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Home My WebLink AboutGoforth & Marti DBA G|M Business Interiors; 2022-09-01; PWLCA-23022LIBPWLCA-23022LIB LIBRARY LEARNING CENTER CONT. NO. PWLCA-23022LIB Page 1 of 3 City Attorney Approved 1/22/2020 CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT CONT. NO PWLCA-23022LIB GOFORTH & MARTI DBA G|M BUSINESS INTERIORS (GMBI) This letter will serve as an agreement between Goforth & Marti DBA G|M Business Interiors, a California corporation (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to create and install custom gate with self-edged door panel, per the Contractor’s proposal dated July 13, 2022, and City specifications, for a sum not to exceed four thousand three hundred forty-seven dollars and eleven cents ($4,347.11.) This work is to be completed within 90 working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad business license 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees and volunteers, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers’ Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Insurance is to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4, California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. ________ in it ________ unit 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. ______ in it ______ infit 7. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 PWLCA-23022LIB LIBRARY LEARNING CENTER CONT. NO. PWLCA-23022LIB Page 2 of 3 City Attorney Approved 1/22/2020 8. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in the execution of the work covered by this Letter of Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 9. City Contact: Community Outreach Supervisor Carrie Scott carrie.scott@carlsbadca.gov 442-339-5515 Contractor Contact: Account Executive Michele Philbin mphilbin@gmbi.net 619-236-0500 CONTRACTOR – GOFORTH & MARTI DBA G|M BUSINESS INTERIORS 110 W. A Street, Suite 140 San Diego, CA 92101 619-236-0500 CITY OF CARLSBAD, a municipal corporation of the State of California mphilbin@gmbi.net By: By: (sign here) SUZANNE SMITHSON Library & Cultural Arts Director as authorized by the City Manager LAURINDA P. EASLEY, President & Secretary By: Dated: (sign here) For FAVIOLA MEDINA City Clerk Services Manager (print name/title) (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.) APPROVED AS TO FORM: For CINDIE K. McMAHON, City Attorney BY: _______________________________ Deputy/Assistant City Attorney DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 PWLCA-23022LIB LIBRARY LEARNING CENTER CONT. NO. PWLCA-23022LIB Page 3 of 3 City Attorney Approved 1/22/2020 EXHIBIT A Quotation 194031 dated 7/13/2022 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 INSR ADDLSUBRLTRINSRWVD 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 Hiscox Insurance Company Inc. 5/04/2022 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 10200 A X X X 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 X X 2961606 03/01/2022 03/01/2023 1,000,000 A B N X 80756387 (CA) WC014122637 03/01/2022 03/01/2022 03/01/2023 03/01/2023 X 1,000,000 1,000,000 1,000,000 C Professional Liab ANE405372522 03/01/2022 03/01/2023 1,000,000 Certificate holder is named as additional insured as respects to General and Auto Liability (on a primary and non-contributory basis) as required by written contract; Waiver of subrogation is issued in favor of certificate holder as respects to General Liability, Auto Liability and Workers Compensation, as required by written contract; All policies contain a 30 day notice of cancellation (10 for non-pay) subject to policy terms and conditions; GL additional insured endorsement includes ongoing and completed ops. (See Attached Descriptions) City of Carlsbad / CMWD c/o EXIGIS Insurance Compliance Services PO Box 4668 - ECM #35050 New York, NY 10163-0000 1 of 2 #S3991153/M3529866 GMBUSINClient#: 164812 KWI01 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) 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. 2 of 2 #S3991153/M3529866 DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 5/4/2022 License # 0757776 (818) 257-7459 25674 GoForth & Marti Inc.; GM Business Interiors 1099 West La Cadena Drive Riverside, CA 92501 10,000,000A CUP 0T277407 22 NF 3/1/2022 3/1/2023 10,000,000 10,000 City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668 - ECM #35050 New York, NY 10163-4668 GOFO&MA-02 KSHYAMALA HUB International Insurance Services Inc. 600 Corporate Pointe Suite 600 Culver City, CA 90230 Jorge Iniguez Jorge.Iniguez@hubinternational.com Travelers Property Casualty Company of America X X X DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 ‚•› »†…–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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 ‚•›»†…–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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ¸˝˝˝ ¸ ˚˛ ˛ 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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 —˙¸˛ ˛ ˛ ˙ ˝˛˝ ˝ —˙ —˝ ˛ ˛¸˙ ˛˛ —˛˚˙¸˝ ‚•›»†…–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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 —˙¸˛˛˛˙ ‚•› »†…–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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 —˙ ¸˛ †›«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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 ‚•› »†…–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¿· 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«†…»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: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381 03/01/2022 WC 080-75-6387 GOFORTH & MARTI - DBA: GM BUSINESS INTERIORS NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. DocuSign Envelope ID: 6B2F0B9E-7D09-4EC0-8A19-BD0FE1F9F381