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HomeMy WebLinkAboutUnderwater Unlimited Inc; 2022-08-15; PWM23-1913FACPWM23-1913FAC Alga Norte Aquatic Center Plaster Repair Ph. 2 Page 1 of 8 City Attorney Approved 1/20/2020 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ALGA NORTE AQUATIC CENTER PLASTER REPAIR PHASE 2 This agreement is made on the ______________ day of _________________________, 2022, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Underwater Unlimited, Inc., a California corporation whose principal place of business is 1106 2nd St. #260, Encinitas, CA 92024 (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 Ron Haugland (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: 598D3B98-23DD-427F-8E94-4817C4BE990E 15th August PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair Ph. 2 Page 2 of 8 City Attorney Approved 1/20/2020 A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five (5) years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ___________________________________ Print Name: ___________Aaron Roslie______________ REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers’ Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than……..$1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ….…$1,000,000 Property damage insurance in an amount of not less than……..$1,000,000 DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair Ph. 2 Page 3 of 8 City Attorney Approved 1/20/2020 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non-scheduled. The automobile insurance certificate must state the coverage is for “any auto” and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that 30 days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY. Workers’ Compensation limits as required by the California Labor Code. Workers’ Compensation will not be required if Contractor has no employees and provides, to City’s satisfaction, a declaration stating this. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys’ fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within forty (40) working days after receipt of Notice to Proceed. /// /// /// /// /// /// DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair Ph. 2 Page 4 of 8 City Attorney Approved 1/20/2020 CONTRACTOR’S INFORMATION: Underwater Unlimited, Inc. 1106 2nd St. #260 (name of Contractor) 734521 (street address) Encinitas, CA 92024 (Contractor’s license number) C53 Swimming Pool 2/28/23 (city/state/zip) 760-994-6265 (license class. and exp. date) 1000737605 6/30/23 (telephone no.) underwaterunlimitedinc@gmail.com (DIR registration number and exp. date) (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 UNDERWATER UNLIMITED, INC, a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Aaron Roslie, President Kyle Lancaster, Parks & Recreation Director, as authorized by the City Manager (print name/title) By: (sign here) Karen Roslie, Secretary & CFO (print name/title) If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Group B Chairman, President, or Vice-President Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair Ph. 2 Page 5 of 8 City Attorney Approved 1/20/2020 EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Type of Work to be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than 50% of the work with its own forces. DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E NONE NONE 0 0 NONE NONE PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair Ph. 2 Page 6 of 8 City Attorney Approved 1/20/2020 EXHIBIT B Alga Norte Aquatic Center Plaster Repair Phase 2 Contractor to provide all labor, equipment, and materials to repair plaster at Alga Norte Aquatic Center competition and instructional pools located at 6565 Alicante Road, Carlsbad, CA 92009. Scope of Work shall consist of all items mentioned in the Contractor's proposal, dated June 29, 2022, and shown in the following Exhibit C. Notes: 1. Permits and Fees to be City responsibility. 2. Contractor shall obtain City of Carlsbad Business License. 3. Contractor shall coordinate start time (work can start as early as 5:00am) and all pool lane closures with Ashlee Benson, Aquatics Center supervisor, cell: 760-271-5553, email Ashlee.benson@carlsbadca.gov. 4. Contractor’s construction schedule is noted as follows: August 22 to September 5, 2022, for work in the comp pool. The remaining work will be completed by October 14, 2022. 5. Contractor will perform work in the instructional pool and the competition pool in a manner that will allow other portions of the pool to remain open. 6. Owner shall provide signage and caution tape to protect all construction areas and guide patrons in the use of open lanes. 7. Contractor shall comply with all OSHA safety requirements JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 lump sum 1 Plaster Repair $19,325 TOTAL* $19,325 *Includes taxes, fees, expenses and all other costs. DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair PH. 2 Page 7 of 8 EXHIBIT C DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E Underwater pool repairs s ince 1985 1106 2nd Street #260 Encinitas, CA 92024 760-994-6]6j PROPOSAL 6/2912022 Alga None Aquatic Center 6565 Alicante Rd. Carlsbad, CA 92099 INSTRUCTIONAL AND COMPETITION POOL PHASE 2 INSTRUCTIONAL POOL PROBLEMS: (4) Rebar Rust Spots. 1 large cluster on West wall I around rope anchor in tile line I at entry steps in tile line I on East wall tile line 8 plaster loss areas I tile cap area to be epoxy molded/grouted Muliple sharp calcium nodules to be sanded down on floor COMPETITION POOL PROBLEMS: I Large Plaster Loss Multiple missing and broken tile caps 2 long cracks with calcium piles coming out PWM23-1913FAC Alga Norte Aquatic Center Plaster Repair PH. 2 Page 8 of 8 DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E PROCEDURE: Rebar Rust Spots Cut out rotted plaster, shotcrete/gunite, and corroded rebar(s). Sterilize clean ends and fi ll cavities with our own plaster based materials. For the tile lines and rope anchor, corrosion will be dug out deep and filled. Existing tiles in this pool are obsolete Plaster Loss Cut out delaminated plaster area down to the gunite/shotcrete and patch. ••• Plaster repairs need to cure undisturbed for 24hrs after completion. Missing and broken tile caps Set new black tiles as needed and epoxy mold chipped areas Cracks Cut out cracks and fill with our own plaster based materials. Sand down calcium WARRANTEE: All rust spot repairs are guaranteed not to rust for the lifetime o f the existing plaster. All plaster loss patches are guaranteed not to lift off from the floor for the lifetime of existing pool plaster. However, additional calciwn deposits may appear depending on water chemistry and how the pool was plastered, therefore we cannot guarantee that you will not have additional nodules/plaster loss areas in the pool. Total Cost: $19,325.00 Aaron Roslie Our comp/ere pool/spa 11ndenvater repair service specializes in reinforcement steel removal (rusted rebar), crack repair, delami11atio11 (plaster loss), hollow sp01s, calcium 11od11/e removal and VGB drain retrofit. Since 1985, we have repaired 1housa11ds of pools w1de1water all over Southem CA. UUI was chosen by the Cou/1/y ofSa11 Diego to demonstrate undenvater VGB retrofit for their drowni11g prevemio11 video. ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME:FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A(Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE 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. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 4/1/2022 License # 0757776 (800) 833-3433 26620 Underwater Unlimited Inc.and Liquid Pool and Spa ServiceAaron Roslie 1106 2nd Street #260 Encinitas, CA 92024 A 1,000,000 X AXRPG1100934-0 4/1/2022 4/1/2023 100,000 5,000 1,000,000 2,000,000 2,000,000 'The City of Carlsbad is named as additional insured per attached form. City of Carlsbad/CMWD Alga Norte Aquatic Center s 6565 Alicante Rd Carlsbad, CA 92009 LIQUPOO-01 NWIN HUB International Insurance Services Inc.2393 Townsgate RoadSuite 101Westlake Village, CA 91361 Axis Surplus Insurance Company X X X DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E ACORD" I ~ I ~ □ □ ~ ~ ~ □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ AXIS 101 2827 0221 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 Endorsement Number Effective Date of Endorsement Policy Number Premium 1 12:01 am Eff. 4/01/2022 AXRPG1100934-0 Incl. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that: A.Section II - Who Is An Insured is amended to include as an additional insured: 1.Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2.Any other person or organization you are required to add as an additional insured under the contract or agree- ment described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such addi- tional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to loss or damage arising from: 1."Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, sur- veys, field orders, change orders or drawings and specifications; or b.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2."Bodily injury" or "property damage" occurring after: DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBRWVDADDLINSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 04/25/2022 Right Source Insurance 125 S Louise St Suite 103 Glendale CA 91205 Perch Kerimyan (800) 485-5554 (818) 241-4487 perch@rightsourceinsurance.com UNDERWATER UNLIMITED INC. 16 E I St Encinitas CA 92024-3617 CALIFORNIA AUTOMOBILE INSURANCE COMPANY(CAIC)38342 A BA040000067600 05/05/2022 05/05/2023 1,000,000 City of Carlsbad/CMWD Alga Norte Aquatic Center 6565 Alicante Rd Carlsbad, CA 92009 DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E ACORD® I ~ I ~ □ □ ~ ~ Fl □ □ ~ ~ X ~ ~ ~ ~ H I I I I I □ DocuSign Envelope ID: 598D3B98-23DD-427F-8E94-4817C4BE990E • Sept. 15, 2021 CERTIFICATE OF EXEMPTION WORKERS' COMPENSATION/EMPLOYERS' LIABILITY INSURANCE Owner Operator !, ______________ _, am the _______________ _ Aaron Roslie [insert name] Underwater Unlimited Inc. of ______________ _ [ name of company] [title] h b 'f th Underwater Unlimited Inc. I ere y cert1 y at __________ _ [name of company] has no employees and is not required by law to maintain workers' compensation or employers' Underwater Unlimited Inc. liability insurance. Should _________________ employ any person [name of company] during the tenn of the Agreement with the City of Carlsbad for ___________ _ Alga Norte Aquatic Center Plaster Repair [ description of project or work that is being contracted] then workers' compensation and employers' liability insurance will be obtained. ~ j [Name] Owner, Underwater Unlimited Inc. [Title and name of company or corporation]