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HomeMy WebLinkAboutCal Pacific Truck Center LLC; 2023-02-01; PSA23-2071FLTPSA23-2071FLT City Attorney Approved Version 8/2/2022 1 AGREEMENT FOR F830 TRANSMISSION REPLACEMENT SERVICES CAL PACIFIC TRUCK CENTER, LLC THIS AGREEMENT is made and entered into as of the ______________ day of ___________________, 2023, by and between the City of Carlsbad, California, a municipal corporation ("City") and Cal Pacific Truck Center, LLC, a California limited liability company ("Contractor”). RECITALS City requires the professional services of a transmission replacement consultant that is experienced in transmission replacement. Contractor has the necessary experience in providing these professional services, has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the “Services”) that are defined in Exhibit “A,” attached and incorporated by this reference in accordance with the terms and conditions set forth in this Agreement. 2. TERM This Agreement will be effective for a period of one (1) year from the date first above written. 3. COMPENSATION The total fee payable for the Services to be performed will be nine thousand eight hundred forty- eight dollars and ninety cents ($9,848.90). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or the Services specified in Exhibit “A.” 4. STATUS OF CONTRACTOR Contractor will perform the Services as an independent contractor and in pursuit of Contractor’s independent calling, and not as an employee of City. Contractor will be under the control of City only as to the results to be accomplished. 5. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorney’s fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney’s fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 February 1st PSA23-2071FLT City Attorney Approved Version 8/2/2022 2 6. INSURANCE Contractor will obtain and maintain policies of commercial general liability insurance, automobile liability insurance, a combined policy of workers' compensation, employers liability insurance, and professional liability insurance from an insurance company authorized to transact the business of insurance in the State of California which has 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, in an amount of not less than one million dollars ($1,000,000) each, unless otherwise authorized and approved by the Risk Manager or the City Manager. Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims- made coverage. The insurance will be in force during the life of this Agreement and will not be canceled without thirty (30) days prior written notice to the City by certified mail. City will be named as an additional insured on General Liability which shall provide primary coverage to the City. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Contractor will furnish certificates of insurance to the Contract Department, with endorsements to City prior to City’s execution of this Agreement. 7. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all four categories. 8. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. 9. TERMINATION City or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. City will pay Contractor's costs for services delivered up to the time of termination, if the services have been delivered in accordance with the Agreement. 10. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees it 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. Contractor further acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to terminate this Agreement. 11. JURISDICTIONS AND VENUE Contractor agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Agreement is the State Superior Court, San Diego County, California. 12. ASSIGNMENT Contractor may assign neither this Agreement nor any part of it, nor any monies due or to become due under it, without the prior written consent of City. 13. AMENDMENTS This Agreement may be amended by mutual consent of City and Contractor. Any amendment will DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 PSA23-2071FLT City Attorney Approved Version 8/2/2022 3 be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. 14. 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 CAL PACIFIC TRUCK CENTER, LLC a California limited liability company CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager Jonathan Evans, President (print name/title) By: (sign here) Justin DeGraff, Director of Finance (print name/title) If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A. Group B. Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON By: City Attorney DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 PSA23-2071FLT 4 EXHIBIT “A” SCOPE OF SERVICES See attached letter dated Dec. 28, 2022. DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 X CAL PACIFIC TRUCK CENTER ESTIMATE No10930 WILLOW CT SAN DIEGO, CA 92127 INTERNATIONAL 760-761-0500 DATE 12/28/2022 NAME/ BUSINESS CITY OF CARLSBAD Make INTERNATIONAL License#Adjuster Address Year Mileage Insure Co City Model Paint #Contact Phone # Vin #Unit#Phone # Repair Description of Repair FREIGHT SUBLET LABOR PARTS TRANSMISSION 2730.00 5559.48 TRANSMISSION FLUID 558.00 MISCELLANIOUS SEALS, SHOP SUPPLIES 489.39 Total Damaged or worn parts removed from vehicle will be junked unless Hourly Rate: owner instructs us otherwise in writing. If new parts listed herein required are not available, we reserve the right to repair such damaged or worn parts. LABOR $ 2730.00 The charge for which will be made on an actual time basis at our PARTS $ 6117.48 labor rate. The above is an approximate estimate of repair required based on the FREIGHT/MISC $489.39 inspection made. Additional parts or labor may be required after the work SUBLET $ has started which were not evident on the first inspection, such additional labor SALES TAX $ 512.03 and material will be charged for in addion to the above. ESTIMATE TOTAL $ LESS DEPOSIT $ AUTHORIZED BY :GRAND TOTAL $ 9848.90 Exhibit A PSA23-2071FLTDocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 --- --- -I T I T I . ' I -~ -_L_ ' -~ -I--- --c__ -'--- -- - ' -'----f----- -I----I--- ->---- -f------I---- -f------- ~ ~ - --- -I----I---- - I----~ -I---I----~ -I---_, ~ -I---_L_ --'--- L- C I I I I I -- 01/19/2023A0164513 Sentry Select Insurance Company CERTIFICATE OF GARAGE INSURANCE DATE (MM/DD/YYYY) PRODUCER INSURED CONTACTNAME: PHONE(A/C, No, Ext): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE FAX(A/C, No): NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS ACORD 30 (2016/03)© 2010-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE #:REVISION #:COVERAGES INSURER F : PROD / CUSTOMER ID: SUBR WVD ADDL INSRD GARAGE LIABILITY ANY AUTO OWNEDAUTOS ONLY AUTO ONLY (Ea accident) OTHER THAN $ $ $AUTO ONLY EA ACCIDENT AGGREGATE GARAGE KEEPERS LIABILITY LEGAL LIABILITY DIRECT BASIS HIRED AUTOSONLY PRIMARY EXCESS COMP /OTCSPECIFIEDPERILS COLLISION LOC LOC LOC LOC $ $ $ $ EACH OCCURRENCE DAMAGE TO RENTEDPREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ $ $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under REMARKS below Y / N N / A REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION AUTHORIZED REPRESENTATIVE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ PERSTATUTE OTH-ER $ OTHER IN GARAGEAUTOS USED BUSINESS NON-OWNED Scheduled Autos 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. 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. 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). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cal Pacific Truck Center LLC 101 E 30th St National City, CA 91950-7341 Refer to attached Page 1 of 2 01/19/2023 Sentry Customer Service 800-473-6879 800-514-7191 businessproducts_direct@sentry.com Sentry Select Insurance Company 21180 Middlesex Insurance Company 23434 2768560 A X X X A0164513009 12/01/2022 12/01/2023 10,000,000 30,000,000 PRODUCTS - COMP/OP AGG 30,000,000 B X A0164513008 12/01/2022 12/01/2023 X 500,000 500,000 500,000 Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481 A0164513001AXX 12/01/2022 12/01/2023 500,000 500,000 2,500,000X A X A0164513001 12/01/2022 12/01/2023 X 7,000,0005 X 7,000,0005 X A0164513001 12/01/2022 12/01/2023 500,000 500,000 5,000 500,000 2,500,000 2,500,000 ERRORS & OMISSIONS Employee Benefits Errors & Omissions Occurrence Limit Annual Aggregate Limit Deductible All Other Errors & Omissions Occurrence Limit Annual Aggregate Limit Deductible $ $ $ $ $ $ A A0164513005 12/01/2022 12/01/2023 500,000 1,000,000 1,000 250,000 500,000 2,500 City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services PO Box 947 Murrieta, CA 92564-0947 00001 0000000000 23019 0 N1 3780cfb6-425a-4837-8f08-c475cb386a2c3780cfb6-425a-4837-8f08-c475cb386a2c DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 ACORD I ~--··.,,.. I tj '-- - - '--'-- '-- '--7 n ~ ~ D □ '-- '-- '--□ □ - '--H I I I I I □ AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY POLICY NUMBER CARRIER NAIC CODE NAMED INSURED EFFECTIVE DATE: ADDITIONAL REMARKS Cal Pacific Truck Center LLC XXXXXX4058 2 2 Jonathan Beeman A0164513001 Sentry Select Insurance Company 21180 12/01/2022 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE:ACORD 30 Certificate Of Garage Insurance Auto Dealers All Projects Garagekeepers Liability State BasisLocation #Collision Limit Comp/OTC/Specified Perils Limit 6 CA Natural Disasters Legal Liability $1,000,000 $1,000,000 Errors and Omissions Liability Coverage: Policy Number: A0164513005 Effective date: 12/01/2022 Expiration Date: 12/01/2023 Per Occurrence Limit: $250,000 General Aggregate Limit: $500,000 Truth-In-Lending and Truth-In-Leasing Odometer Hour Meter and Prior Damage Disclosure Errors and Omissions Dealership Insurance Agents' Errors and Omissions Title Errors and Omissions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 01/19/2023A0164513 Sentry Select Insurance Company DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 ~ ACORD® ~--··.,,.. I 01/19/2023A0164513 Sentry Select Insurance Company CERTIFICATE OF GARAGE INSURANCE DATE (MM/DD/YYYY) PRODUCER INSURED CONTACTNAME: PHONE(A/C, No, Ext): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE FAX(A/C, No): NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS ACORD 30 (2016/03)© 2010-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE #:REVISION #:COVERAGES INSURER F : PROD / CUSTOMER ID: SUBR WVD ADDL INSRD GARAGE LIABILITY ANY AUTO OWNEDAUTOS ONLY AUTO ONLY (Ea accident) OTHER THAN $ $ $AUTO ONLY EA ACCIDENT AGGREGATE GARAGE KEEPERS LIABILITY LEGAL LIABILITY DIRECT BASIS HIRED AUTOSONLY PRIMARY EXCESS COMP /OTCSPECIFIEDPERILS COLLISION LOC LOC LOC LOC $ $ $ $ EACH OCCURRENCE DAMAGE TO RENTEDPREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ $ $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under REMARKS below Y / N N / A REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION AUTHORIZED REPRESENTATIVE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ PERSTATUTE OTH-ER $ OTHER IN GARAGEAUTOS USED BUSINESS NON-OWNED Scheduled Autos 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. 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. 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). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cal Pacific Truck Center LLC 101 E 30th St National City, CA 91950-7341 Page 1 of 2 01/19/2023 Sentry Customer Service 800-473-6879 800-514-7191 businessproducts_direct@sentry.com Sentry Select Insurance Company 21180 2768560 Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481 $AGGREGATE LIMIT $POLLUTION INCIDENT LIMIT $CLEANUP COSTS-COVERED LOCATION LIMIT CLAIMS-MADE OCCUR POLLUTION LIABILITY N / AXA A0164513007 12/01/2022 12/01/2023 1,000,000 1,000,000 50,000 City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services PO Box 947 Murrieta, CA 92564-0947 00001 0000000000 23019 0 N1 4d5da2ff-e606-4ac8-9fb7-1226a35b0b0c4d5da2ff-e606-4ac8-9fb7-1226a35b0b0c DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 ACORD I ~--··.,,.. I tj '-- - - '--'-- '-- '--7 n ~ ~ D □ '-- '-- '--□ □ - '--H I I I I I □ g; □ AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY POLICY NUMBER CARRIER NAIC CODE NAMED INSURED EFFECTIVE DATE: ADDITIONAL REMARKS Cal Pacific Truck Center LLC XXXXXX4058 2 2 Jonathan Beeman Sentry Select Insurance Company 21180 12/01/2022 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE:ACORD 30 Certificate Of Garage Insurance ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 01/19/2023A0164513 Sentry Select Insurance Company DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 ~ ACORD® ~--··.,,.. I COMMERCIAL AUTO CA 88 04 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name of Person or Organization: City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services Start Date of Show:End Date of Show: Event Name: Event Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - General Liability Coverages, Paragraph D. Who Is An Insured is amended by the addition of the following: The following are "insureds" for "auto dealer operations"; The person or organization listed in the Schedule above, but only with respect to liability arising out of your "auto dealer operations" or premises owned by or rented to you. All other terms and provisions of the policy remain unchanged. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Change effective 01/17/2023 Page 1 of 1CA 88 04 10 13 01/19/2023A0164513 Sentry Select Insurance Company 00001 0000000000 23019 0 N1 d7a974bd-6f05-48a9-914a-dd5566b8ee52d7a974bd-6f05-48a9-914a-dd5566b8ee52 DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 IL 70 58 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s) or Organization(s) including mailing address: City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services PO Box 947 Murrieta, CA 92564-0947 All other terms and conditions of this policy remain unchanged. Change effective 01/17/2023 Page 1 of 1IL 70 58 02 14 01/19/2023A0164513 Sentry Select Insurance Company 00001 0000000000 23019 0 N1 ffed74f1-6d83-45eb-a772-e70327d9abbdffed74f1-6d83-45eb-a772-e70327d9abbd DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376 (Ed. 4-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name:City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services Address:PO Box 947 Murrieta, CA 92564-0947 Description of Waiver:Waiver of Our Right to Recover from Others Endorsement. JobID: (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No.Endorsement No. Insured Premium Insurance Company Countersigned by This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. © 1983 National Council on Compensation Insurance. WC 00 03 13 (Ed. 4-84) Change effective 01/17/2023 Page 1 of 1 01/19/2023A0164513008 Middlesex Insurance Company 00001 0000000000 23019 0 N1 5c67c620-dbdd-4cf0-a261-65f0d21e67055c67c620-dbdd-4cf0-a261-65f0d21e6705 DocuSign Envelope ID: F0CAD672-D809-4393-B74B-85EC9706F376