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HomeMy WebLinkAboutCharles Doherty Concrete; 2022-03-07; PWL22-1775FAC PWL22-1775FAC Batiquitos Lagoon Visitor Center Concrete Pad - 1 - City Attorney Approved 2/29/2016 CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT Batiquitos Lagoon Visitor Center Concrete Pad This letter will serve as an agreement between Charles Doherty Concrete, a sole proprietorship (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to construct a concrete pad for the bench seats located at the Batiquitos Lagoon Visitor Center, per Exhibit A and City specifications, for a sum not to exceed four thousand eight hundred sixty dollars ($4,860). This work is to be completed within ten (10) 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. DocuSign Envelope ID: 189E8C13-F132-4C9D-907A-6A3DCE7A13CD PWL22-1775FAC Batiquitos Lagoon Visitor Center Concrete Pad - 2 - City Attorney Approved 2/29/2016 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. 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. /// /// /// /// /// /// /// /// DocuSign Envelope ID: 189E8C13-F132-4C9D-907A-6A3DCE7A13CD w w PWL22-1775FAC Batiquitos Lagoon Visitor Center Concrete Pad - 3 - City Attorney Approved 2/29/2016 /// 9. City Contact: Ron Haugland, 760-975-7410 Contractor Contact: Charles Doherty, 760-721-3351 CONTRACTOR Charles Doherty Concrete, a sole propriertorship CITY OF CARLSBAD, a municipal corporation of the State of California 2850 Industry Street Oceanside, CA 92054 cwdoherty@cox.net By: By: (sign here) Charles Doherty, Owner Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) By: Dated: (sign here) (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: CELIA A. BREWER, City Attorney BY: Assistant City Attorney /// /// DocuSign Envelope ID: 189E8C13-F132-4C9D-907A-6A3DCE7A13CD 3/7/2022 PWL22-1775FAC Batiquitos Lagoon Visitor Center Concrete Pad - 4 - City Attorney Approved 2/29/2016 EXHIBIT A Batiquitos Lagoon Visitor Center Concrete Pad SCOPE OF WORK AND FEE DESCRIPTION PRICE Form, place and finish concrete pad 18' x 18' adjacent existing asphalt path. To include saw cut at asphalt edge to ensure clean fit. Concrete to be 3250 PSI city mix with San Diego buff color (equal or equivalent) 5 1/2" thick. Place on compacted existing sub grade with vibrator plate. Remove forms and backfill edges with existing soil. Concrete finish shall be stamped with wood plank texture. $4,860 TOTAL* $4,860 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: 189E8C13-F132-4C9D-907A-6A3DCE7A13CD ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD 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 AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 12/8/2021 License # 0757776 (760) 707-5659 (760) 804-0942 24856 Charles Doherty Concrete 1302 Crestridge Dr. Oceanside, CA 92054 25674 A 1,000,000 X X CA000024840-06 7/15/2021 7/15/2022 300,000 Per Project Agg.5,000 1,000,000 2,000,000 2,000,000 5,000,000A X X GX000002429-03 7/15/2021 7/15/2022 5,000,000 B Equipment Floater QT-660-2J005245-TIL-21 2/9/2021 Flood 340,677 B Covered Property QT-660-2J005245-TIL-21 2/9/2021 2/9/2022 Earth Movement 340,677 Certificate holder, City of Carlsbad/CMWD, is named as Additional Insured with respect to General Liability per form CG2011 1219, CG2034 1219, CG2010 0413 & CG2037 0413. Insurance is Primary and Non-contributory. Waiver of subrogation applies for General Liability. City of Carlsbad/CMWD 1635 Faraday Ave Carlsbad, CA 92008-7314 CHARDOH-01 JGRAESSLE Carlsbad, CA-HUB International Insurance Services Inc. 1525 Faraday Avenue Suite 200 Carlsbad, CA 92008 Julie Graessle julie.graessle@hubinternational.com Admiral Insurance Company Travelers Property Casualty Company of America 2/9/2022 X X X X X ACORDe I ~ I I □ ~ ~ Fl □ □ ~ ~ ~ ~ ~ ~ ~ ~ ~ □ CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2  Policy Number: CA000024840-06 CG 20 10 04 13 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION THAT IS AN OWNER OR MANAGER OF REAL PROPERTY OR PERSONAL PROPERTY ON WHICH YOU ARE PERFORMING ONGOING OPERATIONS, OR A CONTRACTOR ON WHOSE BEHALF YOU ARE PERFORMING ONGOING OPERATIONS, BUT ONLY IF COVERAGE AS AN ADDITIONAL IN- SURED IS REQUIRED BY A WRITTEN CON-TRACT OR WRITTEN AGREEMENT THAT IS AN “INSURED CONTRACT”, AND PROVIDED THE “BODILY INJURY” OR “PROPERTY DAMAGE” FIRST OCCURS, OR THE “PERSONAL AND AD- VERTISING INJURY” OFFENSE IS FIRST COM- MITTED, SUBSEQUENT TO THE EXECUTION OF THE CONTRACT OR AGREEMENT. ALL LOCATIONS AT WHICH THE NAMED IN- SURED IS PERFORMING ONGOING OPERA-TIONS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2  A.Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(s) shown in the Schedule, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance af- forded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to “bodily injury” or “property damage” occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing oper- ations for a principal as a part of the same project. C.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2011 Page 1 of 2  Policy Number: CA000024840-06 CG 20 37 04 13 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION THAT IS AN OWNER OF REAL PROPERTY OR PERSONAL PROPERTY FOR WHOM YOU WORK OR HAVE WORKED, OR A CONTRACTOR ON WHOSE BEHALF YOU WORK OR HAVE WORKED, BUT ONLY IF COVERAGE AS AN ADDITIONAL INSURED EXTENDING TO "BODILY INJURY" OR "PROPERTY DAMAGE" INCLUDED IN THE "PRODUCTS-COMPLETED OPERATIONS HAZARD" IS REQUIRED BY A WRITTEN CONTRACT OR WRITTEN AGREEMENT THAT IS AN "INSURED CONTRACT" AND PROVIDED THAT THE "BODILY INJURY" OR "PROPERTY DAMAGE" FIRST OCCURS SUBSEQUENT TO THE EXECUTION OF THE CONTRACT OR AGREEMENT. ALL LOCATIONS EXCEPT LOCATIONS WHERE "YOUR WORK" IS OR WAS RELATED TO A JOB OR PROJECT INVOLVING SINGLE-FAMILY DWELLINGS, MULTI- FAMILY DWELLINGS (OTHER THAN RENTAL APARTMENTS IN AN APARTMENT BUILDING: (A) ORIGINALLY CONSTRUCTED AND AT ALL TIMES USED FOR SUCH PURPOSE, OR (B) CONVERTED FROM A COMMERCIAL BUILDING), CONDOMINIUMS, TOWNHOMES, TOWNHOUSES, TIME-SHARE UNITS, FRACTIONAL-OWNERSHIP UNITS, COOPERATIVES AND/OR ANY OTHER STRUCTURE OR SPACE USED OR INTENDED TO BE USED AS A RESIDENCE. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(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”. CG 20 37 04 13 © Insurance Services Office, Inc., 2011 Page 2 of 2  However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance af- forded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Policy Number: CA000024840-06 AD 68 93 0117 Effective Date: 07/15/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCED COVERAGE (Commercial General Liability Coverage Form) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM I. AMENDED EXCLUSIONS NON-OWNED WATERCRAFT COVERAGE-Up to 55 feet SECTION I -COVERAGES -COVERAGE A-BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Exclu- sion g. Aircraft, Auto or Watercraft, Paragraph (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 55 feet long; and (b) Not being used to carry persons or property for a charge; MEDICAL PAYMENTS - PRODUCTS-COMPLETED OPERATIONS HAZARD SECTION I -COVERAGES -COVERAGE C -MEDICAL PAYMENTS Exclusion f. Products-Completed Operations Hazard is deleted in its entirety. CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM EXCLUSION (LIMITED EXCEPTION FOR OPERATIONS A WAY FROM PROJECT LOCATION) The following exclusion is added to paragraph 2., Exclusions of COVERAGE A -BODILY INJURY AND PROPER TY DAMAGE LIABILITY (Section I-Coverages): This insurance does not apply to "bodily injury" or "property damage" arising out of either your ongoing operations or opera- tions included within the "products-completed operations hazard" at any location for which a consolidated (wrap-up) insur- ance program has been provided by the prime contractor/project manager or owner of the construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap-up) insurance program: (1) Provides coverage identical to that provided by this Coverage Form; (2) Has limits adequate to cover all claims; or (3) Remains in effect. However, if the consolidated (wrap-up) insurance program does not provide coverage for your operations that are performed away from the location of the construction project, this exclusion will not apply. AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page 1 of8 □ Il. AMENDEDCOVERAGES KNOWLEDGE OF OCCURRENCE The following paragraph is added to Section IV -Commercial General Liability Conditions Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: Notice of an "occurrence" which may result in a claim under this insurance shall be given as soon as practicable after knowledge of the "occurrence" has been reported to you, one of your "executive officers", or any "employee" authorized by you to give or receive notice of an "occurrence". UNINTENTIONAL ERRORS AND OMISSIONS The following paragraph is added to Section IV -Commercial General Liability Conditions Paragraph 6. Representations: However, the unintentional omission of, or unintentional error in, any information given or provided by you shall not preju- dice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our right of cancellation or non-renewal. ill. ADDED COVERAGES PERSONAL PROPERTY OF OTHERS IN YOUR CARE, CUSTODY OR CONTROL- LIMITED COVERAGE SCHEDULE Sub-Limits of Insurance: $10,000 Each Occurrence Oncluded in the Each Occurrence Limit shown in the Declarations) $10,000 Aggregate (Included in the General Aggregate Limit shown in the Declarations) The Sub-Limits of Insurance shown above are included within and not in addition to the Each Occurrence Limit and the General Aggregate Limit shown in the Declarations. Supplementary Payments will reduce the Each Occurrence and Aggregate Sub-Limits of Insurance shown above. It is agreed COMMERCIAL GENERAL LIABILITY COVERAGE FORM -SECTION I -COVERAGE A Exclusion j. ( 4) is deleted, but only with respect to personal property of others in the care, custody or control of the Named Insured, subject to the following exclusions, conditions and limitations. 1. Exclusions This insurance does not apply to: a. "Property damage" arising out of operations performed on behalf of the Named Insured by others; b. "Property damage" arising out of an "occurrence" at premises owned, rented, leased, operated, occupied or used by you; c. "Property damage" to property while in transit; d. "Property damage" arising out of any error, omission or deficiency in the design, specifications, workmanship or materials of the personal property in the Named Insured's care, custody or control; e. "Property damage" arising out of delay, loss of market, loss of use, loss of profits, or any similar indirect or conse- quential loss of any kind; f. "Property damage" included within the "products-completed operations hazard"; or g. Damages exceeding the actual cash value of the personal property in the care, custody or control of the Named In- sured at the time of the "occurrence." 2. Conditions Our right and duty to defend ends when we have used up the applicable sub-limit of insurance in the payment of judg- ments or settlements or Supplementary Payments under the insurance provided by this endorsement. AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Pagel of8 □ 3. Limits of Insurance a. The amount we will pay for damages is limited as described below with respect to damages covered under this en- dorsement: (1) The Aggregate Limit shown in the Schedule is the most we will pay for the sum of all damages because of "property damage"; (2) The Each Occurrence Limit shown above is the most we will pay for the sum of all damages because of "prop- erty damage" arising out of any one "occurrence"; (3) Supplementary Payments will reduce the Each Occurrence and Aggregate Limits of Insurance shown in the Schedule; and ( 4) All sums we pay for damages or Supplementary Payments under this endorsement will reduce the Each Occur- rence Limit and the General Aggregate Limit shown in the Declarations. 4. Other Insurance This insurance is excess over any other valid and collectible Property or Inland Marine insurance available to you, either as a Named Insured or an Additional Insured, whether primary, excess, contingent or any other basis. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION (Insurance Services Office Endorsement CG 20 01 04 13) The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek con- tribution from any other insurance available to the additional insured. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (Insurance Services Office Endorsement CG 24 04 05 09) SCHEDULE Name Of Person Or Organization: Any person or organization, but only if the following conditions are met: ( 1) You have expressly agreed to the waiver in a written contract; and (2) The injury or damage first occurs subsequent to the execution of the written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Condi- tions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the ''products-completed operations hazard". This waiver applies only to the per- son or organization shown in the Schedule above. AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page3 of8 □ Scheduled Railroad: CONTRACTUAL LIABILITY -RAILROADS (Insurance Services Office Endorsement CG 24 17 10 01) SCHEDULE Designated Job Site: Any railroad, but only if the following conditions are met: a. You have expressly agreed to indemnify the railroad in a written contract entered into by you; and Any job site covered by this insurance where you are per- forming operations for or affecting a Scheduled Railroad. b. The injury or damage occurs subsequent to the execu- tion of the written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applica- ble to this endorsement.) With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "in- sured contract" in the Definitions section is replaced by the following: 9. "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with per- mission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a munici- pality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a munici- pality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liabil- ity that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or dam- age; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT (WITH TOTAL AGGREGATE LIMIT FOR COVERAGES A, BAND C) SCHEDULE Designated Construction Projects: All construction projects covered by this insurance. (Ifno entry appears above, information required to complete this endorsement will be shown in the Declarations as applica- ble to this endorsement.) AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page 4of8 □ A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVER- AGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction pro- ject, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. However, the most we will pay under the Designated Construction Project General Aggregate Limit for all Desig- nated Construction Projects combined is $5,000,000 . 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of"bodily injury" or "property damage" included in the "products- completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such pay- ments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Des- ignated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVER- AGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can- not be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Desig- nated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to ap- ply as stipulated. IV. ADDITIONAL INSUREDS ADDITIONAL INSURED -LESSOR OF LEASED EQUIPMENT- AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU (Insurance Services Office Endorsement CG 20 34 04 13) A. Section II-Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a contract or agree- ment that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organiza- tion(s) is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page 5of8 □ 2.Will not be broader than that which you are required by the contract or agreement to provide for such additional in­sured. A person's or organization's status as an additional insured under this endorsement ends when their contract or agree­ment with you for such leased equipment ends. B.With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence"which takes place after the equipment lease expires. C.With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits OfInsurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement you have entered into with the additional insured; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES (Insurance Services Office Endorsement CG 20 11 04 13) SCHEDULE Designation Of Premises (Part Leased To You): All premises leased to you and covered by this insurance. Name Of Person(s) Or Organization(s) (Additional Insured): Any person or organization that is a manager or lessor of real property, but only if coverage as an additional insured is re-quired by a written contract or written agreement that is an "insured contract", and provided the "bodily injury" or "prop-erty damage" first occurs, or the "personal and advertising injury" offense is first committed, subsequent to the execution of the contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II-Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shownin the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of thepremises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1.Any "occurrence" which takes place after you cease to be a tenant in that premises. 2.Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or or-ganization(s) shown in the Schedule. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to suchadditional insured will not be broader than that which you are required by the contract or agreement to provide forsuch additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits OfInsurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf ofthe additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. AD 68 93 01 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page 6 of8 □ ADDITIONAL INSURED -MORTGAGEE, ASSIGNEE OR RECEIVER (Insurance Services Office Endorsement CG 20 18 04 13) SCHEDULE Name Of Person(s) Or Ore:anization(s) Desie:nation Of Premises Any person or organization that is a mortgagee, assignee or re-All premises covered by this insurance. ceiver for a premises shown in this Schedule, but only if cov- erage as an additional insured is required by a written contract or written agreement that is an "insured contract", and pro- vided the "bodily injury" or "property damage" first occurs, or the "personal and advertising injury" offense is first commit- ted, subsequent to the execution of the contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II-Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the owner- ship, maintenance, or use of the premises by you and shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ADDITIONAL INSURED -TRADE SHOW SPONSOR - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN AGREEMENT WITH YOU A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization who is a sponsor of a trade show where you are operating a booth or displaying your product, but only: 1. For injury or damage occurring at the trade show; and 2. When you and such person or organization have agreed in writing in a contract or agreement executed prior to the beginning of the trade show that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; while attending the trade show sponsored by this additional insured. AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page 7 of8 □ A person's or organization's status as an additional insured under this endorsement ends when your attendance at the trade show ends. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury" or "property damage" arising out of ''your work" or "your product" and included in the "products-completed operations hazard". C. With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ADDITIONAL INSURED -STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION -PERMITS OR AUTHORIZATIONS (INSURANCE SERVICES OFFICE ENDORSEMENT CG 20 12 04 13) SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Any state or governmental agency or subdivision or political subdivision that has issued a permit or authorization for opera- tions performed by you or on your behalf. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products-completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits oflnsurance shown in the Declarations. AD 68 93 0117 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 2009, 2012 & 2013. Page 8of8 □ Policy Number: CA000024840-06 AD 69 63 0519 Effective Date: 07/15/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED STATE EXCLUSION -NEW YORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM Schedule Job or Project: None Premises: None This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury", including costs or expenses, actually or allegedly arising out of, related to, caused by, contributed to by, or in any way connected with: (1) Any operations or activities performed by or on behalf of any insured in the State of New York; or (2) Any premises, site or location owned, leased, occupied, maintained or used by or on behalf of any insured in the State of New York. This exclusion does not apply to the Job or Project, or to the Premises, shown in the Schedule above. We shall have no duty to investigate, defend or indemnify any insured against any loss, claim, "suit," demand, fine or other proceeding alleging injury or damages of any kind, to include but not limited to "bodily injury," "property damage," or "per- sonal and advertising injury" to which this endorsement applies. AD 69 63 0519 Page 1 oft Policy Number: CA000024840-06 CG20111219 Effective Date: 07/15/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): All premises leased to you and covered by this insurance. Name Of Person(s) Or Organization(s) (Additional Insured): Any person or organization that is a manager or lessor of real property, but only if coverage as an additional insured is re- quired by a written contract or written agreement that is an "insured contract", and provided the "bodily injury" or "prop- erty damage" frrst occurs, or the "personal and advertising injury" offense is frrst committed, subsequent to the execution of the contract or agreement. Additional Premium: $ Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II-Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20111219 © Insurance Services Office, Inc., 2018 Page 1 ofl □ CG 20 34 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1  Policy Number: CA000024840-06 CG 20 34 12 19 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – LESSOR OF LEASED EQUIPMENT – AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.Section II – Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and suchperson(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an insured onlywith respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organi-zation(s). However, the insurance afforded to such additional in- sured: 1.Only applies to the extent permitted by law; and 2.Will not be broader than that which you are requiredby the contract or agreement to provide for such ad- ditional insured. A person’s or organization’s status as an additional in- sured under this endorsement ends when their contract or agreement with you for such leased equipment ends. B.With respect to the insurance afforded to these addi- tional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. C.With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional in-sured is the amount of insurance: 1.Required by the contract or agreement you have entered into with the additional insured; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Lim- its of Insurance shown in the Declarations. Certificate Copy 648860138 07-31-2021 12-15-21 07-31-2022 COMMERCIAL CONTACT CENTER CHARLES DOHERTY 2850 INDUSTRY ST OCEANSIDE CA 92054-4812 CERTIFICATE HOLDER CITY OF CARLSBAD/CMWD X X X $ 2,000,000 C/O EXIGIS INSURANCE COMPLIANCE SERVICES PO BOX 947 MURRIETA, CA 92564-0947 CI CW A02 10 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission CI CW A02 10 11 Allstate Insurance Company Page 1 of 1 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder: Named Insured: Automobile Liability Insurer Name: Allstate Insurance Company Policy Number: 1 --- Any Auto 2 --- Owned Autos Only 3 --- Owned Priv. Pass. Autos Only 4 --- Owned Autos Other Than Priv. Pass. Autos Only 5 --- Owned Autos Subject to No Fault 6 --- Owned Autos Subject to a Compulsory UM Law 7 --- Specifically Described Autos 8 --- Hired Autos Only 9 --- Non-owned Autos Only Policy Effective Date: Policy Expiration Date: Combined Single Limit (each accident) Limits Of Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: Authorized Representative: Date: I ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD 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 AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 12/6/2021 (818) 986-7283 (818) 986-4949 21075 Charles Doherty 1302 Crestridge Dr. Oceanside, CA 92054 A X FOR-WC-000000180-0 12/5/2021 12/5/2022 1,000,000 Y 1,000,000 1,000,000 Waiver of subrogation in favor of the certificate holder. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 CHARDOH-01 IFATHIPOUR Paramount Exclusive Insurance Services, Inc. 15760 Ventura Blvd. Suite 500 Encino, CA 91436 Transverse Insurance Company X ACORD" I ~ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/05/2021 Policy No.FOR-WC-000000180-0 Endorsement No.000 Insured Charles Doherty dba Charles Doherty Concrete Premium Insurance Company Countersigned by ____________________ Transverse Insurance Company WC 04 03 06 (Ed. 04-84) Page 1 of 1 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _2.50_% of the California workers’ compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Per Contractual Obligation