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HomeMy WebLinkAboutTim Whittier Welding; 2023-05-22; PWM23-2027UTILPWM23-2027UTIL Fabrication and Installation of Guardrails – Phase 3 Page 1 of 9 City Attorney Approved 8/2/2022 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT FABRICATION AND INSTALLATION OF GUARDRAILS – PHASE 3 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, 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: Don Wasko (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: 8E45B800-C000-4F1E-B562-9467FE4F2657 May 22nd DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTIL 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 (5) years and that debarment by another jurisdiction i~ grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signalure f~ ~ 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 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. Fabrication and Installation of Guardrails -Phase 3 Page 2 of 9 City Attorney Approved 8/2/2022 ~~~ DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTIL 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 twenty (20) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within twenty (20) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Tim Whittier Welding (name of Contractor) 901580 (Contractor's license number) C-60, 08/31/2023 (license class. and exp. date) PW-LR-1000700702, 06/30/2023 (DIR registration number/exp. date) Fabrication and Installation of Guardrails -Phase 3 Page 3 of 9 26830 Kiavo Drive (street address) Valley Center, CA 92082 (city/state/zip) 760-7 40-9069 (telephone no.) tw.welding@att.net (e-mail address) City Attorney Approved 8/2/2022 ,mw. DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTIL 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 ~ WAiti,;. (sign here) Tim Whittier, Owner (print name/title) By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Vicki V. Quiram, Utilities Director, as authorized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !!J! 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 BY: __ 611v_Ji_·t.-_k_, _flt_dltk __ llv_ City Attorney Fabrication and Installation of Guardrails -Phase 3 Page 4 of 9 my ~ved 8/2/2022 DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTIL EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor 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 subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor 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 Business Name and Address DIR Registration License No., % of Total Subcontracted No. Classification & Contract Expiration Date \. 0 () ~ / Total % Subcontracted: ______ _ The Contractor must perform no less than 50% of the work with its own forces. Fabrication and Installation of Guardrails -Phase 3 Page 5 of 9 c;1y AttoW .' s1212022 DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTiL EXHIBITB FABRICATION AND INSTALLATION OF GUARDRAILS -PHASE 3 JOB QUOTATION ITEM NO. UNIT QTY 1 LS 2 LS 3 LS 4 LS Fabrication and Installation of Guardrails -Phase 3 1 1 DESCRIPTION Batiquitos Lift Station: Fabricate and install 24 linear feet of guardrail at $170 per linear foot at each lift station. Fabricate and install 3 straps to permanently close 3 covered openings. Materials to be used: -1.25" galvanized pipe, welds to be covered in spray galvanizing. -42" tall -4" x ¼" added to the bottom for kick plate Homeplant Lift Station: Guardrail #1: Fabricate and install 15 linear feet of guardrail at $170 per linear foot. Add to existing. Guardrail #2: Fabricate and install 15 linear feet of guardrail at $170 per linear foot. Add to existing. No kickplate. Materials to be used: -1.5" galvanized pipe, welds to be covered in spray galvanizing. -42" tall Poinsettia Lift Station: Guardrail #1: Fabricate and install 14.5 linear feet of guardrail at $170 per linear foot. Add 14' of 4" x ¼" to the bottom of existing railing. Guardrail #2: Fabricate and install 20 linear feet of guardrail at $170 per linear foot. Guardrail #3: Fabricate and install 48 linear feet of guardrail at $170 per linear foot. Two gates with heavy duty, weldable, self- closing, sealed bearing hinges. Materials to be used: -1.25" galvanized pipe, welds to be covered in spray galvanizing. -42" tall -4" x ¼" added to the bottom for kick plate Terramar Lift Station: Guardrail #1: Fabricate and install 25 linear feet of guardrail at $170 per linear foot. Add 1 gate with heavy duty, weldable, self-closing, sealed bearing hinges. Guardrail #2: Fabricate and install 18 linear feet of guardrail at $170 per linear foot. Add 1 gate with heavy duty, weldable, self-closing, sealed bearing hinges. Materials to be used: PRICE $4,680 $5,100 $15,525 $8,110 Page 6 of9 City Attorney Apprwv d 8/2/2022 , ~·~ ·. 1 '. ' ,, DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTIL ITEM UNIT QTY DESCRIPTION PRICE NO. -1.25" galvanized pipe, welds to be covered in spray galvanizing. -42" tall -4" x ¼" added to the bottom for kick plate Bressi Pump Station Guardrail #1: Fabricate and install 25.5 linear feet of guardrail at $170 per linear foot 5 LS 1 Materials to be used: $4,335 -1.25" galvanized pipe, welds to be covered in spray galvanizing. -42" tall -4" x ¼" added to the bottom for kick plate Guardrail #2: Fabricate and install 25.5 linear feet of guardrail at $170 per linear foot. Materials to be used: 6 LS 1 -1.25" galvanized pipe, welds to be covered in spray $4,335 galvanizing. -42" tall -4" x ¼" added to the bottom for kick plate 7 LS 1 Labor and Materials Bond $1,500 TOTAL* $43,585 *Includes taxes, fees, expenses and all other costs. *Includes fabrication, delivery, hardware and install. Prevailing wage for installation. *Does not include paint, drywall, texture, stucco, concrete, tile, carpet or any type of flooring. *Does not include anything not specifically writte"!. in this contract. Fabrication and Installation of Guardrails -Phase 3 Page 7 of 9 City Attorney Approved 8/2/2022 DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 Premium based on final contract price EXHIBIT C LABOR AND MATERIALS BONO PWM23-2027UTIL Bond : 100737660 Premium: $785.00 WHE_REAS, the City Council of the City of Carlsbad, State of California, has awarded to Tim Whittier Welding, a sole proprietorship (hereinafter designated as the "Principal"), a Contract for. FABRICATION AND INSTALLATION OF GUARDRAILS -PHASE 3 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 fumi~~ing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, prov1s1ons, 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. Tim Whittier Welding, a sole proprietorship, as Principal, (hereinafter designated as the •Contractor»), and American Contractors Indemnity Compan~s Surety, are held firmly bound unto the City of Car1sbad in the sum of forty-three thousand five hundred and eighty-five dollars ($43,585), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of cartsbad, and for which payment well and truly to be made we bind ourselves, our heirs, exeartors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONOffiO 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, end pajd 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 worx 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 bonds I 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. 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 ~hall 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. Fabrication and Installation of Guerdmils -Phase 3 Page 8 of9 City A~ad 812/2022 DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 PWM23-2027UTIL In the event that Contractor is en individual, it is agreed that the death of any such Contractor shaH not exonerate the Surety from its obligations under this bond. 2023 , 2022 31st SIGNED AND SEALED, this ____ day of March Timothy Whitter OBA Timothy Whittier Welding (SEAL) American Contractors Indemnity Company(SEAL) (Principal) , 8y~~Ml1_ ( i nature) / (Surety) _ By:~ /1:-&Ls- (Signature) Nhu g H. Saephan, Attomey-in--Fact ,. (SEAL ANO NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K McMAHON, City Attorney B r :IA, ' ·1.., k., /tt~tA, y-. l) tU City Attorney - Fabrication and Installation of Guarnrails -Phase 3 Page 9of9 ~~ r:roved 8/2J2022 ~ I~ flVV I DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 .-.w_,, __ ...,, .... ,..,.,™=·-------=.,.,,z-------• ..., .. ,_.,., ____ ..,. _________ _ I [! CALIFORNIA ALL-PURPOSE 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 SACRAMENTO } On 3 j 31 / UYl:Z before me, ___ K~A~T~Y_T~A~Y~L~O"'""R ________ Notary Public, Date (here insert name ) personally appeared _____ __,_N.,_,_H.:..;:Ua...:..N.:....:G::;.....:..aH..:.... =SA"""E=P...:.H..:.:..A..:.:..N_,__ ___________ _ ************************************************* 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 l'le/she/tl:isy executed the same in Mts/her/tl:leir authorized capacity(ies7, and that by his/her/their signature(s) on the instrument the person(-s-), or the entity upon behalf of which the person(&) acted, executed the instrument. , I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing ll paragraph is true and correct. H 1· WITNESS my hand and official seal. (Seal) OPTIONAL INFORMATION ---------------------- Description of Attached Document ! Title or Type of Document: ____________ Number of Pages: __ _ . f Document Date: Other: ---------------------------- I ~-----.-.,_,,,4:!W_,WWW ____ ,;;.,.,-,.e,--mr::z"""""::,::.,. _ _, ...... _,_,,.,, ... WWWK....,..&E_,.WWW_ ... JW""'••·--·=™°"'*"""W_, _ _,,za:_,,,,_, ... _ _,,.~!.t= .... r.:,-"""""'•'--"""""------•i DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 TOKIO MARINE HCC KNOW ALL MEN BY THESE PRESENTS: POWER OF ATTORNEY That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, NHUNG H. SAEPHAN its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number _____ 1_0_0_7_3_76_6_0 ____ _ issued in the course of its business and to bind the Company thereby, in an amount not to exceed -------------'-T'-'-'hr-"e-"-e-'-'m-'-'-il=lio=n-'-a=n-'-'d'-0"-'0'-'-/--'1 o"-'o'---___________ ('-----"$=3..a,o;..;ao..:a.oL.a:Zo;.;:;o..::;.;o.=o=o _ _,}. This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 161 day of September, 2011. "Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s}-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." · The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 18th day of April, 2022. ,,,,,"~'~,~~111,,,, ~"''~'\~ ........ 1.s ;:_✓,,,,., t)r~--~CORPORAIT·~·-.. ~t, \:~\ SEPT. 25, 1990 /; ff \~~·•.... . ... ·~·o.[ ,.,.,,11,,~◄iiFOR""'~,,,,,, 111,11u1,11\''' State of California County of Los Angeles By: AMERICAN CONT S INDEMNITY COMPANY 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, accurac , or validit of that document. On this 18th day of April, 2022, before me, Sonia 0 . Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person 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.. s;gnature ~ (seal} I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 31st day of ___ ---'M=a.:..:rc'-'-h:...,_ __ _ Bond No. Agency No. 100737660 3344 2023 HCCSOll.POAACIC04/2022 DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 TOKI O M ARI N E. HCC Fraud Warnings Fraud Warn ings and Privacy Notice Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. APPLICABLE IN ALABAMA Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution, fines or confinement in prison, or any combination thereof. APPLICABLE IN ARKANSAS, LOUISIANA AND WEST VIRGINIA Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. APPLICABLE IN CALIFORNIA For your protection California law requires the following to appear on this form. Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. APPLICABLE IN COLORADO It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement of award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. APPLICABLE IN THE DISTRICT OF COLUMBIA WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. APPLICABLE IN FLORIDA Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. APPLICABLE IN HAWAII For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment, or both. APPLICABLE IN KANSAS Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act. APPLICABLE IN KENTUCKY Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. APPLICABLE IN MAINE It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or denial of insurance benefits. TMHCCZZM_FRAUDPRIVACY01/2023 DocuSign Envelope ID: 8E45B800-C000-4F1E-B562-9467FE4F2657 TOKIO MARINE HCC APPLICABLE IN MARYLAND Fraud Warn in gs and Pri vacy Notice Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. APPLICABLE IN MINNESOTA Any person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. APPLICABLE IN NEW JERSEY Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. APPLICABLE IN OHIO Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deception statement is guilty of insurance fraud. · APPLICABLE IN OKLAHOMA WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. APPLICABLE IN OREGON Material misstatements, misrepresentations, omissions or concealments by an insured that are fraudulent or material to the insurance contract, the risk assumed, or the interests of an insurer and are relied upon by an insurer may result in policy rescission, cancellation, or denial of claim. APPLICABLE IN TENNESSEE, VIRGINIA AND WASHINGTON It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines or denial of insurance benefits. APPLICABLE IN VERMONT Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law. NOTICE TO NEW YORK APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. TMHCCZZM_FRAUDPRIVACY01/2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBRWVDADDLINSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION$ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY Murrieta, CA 92564 P.O. Box 947 c/o EXIGIS Insurance Compliance Services The City of Carlsbad/CMWD The City of Carlsbad is listed as additional insured and in favor of the waivers of subrogation. 1,000,000 1,000,000 1,000,00009/09/2309/09/22CWC00154001YYB 1,000,000 2,000,000 1,000,000 50,000 50,000 1,000,000 06/27/2306/27/22SCB-GL-000011078YYA Clear Spring Property and Casualty Company Obsidian Specialty Insurance Company 92082CAValley Center, CA 92082 26830 Kiavo Dr. Tim Whittier Welding Tim Whittier (760)687-4007(760)431-0947 Faby Cruz License #: Oceanside, CA 92054 2111 S El Camino Real #201 EMPLOYERS CHOICE INS SVCS INC 09/01/22 ACORD® I ~ I X ~ □ [X] ~ ~ ~ □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I X I I I □ • INTERINSURANCE EXCHANGE of the Automobile Club MAILING ADDRESS: P. 0. BOX 25001 , SANTA ANA, CALIFORNIA 92799-5001 BINDER OF INSURANCE Additonal Insured Provided For: Policy Number CAA 139551837 Control Number CITY OF CARLSBAD/CMWD C/0 EXIGIS INSURAN P.O. BOX 947 NOTICE TO LIENHOLDER IN THE EVENT OF CANCELLATION OF THIS BINDER, THE EXCHANGE WILL GIVE THE LIENHOLDER 10 DAYS WRITTEN NOTICE OF CANCELLATION. MURRIETA CA 92564 Loan Number ---------- Po Ii c y Effective Dates: 04/02/2022 -04/02/2023 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 term of coverage in accordance with the current rates of the Exchange in effect at the 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# Year Trade Name Type of Body or Boat Identification Number 1 2004 DODG RAM 3500 CREW C 3D3LU38614G107580 AUTOMOBILE INSURANCE LIMITS OF LIABILITY "x" indicates Coverage bound and afforded Bodily Injury Liability $1 Million dollars, each person Car#1 Car#2 Car # $1 Million dollars, each occurrence X Property Damage $1 Million dollars, each occurrence X Medical Payments each person Underinsured/U ninsured Motorist Not less Than 100,000 each person/$300,000 each accident X Comprehensive (include Fire and (a) Actual Cash Value less $1 ,000 deductible X Theft) (b) Limit of Liability of less deductible Collision (a) Actual Cash Value less $0 deductible (b) Limit of Liability of less deductible Uninsured Deductible Waiver Uninsured Collision X RENTERS INSURANCE LIMITS OF LIABILITY "x" indicates Coverage bound and afforded Renters Insurance thousand dollars, each occurrence Actual Cash Value not to exceed Limit of Liability of less deductible Effective Date of Binder September 15, 2022 12:01 AM This binder shall expire 30 days from the effective date or may be canceled 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 19 days thereafter, such cancellation shall be effective. The mailing of such notice shall be sufficient proof of notice. District Office By 30510 E B~B7 EZEQUIEL CHAVEZ (Authorized Representative) ACSC Management Services, Inc ATTORNEY-IN FACT