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Home My WebLink AboutGoForth & Marti DBA G/M Business Interiors; 2022-04-25; PSA22-1816FACPSA22-1816FAC City Attorney Approved Version 6/12/18 1 AGREEMENT FOR FIRE STATION NO. 2 FURNISHINGS CIP PROJECT NO. 4060 GOFORTH & MARTI D.B.A. G/M BUSINESS INTERIORS THIS AGREEMENT is made and entered into as of the ______________ day of _________________________, 2022, by and between the City of Carlsbad, a municipal corporation, ("City"), and GoForth & Marti, a California corporation, d.b.a. G/M Business Interiors, ("Contractor"). RECITALS A. City requires the professional services of a consultant that is experienced in procurement, delivery, assembly, locating and alignment of furnishings. B. Contractor has the necessary experience in providing professional services and advice related to procurement, delivery, assembly, locating and alignment of furnishings. C. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", which is incorporated by this reference in accordance with this Agreement’s terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective for a period of six (6) months from the date first above written. The City Manager may amend the Agreement to extend it for one (1) additional six (6) month period or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term will be thirty-five thousand six hundred sixty dollars and eighty-seven cents ($35,660.87). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. If the City elects to extend the Agreement, the amount shall not exceed thirty-five thousand six hundred sixty dollars and eighty-seven cents ($35,660.87) per Agreement year. The City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or Services specified in Exhibit "A". Incremental payments, if applicable, should be made as outlined in attached Exhibit "A". DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 April 25th PSA22-1816FAC City Attorney Approved Version 6/12/18 2 6. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City’s election, City may deduct the indemnification amount from any balance owing to Contractor. 7. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 8. OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys’ fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney’s fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor’s agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 PSA22-1816FAC City Attorney Approved Version 6/12/18 3 in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. 10.1 Coverage and Limits. Contractor will maintain the types of coverage and minimum limits indicated below, unless the Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an “occurrence” basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $2,000,000 combined single-limit per accident for bodily injury and property damage. 10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. 10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor’s profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 PSA22-1816FAC City Attorney Approved Version 6/12/18 4 maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy of the work product for Contractor’s records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City. 15. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City For Contractor Name Steven Stewart Name Jason Stierl Title Municipal Projects Manager Title Project Manager Department Public Works Address 110 W. A. Street, Suite 140 City of Carlsbad San Diego, CA 92101 Address 1635 Faraday Ave. Phone No. 800-686-6583 Carlsbad, CA 92008 Email jstierl@gmbi.net Phone No. 442-339-2938 Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 PSA22-1816FAC City Attorney Approved Version 6/12/18 5 16. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. Yes ☐ No ☒ 17. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 18. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services, the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 20. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement. Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and upon request of City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 PSA22-1816FAC City Attorney Approved Version 6/12/18 6 under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. 21. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement. 23. JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 24. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld. 25. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 PSA22-1816FAC City Attorney Approved Version 6/12/18 7 26. AUTHORITY The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California GoForth & Marti, a California corporation, d.b.a. G/M Business Interiors By: By: (sign here) Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager Laurinda P. Easley, President & Secretary (print name/title) By: (sign here) (print name/title) If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups. Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 PSA22-1816FAC City Attorney Approved Version 6/12/18 8 EXHIBIT “A” SCOPE OF SERVICES Contractor shall provide interior design services (field measurements, ACAD drawings, floorplan layouts, color and finishes selections and recommendations, etc.), procuring and delivering all materials, inspecting and delivery of all materials as outlined in the attached quote (Exhibit “B”) dated April 14, 2022. ITEM NO. UNIT QTY DESCRIPTION PRICE 1 Lot 1 Ancillary – wall mounts, coat racks, clocks, tac boards, glass boards, trash cans, misc. $18,233.49 2 Lot 1 Seating – conference table chairs, armchairs, task chairs, stacking chairs $8,873.28 3 Lot 1 Tables – end tables $869.85 4 Lot 1 Services – taxable labor and freight $1,636.25 Taxable Subtotal $29,612.87 Tax (7.75%) based on taxable subtotal $2,295.00 Services – nontaxable labor $3,753.00 TOTAL, not to exceed $35,660.87 DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 Project ID / Who & Where ERIC EVONSION | FIRE STATION# 2 2025724/14/2022 SHIP TO: CARLSBAD (ARENAL) FIRE STATION# 21906 Arenal Rd Carlsbad CA 92009 Phone:Fax: (858)229-5907 BILL TO:3845 CITY OF CARLSBAD1635 FARADAY AVE CARLSBAD CA 92008 Phone:Fax:ERIC EVONSIONSTEVE STEWART (760)602-7543 Systems Desk Units Tables Files Chairs Ancillary001017 71Product Counts: QuotationDate: Storage 0 QUOTE FOR: ALL SEATING, HERMAN MILLER, NATIONAL, PETER PEPPER, & ULINE FURNITURE ITEMS FOR: ERIC EVONSION | FIRE STATION# 2 **PLEASE NOTE THAT PETER PEPPER IS HAVING AN 8% PRICE INCREASE 05/05/2022, THE SIGNED QUOTE MUSTBE RETURNED NO LATER THAN EOD 04/22/2022 TO ENSURE CURRENT PRICING** LEAD TIMES:ALL SEATING: 3-4 WEEKSHERMAN MILLER: 6-8 WEEKSNATIONAL: 6-8 WEEKSPETER PEPPER: 4-6 WEEKSULINE: 2-3 WEEKS DUE TO PANDEMIC AND SUPPLY CHAIN LOGISTICAL CONSTRAINTS, LEAD TIMES QUOTED TODAY WILL BEVARIABLE WITH POTENTIAL TO CHANGE AND ARRIVE LATER OR EARLIER THAN EXPECTED SCOPE OF WORK: 1) G/M TO RECEIVE AND INSPECT ALL PRODUCT AT OUR SD WAREHOUSE 2) G/M TO ASSEMBLE/SET IN PLACE SEATING, TABLES, & ANCILLARY ITEMS PER CLIENT DIRECTION 3) G/M SERVICES QUOTED AS (1) TRIP DURING NORMAL BUSINESS HOURS 4) JOBSITE MUST BE FREE AND CLEAR OF ALL EXISTING FURNITURE AND PERSONAL ITEMS PRIOR TO G/MARRIVAL Product Summary / Scope of Work GRAND TOTAL $35,660.87 Account Executive: Michelle Philbin Project PAS: 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 1 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Jenna Ralston(jralston@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101G/M Business Interiors PSA22-1816FAC Exhibit "B"DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 5) G/M TO CONTACT ERIC EVONSION @ (858) 229-5907 TO SCHEDULE SERVICES DATE/TIME ONCE ALL PRODUCTHAS BEEN RECEIVED AT OUR SD WAREHOUSE AND ENTERED INTO OUR SYSTEM **G/M WILL HOLD PRODUCT FOR UP TO (2) WEEKS AT OUR WAREHOUSE FREE OF CHARGE. ANY PRODUCTREMAINING IN OUR WAREHOUSE AFTER THIS PERIOD WILL INCUR STORAGE FEES **NOTE: QUOTE WILL NEED TO BE ADJUSTED IF SERVICES TO TAKE PLACE AFTER BUSINESS HOURS, OR DURINGTHE WEEKEND Quotation # 202572G/M 1 27,587.00 27,587.00 18,233.49 Sell ExtSellList ExtList LOT ANCILLARY Who/What/Where 18,233.49 BOM A BOM: See Attached Bill of Materials 79Piece Count: .00.00.00.00 FreightTaxable Srvcs.Non-Tax Srvcs.Description: (12) EA PETER PEPPER WALL-MOUNTED HAT & COAT RACKS, (14) EA PETER PEPPER WALL-MOUNTED CLOCKS, (6) EA PETER PEPPER WALL-MOUNTED TACTICS BULLETIN BOARDS, (1) EA PETER PEPPER WALL-MOUNTED TACTICS COMBINATION BOARD, (7) EA PETER PEPPER WALL-MOUNTED GLASS WRITING SURFACES W/ MAGNETS, (3) EA ULINE BRUTE TRASH CANS, (1) EA PETER PEPPER BRUTE TRASH CAN DOLLY, (13) EA ULINE RUBBERMAID 23 GALLON RECYCLING BINS, (1) EA ULINE RETURN TOWEL CART, (1) EA PETER PEPPER MINIMINT WALL-MOUNTED BULLETIN/TACKBOARD, & (13) EA ULINE RUBBERMAID 7 GALLON TRASH CANS Design Fee 1 18,658.00 18,658.00 8,873.28 Sell ExtSellList ExtList LOT SEATING Who/What/Where 8,873.28 BOM B BOM: See Attached Bill of Materials 17Piece Count: .00.00.00.00 FreightTaxable Srvcs.Non-Tax Srvcs.Description: (11) EA ALLSEATING REQUISITE MID-BACK CONFERENCE CHAIRS, (1) EA NATIONAL TIMBERLANE GUEST ARMCHAIR, (1) EA HERMAN MILLER AERON SIZE B TASK CHAIR, & (3) EA HERMAN MILLER CAPER STACKING CHAIRS W/ GLIDES, & (1) EA HERMAN MILLER CAPER STACKING CHAIR W/ CASTERS Design Fee Account Executive: Michelle Philbin Project PAS: 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 2 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Jenna Ralston(jralston@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101G/M Business Interiors PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 Quotation # 202572G/M 1 1,933.00 1,933.00 869.85 Sell ExtSellList ExtList LOT TABLES Who/What/Where 869.85 BOM C BOM: See Attached Bill of Materials 1Piece Count: .00.00.00.00 FreightTaxable Srvcs.Non-Tax Srvcs.Description: (1) EA NATIONAL TESSERA 23" SQUARE END TABLE Design Fee 1 .00 .00 .00 Sell ExtSellList ExtList LOT Z G/M Services Who/What/Where .00 BOM D BOM: See Attached Bill of Materials Piece Count: .00.00460.003,753.00 FreightTaxable Srvcs.Non-Tax Srvcs.Description: G/M Furniture Planning Services, if applicable, include field measurements, drawing AutoCAD building shells, developing typical workstations and private office standards, space planning typicals into the floorplan, developing furniture color schemes, order specifications and receiving client approvals for all drawings and color schemes for order entry. G/M Project Management Services include drawings and field measure checks, order scheduling & routing, electrical consulting with contractors,field checks,monitoring construction progress along with delivery, assembly, punchlist coordination through final completion. G/M Project Services include receiving and inspecting of each product, shipping damage adjudication with vendors, transporting product if applicable, staging of products, delivery, setting in place of all furniture, level clean and polishing of all items, vacuum floors and recycling of all waste products associated with the furniture project. G/M Punchlist Services include formulation of the project punchlist, ordering and receiving of punchlist products, and delivery and assembly to finalize the punchlist and project. G/M Warranty Services Department is provided to offer clients our no-charge warranty service work for all furniture protected under valid factory warranties. G/M maintains electronic copies of our Client's invoices for warranty enforcement. For service requests, our Warranty Department may be contacted via e-mail at warranty@gmbi.net Design Fee Account Executive: Michelle Philbin Project PAS: 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 3 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Jenna Ralston(jralston@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101G/M Business Interiors PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 Quotation # 202572G/M Product Subtotal: Services (Non-Taxable) Services (Taxable) Freight (Taxable) Design Services (Non-Taxable) Sales Tax (7.750%) $27,976.62 $3,753.00 $460.00 $1,176.25 $0.00 $2,295.00 $35,660.87Total: Taxable Subtotal: Non-Taxable Subtotal: $29,612.87 $3,753.00 Terms: Net 30 Days 100%$35,660.87 Signed Date I have reviewed the quote, the bill of materials, the drawings (if applicable), the color cards (if applicable), and other associated exhibits for my order. I approve the colors, fabrics, and finishes as previously selected and correct as shown on the attached exhibit. I am satisfied that the product I have selected is the correct size and is suitable and will perform for its intended purpose. I am aware this product is manufactured to order and is not returnable to G/M or to the manufacturer. I understand that legal title to the product will transfer upon delivery to my commercial or residential location and all associated labor is taxable until title transfers. I am aware additional costs charged for inside delivery, staging, setting in place, assembly, leveling, cleaning, polishing, recycling of waste materials are separately stated and are elected as an additional contract option. I am aware of the grand total price of this contract as shown on this quote. Approved by: Signature Print Name/Title Date G/M is ordering your furniture from a variety of manufacturers to be aggregated and received into our G/M operated warehouse. Once the final portion of your order has been received, a “ready to deliver” notification will be sent to you. G/M, at this point, will graciously, store your complete order for up to two weeks at no charge. If for some reason you cannot accept a timely delivery within two weeks, a quote for one month’s handling and storage shall be calculated and forwarded to you. This quote is valid for 30 days. Account Executive: Michelle Philbin Project PAS: 800-686-6583 619-236-0500 Fax: 619-236-0550 Page: 4 http://www.gmbi.net (mphilbin@gmbi.net) AMA:Jenna Ralston(jralston@gmbi.net) 110 W. A Street, Suite 140, San Diego CA, 92101G/M Business Interiors PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 ■ ■ ■ ■ ■ ■ ■ ■ Product of the Month -elevate® Wireless Desk Power GIM accepts credit cards at 0% for purchases up to $10,000 Purchases over $10,000 requires a surcharge of 2.75% FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 6FabricInitial Frame, Arm, & Base Finish Black Fabric Finish J. Ennis Premier, Black Allseating Requisite Mid-Back Task Chairs w/ Synchro Tilt & Casters Seating | Qty: (11) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 >I FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 7FabricInitial Molded Back & Seat, Frame, & Arm Finish BK, Black Herman Miller Caper Stacking Chair, Fixed Arms (3) EA w/ Glides & (1) EA w/ Casters Seating | Qty: (4) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 9FabricInitial Frame, Base, & Arm Pad Finish BK, Black Chassis Finish BLX, Onyx Ultra Matte Back & Seat Finish 23105 Pellicle Black Herman Miller Aeron Size B Task Chair, Standard-Height Range, Tilt Limiter & Seat Angle, Height-Adjustable/Pivot Arms, Adjustable Posturefit SL, & Hard FloorCarpet Casters Seating | Qty: (1) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 10FabricInitial Wood Frame Finish Cordovan Fabric Seat Finish Strand Sand National Timberlane Guest Chair Seating | Qty: (1) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 11FabricInitial Laminate Finish MC, Amber National Tessera 24X24 Squae End Table Table | Qty: (1) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 I I< 1 1 '-.· • FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 12FabricInitial Peter Pepper Hat & Coat Rack *to be wall-mounted* Ancillary | Qty: (12) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921• __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 13FabricInitial Peter Pepper Glass Writing Surface *to be wall-mounted* Ancillary | Qty: (4) PSA22-1816FAC Exhibit "B" (continued) (7) DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921• ..._______,) ~----~ FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 14FabricInitial Frame Finish Bright White Peter Pepper Tactics Bulletin Board Ancillary | Qty: (6) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921• __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 15FabricInitial Frame Finish Matte Aluminum Peter Pepper Tactics Bulletin Board Ancillary | Qty: (1) Fabric Finish 2858-024, Lido Style, Oak Bluffs PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 >I FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 16FabricInitial Back Panel Fabric Finish 2858-024, Lido Style, Oak Bluffs Peter Pepper MM Bulletin/Tackboard w/ Glass Doors Ancillary | Qty: (1) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 17FabricInitial Metal Bezel Finish Chrome Peter Pepper Clock Ancillary | Qty: (14) Face Finish Bright White PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 as----_ - ---..... 40 ' 8 ✓.,,/ 35 30 ✓,,,,,1111 5 7 , >I FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 18FabricInitial Finish Black Uline Return Cart Ancillary | Qty: (1) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 I > I FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 19FabricInitial Finish Blue Uline Rubbermaid 23 Gallon Recycling Container Ancillary | Qty: (13) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 20FabricInitial Finish Black Uline Rubbermaid 7 Gallon Trash Can Ancillary | Qty: (13) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 __ >1-- FabricDateProduct images are representational only. Fabrics, finishes and specifications may be different than what is pictured. G|M Business Interiors Elevate your Workplace TM Please initial & date here as approval City of Carlsbad Quote# 202572 Eric Evonsion | Fire Station# 2 Page 21FabricInitial Finish Gray Uline Brute 32 Gallon Trash Can (1) EA w/ Rolling Base Ancillary | Qty: (3) PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 (IHHi=i > IL--=:====----====___JI ERIC EVONSION | FIRE STATION# 2 CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 4/14/2022 4:11:36 PMAQuote #202572 ANCILLARYDepartment: Contract PETERPEPPER 14 621.00 8,694.00 372.60 5,216.40 40.001 %386 CLOCK BEZEL FINISH METAL CHROME BEZEL COLOR BRIGHT WHITE MOVEMENT QUARTZ CLOCK FACE DESIGNFACE NO. 8 ANCILLARYTag: 1 2,229.00 2,229.00 1,337.40 1,337.40 40.002 %MMDRA483602 MM BULLETIN/TACKBOARD 2858-024 BACK PANEL FINISHLIDO, OAK BLUFFS DOORS GLASS ANCILLARYTag: 1 813.00 813.00 487.80 487.80 40.003 %FT4836 TACTICS COMBINATION BOARD FRAME BRIGHT WHITE 2858-024 FABRIC LIDO, OAK BLUFFS ANCILLARYTag: 6 384.00 2,304.00 230.40 1,382.40 40.004 %CK3624-5 TACTICS BULLETIN BOARD FRAME BRIGHT WHITE ANCILLARYTag: 7 33.00 231.00 19.80 138.60 40.005 %GBMAG RARE EARTH MAGNETS MAGNET WHITE ANCILLARYTag: 7 1,220.00 8,540.00 732.00 5,124.00 40.006 %GBX4836 GLASS WRITING SURFACE MOUNTING CONCEALED ANCILLARYTag: 12 398.00 4,776.00 238.80 2,865.60 40.007 %2085AL HAT AND COAT RACK ANCILLARYTag:ULINE 3 .00 .00 56.00 168.008 %H-1045GR RUBBERMAID BRUTE TRASH CAN - 32 GALLON, GRAY ANCILLARYTag: Project DesignerAccount Executive:Michelle Philbin Page: 1 Job Captain Jenna Ralston PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 • • • • • • • • • • • • • • • • • • • • • • • • • • ERIC EVONSION | FIRE STATION# 2 CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 4/14/2022 4:11:36 PMAQuote #202572 ANCILLARYDepartment: Contract ULINE 1 .00 .00 73.33 73.339 %H-1051 RUBBERMAID BRUTE TRASH CAN DOLLY ANCILLARYTag: 13 .00 .00 12.00 156.0010 %S-9970BL RUBBERMAID OFFICE TRASH CAN - 7 GALLON, BLACK ANCILLARYTag: 13 .00 .00 81.33 1,057.2911 %H-1384BLU RUBBERMAID SLIM JIM RECYCLING CONTAINER - 23 GALLON, BLUE ANCILLARYTag: 1 .00 .00 226.67 226.6712 %H-9285BL RETURN CART - BLACK ANCILLARYTag: Product Subtotal: $18,233.49 Project DesignerAccount Executive:Michelle Philbin Page: 2 Job Captain Jenna Ralston PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 • • • • • • • • ERIC EVONSION | FIRE STATION# 2 CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 4/14/2022 4:11:37 PMBQuote #202572 SEATINGDepartment: Contract NATIONAL 1 1,047.00 1,047.00 471.15 471.15 55.001 %39A-GWXX TIMBERLANE,GUEST,ARMS,UPHOLSTERED 3/4 BACK 2 UPHOLSTERY GRADEGRADE 2 20111 PRIMARY UPH PATTERNSTRAND SAND CW FINISH CORDOVAN SEATINGTag:ALLSEATING 11 1,238.00 13,618.00 581.86 6,400.46 53.002 %21032-7AB Requisite, Midback, Conference, Synchro Tilt, Black 7-Arm B Black 7-Arm Black Nylon Base (Std) LH 65mm (2.5") Hard Surface Casters G3 Grade 3 (1)J. ENNIS: Premier F-PBLA Black KD Knocked Down AS Allseating Standard SEATINGTag: HERMANMILLER 1 2,255.00 2,255.00 1,150.05 1,150.05 49.003 %AER1B23AW +Work Chair,New Aeron,B Size,Std-Hgt Range Adj,Tlt Lim and Seat Angle,Hgt Adj Plus Pivot Arms,Non-Uphst Armpads ALP Back Support Option+adjustable posturefit SL BK Frame Finish +black BLX Chassis Finish +onyx ultra matte BK Base Finish +black C7 Casters/Glides +2 1/2" caster, black yoke, hard floors or carpet BK Armpad Finish +black 231 8Z Pellicle +8Z Pellicle-Pr Cat 1 05 231_Colors +8Z Pellicle black SEATINGTag: 3 427.00 1,281.00 209.23 627.69 51.004 %WC410P +Caper Stacking Chair, Molded Seat, Fixed Arms BK Frame Finish +black BK Seat/Back Finish +black Y7 Casters/Glides +acetal glide, carpet only BK Arm Finish/Arm Cap F+black SEATINGTag: Project DesignerAccount Executive:Michelle Philbin Page: 1 Job Captain Jenna Ralston PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ERIC EVONSION | FIRE STATION# 2 CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 4/14/2022 4:11:37 PMBQuote #202572 SEATINGDepartment: Contract HERMANMILLER 1 457.00 457.00 223.93 223.93 51.005 %WC410P +Caper Stacking Chair, Molded Seat, Fixed Arms BK Frame Finish +black BK Seat/Back Finish +black U5 Casters/Glides +soft wheel caster, carpet or hard floors BK Arm Finish/Arm Cap F+black SEATINGTag: Product Subtotal: $8,873.28 Project DesignerAccount Executive:Michelle Philbin Page: 2 Job Captain Jenna Ralston PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 • • • • • • • • ERIC EVONSION | FIRE STATION# 2 CITY OF CARLSBAD PO # Sales Order # Item Qty Product Unit Extended Unit Extended Discount % List Price Sell Price 4/14/2022 4:11:37 PMCQuote #202572 TABLESDepartment: Contract NATIONAL 1 1,933.00 1,933.00 869.85 869.85 55.001 %59N2424ENSQLW TESSERA,24DX24W,END TABLE,SQUARE,LAM/WOOD FEET MC LEG COLOR AMBER MC LAMINATE COLORAMBER TABLESTag: Product Subtotal: $869.85 Project DesignerAccount Executive:Michelle Philbin Page: 1 Job Captain Jenna Ralston PSA22-1816FAC Exhibit "B" (continued)DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 • • • • INSR ADDLSUBRLTRINSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY 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 INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE National Union Fire Ins Co of Pittsburg New Hampshire Insurance Company 2/18/2022 EPIC Insurance Midwest 560 5th Street, Suite 202 Grand Rapids, MI 49504 Kris Hughes - certificatesgrr@epicbrokers.com Goforth & Marti Inc. dba GM Business GM Business Interiors 1099 W. La Cadena Dr. Riverside, CA 92501 19445 23841 A X X X 5180177 03/01/2022 03/01/2023 1,000,000 300,000 25,000 1,000,000 2,000,000 2,000,000 A X 2961606 03/01/2022 03/01/2023 1,000,000 B A N WC014122637 80756387 (CA) 03/01/2022 03/01/2022 03/01/2023 03/01/2023 X 1,000,000 1,000,000 1,000,000 City of Carlsbad is included as Additional Insured with respects to General Liability as required by contract or written agreement. A waiver of subrogation is included for Workers Compensation as required by contract or written agreement. 30 days notice of cancellation. City of Carlsbad 1635 Faraday Ave Carlsbad, CA 92008-0000 1 of 1 #S3451663/M3448990 GMBUSINClient#: 164812 KHU01 DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 I I t--D □ t-- t-- t-- Fl n n t-- t--~ ~ ~ t--- t--H I I I I I □ I ‚•› »†…–ﬁ›»‡»†‹ »””»‰‹•“» ”–ﬁ‡› ¿ ¿ﬁ‹ –” –·•‰§ –•››«»… ‹– § ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ˝¸˛ ˛ ˛ˇ¸˛ ¸˛ ˛ ˛ ˛ ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ–“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ¸˝˝˝ ¸ ˚˛ ˛ ˝¸ ˝¸˛ ŁØº łæº «‹‚–ﬁ•ƒ»… ˛»ﬁ»›»†‹¿‹•“» –ﬁ–«†‹»ﬁ›•„†¿‹«ﬁ » ł•† ˝‹¿‹»› ‚»ﬁ»·•‰¿·» —¿„» –” ˝ ˙ ˚˛ –“»ﬁ¿„» ‚– › †›«ﬁ»… •› ¿‡»†…»… ‹– ¿…… …†§ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ›‚–'† •† ‹‚» ›‰‚»…«·» ¿–“» ‹– '‚–‡ §–« »‰–‡» –·•„¿‹»… ‹– •†‰·«…» ¿› ¿† ¿……•‹•–†¿· •†›«ﬁ»… «†…»ﬁ ‹‚•› –·•‰§ ¿› ¿ ﬁ»›«·‹ –” ¿†§ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ §–« »†‹»ﬁ •†‹– '‚•‰‚ ﬁ»ﬂ«•ﬁ»› §–« ‹– ”«ﬁ†•›‚ •†›«ﬁ¿†‰» ‹– ‹‚¿‹ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† –” ‹‚» ‹§» ﬁ–“•…»… § ‹‚•› –·•‰§ «‹ –†·§ '•‹‚ ﬁ»›»‰‹ ‹– ·•¿•·•‹§ ¿ﬁ•›•†„ –«‹ –” «›» –” ¿ ‰–“»ﬁ»… ¿«‹– –'»“»ﬁ ‹‚» •†›«ﬁ¿†‰» ﬁ –“•…»… '•·· †–‹ »¤‰»»… ‹‚» ·»››»ﬁ –” ł‚» ‰–“»ﬁ¿„» ¿†…æ–ﬁ ·•‡•‹› –” ‹‚•› –·•‰§ –ﬁ ł‚» ‰–“»ﬁ¿„» ¿†…æ–ﬁ ·•‡•‹› ﬁ»ﬂ«•ﬁ»… § ›¿•… ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ˛˝ ææ 22 2961606 ˛ œ ˛ ¸˝˝˝ ˛˛˝ ¸ ˛ ˝¸˛ —˙ —˝¸˛ — ˙ —˛˝ ˛ ˛˘ ˛ ˙¸ ˛ ˛¸˙ ¸ —˛˚ ˝¸˛ ˝¸˝ ¸ ˙ ¨ ˝¸—˛˝ ˛ ˛˘˝ ˙ ˛˝ ¸ ¸˝ ˚˛¸ DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 ~------------ ‚•›»†…–ﬁ›»‡»†‹»””»‰‹•“»”–ﬁ‡›¿¿ﬁ‹–” –·•‰§–•››«»…‹– § ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ –“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ¸˝˝˝ ¸ ˚˛ ˛ ·· –‹‚»ﬁ ‹»ﬁ‡› ¿†… ‰–†…•‹•–†› ﬁ»‡¿•† «†‰‚¿†„»… «‹‚–ﬁ•ƒ»… ˛»ﬁ»›»†‹¿‹•“» –ﬁ Ø º łæ –«†‹»ﬁ›•„†¿‹«ﬁ» ł•† ˝‹¿‹»› ‚»ﬁ»·•‰¿·» ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ˝¸˛ —˛˛˙ ˝ ˛ ˝¸˛˝ ˝»‰‹•–† ˚ «›•†»›› «‹– –†…•‹•–†› »†»ﬁ¿· –†…•‹•–†› º ‹‚»ﬁ †›«ﬁ¿†‰» ‰ •› ¿‡»†…»… § ‹‚» ¿……•‹•–† –” ‹‚» ”–··–'•†„ ›»†‹»†‰» ‚» •†›«ﬁ¿†‰» ¿””–ﬁ…»… «†…»ﬁ ‹‚•› –·•‰§ ‹– ¿† ¿……•‹•–†¿· •†›«ﬁ»… '•·· ¿·§ ¿› ﬁ•‡¿ﬁ§ •†›«ﬁ¿†‰» ”–ﬁ ›«‰‚ ¿……•‹•–†¿· •†›«ﬁ»… '‚»ﬁ» ›– ﬁ»ﬂ«•ﬁ»… «†…»ﬁ ¿† ¿„ﬁ»»‡»†‹ »¤»‰«‹»… ﬁ•–ﬁ ‹– ‹‚» …¿‹» –” ¿‰‰•…»†‹ » '•·· †–‹ ¿› ¿†§ •†›«ﬁ»ﬁ ‹‚¿‹ ‚¿› •››«»… –‹‚»ﬁ •†›«ﬁ¿†‰» ‹– ›«‰‚ ¿……•‹•–†¿· •†›«ﬁ»… ‹– ‰–†‹ﬁ•«‹» ‹– ‹‚» ›»‹‹·»‡»†‹ –” ·–›› ¿ﬁ•›•†„ –«‹ –” ›«‰‚ ¿‰‰•…»†‹ ˛˝ ææ 22 ŒŒŒ ˛ œ ˛ ¸˝˝˝ ˛˛˝ ¸ ˛ ˝¸˛ —˙ —˝¸˛ — PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ¸˝˝˝ ¸ ˚˛ ˛ ŒŁØ łŒ æº ¸˛˘ ˛—˛˝˚ ˛˝ ‚•› »†…–ﬁ›»‡»†‹ »””»‰‹•“» ”–ﬁ‡› ¿ ¿ﬁ‹ –” –·•‰§ –•››«»… ‹– § ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ–“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˚˛ ˛˝˛ ˛˝ ˛˚˛˙ ˝ ˛˝ ¸˝ ł ł ‚» ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ '¿› »†‹»ﬁ»… •†‹– ﬁ•–ﬁ ‹– ¿†§ ¿‰‰•…»†‹ –ﬁ ·–›› – '¿•“»ﬁ –” ‹‚» ﬁ•„‚‹ –” ﬁ»‰–“»ﬁ§ '•·· …•ﬁ»‰‹·§ –ﬁ •†…•ﬁ»‰‹·§ ¿·§ ‹– §–«ﬁ »‡·–§»»› –ﬁ »‡·–§»»› –” ‹‚» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ¿†… '» ﬁ»›»ﬁ“» –«ﬁ ﬁ•„‚‹› –ﬁ ·•»† ‹– » ﬁ»•‡«ﬁ›»… ”ﬁ–‡ ¿†§ ﬁ»‰–“»ﬁ§ ”«†…› –‹¿•†»… § ¿†§ •†¶«ﬁ»… »‡·–§»» ˝»‰‹•–† ˚ «›•†»›› «‹– –†…•‹•–†› –›› –†…•‹•–†› º ﬁ¿†›”»ﬁ –” ˛•„‚‹› –” ˛»‰–“»ﬁ§ „¿•†›‹ ‹‚»ﬁ› ‹– ¸› •› ¿‡»†…»… ‹– ¿…… ‚» ¿‰‰•…»†‹ –ﬁ ·–›› •› …«» ‹– –»ﬁ¿‹•–†› «†…»ﬁ‹¿»† •† ¿‰‰–ﬁ…¿†‰» '•‹‚ ‹‚» ‰–†‹ﬁ¿‰‹ »¤•›‹•†„ »‹'»»† §–« ¿†… ›«‰‚ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ¿†… –'»“»ﬁ '» '•·· '¿•“» ¿†§ ﬁ•„‚‹ –” ﬁ»‰–“»ﬁ '» ‚¿“» ¿„¿•†›‹ ¿†§ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† '•‹‚ '‚–‡ §–« ‚¿“» »†‹»ﬁ»… •†‹– ¿ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ »‰¿«›» –” ¿§‡»†‹› '» ‡¿» «†…»ﬁ ‹‚•› –“»ﬁ¿„» –ﬁ‡ ¿ﬁ•›•†„ –«‹ –” ¿† ¿‰‰•…»†‹ –ﬁ ·–›› •” ææ 22 ŒŒŒ ˛ œ ˛ ¸˝˝˝ ˛˛˝ ¸ ˛ ˝¸˛ —˙ —˝¸˛ — PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 ~11 POLICY NUMBER: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 04 13 Page 1 of 1Insurance Services Office, Inc., 2012 A.Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agree- ment,theinsuranceaffordedtosuchaddi- tional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of Insurance shown in the Decla- rations. GL518-01-77 ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR PER THE CONTRACT OR AGREEMENT. AGREEMENT YOU HAVE ENTERED INTO. PDF created with pdfFactory Pro trial version www.pdffactory.com PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 □ —˙¸˛ ˛ ˛ ˙ ˝˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ˛˛ —˛˚˙¸˝ ‚•›»†…–ﬁ›»‡»†‹‡–…•”•»›•†›«ﬁ¿†‰»ﬁ–“•…»…«†…»ﬁ‹‚»”–··–'•†„ ˛˛˙˚˛—˛ˇ¸˛˙˚˛—˛ —¸˙˚˛—˛ —˛¸˝æ——˛˝˙˚˛—˛ ˝¸ «‡»ﬁ –” ¿§›ø –‹•‰» ł”†–»†‹ﬁ§¿»¿ﬁ›¿–“»•†”–ﬁ‡¿‹•–†ﬁ»ﬂ«•ﬁ»…‹–‰–‡·»‹»‹‚•›˝‰‚»…«·»'•··»›‚–'†•†‹‚»»‰·¿ﬁ¿‹•–†›¿›¿·•‰¿·»‹–‹‚•›»†…–ﬁ›»‡»†‹ –ﬁ¿†§›‹¿‹«‹–ﬁ•·§»ﬁ‡•‹‹»…ﬁ»¿›–†–‹‚»ﬁ‹‚¿††–†¿§‡»†‹–”ﬁ»‡•«‡‹‚»†«‡»ﬁ–”…¿§›ﬁ»ﬂ«•ﬁ»…”–ﬁ†–‹•‰»–”‰¿†‰»··¿‹•–†¿›ﬁ–“•…»…•†¿ﬁ¿„ﬁ¿‚–”»•‹‚»ﬁ‹‚»–‡‡–†—–·•‰§–†…•‹•–†–ﬁ¿›¿‡»†…»…§¿†¿·•‰¿·»›‹¿‹»‰¿†‰»··¿‹•–†»†…–ﬁ›»‡»†‹•›•†‰ﬁ»¿›»…‹–‹‚»†«‡»ﬁ –”…¿§››‚–'†•†‹‚»˝‰‚»…«·»¿–“» –§ﬁ•„‚‹†›«ﬁ¿†‰»˝»ﬁ“•‰»›””•‰»†‰—¿„» –” ºŁØØ PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 □ —˙¸˛˛˛˙ ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ –“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˛ ˛ ˙ ˚˛ —˛ —¿„»–” —˛˛˙ ˛¸˛˙ ˛ ˝¸˛ †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ —˛¸˝æ— —˛˝ ˙ ˚˛ —˛ ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ‚» ”–··–'•†„ •› ¿……»… ‹– ‹‚» ‹‚»ﬁ †›«ﬁ¿†‰» –†…•‹•–† ¿†… ›«»ﬁ›»…»› ¿†§ ﬁ–“•›•–† ‹– ‹‚» ‰–†‹ﬁ¿ﬁ§ —ﬁ•‡¿ﬁ§ †… –†‰–†‹ﬁ•«‹–ﬁ§ †›«ﬁ¿†‰» ‚•› •†›«ﬁ¿†‰» •› ﬁ•‡¿ﬁ§ ‹– ¿†… '•·· †–‹ ›»» ‰–†‹ﬁ•«‹•–† ”ﬁ–‡ ¿†§ –‹‚»ﬁ •†›«ﬁ¿†‰» ¿“¿•·¿·» ‹– ¿† ¿……•‹•–†¿· •†›«ﬁ»… «†…»ﬁ §–«ﬁ –·•‰§ ﬁ –“•…»… ‹‚¿‹ ł ‚» ¿……•‹•–†¿· •†›«ﬁ»… •› ¿ ¿‡»… †›«ﬁ»… «†…»ﬁ ›«‰‚ –‹‚»ﬁ •†›«ﬁ¿†‰» ¿†… ł ˙–« ‚¿“» ¿„ﬁ»»… •† 'ﬁ•‹•†„ •† ¿ ‰–†‹ﬁ¿‰‹ –ﬁ ¿„ﬁ»»‡»†‹ ‹‚¿‹ ‹‚•› •†›«ﬁ¿†‰» '–«·… » ﬁ•‡¿ﬁ§ ¿†… '–«·… †–‹ ›»» ‰–†‹ﬁ•« ‹•–† ”ﬁ–‡ ¿†§ –‹‚»ﬁ •†›«ﬁ¿†‰» ¿“¿•·¿·» ‹– ‹‚» ¿……•‹•–†¿· •†›«ﬁ»… ºŁØØ DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 —˙ ¸˛ †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ Ł —¿„» –” ˚˛ ˛˝˛ ˛˝ ˛˚˛˙ ˝ ˛˝ ¸˝ ˛ ˛ ˙ º ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ –“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˛ ˛ ˙ ˚˛ —˛ —˛¸˝æ— —˛˝ ˙ ˚˛ —˛ ˝¸ ¿‡» ” —»ﬁ›–† ﬁ ﬁ„¿†•ƒ¿‹•–† †”–ﬁ‡¿‹•–† ﬁ»ﬂ«•ﬁ»… ‹– ‰–‡·»‹» ‹‚•› ˝‰‚»…«·» •” †–‹ ›‚–'† ¿–“» '•·· » ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› º ‚» ”–··–'•†„ •› ¿……»… ‹– —¿ﬁ¿„ﬁ¿‚ Ł ﬁ¿†›”»ﬁ ” ˛•„‚‹› ” ˛»‰–“»ﬁ§ „¿•†›‹ ‹‚»ﬁ› – ¸› –” ˝»‰ ‹•–† ˚ –†…•‹•–†› » '¿•“» ¿†§ ﬁ•„‚‹ –” ﬁ»‰–“»ﬁ§ '» ‡¿§ ‚¿“» ¿„¿•†›‹ ‹‚» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ›‚–'† •† ‹‚» ˝‰‚»…«·» ¿–“» »‰¿«›» –” ¿§‡»†‹› '» ‡¿» ”–ﬁ •†¶«ﬁ§ –ﬁ …¿‡¿„» ¿ﬁ•›•†„ –«‹ –” §–«ﬁ –†„–•†„ –»ﬁ¿ ‹•–†› –ﬁ §–«ﬁ '–ﬁ …–†» «†…»ﬁ ¿ ‰–†‹ﬁ¿‰‹ '•‹‚ ‹‚¿‹ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ¿†… •†‰·«…»… •† ‹‚» ﬁ–…«‰‹›‰–‡·»‹»… –»ﬁ¿‹•–†› ‚¿ƒ¿ﬁ… ‚•› '¿•“»ﬁ ¿·•»› –†·§ ‹– ‹‚» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† ›‚–'† •† ‹‚» ˝‰‚»…«·» ¿–“» ºŁØØ —¸˛˝¸ —— ˛ ˛ ˛ ˛ ˙¸ ˛ DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 □ ‚•› »†…–ﬁ›»‡»†‹ »””»‰‹•“» ”–ﬁ‡› ¿ ¿ﬁ‹ –” –·•‰§ –•››«»… ‹– § ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ˝ ˝¸˛ ł—»ﬁ —ﬁ–¶»‰‹ –ﬁ —»ﬁ –‰¿‹•–† „„ﬁ»„¿‹» •‡•‹ ŁŒŒŁ łæ —¿„» –” ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ–“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ˛ ˛ ˙ ˚˛ ˛ ˙–«ﬁ –·•‰§ •› ¿‡»†…»… ‹– •†‰·«…» »•‹‚»ﬁ ¿ —»ﬁ —ﬁ–¶»‰‹ »†»ﬁ ¿· „„ﬁ»„¿‹» •‡•‹ ¿ —»ﬁ –‰¿‹•–† »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ –ﬁ ¿ —»ﬁ —ﬁ–¶»‰‹ ¿†… —»ﬁ –‰¿‹•–† »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ —·»¿›» ›»·»‰‹ –†·§ –†» –” ‹‚» ”–··–'•†„ ¯ ˆ —»ﬁ —ﬁ–¶»‰‹ »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ ¯ ˆ —»ﬁ –‰¿‹•–† »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ ¯ ˆ —»ﬁ —ﬁ–¶»‰‹ ¿†… —»ﬁ –‰¿‹•–† »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ ˛ ˝ ¨˝ ˛ ˝ ˛˝ ˝ ˚ ˛ ˝ ¨˝ ˛ ˝ ˛˝ ˝ ˚ ˝ ˝ ˝¸˛ •› ¿‡»†…»… ‹– •†‰·«…» ‹‚» ”–··–'•†„ ‚» •‡•‹› –” †›«ﬁ¿†‰» ¿†… ‹‚» ﬁ«·»› »·–' ”•¤ ‹‚» ‡–›‹ '» '•·· ¿§ ﬁ»„¿ﬁ…·»›› –” ‹‚» †«‡»ﬁ –” ¿†›«ﬁ»…› ·¿•‡› ‡¿…» –ﬁ ›«•‹› ﬁ –«„‚‹ –ﬁ ‰—»ﬁ›–†› –ﬁ –ﬁ„¿†•ƒ¿‹•–†› ‡¿•†„ ‰·¿•‡› –ﬁ ﬁ•†„•†„ ›«•‹› ‚» »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ ”–ﬁ ‹‚» ›«‡ –” ¿»…•‰¿· »¤»†›»› «†…»ﬁ –“»ﬁ¿„» ¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» »¤‰»‹ …¿‡¿„»› »‰¿«›» –” –…•·§ •†¶«ﬁ§ –ﬁ ﬁ–»ﬁ‹§ …¿‡¿„» •†‰·«…»… •† ‹‚» ﬁ–…«‰‹›‰–‡·»‹»… –»ﬁ¿‹•–†› ‚¿ƒ¿ﬁ… ¿†… ‰¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» ‚» —ﬁ–…«‰‹›–‡·»‹»… »ﬁ¿‹•–†› „„ﬁ »„¿‹» •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ «†…»ﬁ –“»ﬁ¿„» ”–ﬁ …¿‡¿„»› »‰¿«›» –” –…•·§ •†¶«ﬁ§ ¿†… ﬁ–»ﬁ‹§ …¿‡¿„» •†‰·«…»… •† ‹‚» ﬁ–…«‰‹›‰–‡·»‹»… –»ﬁ¿‹•–†› ‚¿ƒ¿ﬁ… ˝«¶»‰‹ ‹– ¿–“» ‹‚» —»ﬁ›–†¿· ¿†… …“»ﬁ‹•›•†„ †¶«ﬁ§ •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ «†…»ﬁ –“»ﬁ¿„» ”–ﬁ ‹‚» ›«‡ –” ¿·· …¿‡¿„»› »‰¿«›» –” ¿·· »ﬁ›–†¿· ¿†… ¿…“»ﬁ‹•›•†„ •†¶«ﬁ§ ›«›‹¿•†»… § ¿†§ –†» »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† º˝«¶»‰‹ ‹– –ﬁ ¿–“» '‚•‰‚»“»ﬁ ¿·•»› ‹‚» ¿‰‚ ‰‰«ﬁﬁ»†‰» •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ ”–ﬁ ‹‚» ›«‡ –” ¿¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» ¿†… »…•‰¿· »¤»†›»› «†…»ﬁ –“»ﬁ¿„» ˛˝ ææ 2 ºŁØØ ˛ œ ˛ ¸˝˝˝ ˛˛˝ ¸ ˛ ˝¸˛ —˙ —˝¸˛ — ¨ PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 ŁŒŒŁ łæ —¿„» –” «‹‚–ﬁ•ƒ»… ˛»ﬁ»›»†‹¿‹•“» –ﬁ–«†‹»ﬁ›•„†¿‹«ﬁ» ł•† ˝‹¿‹»› ‚»ﬁ»·•‰¿·» »‰¿«›» –” ¿·· –…•·§ •†¶«ﬁ§ ¿†… ﬁ –»ﬁ‹§ …¿‡¿„» ¿ﬁ•›•†„ –«‹ –” ¿†§ –†» –‰‰«ﬁﬁ»†‰» Œ ˝«¶»‰‹ ‹– º ¿–“» ‹‚» ¿‡¿„» ‹– —ﬁ»‡•›»› ˛»†‹»… – ˙–« •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ «†…»ﬁ –“»ﬁ¿„» »‰¿«›» –” ﬁ–»ﬁ‹§ …¿‡¿„» ‹– ¿†§ –†» ﬁ»‡•›»› '‚•·» ﬁ»†‹»… ‹– §–« –ﬁ •† ‹‚» ‰¿›» –” …¿‡¿„» § ”•ﬁ» '‚•·» ﬁ»†‹»… ‹– §–« –ﬁ ‹»‡–ﬁ¿ﬁ•·§ –‰‰«•»… § §–« '•‹‚ »ﬁ‡•››•–† –” ‹‚» –'†»ﬁ Ø ˝«¶»‰‹ ‹– º ¿–“» ‹‚» »…•‰¿· ¤»†›» •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ «†…»ﬁ –“»ﬁ¿„» ”–ﬁ ¿·· ‡»…•‰¿· »¤»†›»› »‰¿«›» –” –…•·§ •†¶«ﬁ§ ›«›‹¿•†»… § ¿†§ –†» »ﬁ›–† Ł ˝«¶»‰‹ ‹– º Œ ¿†…æ–ﬁ Ø ¿–“» ‹‚» —»ﬁ —ﬁ–¶»‰‹ „„ﬁ»„¿‹» •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ «†…»ﬁ –“»ﬁ¿„»› ¿†… ‰–‡•†»… ”–ﬁ ‹‚» ›«‡ –” ¿¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» ¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» ¿†… ‰»…•‰¿· ¤»†›»› «†…»ﬁ –“»ﬁ¿„» ¿ﬁ•›•†„ –«‹ –” ¿†§ ›•†„·» —ﬁ–¶»‰‹ …»›‰ﬁ•»… ¿–“» ˝«¶»‰‹ ‹– º Œ ¿†…æ–ﬁ Ø ¿–“» ‹‚» —»ﬁ –‰¿‹•–† „„ﬁ»„¿‹» •‡•‹ •› ‹‚» ‡–›‹ '» '•·· ¿§ «†…»ﬁ –“»ﬁ¿„»› ¿†… ‰–‡•†»… ”–ﬁ ‹‚» ›«‡ –” ¿¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» ¿‡¿„»› «†…»ﬁ –“»ﬁ¿„» ¿†… ‰»…•‰¿· »¤»†›»› «†…»ﬁ –“»ﬁ¿„» ¿ﬁ•›•†„ –«‹ –” ‹‚» ¿†§ ›•†„·» –‰¿‹•–† …»›‰ﬁ•»… ¿–“» ‚» •‡•‹› –” †›«ﬁ¿†‰» –” ‹‚•› –“»ﬁ¿„» —¿ﬁ‹ ¿·§ ›»¿ﬁ¿‹»·§ ‹– »¿‰‚ ‰–†›»‰«‹•“» ¿††«¿· »ﬁ•–… ¿†… ‹– ¿†§ ﬁ»‡¿•†•†„ »ﬁ•–… –” ·»›› ‹‚¿† ‡–†‹‚› ›‹¿ﬁ‹•†„ '•‹‚ ‹‚» »„•††•†„ –” ‹‚» –·•‰§ »ﬁ•–… ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› «†·»›› ‹‚» –·•‰§ »ﬁ•–… •› »¤‹»†…»… ¿”‹»ﬁ •››«¿†‰» ”–ﬁ ¿† ¿……•‹•–†¿· »ﬁ•–… –” ·»›› ‹‚¿† ‡–†‹‚› † ‹‚¿‹ ‰¿›» ‹‚» ¿……•‹•–†¿· »ﬁ•–… '•·· » …»»‡»… ¿ﬁ‹ –” ‹‚» ·¿›‹ ﬁ»‰»…•†„ »ﬁ•–… ”–ﬁ «ﬁ –›»› –” …»‹»ﬁ‡•†•†„ ‹‚» •‡•‹› –” †›«ﬁ¿†‰» ‚» •‡•‹› –” †›«ﬁ¿†‰» ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› ¿ﬁ» …»·»‹»… •† ‹‚»•ﬁ »†‹•ﬁ»‹§ ¿†… ﬁ»·¿‰»… § ‹‚» •‡•‹› –” †›«ﬁ¿†‰» ›»‹ ”–ﬁ‹‚ »·–' •‡•‹› –” †›«ﬁ¿†‰» »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ ¿‰‚ ‰‰«ﬁﬁ»†‰» •‡•‹ —ﬁ–…«‰‹›–‡·»‹»… »ﬁ¿‹•–†› „„ﬁ»„¿‹» •‡•‹ —»ﬁ›–†¿· œ …“»ﬁ‹•›•†„ †¶«ﬁ§ •‡•‹ ¿‡¿„» ‹– —ﬁ»‡•›»› ˛»†‹»… ‹– ˙–« »…•‰¿· ¤»†›» •‡•‹ —»ﬁ —ﬁ–¶»‰‹ »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ —»ﬁ –‰¿‹•–† »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ –ﬁ —»ﬁ —ﬁ–¶»‰‹ ¿†… —»ﬁ –‰¿‹•–† »†»ﬁ¿· „„ﬁ»„¿‹» •‡•‹ ˚˝ ˚ ˝ •› ¿‡»†…»… ‹– •†‰·«…» ‹‚» ”–··–'•†„ –‰¿‹•–† ‡»¿†› ﬁ»‡•›»› •†“–·“•†„ ‹‚» ›¿‡» –ﬁ ‰–††»‰‹•†„ ·–‹› –ﬁ ﬁ»‡•›»› '‚–›» ‰–††»‰‹•–† •› •†‹»ﬁﬁ«‹»… –†·§ § ¿ ›‹ﬁ»»‹ ﬁ–¿…'¿§ '¿‹»ﬁ'¿§ –ﬁ ﬁ•„‚‹–”'¿§ ﬁ¿•·ﬁ–¿… ·· –‹‚»ﬁ ‹»ﬁ‡› ¿†… ‰–†…•‹•–†› –” ‹‚•› –·•‰§ ﬁ»‡¿•† ‹‚» ›¿‡» º PDF created with pdfFactory Pro trial version www.pdffactory.com DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 03/01/2022 WC 080-75-6387 GOFORTH & MARTI - DBA: GM BUSINESS INTERIORS NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. DocuSign Envelope ID: 7404100A-7F42-47A6-B05E-2222CE034921 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM Issued to By forms a part of Policy No. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2 . 00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 (Ed. 11/90) /4tt~ Countersigned by _____________________________ _ Authorized Representative