HomeMy WebLinkAboutTim Whittier Welding; 2023-05-19; PWM23-2191UTILPWM23-2191UTIL
Agua Hedionda Chain Link Gate Replacement Page 1 of 6 City Attorney Approved 2/14/2023
CITY OF CARLSBAD
MINOR PUBLIC WORKS CONTRACT
AGUA HEDIONDA CHAIN LINK GATE REPLACEMENT
This agreement is made on the ______________ day of _________________________, 2023, by the City
of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Tim Whittier Welding, a sole
proprietorship, whose principal place of business is 26830 Kiavo Drive, Valley Center, CA 92082
(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: Jesse Castaneda
(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.
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
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Agua Hedionda Chain Link Gate Replacement Page 2 of 6 City Attorney Approved 2/14/2023
Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which
generally requires keeping accurate payroll records, verifying and certifying payroll records, and making
them available for inspection. Contractor shall require any subcontractors to comply with Section 1776.
FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted
as part of the contract process as set forth in this agreement and not in anticipation of litigation or in
conjunction with litigation.
Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act,
provides for civil penalties where a person knowingly submits a false claim to a public entity. These
provisions include false claims made with deliberate ignorance of the false information or in reckless
disregard of the truth or falsity of the information.
The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining
to false claims are incorporated herein by reference.
Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an
administrative debarment proceeding wherein the contractor may be prevented from further bidding on
public contracts for a period of up to five 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: ____________Tim Whittier_____________
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.
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
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Agua Hedionda Chain Link Gate Replacement Page 3 of 6 City Attorney Approved 2/14/2023
BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid
City of Carlsbad Business License for the duration of the contract.
INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and
hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of
every kind, nature and description, directly or indirectly arising from or in connection with the performance
of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable
law, rules or regulations including those related to safety and health; and from any and all claims, loss,
damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the
nature of the work covered by the Contract, except for loss or damage caused by the sole or active
negligence or willful misconduct of the City. The expenses of defense include all costs and expenses
including attorneys’ fees for litigation, arbitration, or other dispute resolution method.
JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for
resolution of any disputes between the parties arising out of this agreement is San Diego County,
California.
Start Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed.
Completion: Contractor agrees to complete work within thirty (30) working days after receipt of Notice to
Proceed.
CONTRACTOR’S INFORMATION.
Tim Whittier Welding
26830 Kiavo Drive
(name of Contractor)
901580
(street address)
Valley Center, CA 92082
(Contractor’s license number)
C-60, 08/31/2023
(city/state/zip)
760-740-9069
(license class. and exp. date)
PW-LR-1000700702
(telephone no.)
N/A
(DIR registration number)
06/30/2023
(fax no.)
Tw.welding@att.net
(DIR registration exp. date) (e-mail address)
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DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
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Agua Hedionda Chain Link Gate Replacement 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
TIM WHITTIER WELDING,
a sole proprietorship
CITY OF CARLSBAD, a municipal corporation
of the State of California
By: By:
(sign here)
Tim Whittier, Owner
Vicki V. Quiram, Utilities Director, as
authorized by the City Manager
(print name/title)
By:
(sign here)
(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 City Attorney
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
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Agua Hedionda Chain Link Gate Replacement 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
NONE
Total % Subcontracted: ______N/A_________
The Contractor must perform no less than 50% of the work with its own forces.
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
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Agua Hedionda Chain Link Gate Replacement Page 6 of 6 City Attorney Approved 2/14/2023
EXHIBIT B
AGUA HEDIONDA CHAIN LINK GATE REPLACEMENT
JOB QUOTATION
ITEM
NO.
UNIT QTY DESCRIPTION RATE PRICE
1 EA 8 Remove existing chain link on (4) gates and
replace with galvanized expanded metal (2 panels
per gate = 8 total)
$975.00 $7,800.00
2 EA 2 Purchase and install (2) multi lock gate latches $850.00 $1,700.00
TOTAL* $9,500.00
*Includes taxes, fees, expenses and all other costs.
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
~ ACORD• CERTIFICATE OF LIABILITY INSURANCE I DATE(-,OorfYYY}
~ 09/01/22
THIS CERTIFICATE IS ISSUED AS A MATIER 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 oertlftcatl holder Is an ADDITIONAL INSURED, the pollcy(les) 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 stetement on
this oertlftoata does not confer rights to the oertlfloata holder In lieu of such endorsement(s).
PRODUCER CONTACT Fabv Cruz NAIIE:
EMPLOYERS CHOICE INS SVCS INC !:?!~!-c---(760\431-0947 I f~.,_,. 1760)687-4007
2111 S El Camino Real #201 ~;!.':!~~~.
Oceanside, CA 92064 INSURERISI AFFORDING COVERAGE NAICI
License#: INSURER A : Obsidian Snaolaltv lnsuranoe Company
INSURED INSURER&: Clur Spring Property and Casually Company
Tim Whittler INSURERC :
Tim Whittler Welding INSURERD :
26830 Klavo Dr. INSURERE:
Vallev Center CA 92082 CA 92082 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. NOT'MTHSTANOING 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 ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~ TYPE OF INSURANCE ADOL SUBR POUCYEFF POUCYEXP Ua.TS l,u•-
, __
POUCY NUMBER .... Ill
X ~ GENERAL UABIUTY EACH OCCURRENCE $ 1000000
l ClA~E [X] OCCUR UI\Ml\l.>t: I U t<t:N I t:U $ 60 000 PREMISES IEa occurrence) -MED EXP IAnv one oerson) $ 60000
A -SCB-GL-000011078 06/27/22 08/27/23 PERSONAL & ADV INJURY s 1000000
GEN'l AGGREGATE LIIIIIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000
~POucYO~f~ □Loe PRODUCTS -COMP/OP AGG $ 1000000
OTHER: $
AUTOMOBILE UAIIIUTY f~~llNGLE LIMIT $ -Nf'fAUTO BODILY INJURY (Per person) $ -OWNED ~ SCHEDULED BODILY INJURY (Per accident) $ -ALITOSONLY -ALITOS
HIRED NON-OWNED rROPERTY DAMAGE $ ALITOS ONLY ALITOS ONLY Per accident\ --$
UIIBREUA UAB H OCCUR EACH OCCURRENCE $ -EXCESSUAB CLAIMS-MADE AGGREGATE $
OED I I RETENTION $ $
WORKERS COMPENSATION X I ~~~TUTE I I OTH-
AND EIIPLOYERS-LIABILITY ER Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE [yJ NIA CWC00164001 09/09/22 09/09/23 E.L EACH ACCIDENT $ 1000000 B OFFlCERMEMBER EXCLUDED? Y (llandalory In NH) E.L DISEASE -EA EMPLOYEE $ 1000000 ~rssc~ ~PERATIONS below E.L DISEASE -POLICY LIMIT $ 1000000
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarb Schedule, may be attached If,,_. apace la ,-qund)
CERTIFICATE HOLDER
Thia -la---. proof of irlsurwlce.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 26 (2018/03) The ACORD name and logo a.-. reglstared marks of ACORD
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
lnterinsurance Exchange of the Automobile Club
Mailing Address: P.O. BOX 25001 SANTA ANA, CALIFORNIA 92799-5001
BINDER OF INSURANCE
Name and Address of Lienholder or Additional Insured
CITY OF CARLSBAD/CMWD C/0 EXIGIS INSURAN
PO BOX 947
MURRIETA CA 92564
Policy Number: CAA139551837
NOTICE TO LIENHOLDER
IN THE EVENT OF CANCELLATION OF THIS
BINDER, THE EXCHANGE WILL GIVE THE
LIENHOLDER 10 DAYS' WRITTEN NOTICE OF
CANCELLATION.
Loan Number: -------------The lnterinsurance Exchange of the Automobile Club hereby acknowledges itself bound to the named insured for the coverages specified in the schedule subject to all the provisions of the Exchange's applicable policy form. The issuance of a policy to the named insured or, if a policy is in force, the issuance of an endorsement covering the automobile, boat or trailer described herein shall void this binder. A pro rata premium charge computed for the tenm of coverage in accordance with the current rates of the Exchange in effect at inception of the binder will be made unless such a policy or policy endorsement is issued. This binder shall not be construed to afford cumulative Insurance with any existing policy.
Name of Insured: TIMOTHY ALAN WHITTIER
DESCRIPTION OF AUTOMOBILE, BOAT, OR TRAILER
Car No. Year Trade Name Tvpe of B,:,dv ur Boat Identification Number
1 2004 DODG RAM 3500 CREW C 3D3LU38614G107580
·-----· .------
•✓• indicates coverage bound and afforded.
AUTOMOBILE INSURANCE LIMITS 0~ t.lAB!LITY Car# 1 Car#
Bodily Injury Liability $1 ,000 thousand doli;,,rs, e~.::h perscn 0 □ $1,000 thousand dol!ars, .;ach occurrence
Property Damage Liability $1,000 thousand dollars, each occurrence 0 □ Medical Payments □ □ Underlnsured/Unlnsured Motorists Not Less Than $15,000 each person/$30,000 each accident □ □ (a) Actual Cash Value less $1,000 deductible 0 □ Comprehensive (incl. Fire and Theft) □ □ Collision □ □
D Uninsured Deductible Waiver □ □
Uninsured Collision 0 □
WATERCRAFT INSURANCE (Boat) LIMITS OF LIABILITY "✓" indicates coverage bound and afforded.
Bodily Injury Liability and Property Thousand Dollars, each occurrence
Damage Liability Actual cash value not to exceed Limit of Liability of □ Physical Damage $ less $ deductible
Effective Date of Binder: 03/29/2023 12:01 A.M. Pacific Standard Time
This binder shall expire 30 days from the effective date or may be cancelled by the named insured at any time during such 30-day period. The Exchange may cancel this binder by mailing to the named Insured at the address shown above written notice stating when, not less than 10 days thereafter, such cancellation shall be effective. The mailing of such notice shall be sufficient proof of notice.
District Office:
By:
J0l10 (12110)
LCAA0'00A
Ol211l
ACSC Management Services, Inc.
ATTORNEY-IN-FACT
(Authorized Representative)
DocuSign Envelope ID: 6DB13CC3-C2C0-4BD8-BC4D-74AA118F550C
• lnterinsurance Exchange of the Automobile Club
Automobile Insurance Policy Coverages and Limits
Modified Renewal Declarations
l
We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or ~ before the due date. Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as set i forth in the insurance policy and endorsements. These declarations, together with the contract and the endorsements in effect, complete your 8 policy. If any change to your policy or to the information we have on file results in a premium decrease during the policy period, the ~ lnterinsurance Exchange reserves the right to apply any refund due to your outstanding balance.
NAMED INSURED (Item 1.)
AUTO POLICY NUMBER: CAA 139551837
POLICY PERIOD (PACIFIC STANDARD TIME) TIMOTHY ALAN WHITTIER
26830 KIAVO DRIVE
VALLEY CENTER CA 92082-6902 POLICY EFFECTIVE DATE: 04-02-23 12:01 A.M.
POLICY EXPIRATION DATE: 04-02-24 12:01 A.M.
VEHICLES
VEH. YEAR MAKE MODEL IDENTIFICATION NO. NUMBER
1 2004 DODG RAM 3500 CREW C 3D3LU38614G107580
3 2013 HOND CIVIC LX 19XFB2F58DE212659
6 1966 DODG CORONET WH27E67310443
11 1972 PLYM SATILITE RH23G2G176481
12 1936 DODG HUMPBACK PANEL WGN 9249658
COVERAGES AND LIMITS
Coverage Is not In effect unless a premium or the word "Included" Is shown.
COVERAGES
ffl Liability
o Bodily Injury
Property Damage
Medical
LIMITS OF LIABILITY
$1,000,000 each person/ $1,000,000 each occurrence
$1,000,000 each occurrence
VEHICLE GARAGE ANNUAL .. VERIFIED SALVAGE USE ZIP CODE MILES MILEAGE
COMMUTE 92082 25,001 -30,000 NO NO
PLEASURE 92082 7,501 -10,000 NO NO
PLEASURE 92082 1,501 -2,500 NO
PLEASURE 92082 1,501 -2,500 NO
PLEASURE 92082 1 -500 VERIFIED
ANNUAL PREMIUMS
Vehicle 1 Vehicle 3 Vehicle 6 Vehicle 11 Vehicle 12
$402 $376 $121 $121 $ 86
$233 $ 210 $71 $ 71 $ 50
I I I I I I I I I I : No Coverage: No Coverage: No Coverage: No Coverage: No Coverage Physical Damage (Acwal Cash Value unless otherwise stated, less deductible)
Vehicle 1 Vehicle 3 Vehicle 6 Vehicle 11
Comprehensive ACV No Coverage No Coverage $35000
(Less Deductible) $1000 No Coverage No Coverage $500
Collision No Coverage No Coverage No Coverage $35000 (Less Deductible) No Coverage No Coverage No Coverage $1000
Car Rental Elcpense
(Per Day) No Coverage No Coverage No Coverage No Coverage
Uninsured Motorist
' I
Vehicle 12 , ! ! ! I I I I No Coverage: $ 114 : No Coverage: No Coverage:
No Coverage: : ! !
No Coverage: No Coverage: No Coverage: No Coverage:
No Coverage ! ! ! ' ' '
I
$90 I : No Coverage
$39 : No Coverage
I I I I I I I I I I No Coverage i No Coverage i No Coverage i No Coverage i No Coverage i No Coverage
I
Bodily Injury-$100,000 each person/ $300,000 each accident l i $118 $138 $44 $44 $33 Uninsured & Underinsured Vehicles
Uninsured Deductible Waiver
Uninsured Collision
I I I I I I I I
: No Coverage: No Coverage: No Coverage: Included , No Coverage I I I t : ' $15 ' $17 • $4 •No Coverage• $2 ---t-----Total Premium $ 882 $ 741 $ 240 $ 365 $171 PREMIUM DISCOUNTS
Please refer to the enclosed document entitled "Premium Discounts Applied to Your Automobile Policy."
• If at any time you choose to pay less than the full balance outstanding, finance charges of up to 1.5% per month of the balance outstanding wlll apply as explained In your bllllng statements, which are part of these declaratlons.
.. To see the annual mileage for your expiring pollcy, please refer to the "Notice of Annual Mileage" page contained In your renewal package.
PROCESS DATE 03-28-23 PLEASE ATTACH TO YOUR POLICY
"No Coverage" indicates coverage not purchased.
Total Annual Premium* (Includes all applicable discounts.) $ 2399
Less Policyholder Savings Dividend $ 103 Net Premium* -+----,-22-9-6...i
(SEE REVERSE)