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DMI General Engineering dba Dick Miller Inc; 2018-08-14; PWM19-483TRAN
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# 2019-0038394 111111111111 lllll 11111111111111111111 lllll lllll lllll 111111111111111111 Feb 01, 2019 02:21 PM OFFICIAL RECORDS Ernest J Dronen burg 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: 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 Oct. 2, 2018. 6. The name of the contractor for such work or improvement is DMI General Engineering, dba Dick Miller, Inc., a California corporation. 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: PWM19-483TRAN, Daisy Ave and Harbor Dr Traffic Calming, Contract No. 6070. 8. The street address of said property is Daisy Ave and Harbor Dr in the City of Carlsbad. VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Vllage Drive, Carlsb~91_ California, 92008; the City Manager of said City on • g__ 20fl_, accepted the above described work as completed and ordered that a ice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed oA..,:::i:uJ, 3 / , 2ofl, at Carlsbad, California. Cl?:::D , \ ~M §:·lflcd~ ~ARBARA ENGLESON (/' City Clerk 'J ';5 Q \Public Works\PW Common\CAPITAL-ACTIVE\6070 Traffic Calming on Daisy Avenue and Harbor Drive\Supporting lnfo\NOC 6070-Daisy and Harbor.doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS DMI General Engineering, dba Dick Miller, Inc. has completed the contract work required for PWM19-483TRAN, Daisy Ave and Harbor Dr Traffic Calming, Cont. No. 6070. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS City Install Speed Humps, Striping, & Signage VALUE $34,970 CERTIFICATION OF COMPLETION OF IMPROVEMENTS te I 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. ;!M,fL~ Scott Chadwick, ~ Manager Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By c.. _g ~/'. Deputy City Attorney Q:\Public Works\PW Common\CAPITAL-ACTIVE\6070 Traffic Calming on Daisy Avenue and Harbor Drive\Supporting lnfo\API (Public Works) -6070 Daisy and Harbor.doc PWM 19-483TRAN CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT DAISY AVE AND HARBOR DR TRAFFIC CALMING; CONT. NO. 6070 This agreement is made on the {~ day of ~v~ ~ , 20--18', by the City of Carlsbad, California, a municipal corporation, (hereinafterc ed "City"), and DMI General Engineering, dba Dick Miller, Inc., a California corporation whose principal place of business is 930 Boardwalk, Suite H., San Marcos, CA 92078 (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: John Kim (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. DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 1 of 9 City Attorney Approved 9/27 /16 PWM 19-483TRAN FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: ~ -C, ~- Print Name: Glen F. Bullock, President 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. DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 2 of 9 City Attorney Approved 9/27 /16 PWM 19-483TRAN 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 five (5) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within twenty (20) working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. Ill Ill Ill Ill Ill Ill Ill Ill DMI General Engineering, dba Dick Miller, Inc., a California corporation (name of Contractor) 380204 (Contractor's license number) A, 8 and C-12/ Exp. 6/30/2019 (license class. and exp. date) 1000004547 (DIR registration number) 6/30/2019 (DIR registration exp. date) DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 3 of 9 930 Boardwalk, Suite H. ( street address) San Marcos, CA 92078 (city/state/zip) (760) 471-6842 (telephone no.) (760) 471-6178 jgrace@dmiusa.net (e-mail address) City Attorney Approved 9/27 /16 PWM 19-483TRAN 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 DMI General Engineering, dba Dick Miller, Inc., a California corporation By: --(sign here) Glen F. Bullock, President (print name/title) By: ___,__. -'--. ,\...._ __ _ (sign here) Glen F. Bullock, Secretary I Treasurer (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A 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:~ Deputy City Attorney DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 4 of 9 City Attorney Approved 9/27/16 W AIYER OF NOTICE OF ANNUAL MEETING OF SHAREHOLDERs--oF--~------------------------------- . -----· -····---·-----------------·····-··-------~·-·----------·· ···-------------------·--------·-------·--·· -- DICK MILLER, INC. WE, the undersigned, being all of the shareholders of the Corporation, hereby agree and consent that the annual meeting of shareholders of the Corporation be held on the date and time and at the place designated hereunder, and do hereby waive all notice whatsoever of such meeting and of any adjournment or adjournments thereof. We do further agree and consent that any and all lawful business may be transacted at such meeting or at any adjournment or adjournments thereof as may be deemed advisable by any shareholder present thereat. Any business transacted at such meeting or at any adjournment or adjournments thereof shall be as valid and legal and of the same force and effect as if such meeting or adjourned meeting were held after notice. Place of Meeting: Date of Meeting: Time of Meeting: Dated: November 20, 2015 249 E. Fourth Avenue, Escondido, CA 92025 November 20, 2015 4:00 p.m. '-"-'\ -' h \~.L.---- Glen Bullock, Shareholder Z:\Lundlaw\Clienl Foldcrs\M-O\Miller, Dick\Dick:Millerlnc\lS 1120 SHAnnMtgWaivcr.wpd Dick Miller, Inc. November 20, 2015 W AIYER OF NOTICE OF SHAREHOLDERS ANNUAL MEETING Page 1 of 1 MINUTES OF ANNUAL SHAREHOLDERS MEETING OF DICK MILLER, INC. November 20, 2015, 4:00 p.m., 249 E. Fourth Avenue, Escondido, CA 92025 The annual meeting of the shareholders of Dick Miller, Inc., a California corporation, was held at the principal office of the corporate attorney at 249 E. Fourth Avenue, Escondido, CA 92025 on November 20, 2015, at 4:00 p.m., the time and place prescribed by the bylaws for the purpose of electing a Board of Directors, considering reports of the affairs of the corporation, and transacting business within the powers of the shareholders. No notice of this meeting having been given in accordance with the By-Laws, signed Consent to Holding this meeting is attached to these minutes and a part hereof. Call to Order-Chairman and Secretary The meeting was called to order by Glen Bullock, President of the corporation. As authorized by the bylaws, the President presided as chairman of the meeting and acted as secretary of the meeting and recorded the minutes. Corporate counsel, James E. Lund was present. Validity of Meeting Call and notice of the meeting being dispensed with by the bylaws, and the meeting being held at the time and place prescribed by the bylaws, the chairman declared the meeting was lawfully and properly convened. Shareholders Present The following roll of holders of all of the issued and outstanding shares of the corporation was called and the Secretary declared that a quorum was present. Roll of Shareholders Shareholder Number of Shares Glen Bullock as trustee of the Glen F. 24,490 Bullock and Aimee J. Bullock Family 2007 Trust Total 24,490 Z:\Lundlaw\Clienl Foldcr.;\M.Q\Millcr, Dick\DickMillerlnc\15 1120 SHAnnMtg.wpd Dick Miller, Inc. November 20, 2015 Present Yes MINUTES OF ANNUAL SHAREHOLDERS MEETING Page 1 of3 In order to qualify for SDVBO Federal Certification, the stock in corporation will be transferred from Glen Bullock as trustee of his trust to Glen Bullock, a married man, as sole and -··-· -~ separate property. The secretary was directed to prepare a written waiver of notice, consent to meeting, and approval of minutes to be signed by each shareholder present or not present at the meeting and to be filed with the minutes. Approval of Prior Minutes On motion duly made, seconded, and carried the minutes of the annual meeting of shareholders held on December 8, 2014, were unanimously approved, after the reading of the minutes was dispensed with without objection. Annual Report The Chairman presented to the meeting an oral annual report of the corporation for the calendar year. A motion was duly made, seconded, and carried waiving reading of the annual report and a copy of the tax returns, in lieu of the annual report, may be filed with the minutes of this meeting. Nomination and Election of Directors The Chairman then called for nominations for directors to serve for one year and until their successors are elected and qualified. The Secretary nominated the following persons: (1) Glen Bullock The Chairman called for further nominations but none were made. The above persons were unanimously elected directors of the corporation. Ratification of Directors' Actions The Chairman then reported to the meeting the activities of the Board of Directors and proposed that the shareholders ratify those actions of the directors. Upon motion duly made, seconded and unanimously carried, the following resolution was adopted: RESOLVED, that all proceedings of the Board of Directors since the last meeting of_the shareholders, and all acts taken by members of the Board of Directors or by officers of this corporation, are hereby ratified and approved in all respects. Resolutions The Chairman then reported to the meeting that the corporation has bank accounts with. Z:\Lundlaw\Clicol Folders\M-O\MiUer, Dick\DickMillerlnc\15 I 120 SHAnnMtg.wpd Dick Miller, Inc. November 20, 2015 MINUTES OF ANNUAL SHAREHOLDERS MEETING Page 2 of3 Union Bank of California. Upon motion duly made, seconded and unanimously carried, the following resolution was adopted: RESOLVED, that the corporation ratify the continuance of its corporate bank accounts at Union Bank of California, Escondido location. FURTHER RESOLVED, that the corporation is authorized to continue its line of credit with Union Bank of California. Upon motion duly made, seconded, and unanimously carried, the following resolutions were adopted: RESOLVED, that pursuant to the recommendation of corporate accountant, kyle Kammerlander, CPA, AKT, INC., the corporation had converted from a "C" Corporation to an "S" corporation and that all profits will be distributed or retained as directed by the Board of Directors on an annual basis. RESOLVED, that the location of the next annual shareholders' meeting shall be at 249 E. Fourth Avenue, Escondido, CA 92025 in December of 2016 pursuant to notice. Adjournment There being no further business, the meeting was adjourned.· Z:\Lundlaw\Clieol FoldcrslM-O\MiUer, Dick\DickMillerlnc\15 1120 SHAonMlg.wpd Dick Miller, Inc. November 20, 2015 Glen Bullock, Secretary MINUTES OF ANNUAL SHAREHOLDERS MEETING -----~ ---~- Page 3 of 3 -·-·-··----·--- PWM 19-483TRAN 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 ~I/A •WI• • Total% Subcontracted: 0 ------- The Contractor must perform no less than fifty percent (50%) of the work with its own forces DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 5 of 9 City Attorney Approved 9/27 /16 ITEM UNIT QTY NO. 1 LS 1 EXHIBIT B Daisy Ave and Harbor Dr Traffic Calming JOB QUOTATION ··--· -- DESCRIPTION Daisy Ave and Harbor Dr Traffic Calming PWM 19-483TRAN -- PRICE $34,970 TOTAL* $34,970 *Includes taxes, fees, expenses and all other costs. DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 6 of 9 City Attorney Approved 9/27/16 ITEM JOHN KIM ~ ~ INSTALL SPEED HUMPS EXHIBITS -· r---jr(;__ "'""'. ~--.IL V ... . I \ ' .\::/ ,_. / I !..... I ' . L_ ___ ,,L._ /4 ... ,_ .. -____,... __ , GENERAL ENGINEERING CONTRACTOR ----DICK MILLER INC .. 930 Boardwalk, Suite H, San Marcos, CA 92078 Phone 760-471-6842 FAX 760-471-6178 Contractor's State License No. 380204, A, B, C-12-DVBE / SBE #53651 ESTIMATE #18-032 TRAFFIC CALMING PROJECT DESCRIPTION BASE BID INCLUSIONS HARBOR DRIVE & DAISY AVENUE, CARLSBAD N/A Addendas Noted: ESTIMATED QUANTITIES 4 NIA UNIT MEASURE EA 2 INSTALL SPEED HUMP STRIPING AND SIGNAGE 4 EA SCOPE OF WORK INCLUDES: POSTING NO PARK SIGNS & DISTRIBUTING ADVANCED NOTICES TO RESIDENTS EQUIPMENT MOBILIZATION & DEMOBILIZATION TRAFFIC CONTROL FLAGGING 1" NOTCH GRINDING OF EXISTING ASPHALT SWEEPING AND TACKING EXISTING ASPHALT INSTALLING ASPHALT SPEED HUMPS INSTALLING SPEED HUMPS STRIPING AND SIGNAGE --a1: ·ohn.kim UNIT PRICE $7,280.00 $1,462.50 TOTAL LUMP SUM AMOUNT OF BASE BID PROPOSAL: BASE BID EXCLUSIONS: 1. PERMITS OR COSTS RELATED TO SAME FEES BONDS 2. TESTING INSPECTIONS SURVEY & STAKING 3. SURVEYING STAKING LAYOUT ENGINEERING 4. SANITATION FACILITIES 5 NIGHT WEEKEND HOLIDAY OR OTHER OVERTIME WORK 6. CONSTRUCTION WATER AND/OR METER OWNER TO PROVIDE ON-SITE WATER SOURCE AT NO COST TO DMI 7. SWPPP IMPLEMENTATION AND MAINTENANCE 8. EROSION CONTROL MAINTENANCE 9. SWPP BMPS PLAN AND IMPLEMENTATION OF SAME 10. ANY OFFSETS TO CONTRACT BILLINGS FOR JOINT CHECKS MADE BETWEEN SUBCONTRACTORS AND/OR SUPPLIERS. NOTES: 1. PRICES GOOD FOR WORK COMPLETED THROUGH 9/30/18. WORK COMPLETED AFTER 9/30/18 IS SUBJECT TO ADJUSTMENT FOR INCREASED COSTS OF LABOR EQUIPMENT TRUCKING ANO/OR MATERIAL. 2. ALL PRICING BASED ON NORMAL 8 HOUR SHIFTS BETWEEN 7 AM AND 5 PM MONDAY-FRIDAY. NO NIGHT WEEKEND OR HOLIDAY WORK. DMI IS A CERTIFIED DVBE / SB, NON-UNION COMPANY 1. Terms: Payment upon completion unless otherwise noted. 2. DMI will not be liable for delays due to fires, fioods, accidents, strikes or any other cause beyond its control. 3. Buyer agrees to pay court costs and reasonable attorney fees in the event of default, if this contract is turned over to an attorney for enforcement or collection. All sums not paid when due shall thereafter bear interest at maximum interest allowed by law. Acceptance of Proposal Please sign and return one copy. This quotation constitutes the sole and only agreement. Any agreements, negotiations, etc., not set forth herein are of no Submitted for DMI PWM19-483TRAN ate: 05/09/18 4/26/2018 APPROVED TOTAL $29,120.00 $5,850.00 $34,970.00 force or effect. BY: PAUL SMITH I CHIEF ESTIMATOR Date of Acceptance: _____________ _ Signature: ________________ _ 18--032 Harbor Traffic Calming 5.09.18 Page 7 of 9 5/9/2018 9:05 AM EXHIBITC LABOR AND MATERIALS BOND PWM 19-483TRAN Bond No. 024070522 Premium: $403.00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to PMI General Engineering dba Pick Mmer. toe (hereinafter designated as the "Principal"), a Contract for: DAISY AVE AND HARBOR DR TRAFFIC CALMING CONTRACT NO. 6070 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW. THEREFORE, WE, DMI General Engjneerjng, dba Djck MjHer, toe, ' as Principal, (hereinafter designated as the "Contractor"), and The Ohio Casualty Insurance Company _______________ as Surety, are held firmly bound unto the City of Carlsbad in the sum of Ibirty-Ea11r Ibausaod Nioe Hundred Seventy Dollars ($ 34 970 00 ), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 8 of9 City Attorney Approved 9/27/16 PWM 19-483TRAN 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. 1-'"r-' Executed by CONTRACTOR this __ / ___ _ day of --~-·-ef_J'._,,~""-· _·--/-' ___ , 20 I?. u CONTRACTOR: DMI General Engineering, dba Dick Miller, Inc. a California eocporatiao (name of Contractor) By: _______ ~----~-~-~----_-_-_--: __ _ (sign here) G1-e,.ry ~ .18# //,.n"-tf.: (print name here) p~ ~ ..:::£ ~'14,_,.,,,,:- (title and organization of signatory) By:--------"""'~'----""'"~-~-:_-:_-:_-:_-:_-:_-:_ __ _ (sign here) G/2-;; r: ~J/t.)('.,f (print name here) .:::-::S'e C!re~ / 77--~,,~<-re- (title and organization of signatory) Executed by SURETY this ___ 1~st ___ day of _____ A_u~g_us_t _____ , 20~. SURETY: The Ohio Casualty Insurance Company (name of Surety) 790 The City Drive South, Suite 200; Orange, CA 92868 (address of Surety) (714) 634-3311 By: Bart Stewart, 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 CilyAtto~ By: Deputy City Attorney DAISY AVE AND HARBOR DR TRAFFIC CALMING CONT. NO. 6070 Page 9 of9 City Attorney Approved 9/27/16 1/) Q) Q) -C: .•. ;!.!! =a~ fc, (.) Q) o-= ._ ns Q) > --]?~ -"C ;"iii _g f Cl) 0 0~ c: ns _ .. Q)-C)I/) ns a, C) .. t::~ o.5 ECI) .__ o ns ...... "C >, =(.) ns c: > Q) _ .. 0 .. z~ THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. • This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company West American Insurance Company Certificate No. 6725293 POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Bart Stewart: Brittany Aceves: Molly Cashman all of the city of Encinitas , state of CA each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS VVHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 30th day of September 2014 STATE OF PENNSYLVANIA ss COUNTY OF MONTGOMERY American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company West American Insurance Company On this 3oth day of September , 2014 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer . IN WITNESS VVHEREOF, I have hereunto subscrjbedmynaffiE! and affixed my notarial seal at Plymouth I\Aeeting, Pennsylvania, on the day and year first above written. By:~~ Teresa Pastella , Notary Public ~., ,, This Power of Attorney is made and executed·p_~ito.aricl~yauthority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, amrv-k~t Alli§iican Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV -OFFICE RS -Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. Wien so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII -Execution of Contracts -SECTION 5. Surety Bonds and Undertakings. Any officer of !he Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. Wien so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation -The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys-in- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization -By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and VI/est American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. J IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this Is+ day of_~At_...,,..~'1'~.,,)5-t--..__ _______ , 201.:L_. By:~'- Gregory W. Davenport, Assistant Secretary LMS_12873_ 122013 103 of 500 ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Diego } On 8/1/2018 Public before me, ---~~--.,,-,,c'"e-=:-=-=-c--::::~==-=-=:-=------ personally appeared _B_a_rt_S_t_e_w_a_rt _________________ _ who proved to me on the basis of satisfactory evidence to be the person(&) whose name(s-)@)are subscribed to the within instrument and acknowledged to me that ~he/they executed the same in@ier/their authorized capacity(ies), and that by ~er/their signature(&) on the instrument the person(&), or the entity upon behalf of which the person(~ acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Notary Public Signature ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document} (Title or description of attached document continued} Number of Pages __ Document Date. ___ _ CAPACITY CLAIMED BY THE SIGNER D Individual (s) D Corporate Officer (Title) D Partner(s) D Attorney-in-Fact o Trustee(s) D Other _________ _ 2015 Version WVNJ.NotaryClasses.com 800-873-9865 J 8.. ERW ELYSE HAUGH l · CommiMlon No. 2227679 i NOTARY PU8UC • CALIFORNIA ' . SAN DIEGO COUNTY l 1 CommilliDIIExpill.-..Y 6. D2 I ... . INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document. Acknolwedgentsfrom other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California nota1y 1cm'. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary pub! ic must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. lle/she/#!ey, is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. •!• Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document •!• Indicate title or type of attached document, number of pages and date. •!• Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. DICKMIL-01 GRACH1 ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 01/30/2018 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 License# OL48969 CONTACT NAME: C3 Risk & Insurance Services rtig,NJo, Ext): (619) 233-8000 I FAX 404 Camino Del Rio S. STE 410 (A/C, No):(619) 864-7106 San Diego, CA 92108 ith'M~ss: chor@c3insurance.com INSURER/S) AFFORDING COVERAGE NAIC# INsuRERA ,Associated Industries Ins. Co. Inc 23140 INSURED INSURER a: The Ohio Casualtv Insurance Comoanv 24074 Dick Miller, Inc. INSURER c: Tooa Insurance Comoanv 18031 930 Boardwalk Suite H & G INSURER D: San Marcos, CA 92078 INSURERE: 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. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT \NITH 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. l~J: TYPE OF INSURANCE ~.?,,D,\· w,~~ POLICY NUMBER ,&OLICYEFF .. ~91,!CeY E.1(£' .. LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -~ CLAIMS-MADE [Kl OCCUR ~~~~~TcJ9E~~~J~J'ence\ X AES102480607 11/06/2017 11/06/2018 $ 100,000 -MED EXP IAnv one oerson) $ PERSONAL & ADV INJURY $ 1,000,000 ~ I GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ,/ ~ POLICY [Kl ~if8f O LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT /Ea accident\ $ 1,000,000 X ANY AUTO X BA056331886 01/25/2018 01/25/2019 BODILY INJURY (Per person) $ --0\/VNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ --HIRED ~a-rt)~'mJr.~ FP~7~c\'JJeit?AMAGE $ -AUTOS ONLY - $ C X UMBRELLA LIAS M OCCUR EACH OCCURRENCE $ 4,000,000 -XL660748702 11/06/2017 11/06/2018 EXCESS LIAS CLAIMS-MADE AGGREGATE $ 4,000,000 / OED I X I RETENTION $ 0 $ WORKERS COMPENSATION I PER I I OTH-AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, ma! be attached if more Cace is required) Re: Project-Water Valve Replacement Program for Donna Drive-Agreement #PWM1 -97UTIL. City of arlsbad, Carlsbad Municipal Water District, it's officials, employees and volunteers are named as additional insured per the attached form CG2010 07/04 & CG2037 07/04 regarding General Liability and per the attached CA8810 0113 regarding Auto liability. Primary and Non-Contributory wording applies per the attached NXGL009 08/09 form. 30 Days' Notice of Cancellation applies per the attached form regarding General Liability. 30 Days' Notice of Cancellation applies per the attached CA 88 63 09 12 form regarding Auto Liability. *THIS CERTIFICATE SUPERSEDES THE CERTIFICATE PREVIOUSLY ISSUED ON 1/24/18. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad/CMWD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS Insurance Compliance Services PO BOX 4668 -ECM #35050 New York, NY 10163-4668 AUTHORIZED REPRESENTATIVE _,,.- (':' I . (/ .·.; / ' I . -..,._~c-L ·· ( \. ___ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES102480607 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Oraanization(s): Location(s) Of Covered Operations All persons or organizations where required by written contract with the Named Insured. 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions 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, 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 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 en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 D POLICY NUMBER: AES102480607 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations where written contract with the Named Insured requires additional insured completed operations. This form does not apply to your work on "residential property". Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products- completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 D ~ 0 0 0 ~ N 0 - Policy Number: BA056331886 COMMERCIAL AUTO CA8810 0113 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT ~ This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE -BROADENED COVERAGE GLASS REPAIR -WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONALEFFECTSCOVERAGE PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION II -LIABILITY COVERAGE is amended as follows: 1. BROADFORMINSURED PROVISION NUMBER 3 12 19 5 13 1 22 2 23 10 15 6 20 14 16 11 8 9 4 7 17 18 20 SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization; © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 a Policy Number: BAO56331886 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II -LIABILITY, exclusion 8.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION Ill -PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or © 2013 Liberty Mutual Insurance CA88100113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 0 ~ N 0 Policy Number: BAO56331886 b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V -DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION Ill -PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION Ill -PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 © 2013 Liberty Mutual Insurance CA8810 0113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 0 Policy Number: BAO56331886 9. RENTAL REIMBURSEMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE -BROADENED COVERAGE Under SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V -DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: © 2013 Liberty Mutual Insurance CA88100113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 7 - -- iiiiiiiiiiiii N g- 0 ro N 0 -- Policy Number: BAO56331886 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN / LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V -DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. © 2013 Liberty Mutual Insurance CA88100113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 0 0 m Policy Number: BAO56331886 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 17. TWO OR MORE DEDUCTIBLES Under SECTION Ill PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same accident, the following applies to paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deductible will be waived. For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group. SECTION IV -BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. © 2013 Liberty Mutual Insurance CA88100113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 N -= -- g--- Policy Number: BAO56331886 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV -BUSINESS AUTO CONDITIONS, paragraph 8.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V-DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental ~ anguish, mental injury, shock, fright or death resulting from any of these at any time. 0 ;;; COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. -CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 Policy Number: AES102480607 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION -CERTIFICATE HOLDERS (SPECIFIED DAYS) The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. If possible, such copies of the notice will be mailed at least 30 days, except for cancellation for non-payment of premium which will be mailed 10 days, prior to the effective date of the cancellation, to the address or addresses of certificate holders as provided by your broker or agent. Schedule Person(s) or Organization(s) including mailing address: All certificate holders where written notice of the cancellation of this policy is required by written contract, permit or agreement with the Named Insured and whose names and addresses will be provided by the broker or agent listed in the Declarations Page of this policy for the purposes of complying with such request. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule above to any benefit, rights or protection under this policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. All other terms and conditions of this policy remain unchanged. POLICY NUMBER: AES102480607 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD-PARTY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured (Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing work.) Paragraph 4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission -- ~ g--- Policy Number: BA056331886 COMMERCIAL AUTO CA 88 63 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CANCELLATION PROVISIONS Any term or provision of the Cancellation Conditions of the policy or any endorsement amending or replac- ing such Conditions is amended by the following: A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the person or organization shown in the Schedule below. In no event will the notice to the person or organization scheduled below exceed the notice to the first named insured. B. Our obligation to send notice to the person or organization listed in the Schedule below will terminate at the earlier of the current policy period expiration or when you no longer have a legal or contractual obligation to such person or organization to maintain insurance coverage under a policy which requires that such person or organization be notified in the event of cancellation. SCHEDULE 1. Name or Person or Organization: CITY OF CARLSBAD/CMWD ~ 2. Mailing Address: 0 M m 1635 FARADAY AVENUE, CARLSBAD, CA 92008 3. Number Days Advance Notice: 30 All other terms and conditions of this policy remain unchanged © 2012 Liberty Mutual Insurance CA 88 63 09 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1/23/2018 1,,.___, 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{les) must be endorsed. If SUBROGRATION 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 Willis Towers Watson CONTACT NAME: San Diego 12980 Metcalf Ave Suite 500 PHONE (A/C, No Ext}: (858) 314-1100 i FAX (A/C, NO): (360) 828-0699 Overland Park KS 66213 EMAIL ADDRESS: Elke.Wohlgemuth@bbslhq.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Barrett Business Services, Inc. UC/F INSURER C: DICK MILLER, INC. INSURER D: 930 BOARDWALK, SUITE H INSURER E: SAN MARCOS, CA 92078 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 ISSUES 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 TYPI! OF INSURANCI! ADDL SUIIR POLICY NUMIIER POUCYl!FF POLICY l!XP LIMITS LTR INSR WVD (MM/DD/VYYY) (MM/00/VYYY) GENERAL LIABILITY EACH OCCURRENCE $ -COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea $ I CLAIMS-MADE D OCCUR occurence) MEO EXP (Any one pe,son) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 17POLICY n:~-nLOC PRODUCTS -COMP/OP AGO $ s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ,_ (Ea accident) ANY AUTO ,-BODILY INJURY (Per person) $ ALL OWNED AUTOS B SCHEDULED AUTOS ,_ BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS ,_ PROPERTY DAMAGE $ ,_ $ UMBRELLA LIAS HOCCUR EACH OCCURRENCE s -EXCESS UAB OCCUR AGGREGATE $ -OED I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 10/01/17 10/01/2018 ,/ lwc STATU-I IOTH-LIABILITY YIN C64398660 TORY LIMITS ER ANY PROPRIETOR/PARTNER/ EXECUTIVE ~ N/A X E.L EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? Covered states: E.L. DISEASE • EA EMPLOYEE $2,000,000 (Mandatory In NH) II yes, describe under CA DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltional Remarks Schedule, ii more space Is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery In a written contract entered Into prior to the Loss, Insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Carlsbad Municipal Water District EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 5950 El Camino Real AUTHORIZED REPRESENTATIVE Carlsbad CA 92008 Authorized ~ !It>~ Rep I c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: ____________ _ LOC:#:. ____________ _ ADDITIONAL REMARKS SCHEDULE Page_.2..... of-2._ AGENCY NAMED INSURED: Barrett Business Services, Inc. UC/F Arrowhead General Insurance Agency DICK MILLER, INC. POLICY NUMBER 930 BOARDWALK, SUITE H SAN MARCOS, CA 92078 RWC C64398660 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 10/01/17 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: Carlsbad Municipal Water District ADDRESS: 5950 El Camino Real Carlsbad CA 92008 Job: DONNA DRIVE WATER VALVE REPLACEMENT PROGRAM; CONT. NO. 5019-D. 30 notice of cancellation will be provided when possible. ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC. L/C/F DICK MILLER, INC. Policy Number 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Symbol: RWC Number: C64398660 Policy Period Effective Date of Endorsement 10-01-2011 TO 10-01-2018 10-01-2017 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the oolicv number. The remainder of the Information is to be completed onlv when this endorsement is issued subsequent to the preoaralion of the oolicv. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2 . O percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : $0 Authorized Agent WC 9903 22