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Chris R. Sperbeck Inc; 2024-09-30; PWM25-3505FAC
Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 September30th PWM 25-3505 FAC CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT FIRE STATION NO. 4 ROLL UP DOOR REPLACEMENT This contract is made on the ______ day of ----------~ 2024 ("Contract"), by the City of Carlsbad, California, a municipal corporation ("City") and Chris R. Sperbeck, Inc., a Cal ifornia corporation d.b.a. Doorworkx, whose principal place of business is 1070 Commerce Street, Suite A, San Marcos, California 92078 ("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 complet e the Project in accordance with directions and subject to inspection approval and acceptance by Daniel Smith (City Project Manager). PAYM ENT. The City shall withhold retention as required by Public Contract Code Section 9203. PREVAILING W AGE RATES. Any construction, alteration, demolition, repair, and maintenance work, including work performed during design and preconstruction such as inspection and land surveying work, cumulatively exceeding $1,000 and performed under this Contract constitute "public works" under California Labor Code Section 1720 et seq., and are subject to state prevailing wage laws. 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 the Sections 1770, 1773 and 1773.1 of the California Labor Code. Consistent with the requirement of Section 1773.2 of the California Labor code, a current copy of applicable wage rates may be obtained via the internet at: www.dir.ca.gov/dlsr/. Contractor shall not pay less than the said specified prevailing rates of wages to all such workers employed by him or her in the execution of the Contract. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which requires keeping accurate payroll records, verifying and Fire Station No. 4 Roll Up Door Replacement Page 1 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Labor Code Section 1776. DIR REG ISTRATION. California Labor Code Section 1725.5 requires the Contractor and any subcontractor or subconsultant performing any public work under this Contract to be currently registered with the California Department of Industrial Relations ('DIR'), as specified in Labor Code Section 1725.5. Labor Code Section 1771.1 provides that a contractor or subcontractor/subconsultant shall not be qualified to engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Labor Code section 1725.5. Prior to the performance of public work by any subcontractor or subconsultant under this Contract, Contractor must furnish the City wit h the subcontractor or subconsultant's current DIR registration number. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATION. Contractor's vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. CALIFORNIA AIR RESOURCES BOARD (CARB) IN-USE OFF-ROAD DIESEL FUELED FLEETS REGULATION. Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. More information about the requirements and Contractor's required certification is provided in Exhibit D. CONSTRUCTION MANAGEMENT SOFTWARE. Procore Project Management and Collaboration System. This project may utilize the Owner's Procore (www.procore.com) online project management and document control platform. The intent of utilizing Procore is to reduce cost and schedule risk, improve quality and safety, and maintain a healthy team dynamic by improving information flow, reducing non- productive activities, reducing rework and decreasing turnaround times. The Contractor is required to create a free web-based Procore user account(s) and utilize web-based training/ tutorials (as needed) to become familiar with the system. Unless the Engineer approves otherwise, the Contractor shall process all project documents through Procore because this platform will be used to submit, track, distribute and collaborate on project. If unfamiliar or not otherwise trained with Procore, Contractor and applicable team members shall complete a free training certification course located at http://learn.procore.com/procore-certification-subcontractor. The Contractor is responsible for attaining their own Procore support, as needed, either through the on line training or reaching out to the Procore support team. It will be the responsibility of the Contractor to regularly check Proco re and review updated documents as they are added. There will be no cost to the Contractor for use of Procore. It is recommended that the Contractor provide mobile access for Windows, iOS located at https://apps.apple.com/us/app/procore-construction-management/id374930542 or Android devices located at https://play.google.com/store/apps/details?id=com.procore.activities with the Procore App installed to at least one on-site individual to provide real-time access to current posted drawings, specifications, RFls, submittals, schedules, change orders, project documents, as well as any deficient observations or punch list items. Providing mobile access will improve communication, efficiency, and productivity for all parties. The use of Procore for project management does not relieve the contractor of any other requirements as may be specified in the contract documents. Fire Station No. 4 Roll Up Door Replacement Page 2 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC 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 Contract 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 is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: cc Print Name: Chris R. Sperbeck 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 written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. Property damage insurance in an amount of not less than ........ $2,000,000 Automobile Liability Insurance in the amount of $2,000,000 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 in.surance 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. Fire Station No. 4 Roll Up Door Replacement Page 3 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC 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. Contractor agrees to defend (with counsel approved by the City), indemnify, and hold harmless the City and its officers, elected and appointed officials, employees and volunteers from and against 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. THIRD PARTY RIGHTS. Nothing in this Agreement should be construed to give any rights or benefits to any party other than the City and Contractor. JURISDICTION AND VENUE. This Agreement shall be interpreted in accordance with the laws of the State of California. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Contract is San Diego County, California. Start Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within thirty (30) working days after receipt of Notice to Proceed. Fire Station No. 4 Roll Up Door Replacement Page 4 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 CONTRACTOR'S INFORMATION. Chris R. Sperbeck, Inc. d.b.a. Doorworkx (name of Contractor) 783544 (Contractor's license number) C-61/D-28 5/31/2026 (license class. and exp. date) 1000041522 6/30/2027 (DIR registration number/exp. date) PWM25-3 505FAC 1070 Commerce Street, Suite A (street address) San Marcos, CA 92078 (city/state/zip) 760-510-1043 (telephone no.) doorsfixed@yahoo.com (e-mail address) AUTHORITY. The individuals executing this Contract 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 Contract. [signatures on following page] Fire Station No. 4 Roll Up Door Replacement Page 5 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 CONTRACTOR CHRIS R. SPERBECK, INC., a California corporation d.b.a. Doorworkx By: By: c::::::s=:: ?: s (sign here) Chris R. Sperbeck, President and Chief Financial Officer (print name, title) c::::?5 (sign here) PWM25-3505FAC CITY OF CARLSBAD, a municipal corporation of the State of California By: Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager ATTEST: SHERRY FREISINGER, City Clerk , By: c 1-1~J f r>GJe.~ertf lh1~ __ J_~--~-~-~--___ _ (print name, title) Deputy City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. ~ corporation, Contract 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 Sec re ta ry, 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 Assistant City Attorney Fire Station No. 4 Roll Up Door Replacement Page 6 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC 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 Business Name and Address DIR Registration No. to be Subcontracted Total% Subcontracted: ,d7 c & Expiration Date License No., Classification & Expiration Date The Contractor must perform no less than 50% of the work with its own forces. %of Total Contract Fire Station No. 4 Roll Up Door Replacement Page 7 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC EXHIBIT B Fire Station No. 4 Roll Up Door Replacement Contractor to provide all tools, materials, and labor to replace the rolling steel door at the Northeast entrance to the apparatus bay of Carlsbad Fire Station 4, 6885 Batiquitos Lane, Carlsbad, California 92011. All work and materials to be in accordance with Contractor's proposal dated August 19, 2024, and attached to this agreement as Exhibit E. Replacement door to be as specified in Exhibit F. City jobsite to be maintained in a clean and orderly manner so as to minimze the impact on fire station operations. JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LS 1 Replace damaged apparatus bay door $33,661.22 2 LS 1 Labor & Material Bond $505.00 TOTAL* $34,166.22 *Includes taxes, fees, expenses and all other costs. Fire Station No. 4 Roll Up Door Replacement Page 8 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505 FAC EXHIBITC Bond# 67198477 LABOR AND MATERIALS BOND WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Chris R. Sperbeck, Inc. d.b.a. Doorworkx (hereinafter designated as the "Principal"), a Contract for: FIRE STATION NO. 4 ROLL UP DOOR REPLACEMENT 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, CHRIS R. SPERBECK, INC. d.b.a Doorworkx, as Principal, (hereinafter designated as the "Contractor"), and WESTERN SURETY COMPANY as Surety, are held firmly bound unto the City of Carlsbad in the sum of thirty-three thousand six hundred sixty-one dollars and twenty-two cents ($33,661.22), 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 t he contract or to the work or to the specifications. 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. Fire Station No. 4 Roll Up Door Replacement Page 9 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC This labor and materials bond may be approved as to form by the City Attorney for the City in counterpart, and the counterparts shall all constitute a single, original instrument. SIGNED AND SEALED, this _1_9_th __ day of __ s_e_pt_em_be_r ________ , 2024. C//rt' o J/t;-/Z',d.src4' (SEAL) wEsTERN suRETY coMPANY (SEAL) (Principal) (Surety) By: c-By: __ ~...;._ ____ ----_·· _c_-._s_e_n_dt_,_A_ss't Sec. {Signature} {Signature} (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY -ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON City Attorney By: Assistant City Attorney Fire Station No. 4 Roll Up Door Replacement Page 10 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 Western Surety Company POWER OF ATTORNEY -CERTIFIED COPY Bond No. 671984 77 Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents malce, constitute and appoint ~C~. ~B~e~n=d~t~---------------------------------- its true and lawful attorney(s)-in-fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its behalf as Surety, bonds for: Principal: Chris R Sperbeck Inc dba Doorworkx Obligee: City of Carlsbad Amount: $1,000,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Vice President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in- fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise electronic-formatted corporate seal under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 27th day of April, 2022: "RESOLVED: That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confirm the use of a digital or otherwise electronic-formatted corporate seal, each to be considered the act and deed of the Company." ~~~~~------is not issued on or before midnight of October 9th, 2 02 4 , all _ ,ijJ]. this Power of Attorney shall expire and terminate. -•-L•P°"~:~;?,• .:::~Witn f~~Western Surety Company has caused these presents to be signed by its Vice President, Larry Kasten, and its cqro~e.,!>.~~/lt;i;affi~.d_'~is 19th day of September 2 02 4 lf(J,;~···· •• ···i,~·-Yil t~\. t~ .~:-:t~ ~~.:-./ i:~I S'Il ;·:F-;~~1&::~~A .f{ ss ·F~'NEHAHA ~~·-i ~·J;: .-: ; : -~~•~.>~_•J- On this 19th day of September , in the year 2024 , before me, a notary public, personally appeared Larry Kasten, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act a deed of said corporation. +1 .... ~S 1 E~L 1 ~~~~Y~!%~~,c~S~E 1 .·A 11 L""l ~ .., Notary Public -South Dalrnta SOUTH DAKOTA My Commission Expires February 12, 2027 t111h#,aJJ'-.i'•»d',t~,,i,c.,o,,•e~.,,,c,'lt1,C:'1»'W'w■¥• I f h S f S tl D I d h b if h h t e un ersigned officer of Western Surety Company, a stoc c corporation o t e tate o ou 1 a rnta, o ere y cert' y t at t e attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof, I have hereunto set my hand and seal of Western Surety Company this _____ 1_9_t_h _____ day of September 2024 WESTERN a To validate bond authenticity, go to www.cnasurety.com > Owuer/Obligee Services > Validate Bond Coverage. Form F5306-5-2023 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 STATE OF SOUTH DAKOTA .f COUNTY OF JvTINNEHAHA J ss ACKNOWLEDGlVIENTOFSURETY (Corporate Officer) On this __ 1_9_t_h __ day of ____ S_e~p~t_e_mb __ e_r ________ _ __2_0_2_4 __ , before me, a Notary Public in and for said County, personally appeared C . Bendt, Assistant Secretary personally known to me, who being by me duly sworn, did say that he/she is the aforesaid officer of WESTERN SURETY COMP ANY, a corporation duly organized and existing under the laws of the State of South Dakota, that the seal affixed to the foregoing instrument is the corporate seal of said corporation, that the said instrument was signed, sealed and executed on behalf of said corporation by authority of its Board of Directors, and further acknowledge that the said instrument and the execution thereof to be the voluntary act and deed of said corporation. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal the day and year last above written. My commission expires: + ........................ ., ........................ + f J. GORDON j §~NOTARY PUBLIC~$ .r~SOUTH DAKOTA s I S + .............................................. + My Commission Expires May 27, 2029 Form F11692-11-2020 Cj.~ Notary Public Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC EXHIBIT D In-Use Off-Road Diesel-Fueled Fleet Regulation Requirements CARB implemented amendments to the In-Use Off-Road Diesel Fueled Fleets Regulations that apply broadly to all self-propelled off-road diesel ve.hicles 25 horsepower or greater and other forms of equipment used in California. More information about the requirements can be found at https://ww2.arb.ca.gov/our-work/programs/use-road-diesel-fueled-fleets-regulation Contractors are required to comply with the requirements of the In-Use Off-Road Diesel-Fueled Fleet regulations, including, without limitation, compliance with Title 13 of the California Code of Regulations section 2449 et seq. throughout the term of the Project. The City is a "Public Works Awarding Body," as that term is defined under Title 13 California Code of Regulations Section 2449(c)(46). Accordingly, the Contractor must submit, with their pre-award contract documents, valid Certificates of Reported Compliance (CRC) for the Contractor's fleet, and for the fleets of any listed subcontractors (including any applicable leased equipment or vehicles). Failure to provide a valid CRC, will limit the city's ability to proceed with awarding this Contract. Contractor has an on-going obligation for term of this Agreement to provide copies of Contractor's, as well as all listed subcontractors, most recent CRC issued by CARB. Throughout the Project, and for three (3) years thereafter, Contractor shall make available for inspection and copying any and all documents or information associated with Contractor's and subcontractors' fleet including, without limitation, CRC, fuel/refueling records, maintenance records, emissions records, and any other information the Contractor is required to produce, keep or maintain pursuant to the Regulation upon two (2) calendar days' notice from the City. Fire Station No. 4 Roll Up Door Replacement Page 11 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC EXHIBIT D (CONT.) IN-USE OFF-ROAD DIESEL-FUELED FLEET REGULATION CERTIFICATION Contractor hereby acknowledges that they have reviewed the CAR B's policies, rules and regulations and are familiar with the requirements of In-Use Off-Road Diesel-Fueled Fleet Regulation. Contractor hereby certifies, subject to the penalty of perjury, that the option checked below relating to the Contractor's fleet, and/or that of their subcontractor(s) ("Fleet") is true and correct: □ The Fleet is subject to the requirements of the Regulation, and the appropriate Certificate(s) of Reported Compliance have been attached hereto. □ The Fleet is exempt from the Regulation under Section 2449.1(f)(2), and a signed description of the subject vehicles, and reasoning for exemption has been attached hereto. □ Contractor and/or their subcontractor is unable to procure R99 or R100 renewable diesel fuel as defined in the Regulation pursuant to Section 2449.1(f)(3). Contractor shall keep detailed records describing the normal refueling methods, their attempts to procure renewable diesel fuel and proof that shows they were not able to procure renewable diesel (i.e., third party correspondence or vendor bids). □ The Fleet is exempt from the requirements of the Regulation pursuant to Section 2449(i)(4) because this Project has been deemed an "emergency", as that term is defined in Section 2449(c)(18). Contractor shall only operate the exempted vehicles in the emergency situation and records of the exempted vehicles must be maintained, pursuant to Section 2449(i)(4). ~ The Fleet does not fall under the Regulation or are otherwise exempt and a detailed reasoning is attached to this certification. Name of Contractor: Chris R. Sperbeck, Inc. d.b.a. Doorworkx ~c--=~~::~. ~~~--Signature: _c_ z ~ Name: Chris R. Sperbeck Title: President Fire Station No. 4 Roll Up Door Replacement Page 12 City Attorney Approved 6/5/24 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 DOORWORKX 1070 C:OM:tvIERC:E ST, SUITE A SAN MARCOS, CA 92078 760-510-1043 DOORSFIXED@YAHOO.CO:M Nm:ne I Address City of Cciilibad .ATIR Acc<iunt. Paya.bl" !635 F;u;aday An C:rrhbad, CA 9200S Description EXHIBIT E Ship To FIRE STSTAION #4 6SS5 BATIQli1TOS DR CARI.SBAD,CA920l1 T!:lE FOLLOWING PRICING IS IO B.4. \iE.DOOR',VORKX PERFORM THE FOLLOWING- REMOVE E·ITSTING !'.!' X 11'6" WORN OUT C'OII.JNG DOOR SYST.E}sl PREP OPE.l\lING FORJN:,,'TAllATIO~,, Of THE FOllOWING- lE4. COOKSON MODEL EPD300 DOOR SYSTEM G~Y OR T,L~ IN COLOR (CFSTOMER CHOJCE) FOR SAFETY" DOOR. wornn HA V:E IEA \\.'IRELESS SAFETY EDGE AND 1E4.LIGHT CURTllIN DOOR S'{STEM COMES V.'ITH i,VALL MOD!'ITED COMPUIBR. THAT WOuTI)NffD 230V !PH OR. 3FH POWl:lU .... 4...'1 TO ITS LOCATION (BY OTHERS) EXISTrnG RECEIVER FOR E.X!STING RBIOTI:S WOUID BE REINSTJlll.ED INTO NE\V co:i,rIROllER, RAN A,"ID TESTED TOTAL INCLUDING ALL L4BOR O'REVAILING WAG];) MATERIALli.i"ID TA,'IBS- Total Signature Fire Station No. 4 Roll Up Door Replacement Page 13 Date Sfl9!'2024 Terms Net 15 Tola! PWM25-3505FAC Estimate# 2J.12760 Project 33,661.22 505_00 :534)66.22 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC EXHIBIT F INTELLIGENT OPERATION AND HIGH CYCLE LIFE The easy-to-install 300 Series Dooroffers 300,000 cycles of maintenance-free performance -rriaxim!zlnguptJme and lmprovrng productlvlty wl1erever It's lnstalled .. Slnce springs are the most frequent point of failure forhlgh- cycle products, this door features a rugged sprlngless deslgn. It Is fdeal forappllcatlons that do not need a m!Uion cycle door, but do requlrecontinuous upt1me. Need more than 300,000 cycles, butiess th an a mHUon? Ttl1s door can be upgraded to offer soo,ooo qrcles with a 3 year wananty. An lntelllgent control panel featuring plug and play wiring makes Installing and servicing the 300 Serf es Door ea.s,ler than ever before. The LCD screen communicates door stat.is messages, provides easy-to-follow Instructions for door commissioning, and etectmnfcauy sets door lfmlts. 800 .2S\4.4.3'5il I coolrn.Qlldoor.com C.r.-.~IIC.wko;en, ll.C i1;,,nJSO ~£f.ll:lDE r~;;i~r!':'d r.mr•p::i;!J ~ ~~Xl~ Yes, faster doors mean reduced air exchange, but tlm300 s erles Door go es further to lm prove energy efficiency. The Insulated model features the patented Therm Iser Max"' perimeter seairngsystem -whlch meetsASHRAE"' 90.12, 201s IECC" and Ca llfomla's Title 24 alr lnflltratlon requirements with an fndependentlytested value of less rhan 0.3 CFM/FT2. The compact operator features a variable-frequency drlve thatensures a soft start and stop -reduclngwearand tear on both the door and the operator. The 300 Serles Door operates at speeds of up to 24 Inches per second. fn addltfon, the operator's direct drlve design means there's no sprocket and chain to wear or replace. With flexlblUty In mfnd, the 30oseries grlUe is compatible wlth a 120v se rvfce (requl res transformer, provlded with upgrade). E:XTAEME EiERIE6 Fire Station No. 4 Roll Up Door Replacement Page 14 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 PWM25-3505FAC EXHIBIT F {cont.) HiGH PERFOmVU,\NCf:. LINE EXTREME-t• 300 SERIES DOOR Models EPD300& EPI 300 (insulated} STANDARD COMPONENT MATERIALS AND FINISHES . ··" i"k}(tL -Galvanlzl:,d stl:!el with powd2r coat finish to match curtaln. En doses the curtain and provfdesweatherreslstance atthe head of the door. OPERATlON ANO STRUCTURAL REQlJlREMENTS r.tot01' operation r~qulred. Th1s prodLKt ls supported by a gulde assembly atra ched. to the jamb construction, No additional header support is required unless hood supports are mandated by a larger opening width, ► Statk up to 50 PSF design wind-load ► Opllratlonal up to 10 PSF maximum wind-load OPnONAt MATERIALS AND .FINISHES ► S.tainles, Stl!!ll -3.00 series in #4 finish ► CydeShield" Powder Coating is avaJlable in more than 180 colors in addition to the standard Gray, Tan andWhlte-also aw,//ab/ein C}deShield Ultra 2-00,2.''.!4.4353 I cooksohdoor.com Fire Station No. 4 Roll Up Door Replacement i'f'ft/H,t/E i'l·i!'JT -Stoot Design reduces maintenance requirements and focititates cycle capacity. fT!\C,\TS f CD! i. i:O,( i>l 5% M,~L ,· -Smet plate bra.ck.its with powd2r coat Hnlsh to match guides. ili{i;'i"Wl -Co,rnpact, direct d~l11e operator with no rolterchalns or sprockets. !:uHt'?\i\l -G.alvanized steel wfth rust lnhlbltlng CydeShield'" powder coat standard finish In Gray; fan orWhfte. lnterlockrng roll-formed slats wrth end locks riveted to ends of attilmate .slats to maintain slat alignment and preventv1ear.. MODELEPf.300 -Features an lnsulatecl curtain. <iifH,f:"', -Steel ,mg!eos with powder coatfinlsh to match curtaln, Self- !ubricating UHMW ant1-wear strips greatly reduce frict1on and curtaln wear, Perimeter-sealing, double brush vteather strip. 1:cn Lli!;' w,i\i't -Two back to back structural steel angles wlth powdH coat finish to match curtaln, Bottom bar flag tnduded for blanking and c.ommlsslonlngac.c.uracy. UNIQUE FEATURES Ii., iil'.ahn<Yr tOMti,UPJ; U\'f!Ol-! -The Apex"' Sma rteontroller ( t~ EMMX) featurespfug and ptayc.onnectlonsto 0P9ratorand standard sensors to reduce instaUatlon time. Its LCD screen provides stepJby-step lnstructfons for door commissioning, e:lectronlc. llmftsettfng, and status/error messaglng, :.\,J,·.mrmn; i'R•JTFCf!t)i\l, q;m /ff mmi ;;pgrns -The factory-mounted UL 325-201.0 (NEMA4X) compliant photo eye sensors allow for momentary contact operation -mefulln parking garages and otherhJgh"use openings. Jnterrupt1on of the photo r,ye beam before the doorfulty doses cau&es the door to immediately halt downward travel and reverse direction to return to the fully open posftlon. .c,i\1,c l'J(,AtU> UC+ff CIJHfh!t; l li(i'HctJt(H,.\ -The 6' tallllghtcurtafn ls installed within the guide and blends lnto the guide construction without a piece of slotted trlm, If the gritlel.s cycllngand an obJectpa,sse.s through the curtain beams, the doorwill lmmedla!Ely halt downward travel and reverse direction to return to the o.pen posrtlon. l :>.f;'i o::;ViPJ\l'iL!H.IT'!' -Compatible wlth 12OV fnputby addi,ng our transformernptlon. Thetransformermustb2mounted to the waU a.nd ls B 1/2'' wide by 16 '/•" high. CUSTOM-DESIGNED SOUJTJONS Contact our expertencEd Archftectur.rl Deslgn Support Team for help lo customizing our products tom your speclflc apptrcat!on. ® www.archltectdoorhelp.tom COOKSON Page 15 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) � 06/27/24 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ROBERT NAME: BOB WILEY INSURANCE AGENCY INC rA��N,_t c_,_ (760)735-9890 I FAX IA/C Nol: (760)735-2460 PO Box966 E-MAIL rrw5620@aol.com ADDRESS: Escondido. CA 92033-0966 NAIC# License #:0626539 INSURER/SI AFFORDING COVERAGE INSURER A: United National Insurance Company 13064 INSURED INSURERB: Scottsdale Insurance Company 41297 INSURERC: SIRIUS AMERICA INS CO 38776 INSURERD: Chris R. Sperbeck INC. DBA: DoorworkX 1070 COMMERCE STREET. SUITE A SAN MARCOS. CA 92078 INSURERE: 760 �10-10.:t.1 * C.A Q?07R INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A B C TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY � □ CLAIMS-MADE [Z] OCCUR � � GEN'L AGGREGATE LIMIT APPLIES PER: Fl [Z] PRO-POLICY JECT OTHER: AUTOMOBILE LIABILITY � ANY AUTO DLoc � OWNED � SCHEDULED � AUTOS ONLY � AUTOS HIRED NON-OWNED � AUTOS ONLY � AUTOS ONLY UMBRELLA LIAB �OCCUR X EXCESS LIAB CLAIMS-MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS" LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ADDL SUBR POLICYEFF POLICY EXP '"'"" lw\/n POLICY NUMBER IMM/DDNYYYI IMM/DDNYYYI CSC0000908 06/27/24 06/27/25 CXS4028171 06/27/24 06/27/25 N/A WC23528 04 12/01/23 12/01/24 LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES /Ea occurrencel $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS • COMP/OP AGG $ $ COMBINED SINGLE LIMIT $ /Ea accident\ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ /Per accident) $ EACH OCCURRENCE $ AGGREGATE $ $ XI �-\%uTE I I OTH-ER E.L. EACH ACCIDENT $ E.L. DISEASE· EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 1.000.000 100.000 5.000 1.000.000 2.000.000 2.000.000 5.000.000 1.000.000 1.000.000 1 000 000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Carlsbad / CMWDc/o EXIGIS Insurance Compliance ServicesP.O. Box 947Murrieta, CA 92564 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD City of Carlsbad/CMWD IS NAMED AS ADDITIONAL INSURED AS RESPECTS TO THE ABOVE CAPTIONEDPOLICY. PRIMARY AND NON CONTRIBUTORY WORDING IS INCLUDED- WAIVER OF SUBROGATION30 DAYS NOTICE OF CANCELLATION. Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 ,__ ________________ _ Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 POLICY NUMBER: CSC0000908 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and wil l not seek contribution from any other insurance available to an additional insured under your policy provided that: (I) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 □ Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 POLICY NUMBER: CSC0000908 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDI TIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization to whom the Named Insured Where specified by fully executed written contract. has agreed by a fully executed written contract that such person or organization be added as an Additional Insured , but only with respect to operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused , in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded lo such additional insured will not be broader than that wh ich you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 © Insurance Services Office , Inc., 201 2 Page 1 of 2 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 POLICY NUMBER: CSC0000908 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; wh ichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 POLICY NUMBER: CSC0000908 COMMERCIAL GENERAL LIABILITY CG20370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization to whom the Named Where specified by fully executed written contract. Insured has agreed by a fully executed written contract that such person or organization be added as an Additional Insured for Completed Operations Coverage, but only with respect to operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 (at 12:01 A.M . standard time at the address of the Named Insured as showing in the Declarations) forms a part of Policy No: CSC0000908 Issued to: Chris R Sperbeck Inc dba DoorworkX By: United National Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to SECTION IV-CONDITIONS, Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" and included in the "products completed operations hazard" provided you have agreed to do so in writing in a contract or agreement with that person or organization. All other terms and conditions of the policy apply. EPA-1719 (01/2014) Includes copyrighted material of ISO Commercial Risk Services, Page 1 of 1 Inc. with its permission. Copyright, ISO Commercial Risk Services, Inc. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12-01-23 Policy No. WC23528 Endorsement No. Insured Chris R. Sperbeck Inc.Premium $ Incl. Insurance Company SiriusPoint America Insurance Company Countersigned By 1998 by the Workers’ Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB’s California Workers’ Compensation Insurance Forms Manual 1999. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0% of the California workers’ compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION Any person or organization as Required by written contract within states covered under this policy. Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 Docusign Envelope ID: 85642E2F-5280-49C0-AAC5-B602B6126AE5 1.. ' CALJFORN IA ' 1 DEPARTMENT OF INSURANCE I I I I I I