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HomeMy WebLinkAboutS and J Builders and Restoration Services Inc; 2022-04-18; PWM22-1811FACPWM22-1811FAC Reinstall Metal Architectural Panels Page 1 of 11 City Attorney Approved 1/20/2020 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT REINSTALL METAL ARCHITECTURAL PANELS This agreement is made on the ______________ day of _________________________, 2022, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and S&J Builders and Restoration Services, Inc., a California corporation whose principal place of business is 10815 Wheatlands Ave., Suite J, Santee, CA 92071 (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 Jason Kennedy (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. DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B April18th PWM22-1811FAC Reinstall Metal Architectural Panels Page 2 of 11 City Attorney Approved 1/20/2020 A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 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 (5) years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: _________Gracie Wilson_______________ 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 DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B PWM22-1811FAC Reinstall Metal Architectural Panels Page 3 of 11 City Attorney Approved 1/20/2020 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 30 days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY. Workers’ Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. 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 120 calendar days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 10 working days after receipt of Notice to Proceed. /// /// /// /// /// /// DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B PWM22-1811FAC Reinstall Metal Architectural Panels Page 4 of 11 City Attorney Approved 1/20/2020 CONTRACTOR’S INFORMATION. S & J Builders and Restoration Services, Inc. 10815 Wheatlands Ave., Suite J (name of Contractor) 689944 (street address) Santee, CA 92071 (Contractor’s license number) Class B, 3-36 2/29/24 (city/state/zip) 619-449-2014 (license class. and exp. date) 1000018498 6/30/22 (telephone no.) swilson@sandjbuild.com (DIR registration number and exp. date) (email address) 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&J BUILDERS AND RESTORATION SERVICES, INC., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Gracie Wilson, CEO, President & Secretary Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President 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 DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B PWM22-1811FAC Reinstall Metal Architectural Panels Page 5 of 11 City Attorney Approved 1/20/2020 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor 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 subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than 50% of the work with its own forces. DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B None None 0% None NoneNone PWM22-1811FAC Reinstall Metal Architectural Panels Page 6 of 11 City Attorney Approved 1/20/2020 EXHIBIT B REINSTALL METAL ARCHITECTURAL PANELS JOB QUOTATION ITEM NO. UNIT QTY. DESCRIPTION PRICE 1 LS 1 Reinstall exterior metal architectural panels at the Carlsbad Safety Training Center located at 5750 Orion Street, Carlsbad, CA 92010. (See Exhibit C). $8,011.95 TOTAL* $8,011.95 *Includes taxes, fees, expenses and all other costs. /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B 1 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lic 689944 Insured: City of Carlsbad STC Business: (442) 339-5132 E-mail: Jason.Kennedy@carlsbadca.govProperty:5750 Orion Street Carlsbad , CA 92010 Billing: 3911 Harney Street San Diego , CA 92110 Estimator: Sean Wilson Business: (619) 449-2014 x 106 E-mail: swilson@sandjbuild.comCompany: S&J Builders Business: 10815 Wheatlands Ave Suite J Santee, CA 92071 Reference: Company: City of Carlsbad Contractor:Business: (619) 449-2014 Company: S&J Builders and Restoration Services Inc Business: 10815 Wheatlands Ave Suite J Santee, CA 92071 Claim Number:*****Policy Number:Type of Loss:Investigation - Repairs Date Contacted: 2/23/2022 12:00 PM Date of Loss: 5/28/2021 12:00 AM Date Received: 2/23/2022 12:00 PM Date Inspected: 3/1/2022 10:00 AM Date Entered: 3/22/2022 5:22 PM Price List: SJSDPWPWSJSD21 Restoration/Service/Remodel Estimate: CITY-CB-STC-PANELRES EXHIBIT C PWM22-1811FAC Page 7 of 11 DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B 2 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lic 689944 CITY-CB-STC-PANELRES 3/22/2022 Page: 2 We would like to thank you for the opportunity to provide you with this COST PROPOSAL TO Replace five (5) architecture aluminum building panels (owner provided). The total cost for the replacement of the existing aluminum panels with repairs detailed in the following proposal is $ 8,011.95 Proposal includes prevailing wages. The attached estimate details the specific work to be completed. Additional work outside of that specified in this estimate will be through separate proposal(s) and/or change order(s) detailing the additional/changed scope of work as well as the terms and pricing of those changes. Repairs will be scheduled after a signed contract is received by S&J Builders and a PO is issued by the city. Unless noted otherwise, the customer is required to provide heat, water and electricity on-site for the duration of this project. The customer is responsible for providing continuous access to the project area during normal business hours, Monday - Friday, 7:30 am - 4:00 pm. Where an item is being replaced, we will be matching the existing item's quality, color, finish, texture or material as close as possible where applicable unless noted otherwise, there is no guaranty either specified or implied on exact matches. This estimate does not include hazardous material testing or abatement unless specifically detailed in the following estimate. This estimate is valid for 30 days from 3/22/2022. If you have any questions about this estimate, please contact Sean Wilson to discuss those questions. Respectfully, Sean Wilson PWM22-1811FAC Exhibit C (continued) Page 8 of 11 DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B 3 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lic 689944 CITY-CB-STC-PANELRES 3/22/2022 Page: 3 CITY-CB-STC-PANELRES Main Level 5 Building panels Height: 8' DESCRIPTION QTY 1. Carpenter - per hour 32.00 HR 2. Metal Structures & Components Fasteners 1.00 EA General DESCRIPTION QTY 3. Commercial Supervision / Project Management - per hour - Sean 5.00 HR 4. Boom lift - 50'-60' reach (per day)2.00 DA 5. Rental equipment delivery / mobilization and removal 2.00 EA Grand Total $8,011.95 Sean Wilson Grand Total Areas: 248.00 SF Walls 58.50 SF Ceiling SF Walls and Ceiling306.50 58.50 SF Floor 6.50 SY Flooring 31.00 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 31.00 LF Ceil. Perimeter 58.50 Floor Area 69.28 Total Area 248.00 Interior Wall Area 303.00 Exterior Wall Area 33.67 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length PWM22-1811FAC Exhibit C (continued) Page 9 of 11 DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B 4 S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lic 689944 CITY-CB-STC-PANELRES 3/22/2022 Page: 4 1 2 3 4 5 6 7 PWM22-1811FAC Exhibit C (continued) Page 10 of 11 DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B 5CITY-CB-STC-PANELRES3/22/2022Page: 5Main Level5 Building panels5 Building panelsMain Level6' 6"7' 2"9'9' 8"PWM22-1811FACExhibit C (continued)Page 11 of 11DocuSign Envelope ID: B5D21D49-EFE1-4768-B034-0A3C7ECDCD5B ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD 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 2/22/2022 12203 S & J Builders And Restoration Services, Inc. 10815 Wheatlands Ave. Ste. J Santee, CA 92071 38342 12537 10855 11260 31453 A 1,000,000 X 00122993 0 10/15/2021 10/15/2022 100,000 5,000 Ded $5K 1,000,000 2,000,000 2,000,000 1,000,000B BA040000032483 3/1/2022 3/1/2023 2,000,000C BTN2118064 10/15/2021 10/15/2022 2,000,000 D X SJWC350306 1/1/2022 1/1/2023 1,000,000 1,000,000 1,000,000 E Pollution Liability ENP0006552 01 10/15/2021 per occ$1,000,000/ag 2,000,000 F Bailees 60497187 10/10/2021 10/10/2022 Bailees 250,000 Re: All Projects with the City As respects General Liabiliy 'The City of Carlsbad' is additional insured when required by written contract per attached endorsements. Cancellation Clause applies per attached policy language. Waiver of Subrogation applies with respects to Workers Compensation. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 S&JBUIL-01 SCARLILE JPL Insurance Group, Inc. 3033 Fifth Ave. #325 San Diego, CA 92103 Amy Brinkley amy@jplinsurance.com James River Insurance California Automobile Ins Co. United Specialty Insurance Co. Cypress Insurance Company Lloyds of London Financial Pacific Insurance Co X 10/15/2022 X X X X X X X POLICY NUMBER: 00087718-1 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 07 04 © ISO Properties, Inc.,2004 Page 1 of 1 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 Where required by written contract or written agreement All operations of the Named Insureds 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: 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) desig- nated above. B.With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equip- ment 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 in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. POLICY NUMBER: 00122993 0 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 07 04 © ISO Properties, Inc.,2004 Page 1 of 1 ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Opera- tions Where required by written contract or written agreement All operations of the Named Insureds Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products-completed operations hazard". POLICY NUMBER: 00122993 0 NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AP2104US 10-12 Page 1 of 2 COMMON POLICY CONDITIONS All Coverage Parts in this policy are subject to the following Conditions. 1. CANCELLATION AND NON-RENEWAL A. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. B. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or (2) 30 days before the effective date of cancellation if we cancel for any other reason. C. We will mail or deliver our notice to the first Named Insured’s last mailing address known to us. D. Notice of cancellation will state the effective date of cancellation. The policy will end on that date. E. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata unless cancellation is due to non payment of premium, in which case the refund may be less than pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. F. If notice is mailed, proof of mailing will be sufficient proof of notice. If we elect not to renew this policy, we shall mail written notice to the First Named Insured at the address shown in the Declarations. Such written notice of non-renewal shall be mailed at least 30 days prior to the end of the policy term. 2. CHANGES This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy’s terms can be amended or waived only by endorsement issued by us and made a part of this policy. 3. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US If the insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. 4. REPRESENTATIONS By accepting this policy, you agree: A.The statements in the Declarations are accurate and complete; B. Those statements are based upon representations you made to us; and C. We have issued this policy in reliance upon your representations. 5. SERVICE OF SUIT It is agreed that in the event of the failure of this Company to pay any amount claimed to be due hereunder, this Company will submit to the jurisdiction of any court of competent jurisdiction within the United States of America and will comply with all requirements necessary to give such Court jurisdiction and all matters arising hereunder shall be determined in accordance with the law and practice of such Court. It is further agreed that service of process in such suit may be made upon the Company’s President, or his nominee, at the address shown on the Declarations page of this policy, and that in any suit instituted against any one of them upon this policy, this Company will abide by the final decision of Policy # 00122993 0 Endorsement Effective: Policy No.: Insured: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manualpremium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculatedcharge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver – Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium (prior to adjustments) 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 No.: Premium $ Insurance Company: WC 99 04 10 C Countersigned by ______________________________________ (Ed. 01-19) Job Description All CA Operations Cypress Insurance Company SJWC350306 1789.00 01/01/2022