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San Diego Mountain Biking Association; 2024-05-06; PKRC24-0102
Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 1 of 9 City Attorney Approved 5/3/2023 CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 This agreement is made on the ______________ day of _________________________, 20___, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and San Diego Mountain Biking Association whose principal place of business is PO Box 881491, San Diego, CA 92168 (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: _Michael Tully____ (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 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D 6th 24May Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 2 of 9 City Attorney Approved 5/3/2023 for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to 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. DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D Susie Murphy Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 3 of 9 City Attorney Approved 5/3/2023 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. 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 60 working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. San Diego Mountain Biking Association PO Box 881491 (name of Contractor) 1105574 (street address) San Diego, CA 92168 (Contractor’s license number) C-27 / 6/30/2025 (city/state/zip) 619-504-5806 (license class. and exp. date) 1000825232 (telephone no.) N/A (DIR registration number) 6/30/2024 (fax no.) eservesd@gmail.com (DIR registration exp. date) (e-mail address) DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 4 of 9 City Attorney Approved 5/3/2023 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) Susie Murphy, CEO Parks and Recreation Director (print name/title) By: ATTEST: (sign here) SHERRY FREISINGER Gerry Krippner, CFO 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: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D c::,~ Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 5 of 9 City Attorney Approved 5/3/2023 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: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D 0 Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 6 of 9 City Attorney Approved 5/3/2023 EXHIBIT B SCOPE OF WORK Summary: Contractor will perform trail maintenance, repair and safety enhancements along the Lake Loop Trail at Lake Calavera Preserve. This includes the provision of equipment and materials to perform this work. 1. Contractor will perform trail repairs along approximately 1,800 linear feet of trail along the Lake Loop Trail in Lake Calavera: a. Trail repair work will be along the Lake Loop Trail in 10 areas of the trail indicated on the scope of work maps listed below. b. Trail repairs will be performed using a Bobcat E20, Canycom BFP-602, Wacker Neuson WP1500 Aw and hand tools. c. The only fill that will be brought in is the rip rap for drainage ditches. Along the entire stretch, trail repairs will consist of ripping, conditioning, regrading, installation of contour water bars. d. No soil work shall start and be left undone at the end of the workday and if it is, all soil must be compacted at the end of the day to avoid any run-off. 2. Contractor will provide the required signage and trail closure notices to ensure public safety. All signage is encouraged to be put up and taken down by the end of the workday but depending at the discretion of the contractor. The City of Carlsbad will provide the detailed informational signage as well as provide the A-Frames if San Diego Mountain Biking Association is not able to do so. 3. The City of Carlsbad will install three wire fencing with signage after work is completed in Areas 9 and 10 of the scope of work maps listed below. 4. Contractor anticipates that up to 60 working days will be required to complete all work and should be completed by June 30, 2024. Contractor will assume responsibility to conduct a biological survey and hire a biological monitor for all work areas in order to meet regulation requirements at no additional cost to the City of Carlsbad. 5. City of Carlsbad Parks Maintenance staff will work with Contractor in removing all vegetation in habitat areas. Materials: • 6 minus Rip Rap Equipment Needed: • Bobcat E20 Canycom BFP-602 • Hand tools (shovels, pick, mcleod, rogue hoe etc.) • Wacker Neuson WP1550Aw • Toyota Tundra Ford F-250 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D Tracking #: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 7 of 9 City Attorney Approved 5/3/2023 JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE Perform trail maintenance, repair and safety enhancements along the Lake Loop Trail at Lake Calavera Preserve. $59,500 TOTAL* $59,500 *Includes prevailing wage, labor and materials bond, taxes, fees, expenses and all other costs. /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D _J <( 0:: l- a.. 0 0 (/) _J a.. w <( ~ ~ ::5 ~ 0:: 0:: 0 Ou_ $(1) LL 0:: 0<( w a.. a.. w 0 0:: (.)W C/) I- I C/) co _J I-_J -<( co 0:: IW ><> WO Do c u S i g n E n v e l o p e I D : B B 7 0 8 2 0 0 - B 4 C 8 - 4 7 E 7 - 8 8 C 2 - 2 B E B 9 A 0 D A C 8 D Area 3 -Area of disturbance is about 85' in length and 22' wide existing trail width -Two Options for Drainage -3A-Will be 9' length by 4' wide, will need to remove shrubs. -3B-Will be 12' length by 4' wide will not need to remove shrubs herbaceous material only -Grades will pitch towards drainage area towards habitat. -Using existing fill Area 4 -Area of disturbance is about 25' in length and 1 O' wide existing trail width -Drainage Area will be 5' in length by 4' wide. Herbaceous material only. -Grades will pitch towards drainage area towards habitat. -Using existing fill Do c u S i g n E n v e l o p e I D : B B 7 0 8 2 0 0 - B 4 C 8 - 4 7 E 7 - 8 8 C 2 - 2 B E B 9 A 0 D A C 8 D Area 5 -Area of disturbance is about 100' in length and 20' wide on average existing trail width only. -Drainage Area will need to be 10' in length and 4' wide. Herbaceous material only no shrubs. -Grades will pitch towards drainage area towards habitat. -Contour Water Bars to assist with drainage. -Using existing fill Area 6 -Area of disturbance is about 40' in length and 1 0' wide. -No Drainage Area necessary. -Grades will pitch towards drainage area towards habitat. -Contour Water Bars to assist with drainage. -Using existing fill Do c u S i g n E n v e l o p e I D : B B 7 0 8 2 0 0 - B 4 C 8 - 4 7 E 7 - 8 8 C 2 - 2 B E B 9 A 0 D A C 8 D Area 7 -Area of disturbance will be entire length of trail and existing trail width since locations are all rilled and starting to get steep from this point. -No drainage area is necessary already exist -Grades will pitch towards drainage area towards habitat. -Contour Water Bars to assist with drainage. -Using existing fill Area 8 -Area of disturbance will be entire length of trail and existing trail width since locations are all rilled and starting to get steep from this point. -No drainage area is necessary already exist -Grades will pitch towards drainage area towards habitat. -Contour Water Bars to assist with drainage. -Using existing fill Do c u S i g n E n v e l o p e I D : B B 7 0 8 2 0 0 - B 4 C 8 - 4 7 E 7 - 8 8 C 2 - 2 B E B 9 A 0 D A C 8 D Area 9 -• }:-~~~ ,,~-. ,,il!lf ' . ,__.::~)-,>~ • -~ 1 ' -,;,;jf '. . ~~ .• 'I !:.--:.-.)~ ~ ''·1··· ,, t~·... ·-· ,. ,, . '!U'•>i'. ,.dJ ·• ; • 1>i'h :I -\'i'.J)\, ....... , ~-----, ... /~-·---~-''I)\ ·.\ -'\.\\ : f u~~.:::._.: " -• ~\- /~'"\ nm·n Exhibit A will include rip rap inside earthen . drainage ditch -Area of disturbance will be entire length of trail and existing trail width since locations are all rilled and starting to get steep from this point. -Drainage Area 15' in length by 4' wide. Some shrubs may need to go. -Grades will pitch towards earthen drainage ditch area towards habitat. -Contour Water Bars to assist with drainage. -Wire Fence to be installed on left hand side of trail (downhill) 8'-12' (depending on grades) to allow vegetation to grow back. -Using existing fill -No re vegetation will take place at this time -;.\ Area 10 -~ t:J1-;._ -\. :. ~.,\ r··· 1>,1,1, ~----... _:;· ........ ~·~. {:\•.> -"~--, .. \. .. . .,..·\). ~ . ii; a:~ .. ;?f?J_,,F •:~{ Exhibit A will include rip • _,-,,';/;,". 1e "' .. f"J!, Riti rap .inside earthen ,~-r .;,~_;·t "'h ·"· ~. drainage ditch ~-,....,~-w •• '·--Area of disturbance will be entire length of trail and existing trail width since locations are all rilled and starting to get steep from this point. -Drainage Area 12' in length by 4' wide. Herbaceous material only to be removed . -Grades will pitch towards earthen drainage ditch area towards habitat. -Contour _Water Bars to assist with drainage . -Wire Fence to be installed on left hand side of trail (downhill) 8'-12' (depending on grades) to allow vegetation to grow back. -Using existing fill -No re vegetation will take place at this time Do c u S i g n E n v e l o p e I D : B B 7 0 8 2 0 0 - B 4 C 8 - 4 7 E 7 - 8 8 C 2 - 2 B E B 9 A 0 D A C 8 D Area 11 -Area of disturbance will be entire length of trail and existing trail width it is starting to get less steep but still needed. -Drainage Area 8' in length by 4' wide. Herbaceous material only to be removed. -Grades will pitch towards drainage area towards habitat. -ContoLJr Water Bar to assist with drainage. -Using existing fill Area 12* *No picture but similar to Area 11 -Area of disturbance will be entire length of trail and existing trail width it is starting to get less steep but still needed. • -Drainage Area 1 O' in length by 4' wide. Herbaceous material only to be removed. • -Grades will pitch towards drainage area towards habitat. -Contour Water Bar to assist with drainage. -Using existing fill DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D EXHIBIT C LABOR AND MATERIALS BOND Bond No. S7 A2SU0002917 Tracking#: WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to San Diego Mountain Biking Association (hereinafter designated as the "Principal"), a Contract for: LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA CONTRACT NO. PKRC24-0102 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, San Diego Mountain Biking Association, PO Box 881491, San Diego, CA 92168, as Principal, (hereinafter designated as the "Contractor"), and American Alternative Insurance Corporation, 555 College Road East, Princeton, NJ 08543 as Surety, are held firmly bound unto the City of Carlsbad in the sum of Fifty Nine Thousand Five Hundred & No/100 ------------------------------ ------------------------------------------dollars ($ 59,500.00 ), 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 Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 8 of 9 City Attorney Approved 5/3/2023 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D Tracking#: In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. SIGNED AND SEALED, this __ 2_1_s_t ___ day of ____ Fe_b_r_ua_ry~-----~ 20~ San Diego Mountain Biking Association (SEAL) American Alternative Insurance Corporation (SEAL} (Principal} (Surety} By: ~v..ritf Murph/ {Signature) By: -~-it\--J-o~-g-e-ns_o_n_,-A-+-o~-n-e""~----1_-F-ac_t ___ _ (Signature) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTIFICATE} APPROVED AS TO FORM: CINDIE K. McMAHON City Attorney By: ll.l11fj"'· fvw.t Deput/Assistant City Attorney Agent: ALEXIS R. JOHl'ISOM Mot•ry Public • C•llfornla San Oi~go County Commission II 2387936 •,.,, •' My Comm. Ex~\r,s 0& 23, 2025 ACORA Surety & Insurance Services, LLC PO Box 506 LAKE LOOP TRAIL REPAIR WORK AT LAKE CALAVERA; CONT. NO. PKRC24-0102 Page 9 of 9 Montevideo, MN 56265 Ph: 320-269-8546 City Attorney Approved 5/3/2023 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D Bond Number S7 A2SU0002917 CERTIFI ED COPY POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the AMERICAN ALTERNATIVE INSURANCE CORPORATION, a corporation organized and existing by virtue of the laws of the State of Delaware ("Corporation") with offices at 555 College Road East, Princeton, N.J. 08543, has made, constituted and appointed, and by these presents, does make, constitute and appoint: Jack Anderson and Rita Jorgenson its true and lawful Attorneys-in-Fact, at Princeton, in the State of New Jersey, each of them alone to have full power to act without the other or others, to make, execute and deliver on its behalf, as Surety or Co-surety, bonds and undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating to such bonds or undertakings provided, however, that no single bond or undertaking so made, executed and delivered shall obligate said Company for any portion of the penal sum thereof in excess of the sum of One Hundred Million Dollars ($100,000,000). Such bonds and undertakings for said purposes, when duly executed by said Attorney(s)-in-Fact, shall be binding upon said Company as fully and to thesame extent as if signed by the President of said Company under its corporate seal attested by its Secretary. This appointment is made under and by authority of a certain Resolution adopted at a meeting of the Board of Directors of said Company duly held on the 27th day of August, 1975, a copy of which appears below. IN WITNESS WHEREOF, the AMERICAN ALTERNATIVE INSURANCE CORPORATION has caused its corporate seal to be hereunto affixed, and these presents to be signed by its duly authorized officers this 24th day of September, 2021 . By: Attest 'i,I,, { (~,. Michael G. Kerner President <f::- Ignacio Rivera Deputy General Counsel & Secretary STATE OF NEW JERSEY, COUNTY OF SOMERSET The foregoing instrument was acknowledged before me by means of online notarization this 24th day of September, 2021 , by Michael G. Kerner and Ignacio Rivera, who are personally known to me. le o My Commission Expires FebNaiy 8, 2026 SECRETARY'S CERTIFICATE The undersigned, Ignacio RiYera, hereby ce1tifies: 1. That the undersigned is Secreta1y of American Alternati,·e Insurance Co1poration, a corporation of the State of Delaware; 2. That the original power of attorney of which the foregoing is a copy was duly executed ou behalf of said Co1poratio11 on the day of its elate, and has not since been revoked, amended or modified; that the undersigned has compared the foregoing copy thereof with said original pO\wr of attomey, and that the same is a trne aud con-ect copy of said original power of attomey and of the "·hole thereof; 3. That the original resolution of \\'hich the following is a copy was duly adopted at, and recorded in the minutes of, a regular meeting of the Board of Directors of said Co1poratio11 duly held 011 August 4, 1998, and has not since been rernked, amended or modified. RESOL\"ED, that each of the following officers of this Co1poration, namely, the President, the Executiw ,·ice President, the Senior ,·ice Presidents, and the Yice Presidents, be, and they hereby are, authorized, from time to time in their discretion, to appoint such agent or agents or attomey or attorneys-in-fact as deemed by them necessruy or desirable for the pmpose of canying on this Co1poration's business, and to empower such agent or agents or attorney or attorneys-in-fact to execute and deti,·er, in this Co1poration 's name and on its behalf, and undei· its seal or otherwise, smety bonds, surety unde1taki.ngs or surety contracts made by this Co1poratio11 as surety thereon. RE SOL, "ED, that the siguan1re of any authorized officer of the Co1poration and the Co1poration's seal may be affixed by facsinlile to ru1y power of attorney and revocation of any power of attomey or ce1tificate of either given for the execution of any surety boud, stuety unde1taki.ng, or surety contract, such sig11ature and seal, when so used being hereby adopted by the Co1poration as the original sig11an1re of such officer and the original seal of the Co1poration, to be valid and binding upon the C01poration with the same force and effect as though manually affixed. FURTHER RESOL \ "ED, that any prior appointments by the Co1poration of MGAs are, in all respects, hereby ratified, confmned and approved. FURTHER RESOL \ "ED, that the Secretruy or any Assistant Secretruy of this Co1poration is hereby authorized to certify ru1d deliver to any person to whom such ce1tification and delivery may be deemed necessruy and desirable in the opinion of such Secretruy or Assistant Secretruy , a tme copy of the foregoing resolution. 4. TI1e tmdersigned has compru·ed the foregoing copies of said 01iginal resolutions as so recorded, and they are the sruue tme and con·ect copies of said original resolutions as so recorded and of the whole thereof. Al\IERIC . ..\.l"'I ALTERNATIVE INSUR.-\.l"'ICE CORPORATION Ignacio Ri,·era Deputy General Cotmsel & Secretruy TRS-1001-1 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D ACKNOWLEDGEMENT OF SURETY STATE OF MINNESOTA COUNTY OF CHIPPEWA } On this 21st day of February , 2024 , before me, a Notary Public within and for said County, personally appeared Rita Jorgenson to me personally known, who being by me duly sworn he/she did say that he/she is the attorney-in-fact of American Alternative Insurance Corporation , the corporation named in the foregoing instrument, and the seal affixed to said instrument is the corporation seal of said corporation, and sealed on behalf of said corporation by authority of its Board of Directors and said Rita Jorgenson acknowledged said instrument to be the free act and deed of said corporation. NOTARY PUBLIC My Commission Expires ( /31 (;;io?y DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT 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 ~(1\'\ D~ ~o On 'L\ 1-3\ Jl}ly\ ~-00\t\n~on Notary Public, personally appeared ......aa ......... --=c~__,__.____.__~.___.-----+--+-'1----------------~ who pro. ved to me on the basis of satisfactory evidence to be the per~) whose name(s i are subsc~ to the within instrument and acknowledged~ that he~hey executed the same in hi~heir authorized capacity(ies), and that by h~/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of State of California that the foregoing paragraph is true and correct. J ft ; ft ft :L~l;R,~O~;JNe ft ( -Notary Public -California r ) i ' San Oi~o County f WITNESS h d d ffi ' 1 1 , Commission If 2387936 -my an an O lCla Sea . --'~"~~~~:=~:~~:::~~:-------S!GNATU~t?IJ®~ --- Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of attached document Title or type of document: ________________________ _ Document Date: ________________ N.umber of Pages: ______ _ Signer(s) Other than Named Above: ____________________ _ DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D City of Carlsbad Parks and Recreation Department Michael Tully Parks Planner Lake Calavera Quote Bat1BIB!ID llllilln'taln· ,BilllnjJ, • Assaa;auon • • Project: FY 2024 Lake Calavera Project Term : Dec. 22nd, 2023 -June 30, 2024 Project Amount: $59,500 DIR Number: PW-LR-1000825232 CA Contractor License: 1105574 Scope of Work: SDMBA is to perform trail maintenance, repair and safety enhancements for the City of Ca rlsbad . This work is in the attached scope of work. Equipment to be used: Bobcat Mini-Excavator E20, Canycom BF P-602 Motorized wheelbarrow, Hand tools (shovels, pick, mcleod, rogue hoe etc), Wacker Neuson WP1550Aw plate compactor, Toyota Tundra and Ford F-250. Additional Details: -See attached scope of work. -Labor and Materials Bond is included. -This Project is subject to Prevailing Wage. -Work to be completed by Thursday February 15th or a biological monitor and pre construction survey will be necessary. -SDMBA will need at least 10 working days to complete scope of work. -Access will be provided to the jobsite via the adjoining service road that connects to SOW .. -The City of Carlsbad will install fencing mentioned in scope of work. -Limit of work on trail is an approximation and may vary plus or minus 15ft. This is specific to the limit of work and does not affect impact to habitat. -Contractor will maintain closed signage and caution tape on a daily basis within the work area. -The City of Carlsbad will post official signage before the project begins warning of the impending closure during the working period. General Exclusions: Bonding not mentioned, insurance exceeding agreed upon limits provided to the client, permit fees, water costs, water meter fees, any hazardous materials removal and costs of development of SWPPP plan. Please contact: Ben Stone Trails Coordinator 619-504-5806 I bens@sdmba.com PO Box 881491 San Diego, CA 92168-1491 www.SDMBA.com A 501 (c) 3 organization -Tax ID# 20-1701837 05/01/2024 Conservation United PO Box 759 Higley AZ 85236 Shasha Nguyen (855) 570-2797 (602) 388-8110 shasha@insuranceunited.com San Diego Mountain Biking Association 718 ELM AVE. CHULA VISTA CA 91910 Philadelphia Indemnity Ins Co 18058 National Casualty Company 11991 2024-06/30 Master A Y Y PHPK2624332 11/15/2023 06/30/2024 1,000,000 100,000 5,000 1,000,000 3,000,000 3,000,000 Professional Liability 1,000,000 A PHPK2624332 11/15/2023 06/30/2024 1,000,000 A 10,000 PHUB889405 11/15/2023 06/30/2024 2,000,000 2,000,000 B WCC349302A 02/15/2024 07/01/2024 1,000,000 1,000,000 1,000,000 The City of Carlsbad, its officials, employees and volunteers are afforded additional insured status with respect to general liability when agreed by writtencontract. A waiver of subrogation in favor of the certificate holder applieds to general liability. Primary and non contributory wording applies. A thirty (30) daynotice of cancellation applies except for ten (10) days due to non payment of premium. Umbrella follows form. City of Carlsbad 1200 Carlsbad Village Drive Carlsbad CA 92008 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 SUBR WVD ADDL INSD 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 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 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D ~ ACORD® ~ X I - - Fl □ -X -- X IXI [8] □ - 1-- I-- H XI I 7 □ City of Carlsbad 1200 Carlsbad Village DriveCarlsbad, CA 92008 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D PI-CANXAICH-002 (05/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR CERTIFICATE HOLDER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART COMMERCIAL CRIME COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS Al or CH Additional Insured or Certificate Holder Address AI The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part: A. In the event we cancel the policy in accordance with the policy's terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives. 1. .1.Q__days before the effective date of cancellation if we cancel for any reason other than for non -payment of premium. As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage. Page 1 of 1 PI-GLD-HS (10/11) Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments Bail Bonds $5,000 5 Supplementary Payment Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement Janitorial Services Client Coverage $10,000 limit 6 Additional Insured Newly Acquired Time Period Amended 6 Additional Insured Medical Directors and Administrators Included 7 Additional Insured Managers and Supervisors (with Fellow Employee Coverage) Included 7 Additional Insured Broadened Named Insured Included 7 Additional Insured Funding Source Included 7 Additional Insured Home Care Providers Included 7 Additional Insured Managers, Landlords, or Lessors of Premises Included 7 Additional Insured Lessor of Leased Equipment Included 7 Additional Insured Grantor of Permits Included 8 Additional Insured Vendor Included 8 Additional Insured Franchisor Included 9 Additional Insured When Required by Contract Included 9 Additional Insured Owners, Lessees, or Contractors Included 9 Additional Insured State or Political Subdivisions Included 10 DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D PI-GLD-HS (10/11) Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury includes Mental Anguish Included 11 Personal and Advertising Injury includes Abuse of Process, Discrimination Included 11 A. Extended Property Damage SECTION I COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury This exclusion does not apply t reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. liability insurance of the client. C. Non-Owned Watercraft SECTION I COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D "Bodily injury" or property damage" expected or intended from the standpoint of the insured. o "bodily injury" or "property damage" resulting from the use of Based on the named insured's request at the time of claim, we agree to indemnify the This coverage is excess over any renter's PI-GLD-HS (10/11) Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company LIABILITY, Subsection 2. Exclusions, Paragraph j. Damage to Property, Item (1) is deleted in its entirety and replaced with the following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the w a. The last paragraph of SECTION I COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III LIMITS OF INSURANCE. b. SECTION III LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess Insurance, (1) (a) (ii) is deleted in its entirety and replaced by the following: That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D to a person or damage to another's property, unless the damage to property is caused by ord "fire" is changed to "fire, lightning, explosion, smoke, or leakage from automatic fire protective systems" where it appears in: PI-GLD-HS (10/11) Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because ity and Accountability Act (HIPAA). We have 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional, Willful, or Deliberate Violations b. Criminal Acts riminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V DEFINITIONS is amended to include the following additional definitions: a. b. c. regulations included in the HIPAA. DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D of a "violation(s)" of the Health Insurance Portabil the right and the duty to defend the insured against any "suit," "investigation," or "civil proceeding" seeking these damages. However, we will have no duty to defend the insured against any "suit" seeking damages, "investigation," or "civil proceeding" to which this insurance does not apply. Any willful, intentional, or deliberate "violation(s)" by any insured. Any "violation" which results in any c "Civil proceeding" means an action by the Department of Health and Human Services (HHS) arising out of "violations." "Investigation" means an examination of an actual or alleged "violation(s)" by HHS. However, "investigation" does not include a Compliance Review. "Violation" means the actual or alleged failure to comply with the PI-GLD-HS (10/11) Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company G. Medical Payments Limit Increased to $20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGE A AND B are amended as follows: 1. b. is deleted in its entirety and replaced by the following: 1. b. Up to $5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I COVERAGES, SUPPLEMENTARY PAYMENTS COVERAGES A AND B the following is added: We will pay occurring in the course of employment. proceeding is $25,000 regardl . DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D , on your behalf, defense costs incurred by an "employee" in a criminal proceeding The most we will pay for any "employee" who is alleged to be directly involved in a criminal ess of the numbers of "employees," claims or "suits" brought or persons or organizations making claims or bringing "suits PI-GLD-HS (10/11) Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company K. Key and Lock Replacement Janitorial Services Client Coverage SECTION I COVERAGES, SUPPLEMENTARY PAYMENTS COVERAGES A AND B is amended to include the following: W , up to a $10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that authorized representatives or any one to purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client" means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any "manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee." c. "Manager" means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D e will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your "client " you or any of your partners, members, officers, "employees", "managers", directors, trustees, whom you entrust the keys of a "client" for any PI-GLD-HS (10/11) Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and - employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a) as it applies to managers of a limited liability company. c. Broadened Named Insured Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) e a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment Automatic Status When Required in Lease Agreement With You Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D supervisors who are your "employees" are also insureds for "bodily injury" to a co "employee" while in the course of his or her Any "occurrence" which takes place after you cease to b PI-GLD-HS (10/11) Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company or aused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. A when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not h. Grantors of Permits Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. i. Vendors which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D organization is an insured only with respect to liability for "bodily injury," "property damage" "personal and advertising injury" c person's or organization's status as an additional insured under this endorsement ends apply to any "occurrence" which takes place after the equipment lease expires. -Only with respect to "bodily injury" or "property damage" arising out of "your products" PI-GLD-HS (10/11) Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for "bodily injury," "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations l. Owners, Lessees or Contractors Any person or organization, 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 when required by a contract. 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: (a) 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 (b) 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. DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D PI-GLD-HS (10/11) Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company m. State or Political Subdivisions Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or (b) "Bodily injury" or "property damage" included within the "products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer of Rights of DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D applies only when the "occurrence" or offense is known to: will not be considered breached unless the breach occurs after such claim or "suit" PI-GLD-HS (10/11) Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. Therefore, the i ecovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury Mental Anguish SECTION V DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: njury means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. R. Personal and Advertising Injury Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of amended as follows: 1. SECTION V DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of, or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D nsured can waive the insurer's rights of r "Bodily i "personal and advertising injury" is PI-GLD-HS (10/11) Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. DocuSign Envelope ID: BB708200-B4C8-47E7-88C2-2BEB9A0DAC8D