164143-0 09/23/2021 09/23/2022 2,000,000 2,000,000 C Y Y 9305626-2021 09/23/2021 09/23/2022 1,000,000 1,000,000 1,000,000 The City of Carlsbad is Included as Additional Insured as Respects Liability arising out of work or operations performed by or on behalf of the Contractor. 110 Days Notice of Cancellation for Non-Payment of Premium, 30 Days for all other Cancellations. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 COMMERCIAL AUTO NXT-0004 BM CA 0418 Includes material copyrighted by Insurance Services Office, Inc. used with its permission Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED COVERAGE – CERTIFICATE OF INSURANCE HOLDERS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Section II – Covered Autos Liability Coverage, A. Coverage, paragraph 1. Who Is An Insured: Any person or organization arising out of your operation, maintenance, or use, of a covered “auto”, provided that you and such person or organization have agreed under an expressed provision in a written “insured contract” or agreement or a written permit issued to you by a governmental or public authority, to add that person or organization to this policy as an additional “insured”. However, such person or organization is an additional “insured”: (1) Only arising out of the operation, maintenance, or use, of a covered “auto“ by or on behalf of the Named Insured; (2) Caused in whole or in part by your acts or omissions or the acts or omissions of those acting on your behalf; and (3) Only for bodily injury or property damage caused by an “accident” which takes place after: (a) The written “insured contract” or agreement has been executed by you; or (b) The permit has been issued to you by a governmental or public authority. This insurance does not apply to damages arising out of the negligence of such person or organization. The provisions of this endorsement also apply to such person or organization when named as a Certificate Holder on a Certificate of Insurance that affirms valid insurance coverage provided by us for the Named Insured. All other terms and conditions of the policy remain unchanged. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100163944-0 09/23/2021 12:01AM at the Named Insured address shown on the Declarations PBA South LTD Additional Premium:Return Premium: $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE A. SECTION II - WHO IS AN INSURED is amended to include any person or organization you are required to include as an Additional Insured on this Policy by written contract in effect during the policy period and executed prior to the “occurrence” of the “bodily injury” or “property damage”, but only for the vicarious liability imposed on the Additional Insured provided that such liability is caused by the sole negligent conduct of the Named Insured and is proximately caused by “your work” or “your product” for the Additional Insured. However: 1.The insurance afforded to such Additional Insured only applies to the extent permitted by law; and 2.Will not be broader than that which you are required by the written contract to provide for such Additional Insured. B. The insurance provided to the Additional Insured under this endorsement is limited as follows: 1.This insurance does not apply to “bodily injury” or “property damage” arising out of “your work” or “your product” included in the “products-completed operations hazard” unless you are required to provide such coverage by written contract. If such insurance is required by written contract, the insurance provided to the Additional Insured is limited to the alleged or actual vicarious liability imposed on the Additional Insured as a result of the alleged or actual negligent conduct of the Named Insured as a result of liability solely caused by “your work” or “your product” for the Additional Insured. 2.Any insurance provided by this endorsement to an Additional Insured shall be excess with respect to any other valid and collectible insurance available to the Additional Insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis, in which case this insurance shall be primary and non-contributory. 3.Where there is no duty to defend the Named Insured, there is no duty to defend the Additional Insured. Where there is no duty to indemnify the Named Insured, there is no duty to indemnify the Additional Insured 4.This insurance does not apply to “bodily injury” or “property damage,” arising out of the sole negligence of the Additional Insured or any employees of the Additional Insured. CAS5010 0420 Page 1 of 2 C.With respect to the insurance afforded to the Additional Insured, the following is added to SECTION III – LIMITS OF INSURANCE: The most we will pay on behalf of the Additional Insured is the amount of insurance: 1.Required by the written contract; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. D.Duties of the Additional Insured in the event of “occurrence”, claim, or “suit”: 1.The Additional Insured must promptly give notice of an “occurrence”, a claim which is made, or a ”suit” to any other insurer which has insurance for a loss to which this insurance may apply. 2.The Additional Insured must promptly tender the defense of any claim made or ”suit” to any other insurer which also issued insurance to the Additional Insured as a Named Insured or to which the Additional Insured may qualify as an Additional Insured for a loss to which this insurance may apply. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS5010 0420 Page 2 of 2 STATE ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BROKER COPY COM�ENSATJON INSURANCE FUND 9306038-21 NEW HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DA TES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME SC PAGE EFFECTIVE NOVEMBER 29, 2021 AT 12.01 A.M. AND EXPIRING SEPTEMBER 23, 2022 AT 12.01 A.M. PBA, LTD. SOUTH 4135 PARK DR CARLSBAD, CA 92008 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF CARLSBAD WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, PBA, LTD. SOUTH IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2570 ��� NOVEMBER 29, 2021 PRESIDENT AND CEO SCIF FORM 10217 mev.7-2014) 1 OF 1 OLD DP 217