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HomeMy WebLinkAboutFence, Scott; 2023-04-17; PKRC23-0329Tracking #: ZONE 5 PARK GATE AND FENCE PROJECT CONT. NO. PKRC23-0329 Page 1 of 6 City Attorney Approved 2/14/2023 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ZONE 5 PARK GATE AND FENCE PROJECT; CONT. NO. PKRC23-0329 This agreement is made on the ______________ day of _________________________, 20___, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Scott Fence whose principal place of business is 1255 Distribution Way, Vista, CA 92081 (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, as contained in the Standard Specifications for Public Works Construction “Greenbook,” latest edition and including all errata; Part 1 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: Temujin Matsubara (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. 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. DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 23April17th Tracking #: ZONE 5 PARK GATE AND FENCE PROJECT CONT. NO. PKRC23-0329 Page 2 of 6 City Attorney Approved 2/14/2023 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 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: ___________________________________ 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 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 thirty (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. DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 Stilson Kent Scott -Hq? S f"'Y4 'vWS14 S Tracking #: ZONE 5 PARK GATE AND FENCE PROJECT CONT. NO. PKRC23-0329 Page 3 of 6 City Attorney Approved 2/14/2023 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 15 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 30 working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Scott Fence 1255 Distribution Way (name of Contractor) 581918 (street address) Vista, CA 92081 (Contractor’s license number) C13, B - 11/30/2023 (city/state/zip) 760-598-0070 (license class. and exp. date) 1000002709 (telephone no.) 760-598-0098 (DIR registration number) 6/30/2024 (fax no.) patrickglass@scottfence.com (DIR registration exp. date) (e-mail address) /// /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 Tracking #: ZONE 5 PARK GATE AND FENCE PROJECT CONT. NO. PKRC23-0329 Page 4 of 6 City Attorney Approved 2/14/2023 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 CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Stilson Kent Scott, Owner Assistant City Manager, Deputy City Manager, or Department Director as Authorized by the City Manager (print name/title) By: ATTEST: (sign here) SHERRY FREISINGER Christina Glass, Secretary City Clerk (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: _____________________________ Deputy / Assistant City Attorney DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 Tracking #: ZONE 5 PARK GATE AND FENCE PROJECT CONT. NO. PKRC23-0329 Page 5 of 6 City Attorney Approved 2/14/2023 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 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: 41BED9C4-54CF-4083-B955-6149A8092BD6 0 Tracking #: ZONE 5 PARK GATE AND FENCE PROJECT CONT. NO. PKRC23-0329 Page 6 of 6 City Attorney Approved 2/14/2023 EXHIBIT B (ENTER SCOPE OF WORK, SPECIFICATIONS, CONTRACTOR’S PROPOSAL, ETC.) JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 1 Scope of Work Summary: Provide materials for, and install, a 4’ tall galvanized chain link fence (approx.. 64 LF) and a 25’ double vehicle barrier gate that is pad lockable (36-42” tall) at Zone 5 Park. 2 1 Install 25' Double Vehicle Barrier Gate (Pad Lockable) (36" - 42" Tall): • 2-3/8" 40WT Gate Frame, 4" Posts w/ 12"x 36" Concrete Footings • Pipe Sleeve Hinges • 2-7/8" Hold Open Posts w/ Concrete Footings • (2) OM1-1 Yellow Reflector Warning Signs - 18x18 • Pad lockable mechanism $5,482.00 3 1 Install 4' Tall Galvanized Chain Link Fence (Approx. 64 LF): • 64 linear feet x 4’ tall galvanized chain-link fence • 2-3/8” 40WT terminal posts • 1-7/8” 40WT line posts 10’ OC • 8” x 24” concrete footing per each post • 1-5/8” top rail • 7-gauge tension wire bottom reinforcement • 2” x 9” gauge KK chain-link mesh $4,280.00 4 1 Excludes: • Utility locating, surveying, staking and layout • Deferred submittals, structural calculations and stamped drawings by a licensed engineer • Traffic Control • All concrete, curbs, masonry (fence post, railing and gate footings are included) • The contractor will not be responsible for any damages incurred to service lines (irrigation mainlines, lateral pipes, wires, etc.). City staff will repair all damages incurred during this project. TOTAL* $9,762.00 *Includes taxes, fees, expenses, prevailing wage and all other costs. DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 Cam in o H ills D r Cam ino H ills D r Ca m ino H ills D r Gate Galvanized fence ArcGIS Web Map Esri Community Maps Contributors, SanGIS, California State Parks, © OpenStreetMap, Microsoft, Esri, HERE, Garmin, SafeGraph, City Boundary Parcel Boundary - Existing Street Name Minor Private Address Range Labels 3/16/2023, 2:32:07 PM 0 0 0.010 mi 0 0.01 0.010 km 1:282 ArcGIS Web AppBuilder Copyright nearmap 2015 | Earthstar Geographics | SanGIS, California State Parks, Esri, HERE, Garmin, SafeGraph, FAO, METI/NASA, USGS, Bureau of Land Management, EPA, NPS | DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 D D PROPOSAL SUBMITTED TO:City of Carlsbad Zone 5, Camino Hills Dr, Carlsbad, CA 92008 DATE:ATTN: 3/21/2023 Temujin.Matsubara@carlsbadca.gov 25' Double Vehicle Barrier Gate (Pad Lockable) (36" - 42" Tall)$5,482.00 2-3/8" 40WT Gate Frame, 4" Posts w/ 12"x 36" Concrete Footings, Pipe Sleeve Hinges, 2-7/8" Hold Open Posts w/ Concrete Footings, (2) OM1-1 Yellow Reflector Warning Signs - 18x18 4' Tall Galvanized Chain Link Fence (Approx. 64 LF)$4,280.00 2-3/8" 40WT Terminal Posts, 1-7/8" 40WT Line Posts 10' O.C., 8"x 24" Concrete Footings, 1-5/8" Top Rail, 7 Gauge Tension Wire Bottom Reinforcement, 2"x 9 Gauge KK Chain Link Mesh, Total Dollars($$9,762.00 **Bid Prevailing Wages** **Excludes Utility Locating, Surveying, Staking, & Layout** **Excludes Deferred Submittals, Structural Calculations, & Stamped Drawings by a Licensed Engineer** **Excludes Traffic Control** **Excludes All Concrete, Curbs, Masonry, (Exceptions) Fence Post, Railing, & Gate Footings** Authorized Patrick Glass Signature Note: This proposal may be withdrawn if not accepted within 30 Days Signature Date of Acceptance:Signature DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 S 1255 Distribution Way • Vista, CA 92081 Cott ';e-HU (760) 598-0070 • Fax (760) 598-0098 Since 1956 CALIFORN IA LICE SE C-13581918 • LOUISIANA LICENSE 15558 Offices: Carlsbad, California; Port Arthur, Texas; Baton Rouge, New Orleans, Lafayette, Louisiana; Grand Cayman, West Indies All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to specifications submitted, per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. Location of fence is sole responsibility of the land owner. Survey stakes required, in order to properly place fence. Lumber products are nominal sizes not actual sizes. In the event litigation is required, reasonable attorneys fees, expert witness fees, court costs, Etc. shall be awarded to prevailing party. We measure through the gates. 1.5% interest will be charge on invoices past 30 days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 ~ SCOTFEN-01 SGONZALEZ ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 3/8/2023 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). PRODUCER License # 0757776 S~tm•CT Sandra Cooper HUB International Insurance Services Inc. rtr,Nrfo, Ext): (858) 255-3275 I Fffc, No):(951) 231-2572 9855 Scranton Road Suite 100 i~nAJ~ ..... cal.cpu@hubinternational.com San Diego, CA 92121 INSURER/SI AFFORDING COVERAGE NAIC# 1NsuRER A: GuideOne National Insurance Comoanv 14167 INSURED INSURER B: Burlinaton Insurance Comoanv 23620 Scott Fence 1NsuRER c : Falls Lake Fire & Casualtv Comoanv 15884 dba: Stilson Kent Scott 1255 Distribution Way INSURER D: Vista, CA 92081 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH 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. l~f~ TYPE OF INSURANCE ~J>.\-~~ POLICY NUMBER ..1~9LICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE [K] OCCUR ~~~t~~J9lENTEP._ 100,000 X 70K100189-02 3/7/2023 317/2024 ., s -5,000 MED EXP IAnv one oersonl s -PERSONAL & ADV INJURY s 1,000,000 -2,000,000 ~•L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [K] ~&?i □ LOC PRODUCTS · COMP/OP AGG $ 2,000,000 OTHER: Cyber Liability s 50,000 A AUTOMOBILE LIABILITY n,q~~.!_"!_fi~1f1NGLE LIMIT $ 1,000,000 -X ANY AUTO 70K100190-02 317/2023 317/2024 BODILY INJURY /Per oersonl s -OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY /Per accidentl S --X ~/filb°sONLY X ~aras~1~ ft,OPERTY 1~AMAGE eraoodent s Comp/Coll Ded $ 1,000 B UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 5,000,000 -804BE01375-02 317/2023 317/2024 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE s OED I I RETENTION s s C WORKERS COMPENSATION XI ~ffrnTE I I ~~H-AND EMPLOYERS" LIABILITY YI N X FLA005898-05 6/1/2022 6/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Cr] E.L. EACH ACCIDENT s filFICER/MlMBJIR EXCLUDED? NI A 1,000,000 andatory n N ) E.L. DISEASE· EA EMPLOYEF S ~m:~rm~ tf~PERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Operations of the Named Insured during the current policy term. City of Carlsbad is Additional Insured with regard to General Liability when required by written contract per the attached endorsement form CG2010 12/19. Waiver of Subrogation with regard to Workers Compensation applies when required by written contract per the attached endorsement form WC040306 (Ed. 4/84). Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within thirty (30) days of the SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad/CMWD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 AUTHORIZED REPRESENTATIVE I ~;u__ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 AGENCY CUSTOMER ID: SCOTFEN-01 SGONZALEZ -------------------LO C #: 1 --------~ ACORD" ~ ADDITIONAL REMARKS SCHEDULE AGENCY License# 0757776 IHUB International Insurance Services Inc. POLICY NUMBER !SEE PAGE 1 CARRIER I NAIC CODE !SEE PAGE 1 SEEP 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: NAMED INSURED Scott Fence dba: Stilson Kent Scott 1255 Distribution Way Vista, CA 92081 EFFECTIVE DATE: SEE PAGE 1 Page 1 of 1 cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation date. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 POLICY NUMBER: 70K100189 Effective Dates: 3/7/2023 -3/7/2024 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 10 1219 (Blkt) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Blanket as required by written contract and effective Primary Insurance applies: It is agreed that such during the policy period as stated on the policy insurance as is afforded by this policy for the declarations. benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured or its subcontractors, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 1219 (81kt) © Insurance Services Office, Inc., 2018 Page 1 of 2 DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section 111-Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 1219 (81kt) DocuSign Envelope ID: 41BED9C4-54CF-4083-B955-6149A8092BD6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 4-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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 2.5% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Blanket Waiver of Subrogation Schedule Job Description As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 06-01-2022 -06-01-2023 Insured Stilson, Kent Scott (An Individual) Policy No. FLA005898-05 Insurance Company Falls Lake Fire & Casualty Company Endorsement No. Countersigned By ______________________ _ ©1 998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.