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HomeMy WebLinkAboutHaixin Flooring Inc; 2022-08-08; PWM23-1889FACPWM23-1889FAC Faraday 1st Floor File Area Carpet Replacement Page 1 of 10 City Attorney Approved 1/20/2020 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT FARADAY 1ST FLOOR FILE AREA CARPET REPLACEMENT This agreement is made on the ______________ day of _________________________, 2022, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Haixin Flooring, Inc., a California corporation dba Carpet Club, whose principal place of business is 506 W. Washington Ave Ste A, Escondido, CA 92025 (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 Lauren Milliken (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: B7263E11-EA89-4D08-AC5A-9E60B417A534 8th August DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 PWM23-1889FAC 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: Huafang Mo 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 stirplus ·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 Faraday 1st Floor File Area Carpet Replacement Page 2 of 10 City Attorney Approved 1/20/2020 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 PWM23-1889FAC 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 thirty (30) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within sixty (60) working days after receipt of Notice to Proceed. Ill Ill Ill Ill Ill Ill Faraday 1st Floor File Area Carpet Replacement Page 3 of 10 City Attorney Approved 1/20/2020 CONTRACTOR'S INFORMATION. Haixin Flooring, Inc. dba Carpet Club (name of Contractor) 1032021 (Contractor's license number) C15 10/31/2023 (license class. and exp. date) 1000053606/ 6/30/2023 (DIR registration number/exp. date) PWM23-1889FAC 506 W. Washington Ave., Ste. A (street address) Escondido, CA 92025 (city/state/zip) 760-7 40-9545 (telephone no.) ireyes@carpetclub.com (e-mail 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 HAIXIN FLOORING, INC., a California corporation b Carpet Club By: (sign here) Huafang Mo, Chairwoman, CFO (print name/title) (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: __________ _ Assistant City Attorney Faraday 1st Floor File Area Carpet Replacement Page 4 of 10 City Attorney Approved 1/20/2020 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 PWM23-1889FAC 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 Type of Work to Business Name and Address DIR License No., %of be Subcontracted Registration Classification & Total No. Expiration Date Contract NONE Total% Subcontracted: 0 ------- The Contractor must perform no less than 50% of the work with its own forces. Faraday 1st Floor File Area Carpet Replacement Page 5 of 10 City Attorney Approved 1/20/2020 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 PWM23-1889FAC EXHIBIT B Faraday 1st Floor File Area Carpet Replacement Contractor to provide all materials, tools and labor necessary to remove and replace a section of carpet on the first floor of the Faraday Center located at 1635 Faraday Ave, Carlsbad, CA 92008. All work and materials to be consistent with the Contractor's proposal dated July 19, 2022, and is attached to this agreement as Exhibit B. The scope of work shall consist of: Demolition and disposal of existing carpet and top set base at specified area. • Floor prep and clean up. • Install Owner provided carpet materials, contractor to provide adhesive. • Provide and install top set base at all areas where removed. • Provide and install appropriate transitions at flooring changes as necessary and seam carpet at appropriate areas. JOB QUOTATION ITEM UNIT QTY DESCRIPTION PRICE I· NO. 1 LS 1 Demo, prep, and install replacement carpet and $30,399 top set base 2 LS 1 Labor & Material Bond $911 TOTAL* $31,310 *Includes taxes, fees, expenses and all other costs. Faraday 1st Floor File Area Carpet Replacement Page 6 of 10 City Attorney Approved 1/20/2020 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 CARPET CLUB 506 W. WASHINGTON AVENUE STE A ESCONDIDO, CA 92025 Telephone: 760-740-9545 Fax: 760-740-9648 ESTIMATE Sold To . Ship To PWM22-1889FAC Exhibit "B" (cont'd) Page 1 m u, N ... ... en ~ CITY OF CARLSBAD 405 OAK DRIVE CARLSBAD, CA 92008 PROPERTY AT:, JOHN MMSHOFF 442-339-2980 1635 FARADAY AVE CARLSBAD, CA 92008 Supply labor & adhesive to install CARPET TILBS PROVIDBD BY CD'STOMBR in small section of hallway, 3 offices & file expansion area. (AREAS SPECIPIBD ON JOB WALlt) Supply and install coordinating 4" top set base in new carpet areas. Pull up and dispose of old carpet, Supply basic floor prep and clean up, All areas to he empty at time of installation. CUSTOMER TO REMOVE & DISPOSE OF ALL HARDWARE ON THE FLOOR FOR CABINETS Supply and install coordinating transitions. TOTAL ESTIMATBD PRICB $31,310.00 PRICE INCLUSIVB OP ALL APPLICABLB TAXBS If any unforseen floor prep is required it will incur additional charges. QUOTE BASBD ONDBR PREVAILING WAGB, WORX TO BB DONB AT NORMAL BUSINBS HOURS. MOISTURB CONTROL OR SEAL NOT INCLODBD. -07/19/22-----------------------------10:33AM- Sales Representative(s): IANREYES QUOTE IS GOOD FOR 30 DAYS ESTIMATE TOTAL: $31,310.00 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 PWM23-1889FAC EXHIBIT B {Continued) Faraday 1st Floor File Area Carpet Replacement Page 8 of 10 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 r>----,,,, ..... will be adjusted anal contract price EXHIBIT C LABOR AND MATERIALS BOND PWM23-1889FAC Bond No .: HA10104509 Premium: $939.00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Haixin Flooring, Inc., a California corporation dba Carpet Club (hereinafter designated as the "Principal"), a Contract for: FARADAY 1ST FLOOR FILE AREA CARPET REPLACEMENT CONTRACT NO. 47501 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond , providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in , upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Haixin Flooring, Inc. dba Carpet Club, as Principal, (hereinafter designated as the "Contractor"), and -'--H"'""'u=d-=-so""'n"-l"'"'n-=-su=r=a'-'-ncc..ce'-C"""o""'m'""p"-'a"""n;..,..y __________ _ as Surety, are held firmly bound unto the City of Carlsbad in the sum of thirty one thousand three hundred ten dollars ($31,310), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. Faraday 1st Floor File Area Carpet Replacement Page 9 of 10 City Attorney Approved 1/20/2020 PWM23-1889FAC In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. SIGNED AND SEALED, this 26th day of ___ J_ul� ________ ,2022 ' 1 t-iai�in Flooring, Inc., a California corporation' -�ba Carpet Club (SEAL) ', I Pr" H_u_d_s_o_n _ln_s_u _ra_n _ce_C_o_m_p_an_y ____ (SEAL) (Surety) By: ��--"---"-------J..�11All d....-v-· (Sign�' Rebecc a James, Attorney in fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY -ATTACH ATTORNEY-IN­FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE By: Assistant City Attorney Faraday 1st Floor File Area Carpet Replacement Page 10 of 10 City Attorney Approved 1/20/2020 K. McMAHON, City Attorney DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 V i al) Bv.·_ ,_£~~~-✓~re)~----~-. ~ DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 HUDSON Bond Number: HAIOJ04509 I lStJ , N . ~H ) !' POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That HUDSON INSURANCE COMPANY, a corporation of the State of Delaware, with offices at 100 William Street, New York, New York, 10038, has made, constituted and appointed, and by these presents, does make, constitute and appoint Rebecca James of the State of CA its true and lawful Attorney(s)-in-Fact, at New York, New York, each of them alone to have full power to act without the other or others, to make, execute and deliver on its behalf, as Surety, bonds and undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating to such bonds or undertakings provided, however, that no single bond or undertaking shall obligate said Company for any portion of the penal sum thereof in excess of the sum of Such bonds and undertakings when duly executed by said Attorney(s)-in-Fact, shall be binding upon said Company as fully and to the same extent as if signed by the President of said Company under its corporate seal attested by its Secretary. In Witness Whereof, HUDSON INSURANCE COMP ANY has caused these presents to be of its Senior Vice President thereunto duly authorized, on this ___1!!S!__ day of June 20 R_ at New York, New York. ~~~wt~~ ri>;u-\. ··~): sf) ,,;:;;,; /); I\ Attest. .......... ~.(_JJ./!J~. Dina Daskalakis No. 01MU6067553 HUDSON INSURANCE COMPANY < ~1( By ........................... \ .. . Michael P. Cifonc Corporate Secretary Senior Vice President f 0--1-. . . . . . . . . . . . . . . . . . . . . 0 . . . STA TE OF NEW YORK COUNTY OF NEW YORK. SS. On the .......l!!L day of June 20 _1L before me personally came Michael P. Cifone to me known, who being by me duly sworn did depose and say that he is a Senior Vice President of HUDSON INSURANCE COMPANY, the corporation described herein and which executed the above instrument, that he knows the seal of satd Corporation, that the seal affixed to satd tnslt ument 1s such corporate seal. that 1t was so afffed by order of the Board of Directors of said Corporation, and that he signed 111s name thereto by like ordet / , / I (Notanal Seal) h [ /I - ,,,,,111111111,,,,,,,,, {.._j ....... 11 . ,,,✓~~\ ,,•••' ~ M. '1,? ,,,,,, .. ..?:: .. ~· . . ./ l"':..·· .... · ... ~~,.o'\ ANN M. MURl'tlY f / ~O.T,q-? \ ~ \ Notary Public. State ofNew York ~ en, :. ,o -·-.L J ] No. 0 I MU6067553 \ ~ · ... llsuc./ i Qualified in Nassau County •,, ~ 0 ·• ...... •· ~4:-i' Commission Expires December I 0, 2025 ,,,,,,, '/:' NEVV '(O ~••~ ,,,,,,,,,,11,1110'\''' CERTIFICATION STATE OF NEW YORK COUNTY OF NF.:W YORK SS. The undersigned Dina Daskalakis hereby certifies: That the original resolution, of which the following is a true and correct copy, was duly adopted by unanimous written consent of the Board of Directors of Hudson Insurance Company dated July 27~', 2007, and has not since been revoked, amended or modified: "RESOLVED, that the President, the Executive Vice Presidents. the Senior Vice Presidents and the Vice Presidents shall have the authority and discretion, to appoint such agent or agents, or attorney or attorneys-in-fact, for the purpose of carrying on this Company's surety business, and to empower such agent or agents, or attorney or attorneys-in-fact, to execute and deliver, under this Company's seal or otherwise, bonds obligations, and recognizances, whether made by this Company as surety thereon or otherwise, indemnity contracts, contracts and certificates, and any and all other contracts and undertakings made in the course of this Company's surety business, and renewals, extensions, agreements. waivers, consents or stipulations regarding undertakings so made; and FURTHER RESOVLED, that the signature of any such Officer of the Company and the Company's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seal when so used whether heretofore or hereafter, being hereby adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed." THAT the above and foregoing is a full, true and correct copy of Power of Attorney issued by said Company, and of the whole of the original and that the said Power of Attorney is still in full force and effect and has not been revoked, and furthermore that the Resolution of the Board of Directors, set forth in the said Power of Attorney is now in force. Witness the hand of the undersigned and the sea! of said Corporation this 26th seal) By .... day of July /J 1W, I\ £(, r ·················~··~·~····· Dina Daskalakis, Corporate Secretary DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of San Diego } On 7/26/2022 before me, Pam Davis , Notary Public, ---'--'--'--C...L..-~=------------------------ Date Insert Name of Notary exactly as it appears on the official seal personally appeared ____ R_eb_e_c_c_a_J_a_m_e_s _______________________ _ PAM DAVI S =1 COMM. #2359823 o NOTARY PUBLIC-CALIFORNIA (')Cl} SAN DIEGO COUNTY ""' My Commission Expires JUNE 1, 2025 Place Notary Seal Above Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my han~ial seal. Signature v--""~ Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of the form to another document. Descri ption of Attached Document Title or Type of Document: ------------------------------- Document Date: -------------------Number of Pages: ________ _ Signer(s) Other Than Named Above: _________________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: _____________ _ D Individual D Corporate Officer -Title(s): ________ _ D Partner D Limited D General ~ Attorney in Fact D Trustee D Guardian or Conservator D Other: _______ _ Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here Signer's Name: _____________ _ D Individual D Corporate Officer -Title(s): ________ _ D Partner D Limited D General D Attorney in Fact D Trustee D Guardian or Conservator D Other: _______ _ Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 MOBICAR-01 LHOUSTON ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~-8/25/2021 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY ANO 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 certlflcate does not confer rlahts to the certificate holder In lleu of such endorsementlsl. PRODUCER License# OC36861 coNTACT Lisa Houston _NAME: San Diego-Alliant Insurance Services, Inc. PHONE I FAX 701 B St 6th Fl JAIC, No, E>itl: (AIC, No): San Diego, CA 92101 JifftR'iss· Lisa.Houston@alliant.com INSURER(~} AFFORDING COVERAGE NAIC# INSURER A: Colony Insurance ComP-any 39993 INSURED INSURER a: Ohio Security Insurance ComP-any 24082 Halxln Flooring, Inc. OBA Carpet Club INSURERC: 518 W Washington Ave INSURERD: Escondido, CA 92025 _!NSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· 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. •~J: I TYPE OF INSURANCE ;~.\lf~.~I POLICY NUMBER POLICY EFF POLICY EXP LIMITS A f MERCIAL GENERAL LIABILITY L~glj_O~C_URRENCE s 1,000,000 CLAIMS-MADE []) OCCUR X 600GL001984304 9/5/2021 9/5/2022 ri~~i:JjE~~!l'J'el\CO). __ s'-'-___ 1_00..,. • ...,..0..,..ooc-l • ~0 EXP (~Y. on11.~er.;onl__ .S. ____ .___,5_,0 .... 0 __ 0 ~!;)'!\l.ONAL & ADV INJURY $ 1,000,000 RGEN1. AGGREGATE LIMIT APPLIES PER: POLICY □ ~rs= □ LOC OTHER: 8 ~UTOMOBILE LIABILITY X ANYAIJTO OWNED M SCHEDULED AUTOS ONLY AUTOS X ~lfllH>s ONLY X : ~Broi~~ H UMBRELLA LIAB H OCCUR I EXCESS LIAB CLAIMS.MADE: I OED I j RETENTION s 'woRKERS COMPENSATION X 1 AND EMPLOYERS' LIABILITY y / N r ANY PROPRIETOR/PARTNER/EXECUTIVE u·. N I A I OFFICER/MEMBER EXCLUDED? (Mandatory In NHI 1 i11~~ftfiJ~ ~,OPERATIONS belmv IBA52258123383 9/5/2021 9/5/2022 ,.ggNJ,RAL.M>JIB~!=-_s. ___ -=2""',o'"'o""o""',o·-=0,0= PRODUCTS. COMP/OP AGG . 05 ____ 2_,0_0_0_,0_0--10 s COMBINED SINGLE LIMIT 1 1 000 000 (Ee.ocooentl _____ .s. ____ , __ , --1 _BODILY INJURY (Per PJ>fSOllil $. _______ 1 _!IODlL Y INJURY (Par a,;,;ident)J $, ______ -! PROPERTY DAMAGE I (Po, acefdenl) ____ -t-· .$--,-------1 l s OCCURRENCE S ~~----➔~------~ $ I PER I f OTH-I _!.SI~T:UIE..l__LE8_.-..._~----i ,_E,\.,_EAS!:i.~CCIOENT I $ i E.L. DISEASE • EA EMPLOYEE $ E.l. 01si:.o.,::i:. POLICY LIMIT j $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES !ACORD 101, Acldlllonal R.maru SclMdulo, may bo attachod If moro apaco 19 roqulrod) RE: All Projects The City of Carlsbad Is Included as additional Insured. 30 day Notice of Canc:ellatlon for the City of Carlsbad. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OESCRIBED POLICIES 8E CANCELLED BEFORE City of Carlsbad/CMWD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services P.O. Box947 Murrieta, CA 92564 AUTHORIZED REPRESENTATIVE ~2>-~. I ACORD 25 (2016/03) © 1988·2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 POLICY NUMBER: 600GL00l 984303 COMMERCIAL GENERAL LIABILITY CG20100413 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 All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured 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 "persona! 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 ~dditional 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 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 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 operations for a principal as a part of the same project. CG 20 1D 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG20100413 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 POLICY NUMBER: 600GL001984303 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 All persons or organizations as required by written As designated in written contract with the Named Insured contract with the Named Insured 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" 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 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 Ill -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 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 600GL001984303 COMMERCIAL GENERAL LIABILITY CG 20 010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 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: (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 600GL00 1984303 DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT -RESTRICTED FORM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: All projects during the policy period. (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" Under SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under SECTION I -COVERAGE C MEDICAL PAYMENTS, which can be attributed only to ongoing operations at a single designated con- struction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under SECTION 1-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under SECTION I - COVERAGE C MEDICAL PAYMENTS 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 SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I -COVERAGE C MEDICAL PAYMENTS shall reduce the Designated Construction Project General Aggregate Limit for that des- ignated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated 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, Damages to Premises Rented to You 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. 5. The most we will pay for the sum of all Designated Construction Project General Aggregate Limits combined and to which this insurance applies is $5,000,000. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" Under SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE UCG2503-1013 Includes copyrighted material of Insurance Services Office, Inc., 1996 with its permission. Page 1 of 2 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 600GL001984303 LIABILITY, and caused by accidents under SECTION I -COVERAGE C MEDICAL PAYMENTS, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages or under SECTION I -COVERAGE C MEDICAL PAYMENTS 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 resulting from 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 Designated 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 SECTION Ill -LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. UCG2503-1013 Includes copyrighted material of Insurance Services Office, Inc., 1996 with its permission. Page 2 of 2 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 ---- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 48 02 99 DESIGNATED INSURED ENDORSEMENT The endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s} or organization(s) who are "insureds" under the WHO IS AN IN- SURED provision of the Coverage Form. This endorsement does not alter coverage provided in the Cov- erage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective Named Insured Name of Person(s) or Organization(s) City of Carlsbad/CMWD Policy Number Countersianed SCHEDULE c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 bv '(Authorized Representative) (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) Each person or organization shown in the Schedule is an "insured" for LIABILITY COVERAGE, but only to the extent that person or organization qualifies as an "insured" under the WHO IS AN INSURED provision contained in SECTION II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 - ~ --=== = = -= - a;;;;;;;;;;;;;; - COMMERCIAL AUTO CA 88 63 09 12 THIS ENDORSEME.NT CHANGES THE POLICY. PLEASE READ IT CAREFULL V. AMENDMENT OF CANCELLATION PROVISIONS Any term or provision of the Cancellation Conditions of the policy or any endorsement amending or replac- ing such Conditions is amended by the following: A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the person or organization shown in the Schedule below. ln no event will the notice to the person or organization scheduled below exceed the notice to the first named insured. B. Our obligation to send notice to the person or organization listed in the Schedule below will terminate at the earlier of the current policy period expiration or when you no longer have a legal or contractual obligation to such person or organization to maintain in'surance coverage under a policy which requires that such person or organization be notified in the event of cancellation. SCHEDULE 1. Name or Person or Organization: City 9f Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services ~ ·2. Mailing Address: 0 P.O. Box 947 Murrieta, CA 92564 3. Number Days Advance Notice: 30 All other terms and conditions of this policy remain unchanged © 2012 Uberty Mutual Insurance CA 88 63 0912 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/07/2022 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 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). PRODUCER CONTACT NAME: Breckpoint PHONE (A/C, No, Ext): (800) 592-0047 FAX (A/C, No, Ext): (800) 592-2541 Administrator, California Contractors Network, Inc. E-MAIL ADDRESS: service@breckpoint.com 1481 S. Balboa Ave.. INSURER(S) AFFORDING COVERAGE NAIC # Ontario, CA 91761 INSURER A: California Contractors Network, Inc.* INSURED INSURER B: Safety National Casualty Corporation 15105 Haixin Flooring, Inc. INSURER C: Affiliate of California Contractors Network, Inc.INSURER D: 506 W. Washington Ave. INSURER E: Escondido, CA 92025 INSURER F: COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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 EQUIREMENT, 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence)$ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident)$ ANY AUTO BODILY INJURY (Per person)$ ANY OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident)$ HIRED AUTOS NON- OWNED AUTO PROPERTY DAMAGE (Per accident)$ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N X WC STATU- TORY LIMITS OTH- ER A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED?N N/A X 4503-0259 01/01/2022 01/01/2023 E.L. EACH ACCIDENT $5,000,000.00 (Mandatory in NH)E.L. DISEASE - EA EMPLOYEE $5,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $5,000,000.00 B EXCESS WORKERS COMPENSATION SP4066022 01/01/2022 01/01/2023 AND EMPLOYERS LIABILITY Applicable to WC Statutory Limits and Employers Liability Limits. DESCRIPTION OF OPERATIONS / LOCATION / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: All Projects with the City of Carlsbad ** Waiver of Subrogation applies - see attached ** 30 Days Notice of Cancellation ** See Notes ** *Complies with the requirements of the Director of Industrial Relations under the provisions of Sections 3700 to 3705, inclusive, of the Labor Code of the State of California, holder of Master Certificate of Consent to Self-Insure No. 4503 CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947, Murrieta, CA 92564 ACORD 25 (2014/01)The ACCORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A. Seegmiller DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534- I -L~KI..J ~ I f---□ □ f--- f---□ □ f--- ~ □ □ - -~ □ □ -f--- -f--- -□ □ □ -n I I I □ □ □ □ PAGE 2 NOTEPAD: INSURED'S NAME: Haixin Flooring, Inc. DATE: 07/07/2022 City of Carlsbad as additional insured. DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534 WORKERS COMPENSATION AND EMPLOYERS LIABILITY California Contractors Network, Inc. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS We have the right to recover our payments from anyone liable for a covered injury. 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name of Person or Organization: City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta CA 92564 City of Carlsbad as additional insured. Insured: Haixin Flooring, Inc. Policy No.: 4503-0259 DocuSign Envelope ID: B7263E11-EA89-4D08-AC5A-9E60B417A534