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Blue Locker Commercial Diving LLC; 2022-12-13; PWM23-1953UTIL
DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A84998813th DecemberCARLSBAD MUNICIPAL WATER DISTRICT MINOR PUBLIC WORKS CONTRACT PWM23-1953UTIL CLEAN AND INSPECT MAERKLE UNDERGROUND WATER RESERVOIR This agreement is made on the ______ day of ___________ , 2022, by the Carlsbad Municipal Water District, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, hereinafter referred to as "CMWD", and Blue Locker Commercial Diving, LLC, a Nevada limited liability corporation, whose principal place of business is 544 Aspen Leaf St., Las Vegas, NV 89144 (hereinafter called "Contractor''). CMWD 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 Timothy Smith (CMWD Project Manager) PAYMENT. CMWD 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 CMWD'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. Clean And Inspect Maerkle Underground Water Reservoir Page 1 of9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988PWM23-1953UTIL 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 CMWD 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 CMWD to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: Print Name: REQUIRED INSURANCE. The successful contractor shall provide to CMWD, 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 CMWD 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 Clean And Inspect Maerkle Underground Water Reservoir Page 2 of9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988PWM23-1953UTIL 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 CMWD prior to such cancellation. The policies shall name CMWD as additional insured. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. WORKERS COMPENSATION AND EMPLOYER'S LIABILITY. Worker's 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 CMWD and the City of Carlsbad, and its 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 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 CMWD or City of Carlsbad. 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 one-hundred eighty (180) working days after receipt of Notice to Proceed. Ill Ill Ill Ill Ill Clean And Inspect Maerkle Underground Water Reservoir Page 3 of9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Blue Locker Commercial Diving, LLC (name of Contractor) (Contractor's license number) (license class. and exp. date) PW-LR-1000926191 6/30/24 (DIR registration number & exp. date) Clean And Inspect Maerkle Underground Water Reservoir Page 4 of9 PWM23-1953UTIL 544 Aspen Leaf St. (street address) Las Vegas, NV 89144 (city/state/zip) 951-501-6935 702-534-7843 (telephone no.) (fax no.) mark@bluelockerdiving.com (e-mail address) General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988PWM23-1953UTIL 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 BLUE LOCKER COMMERCIAL DIVING, LLC, a Nevada limited liability corporation ~ {!_..r-., ' =,. I Oo Q.._(;2 By: ging Member (print name/title) (sign here) (print name/title) CARLSBAD MUNICIPAL WATER DISTRICT By: Vicki V. Quiram, General Manager as authorized by the Executive Manager If required by CMWD, 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, General Counsel BY: uv,)it-k, /1.t~IA, Assistant General Counsel Clean And Inspect Maerkle Underground Water Reservoir Page 5 of9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A8499880%PWM23-1953UTIL EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor 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 sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project Business Name and Address DIR License No., %of to be Registration Classlflcatlon & Total Subcontracted No. Exolratlon Date Contract >-.Jo JvB-& r.S~/2___ K . ., .. Total% Subcontracted: -------The Contractor must perform no less than 50% of the work with its own forces. Clean And Inspect Maerkle Underground Water Reservoir Page 6 of9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988PWM23-1953UTIL EXHIBIT B CONTRACTOR TO PROVIDE COMMERCIAL DIVING SERVICES TO CLEAN AND INSPECT MAERKLE UNDERGROUND WATER RESERVOIR JOB QUOTATION '··· .. , ', .. QTY ~ DESCRIPTION ., . ' ITEM 'UNIT: 1, NO. 1 Job 1 Contractor to provide a 3-man commercial dive team with divers meeting the new OSHA mandates to clean and inspect full interior of 10,000,000-gallon underground water reservoir. 2 Job 1 Contractor to provide four (4) sediment bags for removed sediment. 3 Job 1 Contractor to perform dichlorination. 4 Job 2 Comprehensive electronic written and video reports of the services and condition inspection performed by Contractor are included in the cost. TOTAL NOT TO EXCEED* *Includes taxes, fees, expenses and all other costs. CMWD to provide the following: • Access to the site • Staff on site '" PRICE '' $38,400.00 $1,200.00 $200.00 $39,800.00* • Reservoir at full water level for diver safety and to maximize suction from pumps • Off-site disposal of sediment/debris from the tank Clean And Inspect Maerkle Underground Water Reservoir Page 7 of9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988 THE FINAL PREMIUM IS PREDICATED ON THE FINAL CONTRACT AMOUNT EXHIBITC LABOR AND MATERIALS BOND PWM23-1953UTIL Bond No. SU 1189292 Premium: $199.00 WHEREAS, the Board of Directors of the Carlsbad Municipal Water District has awarded to Blue Locker Commercial Diving Services, LLC, a Nevada limited liability company (hereinafter designated as the "Principal"), a Contract for commercial diving services to: CLEAN AND INSPECT MAERKLE UNDERGROUND WATER RESERVOIR CONTRACT NO. PWM23-1953UTIL in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Blue Locker Commercial Diving Services, LLC, a Nevada limited liability company, as Principal, (hereinafter designated as the "Contractor"), and Arch Insurance Company as Surety, are held firmly bound unto CMWD in the sum of Thirty-Nine Thousand Eight Hundred and 00/100 dollars ($ 39,aoo.oo ), said sum being an amount equal to: 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. Clean And Inspect Maeride Underground Water Reservoir Page 8 of 9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988 PWM23-1953UTIL 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. 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 21st day of September 20--E_ (SEAL) (SEAL) (Principal) ocker Commercial Diving, LLC By: By: (Signature) (Signature) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTOHNEY-IN- FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON General Counsel By: Ulhht-k.. f\.t~lh Deputy General Counsel , r Clean And Inspect Maerkle Underground Water Reservoir Page 9 of 9 General Counsel Approved 1/20/2020 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988 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 __ O_ra_ng"'-e __________ _ On 09/21/2022 before me, Melissa Ann Vaccaro, Notary Public ------------(insert name and title of the officer) personally appeared Daniel Huckabay 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 PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ffi~o.~O(_L.Q/'O Melissa Ann Vaccaro (Seal) MELISSA ANN VACCARO " COMM. #2401942 ,, ~ Notary Public-California ~ u. ORANGE COUNTY u. y Comm. Expires May 12, 2026 DocuSign Envelope ID: D2880D94-94E8-44A9-87ED-764D7A849988 Bond No. SU 1189292 AIC 0000376970 This Power of Attorney limits the acts oftlwse named herein, and they have 110 authority to bind the Company except in the manner and to the extent herein stated. Not valid/or Note, Loan, Letter of Credit, Currency Rate, Interest Rate or Residential Value Guarantees. POWER OF ATTORNEY Know All Persons By These Presents: That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrative office in Jersey City, New Jersey (hereinafter referred to as the "Company") does hereby appoint: Ben Stong, Michael D. Stong and R. Nappi of Riverside, CA (EACH) Ben Wolfe, Chelsea Arnold of Sacramento, CA (EACH) Arturo Ayala, Daniel Huckabay, Dwight Reilly, Frank Morones and Shaunna Rozelle Ostrom of Orange, CA (EACH) its true and lawful Attorney(s)in-Fact, to make, execute, seal, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed: Any and all bonds, undertakings, recognizances and other surety obligations, in the penal sum not exceeding Ninety Million Dollars (90 000 000.00). This authority does not permit the same obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as set forth herein. The execution of such bonds, undertakings, recognizances and other surety obligations in pursuance of these presents shall be as binding upon the said Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal administrative office in Jersey City, New Jersey. This Power of Attorney is executed by authority ofresolutio_ns adopted.by unanimous consent of the Board of Directors of the Company on December 11, 2020, true and accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys-in-fact, and to authorize them subject to the limitations set forth in their respective powers of attorney, to execute on behalf of the Company, and attach the seal of the Company thereto, bonds, undertakings, recognizances and other surety obligations obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process." This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of Directors of the Company on December 11 , 2020: VOTED, That the signature of the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on December 11, 2020, and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company. In Testimony Whereof, the Company has caused this instrument to be signed and its_ corporate seal to be affixed by their authorized officers, this 5th day of I!!.!Y, 2022 Attested and Certified &gr-: A .9Ji---.- Regan A. Shulman, Secretary STATE OF PENNSYLVANIA SS COUNTY OF PHILADELPHIA SS --- Stephen C. Ruschak, Executive Vice President I, Michele Tripodi, a Notary Public, do hereby certify that Regan A. Shulman and Stephen C. Ruschak personally knowh to me to be the same persons whose names are respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri, subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes therein set forth. ~-. ~-. · Con,monweallh of Penn,ytvanla • Notary Seat ' ¼ ~f-·· ~ · MJCHELE TRIPODI, Notary Public ~ Phlladelphla County CERTIFICATION 1/;'J Commission Expires July 31, 2025 Commli,llon Numbef' 1168622 Michele Tripodi, Notary Public My commission expires 07/31/2025 I, Regan A. Shulman, Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated July 5, 2022 on behalf of the person(s) as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this certificate; and I do further certify that the said Stephen C. Ruschak, who executed the Power of Attorney as Executive Vice President, was on the date of execution of the attached Power of Attorney the duly elected Executive Vice President of the Arch Insurance Company. ~2~EIITIMONY WHEREOF, I h,~ hore,a<o s,bse,ibed my ,ame Md ,m,oo •• eo~orare swl of ili• A~ CoAM~9~•olemb" Regan A. Shulman, Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company except in the manner and to the extent herein stated. PLEASE SEND ALL CLAIM INQUIRIES RELATING T(J THIS BOi\l} TO 1'HZ FOLLOWIN'G ADDRESS: Arch Insurance -Surety Division 3 Parkway, Suite 1500 Philadelphia, PA 19102 To verify the authenticity of this Power of Attorney, pleas-, ct1ntCTCt Arch Insurance Company at SuretyAuthentic@arc insurance.com Please refer to the above named Attorney-in-Fact and the details of the bond to which the power is attached. AICPOA040120 Printed in U.S.A. ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD 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 12/7/2022 (909) 593-7776 7907 (909) 593-5477 44520 Blue Locker Diving27476 Via Industria Temecula, CA 92590 11150 A 1,000,000 X EPK-141438 11/1/2022 11/1/2023 250,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000B 71CAB8986800 11/1/2022 11/1/2023 10,000,000A EFX-121398 11/1/2022 11/1/2023 10,000,000 B X 74WC18986800 11/1/2022 11/1/2023 1,000,000 1,000,000 1,000,000 A Pollution Liability*EPK-141438 11/1/2022 11/1/2023 Per OCC 1,000,000 *Pollution Liability - $2,000,000 AGG Limit applies **Professional Liability included at $1,000,000 each Claim/$2,000,000 AGG under same policy # as the General Liability and the Pollution Liability with Crum &Forster Specialty Ins. Co. Excess Liability policy is Following Form thus the Additional Insured and Waiver of Subrogation provisions of the underlying primary CGL & CPL policyapplies. NOTE: Excess Liability Policy provides $10M OCC/AGG Limit excess over CGL, CPL, PL, WC/EL coverages and $5M Limit cap excess over AUTO LIABcoverage. SEE ATTACHED ACORD 101 City of Carlsbad/CMWD 5959 El Camino Real Carlsbad, CA 92008 ASSOCON-01 IJACKSON Hardy Insurance Services, Inc.2911 Bonita Avenue Suite ALa Verne, CA 91750 Lisa Perrault, CISR lperrault@hardyirm.com Crum & Forster Specialty Insurance Company Arch Insurance Company X X X X X X X X X ACORD" I ~ I -D □ --- Fl □ □ ------ - -H I I I I I □ I FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. Hardy Insurance Services, Inc. ASSOCON-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 1 SEE P 1 Blue Locker Diving27476 Via IndustriaTemecula, CA 92590 SEE PAGE 1 IJACKSON 1 Description of Operations/Locations/Vehicles:RE: Project: 10.0 Maerkle Reservoir, (contract value $40,000) Certficate Holder is included as Additional Insured per EN0111-0211 attached endorsement. W/C waiver of subrogation applies per WC040306 (04/84). ~ ACORD" ~ I EN0111-0211 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) or Organization(s) SECTION III – WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability caused, in whole or in part, by “your work” for that insured which is performed by you or by those acting on your behalf. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Where Required by Written Contract WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA WC040306 (Ed. 04-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _2_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization where waiver of our right to Insureds Operations recover is permitted by law and is required by written contract provided such contract was executed prior to the date of loss Notes: 1. This endorsement may be used to waive the company's right of subrogation against named third parties who may be responsible for an injury. 2. The sentence in ( ) is optional with the company. H limits the endorsement to apply only to specific jobs of the insured, and only to the extent that the insured is required to obtain this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The infonnation below is required oliy when this endorsement is issued subsequent to preparation of the policy.) Endorsement No. 000 Insured: Blue Locker Diving Insurance Company: Arch Insurance Company WC040306 (Ed. 04-84)