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Cyber Professional Solutions Corp; 2017-11-27; PWM18-59TRAN
RECORDED REQUESTED BY CITY OF CARLSBAD AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 DOC# 2018-0108032 111111111111 lllll 1111111111111111111111111111111111111111111111111111I Mar 19, 2018 04:55 PM OFFICIAL RECORDS Ernest J. Dronenburg Jr SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins: $0.00) PAGES: 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 215-050-70-00 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on Dec. 21, 2017. 6. The name of the contractor for such work or improvement is Cyber Professional Solutions Corp. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Project No. 4030 (PWM18-59TRAN), Dove Library Fireplace Screen and Seating Repair. 8. The street address of said property is 1775 Dove Ln., in the City of Carlsbad. VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Carlsbad, nr Carlsbad Village Drive, Carlsbad, California, 92008; the City/Executive Manager of said City on 7:J' ,:· ,,c b 4? , 2ofl_, accepted the above described work as completed and ordered that a Notice of Completion be filed. · I declare under penalty of perjury that the foregoing is true and correct. Executed on'l))c,/u,' h )< , 20 (';i, at Carlsbad, California. Q:\Public Works\PW Common\CAPITAL-ACTIVE\4030 Dove Library Additional Fireplace Seating\NOC.doc qg CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Cyber Professional Solutions Corp. has completed the contract work required for Project No. 4030 (PWM18-59TRAN), Dove Library Fireplace Screen and Seating Repair. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS (Specify if City or CMWD) Fireplace screen & seating repair (city) VALUE $26,266 CERTIFICATION OF COMPLETION OF IMPROVEMENTS E~ CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk is hereby authorized to record the Notice of Completion and release the bonds in accordance with State Law and City Ordinances. The City of Carlsbad is hereby directed to commence maintaining the above described improvements. ~ Ke 1'1)--, APPROVED AS TO FORM: CELIA BREWER, City Attorney By:_~_a_~_-· _..........___ Deputy City Attorney Q:\Public Works\PW Common\CAPITAL-ACTIVE\4030 Dove Library Additional Fireplace Seating\APl.doc Tracking#: PWM18-59TRAN CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT DOVE LIBRARY FIREPLACE SCREEN AND SEATING REPAIR; CONT. NO. 4030 This agreement is made on the r:97 -f:h-day of -, 2017, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Cyber Professional Solutions Corp., a California corporation, whose principal place of business is 3441 Main Street, Suite 104, Chula Vista, CA 91911 (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor's proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Steve Didier City Project Manager WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT. NO. 4030 Page 1 of 8 City Attorney Approved 9/27/2016 Tracking#: PWM18-59TRAN 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 subc or from · g in contract bidding. Signature: Print Name: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than ........ $1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ....... $1,000,000 Property damage insurance in an amount of not less than ........ $1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT NO. 4030 Page 2 of 8 City Attorney Approved 9/27/2016 Tracking#: PWM18-59TRAN INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys' fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed. Completion: to Proceed. Contractor agrees to complete work within thirty (30) working days after receipt of Notice CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Cyber Professional Solutions Corp (name of Contractor) 771115 (Contractor's license number) C-7, C33, B (5/31/18) (license class. and exp. date) 1000008478 (DIR registration number) 6/30/2018 (DIR registration exp. date) DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT NO. 4030 Page 3 of 8 3441 Main Street, Suite 104, (street address) Chula Vista, CA 91911 (city/state/zip) 619-498-4819 (telephone no.) N/A (fax no.) joaquin@cyberpsc.com (e-mail address) City Attorney Approved 9/27/2016 Tracking#: PWM18-59TRAN 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 By~ ~ Joaquin Campos/ President / Cfi:> (print name/title) ~ Joaquin Campos/ President ( C fO (print name/title) CITY OF CARLSBAD, a municipal corporation of the State~ oC~-lifornia_ By. n_ &// ~1~- Elaine Lukey/P c:Works Director as authorized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f.E. corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: CL!e~ Deputy City Attorney DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT NO. 4030 Page 4 of 8 City Attorney Approved 9/27/2016 Tracking#: PWM18-59TRAN 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 Portion of Project to Business Name and Address DIR Registration License No., % of be Subcontracted No. Classification & Total Expiration Date Contract Sheet Metal Dave Whipple Sheet Metal, Inc 10000 02501 736812 C-43 Exp 6/30/19 35% Total% Subcontracted: ~3~5~o/c~o ___ _ The Contractor must perform no less than fifty percent (50%) of the work with its own forces. DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT. NO. 4030 Page 5 of 8 City Attorney Approved 9/27/2016 ITEM UNIT QTY NO. 1. LS 1 EXHIBIT B JOB QUOTATION DESCRIPTION General Conditions: Mobilization/Demobilization Tracking#: PWM18-59TRAN PRICE $4,932.80 2. LS 1 New IPE Wood Seating and surround per attached $7,241.92 plans 3. LS 1 New stainless steel fireplace screen and other metal $9,292.00 fabrications per attached plans 4. LS 1 Taxes, bonding and insurance, markup *Includes taxes, fees, expenses and all other costs. DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT. NO. 4030 Page 6 of 8 $2,519.48 TOTAL* $26,266.20 City Attorney Approved 9/27/2016 9'-10" 2'-9" 2'-12" PLUGGED FASTENER LOCATIONS, ALIGNED WITH IPE BENCH FASTENERS & 4" FROM EACH END, TYP. ~----<PE BENCH 50'-8" V.I.F. E) RETAINING WALL ~-----<E) CHIMNEY ------STONE SURFACE E) IPE WOOD BENCH 5'-8 314" 9'-10" @ :c'.:EN 1/2" = 1' -O" GROUP 4 ARCHITECTURE RESEARCH + PLANNING, INC 211 LINDEN AVENUE SO. SAN FRANCISCO CA94080USA 650 871 0709 CARLSBAD DOVE LIBRARY FIREPLACE+ COURTYARD RENOVATIONS 1775 DOVE LANE CARLSBAD, CA 92011 PROJECT ARCHITECT CA REG. LICENSE# PROJECT PROJECT# FILE· FILE# ISSUE DATE BID 12/0212016 t PLAN CHECK REV. 03/2812016 BID ADDENDUM 03/2812016 UPDA.TED 05/30/2017 SHEET TITLE AND NO. SKA-1 ---(E) METAL ANGLE ,---------+'ERFORA TED METAL SCREEN SEE 1/SKA-3 2" x 1 t SEALED IPE TRIM, CONFORMED TO RADIUS SHOWN, TYP. ATTACH IPE TRIM TO CONC. WITH CONC. SCREWS AS SHOWN ON PLAN. PLUG FASTENER HOLES WITH IPE CAPS, TYP. ALIGN OUTSIDE FACE OF IPE WITH INSIDE FACE OF ADJACENT PLANTER, V.I.F. SEE PLAN ------ADHERE IPE FURRING TO CONC, TYP. ----,OOSE LAID STONE BY OWNER ----1PE WOOD BOARDS, SEALED ------1PE FURRING, SEALED SCREW BOARDS TO IPE WOOD FURRING FROM BELOW (E) CONCRETE CAP FIREPLACE -STONE SET DETAIL SCALE: 3" = 1' -O" ~-----a OOSE LAID STONE IPE SLAT, SEALED IPE FURRING, SEALED WITIH IPE OIL, TYP. FIREPLACE -STONE SET DETAIL SCALE: 3" = 1' -0" ····111 6" .f, .. SPACE CONCRETE SCREWS EVENLY, MAX 24" O.C., ~4" FROM EDGES OF SEAT PANELS I I •••• IPE WOOD BOARDS, SEALED WITH IPE OIL, TYP. SCREW BOARDS TO IPE WOOD FURRING FROM BELOW, USE S.S. COUNTERSUNK IPE FURRING, SEALED I 'ix, WITH IPE OIL, TYP. ROUNDED BENCH EDGE,¾" RADIUS .=.K'J z C) __J <( (E) CAST IN PLACE CONG. SPANDREL FIREPLACE-IPE WOOD BOARD DETAIL SCALE: 3" = 1' -O" IPE WOOD BOARDS, SEALED WITH IPE OIL, TYP. SCREW BOARDS TO IPE FURRING FROM BELOW; USE S.S., COUNTERSUNK -----<PE FURRING, SEALED WITH IPE OIL, TYP. (E) CAST IN PLACE CONCRETE SPANDREL ..C,N ~--CONCRETE SCREW MIN. 1" EMBED. (4) SCREWS MIN. PER SECTION FIREPLACE-BENCH DETAIL SCALE· 3" = 1' -O" G R O U P 4 ARCHITECTURE RESEARCH + PLANNING, INC 211 LINDEN AVENUE SO. SAN FRANCISCO CA94080USA 650 871 0709 CARLSBAD DOVE LIBRARY FIREPLACE+ COURTYARD RENOVATIONS 1775 DOVE LANE CARLSBAD, CA 92011 PROJECT t..RCHITECT CA REG LICENSE# PROJECT: PROJECT# FILE FILE# ISSUE DATE BID 12/02/2016 t PLAN CHECK REV 03/28/2016 BID ADDENDUM 03/28/2076 UPDATED 05/3012017 SHEET TITLE AND NO. SKA-2 ~----CONCRETE SCREWS@12" O.C. MAX, 4" FROM EDGE, PAINTED WHERE VISIBLE, MIN 1" EMBED fef' THICK CONTINUOUS STEEL ANGLE W/ THREADED HOLES FOR -------c=::;J;l;.~-~/:::::~;;;;;,Et("""'----;a,.~ FASTENERS, PAINTED ~ COUNTERSINK & PAINT FASTENERS, 24" O.C. TYP., 4" FROM EDGES. GAS BURNER & FIRE ROCK Lt') 1111 -i" THICK REMOVABLE TRIM, PAINTED, CONTINUOUS ALONG LENGTH OF PERFORATED METAL ~----f;" THICK PERFORATED S.S. / / SCREEN W/ 3/8" HOLES ON fa" CENTERS, STAGGERED PATTERN, 40% OPEN AREA i'° THICK CONT. S.S. CHANNEL FASTEN W/ CONCRETE SCREWS AS REQ'D, MIN. 1" EMBED @ FIREPLACE -PERFORATED METAL SCREEN DETAIL -----------SC ALE: 6" = 1' -O" GROUP 4 ARCHITECTURE RESEARCH + PLANNING, INC 21 l LINDEN AVENUE SO. SAN FRANCISCO CA94080USA 650 871 0709 CARLSBAD DOVE LIBRARY FIREPLACE+ COURTYARD RENOVATIONS 1775 DOVE LANE CARLSBAD, CA 92011 PROJECT ARCHITECT CA REG. LICENSE# PROJECT: PROJECT# FILE FILE# ISSUE Dt\TE BID 72/02/2016 i PLAN CHECK REV. 03/28/2016 BID ADDENDUM 03/28/2016 UPDATED 05/30/2017 SHEET TITLE AND NO. SKA-3 EXHIBIT C LABOR AND MATERIALS BOND Bond No: 1001084557 Premium: $473.00 Premium Based on Final Contract Amount Tracking #: PWM18-59TRAN WHEREAS, the City of Carlsbad, State of California, has awarded to Cyber Professional Solutions Corp. (hereinafter designated as the "Principal"), a Contract for: DOVE LIBRARY FIREPLACE SCREEN AND SEATING CONTRACT NO. 4030 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 tl;ereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, Cyber Professional Solutions Corp., as Principal, (hereinafter designated as the "Contractor"), and American Contractors Indemnity Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of Twenty Six Thousand Two Hundred Sixty Six Dollars and Twenty Cents ($26,266.20), 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 stipuiates 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 aoes he,eoy 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. DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT. NO. 4030 Page 7 of 8 City Attorney Approved 9/27/2016 Tracking #: PWM18-59TRAN 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. Executed by CONTRACTOR this __ 0..=;. __ day Executed by SURETY this _1 s_t ___ day of _ ___,N~O'-!_£._W\_~_t,_1/ __ ; 20..!1:.._. of November , 20j]_. CONTRACTOR: SURETY: Cyber Professional Solutions Corporation 8~ (sign here) American Contractors Indemnity Company (name of Surety) 801 S Figueroa St, Suite 700 Los Angeles, Ca 90017 (address of Surety) Joaquin Campos (print name here) President / Cft::> (title and organization of signatory) By: (310) 649 9449 (teiephone number of Surety) -;: ; =~4 ~--t!fZ-(signature of Attorney-in-F~ct) By: ______________ _ (sign here) (print name here) (title and organization of signatory) Patricia Zenizo, Attorney-in-Fact (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER City Attorne~ By: ~ Deputy CityAttomey DOVE LIBRARY FIREPLACE SCREEN & SEATING REPAIR; CONT. NO. 4030 Page 8 of 8 City Attorney Approved 9/27/2016 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 5C\.V\ Dl~a ) On V\ 0 V . \3 'lo ,--¥ before me, ______,_,__(}\_V\_~_i---'--'<.,.,_l_. _N-----'-u.'-----"--"'-__ n_____c.o_t_o,._~ --+-'----'-------'-- Date r \ Here Insert Name and Title of the Offic r personally appeared ------~U~O_O\_q--+-u_\_h~~G~o._1/V)~~ ........... o--S~·-------- j Name(s) of Signer(~ who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/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 PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature~~ Signature of Notary Public Place Notary Sea/ Above OPTIONAL-------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: _____________ Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ___________ _ LJ Corporate Officer -Title(s): ______ _ l . Corporate Officer -Title(s): ______ _ Partner -LJ Limited IJ General I I Partner -U Limited r-i General [l Individual Attorney in Fact ! I Individual · Attorney in Fact I J Trustee i i Guardian or Conservator : _; Trustee i I Guardian or Conservator ! 1 Other: ______________ _ !I Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ • ©2014 National Notary Association· www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827} Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 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 Los Angeles On H-\-I'} before me, Angel Nunez, Notary Public Date Here Insert Name and Title of the Officer personally appeared __,P_,a,,_,t"-'ric"'-'i=a_,,Z=e'-'-'n=iz""o ______________________ _ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person($) whose name(~) is/are subscribed to the within instrument and acknowledged to me that We/she/t'fi,Jy executed the same in l)Js/her/tli'e'ir authorized capacity(i11s), and that by 'wf3/her/t;>t,Jr signature(,) on the instrument the person(i:,), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Place Notary Seal Above --------------OPTIONAL-------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document ntle or Type of Document: ____________ Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ___________ _ :-1 Corporate Officer -Title(s): ______ _ n Corporate Officer -Title(s): ______ _ Partner -Limited '.J General [J Partner -[] Limited LJ General : Individual !xJ Attorney in Fact Individual D Attorney in Fact 1 Trustee lJ Guardian or Conservator D Trustee Guardian or Conservator Other: _____________ _ Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ • ©2014 National Notary Association· www.NationalNotary.org • 1-800-US NOTARY {1-800-876-6827) Item #5907 POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company, a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies"), do by these presents make, constitute and appoint: Patricia Zenizo, Elisabete Salazar or Pietro Micciche of Los Angeles California its true and lawful Attorney(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed *****Three Million***** Dollars ($ **3,000,000.00** ). This Power of Attorney shall expire without further action on November 3,2019. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: Be ii Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorncy(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attornev-in-Foct may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages andior final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and scaled and effected by the Corporate Secretary. Be ii Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 1st day of November, 2016. AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY Daniel P. Aguilar, Vice President 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 tmthfulness, accuracy, or validity of that document. State of California County of Los Angeles SS: On this I st day of November, 20 l 6, before me, Sabina Morgenstein, a notary public, personally appeared Daniel P. Aguilar, Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. s;'"""'" 7}= (Seal) I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; furthennore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this I '7f day of Niv1AMf.tf , ??1 f'. ~ Corporate Seals \,\\\\1,1,i1111,"11,, ,,,\\\\\IS'U'",,,,,, ,,,,,,~~1i'~11~,,,1,,, ,,,,11111111111,,,, ~\},,,~~CTDRs4.,,..,,_ ,,'\~S ... f?1::j1.1~ ,,, O C 11,, ~,,<:1-,'1 \f'_surq/);;1\, f~v -~ ft;"' '$;; ~c'.\ //~0l:;'i; tf!:° ·~ -°0 !og:~ty%~_oo IO~~~ 51-l{,~,,:,:',.~l~;,·,~0 0,:,:~,:,.·,~,JJ lt; .. , . ~--~t) lt~~}~'J,;~SJ \~:. ,,~~ -;) Kio Lo, Assistant Secretary 11111•111:;111 11111 '1"11JJt111111''''''' "i,,,,,,t,~1~1~1111111'' 1 /11111111Ht~\\i\1'1111,, ... ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 11/0212017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Valeri Orsini NAME: Fusco & Orsini Insurance Services Inc. iA~gNflTo Extl: (858)384-1506 I FAX (A/C, No): (800)209-9298 5095 Murphy Canyon Road E-MAIL valeri@foagency.com ADDRESS: Suite 200 INSURER($) AFFORDING COVERAGE NAIC # San Diego CA 92123 INSURER A: Allied World Surplus Lines Ins. Co 24319 INSURED INSURER B: lntegon National Ins. Co. 29742 Cyber Professional Solutions Corp INSURER C: UFG Specialty Ins. Co. 19526 3441 Main Street #104 INSURER D: Benchmark Insurance Company 41394 INSURER E: Houston Casualty Company 42374 Chula Vista CA 91911 INSURER F: COVERAGES CERTIFICATE NUMBER: 17-18 GLAI WC/BA/EX/ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL0\7\l"riAVE 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE [81 OCCUR DAMAc,c I u REN I cu PREMISES /Ea occurrence! $ 50,000 MED EXP (Any one person) s Excluded -A y 50570551 01/31/2017 01/3112018 PERSONAL & ADV INJURY $ 1,000,000 -GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 ~ DPRO DLOC PRODUCTS· COMP/OP AGG $ 2,000,000 POLICY JECT OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 /Ea accident) >--X ANY AUTO BODILY INJURY (Per person) $ >--OWNED -SCHEDULED B AUTOS ONLY AUTOS 12002321 05122/2017 05/22/2018 BODILY INJURY (Per accident) $ -HIRED -NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ ->-- $ UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 2,000,000 C x EXCESS LIAB CLAIMS-MADE 27305947 01/31/2017 01/31/2018 AGGREGATE $ 2,000,000 OED I I RETENTION $ $ WORKERS COMPENSATION XI PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE [2J CST5011391 EL EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? N/A 10/20/2017 10/20/2018 (Mandatory in NH) E L DISEASE -EA EMPLOYEE s 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ Professional Liability Aggregate Limit $2,000,000 E HCC1765688 10/28/2017 10/28/2018 Each Claim $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE Dove Library Fireplace Screen and Seating Repair; 1775 Dove Lane, Carlsbad, California 92011. The City of Carlsbad, its officials and employees are named as additional insured per endorsement CG 201 O 0413 on general liability only. Primart wording applies per CSGL 00233 00 08 16*10 day notice of cancellation for non payment of premium, 30 days written notice to certificate holder for all others.* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad ACCORDANCE WITH THE POLICY PROVISIONS. 1635 Faraday Avenue AUTHORIZED REPRESENTATIVE --Carlsbad CA 92008 . ~ I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a con- tract or agreement that such person or organization be added as an additional insured on your policy. 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) desig- nated 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 in- surance afforded to such additional insured will not be broader than that which you are re- quired 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 ex- clusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work. on the project (other than service, mainte- nance or repairs) to be performed by or on behalf of the additional insured(s) at the loca- tion of the covered operations has been com- pleted; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project CG20100413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion 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 Insur- ance shown in the Declarations: whichever is less. This endorsement shall not increase the applica- ble Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc, 2012 CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY/ NON-CONTRIBUTORY INSURANCE ENDORSEMENT (BLANKET) It is agreed that this policy is amended as follows: Notwithstanding any other provision of this policy to the contrary, the insurance afforded an additional insured shall be primary to, and non-contributory with, any other insurance available to that person or organization in the event a written contract or written agreement you enter into requires you to furnish insurance to that person or organization of the type provided by this policy, but only as respects liability resulting from "your work" performed by the Named Insured at the project designated in the such contract. This endorsement applies only to "bodily injury" or "property damage" caused by an "occurrence" under Coverage A and not otherwise excluded in the policy. All other terms, conditions and exclusions under the policy are applicable to this endorsement and remain unchanged. CSGL 00233 00 08 16 Includes copyrighted material of Page 1 of 1 Insurance Services Offices, Inc., used with its permission ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 11/06/2017 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 Valeri Orsini NAME: Fusco & Orsini Insurance Services Inc. rrigNr,1'0 Extl: (858)384-1506 I FAX (A/C, No): (800)209-9298 5095 Murphy Canyon Road E-MAIL valeri@foagency.com ADDRESS: Suite 200 INSURER(S) AFFORDING COVERAGE NAIC# San Diego CA 92123 INSURER A: Allied World Surplus Lines Ins. Co 24319 INSURED INSURER B: lntegon National Ins. Co. 29742 Cyber Professional Solutions Corp INSURERC: UFG Specialty Ins. Co. 19526 3441 Main Street #104 INSURER D: Benchmark Insurance Company 41394 INSURERE: Houston Casualty Company 42374 Chula Vista CA 91911 INSURER F: COVERAGES CERTIFICATE NUMBER: 17-18 GLAI WC/BA/EX/ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOl/'\Ni;l>,VE 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 TYPE OF INSURANCE ~uu ~uu, POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER /MM/DD/YYYY) IM M/DD/YYYYl X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -CJ CLAIMS-MADE ~ OCCUR DAwiAc,tc I u KtcN I tcu PREMISES /Ea occurrence) $ 50,000 - MED EXP (Any one person) $ Excluded -A y 50570551 01/31/2017 01/31/2018 PERSONAL &ADV INJURY $ 1,000,000 - GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 :8j DPRO-DLOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) -X ANY AUTO BODILY INJURY (Per person) $ -OWNED ~ SCHEDULED 05/22/2017 05/22/2018 B 12002321 BODILY INJURY (Per accident) $ -AUTOS ONLY -AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident} --$ UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 2,000,000 -C X EXCESS LIAB CLAIMS-MADE 27305947 01/31/2017 01/31/2018 AGGREGATE $ 2,000,000 OED I I RETENTION $ $ WORKERS COMPENSATION x1 mTUTE 1 I OTH- AND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ~ y CST5011391 10/20/2017 10/20/2018 E.L. EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ Aggregate Limit $2,000,000 E Professional Liability HCC1765688 10/28/2017 10/28/2018 Each Claim $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Carlsbad is named as additional insured per endorsement CG 201 O 0704 on general liability only. Work comp waiver applies per WC 040306. *1 o day notice of cancellation for non payment of premium, 30 days written notice to certificate holder for all others.* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4668 -ECM #35050 AUTHORIZED REPRESENTATIVE , New York NY 10163-4668 ,. ~ , -I - © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a con- tract or agreement that such person or organization be added as an additional insured on your policy. 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} desig- nated 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 in- surance afforded to such additional insured will not be broader than that which you are re- quired 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 ex- clusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on behalf of the additional insured(s) at the loca- tion of the covered operations has been com- pleted; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion 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 Insur- ance shown in the Declarations; whichever is less. This endorsement shall not increase the applica- ble Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 040306 (ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We hcr..e the right to reco\ef our payments from anyone liable for an injury co-.ered by this policy. We Vv'ill not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform IM)rk under a 'Mitten 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 IM)rk described in the Schedule. The additional premium for this endorsement shall be .2.Q_¾ of the California IM)rl(ers' compensation premium otherVv'ise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract This endorsement changes the policy to which it is attached and is effecti-.e 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 Effecti-.e Date: 10/20/2017 Policy No. CST5011391 Endorsement No. Policy Effecti-.e Dates: 10/20/2017 -10/20/2018 Insured: Cyber Professional Solutions Corp Carrier Name / Code: Benchmark Insurance Company A WC 04 03 06 (Ed. 4-84) Countersigned by Premium$ Page 1 of 1