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Nu-Line Technologies LLC; 2018-03-29; PWM18-122UTIL
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# 2018-0320920 11ml 111111111111111111111111111111111111111111111111111111111111111 Aug 06, 2018 03:10 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: n/a 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 June 29, 2018. 6. The name of the contractor for such work or improvement is Nu-Line Technologies, LLC. 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. 55031 (PWM18-122UTIL), Sewer Main Lining at Valley Street and Magnolia Avenue. 8. The street address of said property is along Valley Street at Magnolia Avenue 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 Village Drive, Carlsbad, California, 92008; the City Manager of said City on Ci_ 1 ~d : d J , 2o_I8_, accepted the above described work as completed and ordered that a Notice o ompletion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed onCL.U.t, 1,;.,.')t:;J. , 20}2_, at Carlsbad, California. ,:s "'~ OF ~~LSBAD ') . ~)_AQ,, A.WL?lA·i-v~ BARBARA ENGLESON City Clerk Q·\Public Works\PW Common\CAPITAL-ACTIVE\5503-1 Sewer Main Lining at Valley Street and Magnolia Ave\NOC.doc CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Nu-Line Technologies, LLC has completed the contract work required for Project No. 55031 (PWM18-122UTIL), Sewer Main Lining at Valley Street and Magnolia Avenue. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE Sewer rehabilitation & lining $30,665 CERTIFICATION OF COMPLETION OF IMPROVEMENTS 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 improvements. ~CizyftQ.,WA APPROVED AS TO FORM: CELIA BREWER, City Attorney By:~~ Deputy City Attorney directed to commence maintaining the above described ~ I, I, g Date Q:\Public Works\PW Common\CAPITAL-ACTIVE\5503-1 Sewer Main Lining at Valley Street and Magnolia Ave\APl.doc Tracking#: PWM18-122UTIL CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE CONT. NO. 55031 This agreement is made on the L~ day of r\.k.rz, ~ , 2018, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Nu-Line Technologies, LLC, a limited liability corporation whose principal place of business is 102 Second Street, Suite B, Encinitas, CA 92509 (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 PJans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor's proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Don Wasko (City Project Manager) 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. SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Page 1 of 8 City Attorney Approved 9/27/16 Tracking#: PWM18-122UTIL 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. Sign&ure ~ ~ PrintName: Pam0 eW 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. SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Page 2 of 8 City Attorney Approved 9/27/16 Tracking#: PWM18-122UTIL 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 twenty (20) working days after receipt of Notice CONTRACTOR'S INFORMATION. Nu-Line Technologies, LLC (name of Contractor) 997520 (Contractor's license number) A-10/31/18 (license class. and exp. date) 1000003808 (DIR registration number) 6/30/18 (DIR registration exp. date) /II /II /II /II Ill Ill /II /II /II /II /II /II SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Page 3 of 8 102 Second Street, Suite 8 (street address) Encinitas, CA 92509 (city/state/zip) 760-634-5153 (telephone no.) 760-634-6780 (fax no.) fdurazo@nulinetech.net (e-mail address) City Attorney Approved 9/27/16 Tracking#: PWM18-122UTIL 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 NU-LINE TECHNOLOGIES, LLC, a limited liability corporation By: By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: ambers/Utilities Director rized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. ~ 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 SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Page 4 of 8 City Attorney Approved 9/27/16 LINE Technologies, LLC RESOLUTION OF NU LINE TECHNOLOGIES, LLC RESOLVED BY THE MEMBERS/P AR1NERS of Nu-Line Technologies, LLC, a California Corporation as follows: Appointment of Dominic J. Burtech Jr. as the official signatories for: -Bidding Purposes -Contract Award Change Orders -Dispute Resolutions -Project Completion Documents The resolution was adopted by the MEMBERS/PARTNERS of the LLC on this 21 st day of July, 2015 at 102 Second Street SUITE B, Encinitas, CA 92024. CERTIFICATE OF MEMBERS/PARTNERS California Acknowledgment Form A nolary public or other. officer completing this certificate verifies only the identity of the individual who signed the document co which this certificate is .attached, and not the truthfulness nccuruc , or validi of tha't document State of Cali(<iaia il+r County of )ftU/l.. . :0 C> • } ss. _.,.,I /~; ~I -~ b f Arthur P. Arquilla, Notary Public On _ _ L.!__ ._. e ore me, . . , ' / / _// (h9fe 111~rt nam11 and title oi Lhe officer) personally appeare m ~~ ·. /Jvd"-etf~, _. L,~ J: /Jvd-ee/4. r;ra,,..,K.,. rr:Our,11:·z.,r>J'j r.Sa./~oi.. S. . . . . A?_p·,1 who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) i@ubscribed ir_ to t~e within in~~ment and acknow!edged to_ m~ that he/s~xecuted the same in his/her6:a_u- thorrzed capac1ty(1es), and that by h1s/h~s1gnature(s) ornne'"instrumerit the person(s), or the entity upon behalf of which the person(s) acte~uted 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. Seal ARTHUR P. ARQUILLA! Commission No. 2051358 p NOTARY PUBLIC-CALIFORNIA ~ SAN DIEGO COUNTY i Commissio~ Expires January 7, 201 B I ---------Optional Information To help prevent fraud, it is recommended that }'.OU provide information about the allachcd document below . .. "Thi.~ is .!ll!! required under Califomia Sllltc notary public law.••* Document Title:. ____________________ # of Pages:. __ _ Notes 111111\11 :\Jn1-:1n., ,,_.., Tracking#: PWM18-122UTIL 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 NON~ Total % Subcontracted: l\XJN g- The Contractor must perform no less than fifty percent (50%) of the work with its own forces SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Page 5 of 8 City Attorney Approved 9/27/16 Tracking#: PWM18-122UTIL ITEM NO. 1 2 3 4 EXHIBIT B SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE JOB QUOTATION UNIT QTY DESCRIPTION Valley Street sanitary sewer rehabilitation -pre-cleaning & post installation, pre-& post CCTV, 280 linear feet of 8-inch CIPP liner w/polyester resin -provide CCTV post video in PACP 6.0 format & exported to agency's PACP Job 1 database Job 1 UV too hat installation Magnolia Avenue sanitary sewer rehabilitation -pre- cleaning & post installation, pre-& post CCTV, 360 linear feet of 8-inch CIPP liner w/polyester resin -provide CCTV post video in PACP 6.0 format & exported to Job 1 aaencv's PACP database Job 1 Traffic control, oermittino & bond TOTAL* *Includes taxes, fees, expenses and all other costs. PRICE $11,830 $2,375 $15,210 $1,250 $30,665 SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Page 6 of 8 City Attorney Approved 9/27/16 EXHtBITC LASORAND MATERIALS BOND EXECUTED IN DUPLICATE BOND No 2269262 PREMIUM IS FOR CONTRACT TERM " AND IS SUBJECT TO ADJUSTMENT PREMIUM: $299.00 BASEDONFINALCONTRACTPRICE Tracking#: PWM18-122UTIL WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Nu-Line Technologies, LLC (hereinafter de$ignated as the "Principal''), a Contract for: SEWER MAIN LININS AT VALLEY STREET AND MAGNOLIA AVENUE CONTRACT NO. 55031 in the City of Carlsbad, in ~ct 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 fuml$hlng ofa 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, Nu~Line Technologies, LLC, as Principal, (hereinafter designated as the "Contractor"}, and NORTH AMERICAN SPECIAL TY INSURANCE COMPANY as Sutety, are held firmly bound unto the City of Carlsbad in the sum of Thirty Thousand $Ix Hundred Sixty- five Dollars ($30,665), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the tenns of the Contract by the Clty of Carlsbad, and for which payment well. and truly to be made we bind ourselves, our hairs, executors and administrators, successo,s, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontrac;tors fail to pay for any materials, provisions, provender, supplies, or teams used In, upon, for, or about the performance of the work contracted t0. be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor perfom,ed under this Contract, or for any amounts tequired to be deducted, withheld, and paid over to the Employment Development Departmentfrom the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to tlie work and labor, that the Surety wm pay for the same, and, also, in case suit is brought upon the bond, 'reasonable attorney's fees, to be fixed by the court consistent with.California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California CMI Code section 9100, so as to give a right of action to those persons or their assigns in ·any suit brought upon the bond. Surety stipulates and agree$ th.at no change, extension of time, alteration pr additic>n to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obfigations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addttlon to the terms of the contract or to the work or to the specifications. SEWER MAIN LINING AT VALLEY STREET AND MAGNOLIA AVENUE; CONT. NO. 55031 Pege7of8 City Attorney Approved 9/27/16 ,l CALIFORNIA 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 } } On _____ _,_ ____ ~-Arthur P. Arquilla, Notary Public person a II y appeared 6rrJ I r7 I 2---.....----------------------------who proved to me on the basis of satisfactory evidence to be the person(s) whose e(s~re subscribed to the wi ·n instrument and acknowledged to me that he/tliey executed the same · his/ er/their authorized capacity(ies), and that by er/their signature(s) on the i rument the person(s), or the entity upon behalf of h 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. and official seal. l .ARTHU_.R,P. ARQUILL.At in -· COflMISSION NO. 2225407 p d -NOTARY PUBLIC-CALIFORNIA ~ ~ · SAN DIEGO COUNTY i ~ • COMMISSION EXPIR~S JAN 7, 2022 ~ Nota (Notary Public Seal) INSTRUCTIONS FOR COMPLETING THIS FORM ADDITIONA IONAL INFORMAT~ON This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknowledgments from other states may be !:ompletedfor documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (liHe or description of attached document) (TiHe or descripti!)n 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) o Other _________ _ • 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 public must print his or her name as it appears within his or her commission followed by a co=a 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 fonns by crossing off incorrect forms (i.e, he/she/they, 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 photo~phically 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. 0 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, nwnber 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). Q Securely attach this document to the signed document with a staple. t ! 1· I I [ I I / I I I i /. J/ Ii /! 11 H !, Tra9king #: PWM18-122UTIL In the event that Contractor is an indivjdual, It is agreed that the death of any such Contractor shaU not exonerate the Surety from Its obligations under this bond. Executed by CONTRACTOR this _1_9_TH __ _ day of __ M_A_R_C_H ____ __, 20~. CONTRACTOR: NU LINE TECHNOLOGIES, LLC By: (sign here) DOMINIC J. BURTECH, JR. PARTNER By: (sign here) {print name here) (title and organization of slgnatory) Executed by SURETY thls __ 1_9T_H __ day of MARCH • 2018 . SURETY: NORTH AMERICAN SPECIAL TY INSURANCE COMPANY (name of Suretv) 6 HUTTON CENTRE DRIVE, SUITE 850 SANT A ANA CA 92707 (address of Surety) 714/550-4141 (telephone number of Surety) By:/v(~O-~ (signature of Attorney-in-Fact) MARK D. IATAROLA, ATTORNEY-IN-FACT (printed name of Attorney-in-Fact) (attach corporate resolution showing current power ofattomey} (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 Sign$, the ,corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowertng that officer to· bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER City AttornEiy By: c/L,cuhu~ Deputy City Attomey $EwER MAIN LINING AT VALLEY STREET ANO MAGNOLIA AVENUE; CONT. NO. 65031 Page8of8 City Att0'.'16Y Approved 9127/16 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 SAN DIEGO On 3/19/2018 b f e HELENE. WHEALDON, NOTARY PUBLIC __________ e or me,-------------'------------ Date Here Insert Name and Title of the Officer personally appeared __________ M_A_R_K_D_._I_A_T_A_R_O_L_A ___________ _ Name(e) of Signer(s} who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s-) islafe subscribed to the within instrument and acknowledged to me that helsl=leftl=ley executed the same in hisfl=lel'l'tl'leir authorized capacity(ies), and that by hi~/hoi:/thoir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. H 0 ELEN E. WHEALDON COMM. #2194350 z Notary Public -California ~ San Diego County - Comm. Ex ires r. 28, 2021 Place Notary Seal Above 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 11-A £ ~ Signature of Notary Public ---------------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: MARK D. IATAROLA Signer's Name: ____________ _ D Corporate Officer -Title(s): ______ _ D Corporate Officer -Titl_e(s): ______ _ D Partner -D Limited D General D Partner -D Limited D General D Individual IXl Attorney in Fact D Individual D Attorney in Fact D Trustee D Guardian or Conservator D Trustee D Guardian or Conservator D Other: ______________ _ D Other: ______________ _ Signer Is Representing: _________ _ Signer Is Representing: ________ _ • ©2014 National Notary Association• www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHING TON INTERNATIONAL INSURANCE COMP ANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg, Illinois, each does hereby make, constitute and appoint: JOHN G. MALONEY, HELEN MALONEY, SANDRA FIGUEROA, and MARK D. !AT AROLA JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of surety ship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION ($50,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9th of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." By __ _,;;.,~------ Steven P. Anderson, Senior Vice President of Washington International Insurance Company & Senior Vice President of North American Specialty Insurance Company By Michael A. Ito.="'"'"'=~=:=.,:rn,c;;:-d,S::::'-,:±.:==n===='"""=:c:--- & Senior Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this .l1!!:!_ day of September , 20 J2._. State of Illinois County of Cook ss: North American Specialty Insurance Company Washington International Insurance Company On this 17th day of September , 20 J2..., before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michael A. Ito , Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. M. Kenny, Notary Public __ ) I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 19th day of MARCH , 20 18 . //bg~~- Jeffrey Goldberg, Vice President & Assistant Secretary of Washington Intemat1onal Insurance Company & North American SpeciaJty Insurance Company Client#· 431842 BURTEPIPEL 1 ACORD,M CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 3/19/2018 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 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 ~2ti~cT Krista Mitchell Marsh & McLennan Agency LLC r..tJSN:o, Extl: 858-750-4425 I iffc, No): 858-909-9734 Marsh & McLennan Ins. Agency LLC :fD~~ss: Krista.Mitchell@MarshMMA.com PO Box 85638 INSURER(S) AFFORDING COVERAGE NAIC# San Diego, CA 92186 INSURER A : Allied World Assurance Company 19489 INSURED INSURER B : Zurich American Insurance Campa 16535 Nu Line Technologies, LLC INSURER C: 102 Second Street INSURER D: Encinitas, CA 92024 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR ,&~Mg~l 1,&~Jclg~l LIMITS LTR INSR WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY X 03109124 09/03/2017 10/01/201 B EACH OCCURRENCE $1 000,000 ~ D CLAIMS-MADE ~ OCCUR f--s~~~ffiH9E~~~J.frPence) $100 000 X Bl/PD Ded:15000 f--MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ~ ~PR~ DLOC $2,000,000 POLICY X JECT PRODUCTS -COMP/OP AGG OTHER: $ B AUTOMOBILE LIABILITY BAP551380201 10/01/2017 10/01/2018 ~~~~~~~~tf'NGLE LIMIT $1,000,000 - X ANY AUTO BODILY INJURY (Per person) $ -ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ f---NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS /Per accidentl $ - $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -- EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION X WC551380301 10/01/2017 10/01/2018 X l~~~TIITF' T l~JH-AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVED E.L. EACH ACCIDENT $1 000 000 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 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) re: Agreement Number: PWM18-122UTIL-Sewer Main Lining at Valley Street and Magnolia Avenue The City of Carlsbad, it's officials, employees and volunteers are included as additional insured with respects to General Liability per the attached endorsements.Waiver of subrogation applies to Workers Compensation per the attached endorsements. 30 days notice of cancellation applies to General Liability, Automobile Liability and Workers Compensation per the attached endorsements. CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD c/o EXIGIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DA TE THEREOF, NOTICE WILL BE DELIVERED IN Insurance Compliance Services ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4668 • ECM #35050 New York, NY 10163 AUTHORIZED REPRESENTATIVE I<~ 1'n-'1.fcuU.. I © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3355006/M29927 40 WSKTM INSURED: Nu Line Technologies, LLC POLICY#: 03109124 POLICY PERIOD: 09/03/2017 TO: 1010112018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -WHERE REQUIRED UNDER CONTRACT OR AGREEMENT (PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED UNDER CONTRACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II -Who Is An Insured is amended to include any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy. However, the insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy; or b. The coverage and/or limits required by said contract or agreement. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization where required of you by written contract or agreement. GL 00030 00 (10/09) INSURED: Nu Line Technologies, LLC POLICY#: 03109124 POLICY PERIOD: 09/03/2017 TO 101011201a COMMERCIAL GENERAL LIABILITY CG 20100413 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 Organlzatlon(s) Locatlon(s) Of Covered Ooeratlons When required by written contract As Required Per Written Contract Information required to comolete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work'' out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 0413© Insurance Services Office, Inc., 2012 Page 1 of2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section 111-Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 INSURED:Nu Line Technologies, LLC POLICY#:03109124 POLICY PERIOD: 09/03/2017 TO: 101011201a COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All persons or organizations as required by written As designated in written contract with the Named Insured 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 INSURED: Nu Line Technologies, LLC POLICY#: 03109124 POLICY PERIOD: 09/03/2017 TO 101011201s COMMERCIAL GENERAL LIABILITY CG 25 030509 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULL V. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: Blanket as required by written contract and effective during the pol- icy period as stated in the policy declarations. This endorsement applies only to your projects away from premises owned by or rented to you for which vou have certificates of insurance on file at vour office. Information rP.Ouired to comolete this Schedule if not shown above will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by ·occur- rences" under Section I -Coverage A. and for all medical expenses caused by accidents under Section I -Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A. ex- cept damages because of "bodily injury" or "property damage• included in the "products- completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Clalms made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A tor damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit tor that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations tor Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. CG 25 0305 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I -Coverage A, and for all medical expenses caused by accidents under Section I -Coverage C, which cannot be attrib- uted only to ongoing operations at a single des- ignated construction project shown in the Sched- ule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage• included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag· gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de· signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section Ill -Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25030509 INSURED: Nu Line Technologies, LLC POLICY#: WC551380301 POLICY PERIOD: 1010112011 WORKERS' COI\FENSATION AND EMPLOYERS' UABIUTY INSURANCE POLICY TO 10I01I201a \\e040306 Ed. 4-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have 1he right to recover our payments from anyone liable for an injury covered by this policy. We will not enforr-.e our right AIJRin.<it the perMn or nrgani7fltion MITlf!d in the Schedule. (This Agreerrent Applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You roost main1ain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be O. 0 % of the Galifornia workers' compensation pre- mium dherwise due on such rerrunerdlion. Person o.-Oiganlzatlon ALL PERSONS AND/OR ORGANIZA'lI0111S TBA'l' ARB UQOIRBD BY MRIT'l'l:H CONTRACT Oil AGREEMENT WITH THE IHSU:U:D, BXBCUTJ:D PRIOR TO TBE ACCIDENT OR LOSS, THAT WAIVER 01!' SUBROGATION Bl!! PROVIDED UNDER THIS POLICY :&'OR WORK PERFORMED BY YOO FOR THAT PERSON AND/OR ORGANIZA'HON WC 2fi2 C484) WC 04 03 06 (Ed. -4-84) Sctadule Job Doscrtptlon ALL CALil'ORNIA OPERATIONS Page 1 of1 INSURED: Nu Line Technologies, LLC POLICY#: BAP551380201 POLICY PERIOD: 1010112017 Coverage Extension Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, Thia endorsement modlllee lnannce provided under th11: Buelntn Auto Coverage Fann Motor Carrier Cov~ Fann A. Amended Who le An lnaurad TO 101011201s 1. The following Is added to the Who la An lmured Provision in Section 11-Covend Autoe Llablllty Coverage: _ The following arw also "insureds": a. Any "employee" of yours Is an "Insured" whlla using a covered •auto• you don't own, hire or borrow for acta perf'onned v.Athln the scope of employment by you. Any "employee" of yolJfl II also an "lnaured" while operating an •auto• hired or rented under a contract or agreement In that •employee's" name, with your permia11lon, whlle performing duties l'9lated to the conduct of your bulllneaa. b. Anyone volunte«lng services to you Is an "Insured" whle using a covered "auto" you don't awn, hire or borrow lo nnsport your clients or other persons In activities nece .. ry ID your business. c. Anyone else who fumllhea an "auto" ...r.nmced In Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any penon(s) or organlution(1) wherw required by written contract or written agreement with you executed prior to _any "accldenr, lnelucling thole pnon(a) or organlzallon(a) directing your work pursuant to 1uch written contract or written agreement with you, provided the ·acc:ldenr arilN out of operation• governed by such contract or agreement and only up to the llmltl required In the written coniract or vltten agreement, or the Llmlla d Insurance shown In the Dedaratlons, whichever is leas. 2. The following Is added to the Other Insurance Condition In the Buelneu Auto Coverage Form and the Other ln1urance-Prlmary and ExCffll Insurance Provillons Condition In the Motor Carrier Coverage Form: Coverage for any peraon(a) or organlzatlon(i), where raqund by written contract or written agieement wllh you executed prior to any "accidenr, wlll apply on a primary and non-contributory baala sid any Insurance maintained by the addHlonal "lnaured" will appiy on an excea balls. However, in no event-wll this coverage extend beyond the terms and condition• of the Coverage Fonn. B. Amendment -Supplementary Payments Paragraphs L(2) and a.(4) of the Coverage Extensions Provision In Section D -Covered Autos Llablnty Coverage are replaced by the following: . . (2) Up to $5,000 for lie 0011 of bal bonds ~ncludlng bond, for rvlated traffic law violations) requlnicl because of an "accident" we cover. We do not have to fUmlah these bonds. (4) All reaaonable axpenaes Incurred by 1he •insured" at ow-request, including actual loss of eamlng1 up to $500 a day becauee of time off from work. U-CA-424-F CW (04-14) Page 1 of8 C. Fellow Employn Coverage The Fellow Employee Exclullon contained in Section 1I-CovlNd Autoa Uablnty Coverage does not apply. D. Driver Safety Program Uablllty and Phyalcal Damage Coverage 1. The following la added to the Racing Exclualon In lactfon II -Covered Autlo9 Uabillty Coverage: Thia exclusion doea not apply 1D covered -autos· partii::lpatlng in a driver safety program event, such •, but not llmlled 10, 1u10 or truck rodeos and other auto ortruck agility demonstratlone •. 2. The following Is added to Paragraph 2. In the Excluslona of Bactlon ID -Physical Damage Coverage of the Business Auto Covaraga Form and Paragraph 2.b. In the Exclualona of Section. IV -Physical Dunage Coverage of the Motor Carrier Coverage Fann: Thie excluelon don not apply to cove"'d ''autoe~ participating In a driwr safety program event, such •. but not Dmltad to, auto or truck rodece and other auto _or truck agUlty demonatratione. · E. Leaae or Loan Gap Coverage The following la added to the Coverage Provision of the Phyalcal Damage Coverage Section: I.NM Or Loan Gap Coverage In the event of a total "1081" to a covenid •auto•, we wiH pay any unpaid amount due on the 198H or loan for a coverad "auk>'',~: . .a, Any amount paid under the Physical Damage Coverage Section of the Coverage Fonn: and b. Any: (1} Overdue lease ·or loar:i payments at the time of the "loss"; (2) Financial penallles Imposed under a lease for excaullla uae, abnormal wear and tear or high mUaage; (3} Security depoelta not returned by the leesor; (4) Costs for extended warranties, credit life Insurance, health, accident or dlaablllty Insurance purchased with the loan or lease; and (I} Carry-over balances from previous INsea or loans. F. Towing and Labor Paragraph A.2. of the Physical Damage Coverage Sacl!on Is replaced by the following: Wt will pay up lo $75 for towing and labor coata incurred each time a covered •auto" of the private paaaenger type la dlaabled. However, the labor muat be performed at the ·place of dliablement. O. Eldllndad Gia• Coverage The following la added to Paras,'aph A.3.a. of the Ph-y9ical Damage Coverage Section: If gi .. must be replaced, the deductible 9hown In the Declaratlona will apply. However, if glaaa can be 19pall8d and la actually reparad rather than replaced, the deductible will be waived. You have the option of having the glala repaired rather than rapllleied. . H. Hired Auto Phyalcal Damage -lncrtnecl Lou of U.. Expaneea The Coverage Extanslon for l.oall Of U.. Expens• In the Physical Damage Coverage Section Is replaced by the following: Lou Of '1H Expe!Ma For Hired Auto Physical Damage, we ~I pay expanses for which an insured" becomes legally responsible to pay for loss of use of a vehlcle rent8C! or hired without a driver under a written rental contract or wrlttan rental agreement. We will pay for loss of uae expen ... if caused by: lndudN coP','llgllt8d matellal cf lnllnnce Servlcea 011:ie. Inc., with bl pannl111ton. lJ-CA...42,,t.F CW (04-14) Page2 ore (1) other than colllllon only If tha Oeclaratlona indicate that Comprehensive Coverage Is provided for any covered . •auto"; · · (2) Speclffed C&Ulfl Of Losa only If the Declarat10111 lncficate that Speoltled eau ... or Loli Cc!verage la provided for any covered "auto"; or · · · (3) Colhion only if the Dedaratlona Indicate that ColD1lon Coverage la provided for any COV11rad "auto". However, the most we wlH payforany expens&1for Iola of use la $100 per day, to a maximum of$3000. I. Pwsonal Eff9ce. Covtrage The following Is added to the Coverage Provlllon cl the Physical Damage Coverage Section: Perlonal Effectll Coverage a. Wa wll pay up to $750 for ,on" ta pel"IIOnal effecti which are: (1) Pal'lonal property owned by 111 inaur9d"; and (2) In or on a covered •auto•. b. subject to Paragraph a. abow, the amount ID be paid for "1088" to personal effectl wtll be baled on the letler of: (1) The reuoneble coat to replace; or (2) The aclual ca1h vakle. c. The coverage provided h Paragraphs a. and b. above, only applin in the event of a total theft; of. a covwecl -.'40". No deductible applies to 1h11 coverage. HOWflllW', we wll not pay for "loss" to pe.raonal etrecta of m,y of the following: · · · (1) Account., bllla, a,rrency, deeds, evidence of debt, money, not... Meut'ltiea, or cornrnen:lal pap,r or other documents cf value. (2J BuUlon, gOld, sliver, platlnum, or other precious alloys or melal1; furs or fur garments; jewelry, watchaa, precloul or aeml-precloua 11Dnea. (3) Paintings, statuary and other wcrlcs of art. (4J Contraband or property In the COUl'M of Illegal tranapor1atlon orlrada. (I) Tapea, 1'9CC11dt, dlsca or other 1lmllar davlcel uaed wllh audio, vtaual or data elactronlc equipment. My coverage protAcled by this Provision II 9XC888 aver any olhar haurance ooverage avaRable for the ume ,091". J, Tapea, Records and Dl8CII Cov .. ga 1. The Exclullon In Paragraph B.4.a. of Section Ill -Phplcal D1n11g1 Coverage In the Butiilna Auto Coverage Form and the Exclutlon In Paragraph B.2.c. of Sadlon IV -Phy91cal Damage Coverage In Ile Motnr Carrier Coverage Fann doas not apply. · 2. The fo1kM1ng la added to Paragraph 1.a, Comprehenllva Coverage under the Coverage Provlllon of th• Phplcal Damage Coverage Section: · We wil pay for "lots" to tapes, records, discs er other almllar devices uaed with audio, viaual or data electronic equipment. We wll pay only If the tapes, records, discs or otienlmllar audio, vleual or data elac:tn,nlc devices: (a) Al9 the property r,f an "lnaured"; and (b) Are In a.covered "auto" at the time of "kma''. · The most we WW pay for IUch ,oaa" to tapaa, records, dlaca or other almDar d9Vlcaa Is $500. The Physical Damage co.verage Deductible Provlalon doea not apply to such "1088·. . . . lni:lud• c:opynghted mllerlll of Nll'IJICI Sl!Vlcel Offlce, Jnc., WIIII b permlalllln. lJ.CA""24-F CW (04-14) Pali• 3 016 K. Airbag Coverage The Exolullon In Pwagraph B.3.a. of Section Ill -Pllyslcal Damage Coverage In the Bulin ... Auto Coverage Form and the Exclusion In Paragraph a,,.a. of Section N -Phyu:al Damage Coverage·ln 1he Motor Carrier Coverage Form does not apply to the accidental dlschage ~ an airbag. L. Two or More Deductlbles The following Is added to the Deducllble ·Provision of the Phyelcel Damage Coverage Section: If an accident II covered both by this policy or Cov«11ge Fonn and by another pollcy or Coverage Form iaaued to you by us, the f01lowing applies for each COYered "auto" on a par Yllhlcla buls: 1. If the deducllble on this policy or Coverage-Form Is the ernaler_ (or 1mallelf) deductible, It will be waived; or 2. If the deductible on this policy or ~ge Form la not the 1maller (or lffl8llut) deductible, It wRI be reduced by the amount of the smaller (or smallest) dedu~le. M. Physical Damas1e -Comprehensive Coverage -Deductible The following It added to the Deducllble Provlalon of the Phyalcal Damage Coverage Section: Regardless of the number ot covered ''auto1· damaged or stolen, tf'.18 maximum deductible that wRI be applied to Comprehensive Coverage for all '1ou" from any one cauae ie $5,000 or the deductible 1hown In the Declarations, whichever 18 greater. N. Temporary 8ubetltuta Autos -Physical Damage 1. The folowlng II added~ Section I -COY81'9d Autoe: Temporary Subelltute Autos -Phyalcal Damage If Phytlcal Damage Coverage la provided by this Coverage Fonn on your owned cowred •autos", the following typea ofvehlclN are al1SO covered "autoa" for Physlcal Damage Coverage: Any •au10• you do not own when used with the pennlulon of its owner as a temporary substltut8 for a covered "auto• you do own but II out of service because of b: 1. Breakdown; 2. Repair; 3. Servicing; ,. "Loaa"; or 6. Dastructlon. z. The following la added to the Paragraph A. Coverage Provision of the Phyalcal Damage Coverage Section: T11111porary Substltut. Autos -Physical Damag• We will pay the owner for "lose" to the temporary aubatllute •autoN unleea the "loss" reaub from fraudulent acts or omlalons on your part If we make any payment to 1he owner, we will obtain the owner's rlghtS again at any other party. The dedUctlble for the temporary 11.1bstllute "auto" WIii be the eame u the deductible for the covered "auto• It 1'8place1t. . . O. Amended DutiN In The Event Of Accklent. Cllllm, Sult Or loll• Paragraph L of the Dull" In Th• Event Of Accldont, Claim, Sult. Or Loa• Condition 11 replaced by the following: L In the event of "accident", claim,. "suit" or "loes", you must give ua or our auttlorized representative prompt notice of the ·accident", clalm, -.ult" or "loss". However, theae dutl~ only apply when the "accldentN, claim, "ault" or "losa" is known to you (J you are an lndMdual), a partner (If you are a partnership), a member (If you are a limited llablllty company) or an executive officer or lnaurance manager (If you are a corpordon). The failure of ·any lncludw c:opyitghtllcl mlllfllll Df Insurance 6t111lG118 Ollce, Inc., With Ila pennlalon. IJ.CM24-F ~ (04-14) Paga~of8 agent, ,ervant or employee of the ·insured" to notify u, of any "accldanf', clalm, "tuit" or "1011" shall not invaldata tha Insurance afforded by thll pollcy. · · · Include, • 100r1 u pracllcable: (1) How, when and Yoittei'e the "accident" or '10111" occumsd and If a clalm 18 made or "suit" Is brought, written notice of the clalm or "eull" lncludlng, but not limited to, the date and detall1 of IUCh dalm or "lull''; · · (2) The •1n1ured'1" name and addren; and (3) To the extent-po11lble, the names and addressee of any Injured persona and wttneaaes. If. you report an •acc1dent", claim, •,ult" or •1oa11• to another ln1urer when you should have reported to ue, your fatlure to report to us wlll net be Nen aa a violation of~ amended duties provided you give us notice u .1001'1 u practlcab!9 aft8r the fact of the delay becomes known to you. P. 'Waiver of T......t.r Of Rlghta Of Recovery Agalnet Othlra To U. The following is added to the Transtwr 01 Righi& Of Recovery Ag11Mt Olh&ra To 0. CondlUon: Thia Condition doff not apply to the extent required of YGl.l by a written contract, executed prior to any "accident" or "Ion", provided lilt the "accident" or "loll" art•• out of operations contemplated by such contraet. This waiver only appllel ID the pel'10n or organization designated In the contracl Q, Emplo~ Hlrad Autoll -Physlcal Damage . Paragraph b, of the Other lnaurance Condition In the Bullneaa hA0 Coverage Form and Paragraph f. of the Other lnnl'lnCe -Primary and Excea lnaurance Prvvlslons Condition· In lhe Motor Carrier Coverage Form ara replaced by the fallowi'lg: For Hred Auto Phyacal Damage Coverage, the following are deemed to be CX>\191'ed ·autm" you own: (1) NIY covanid "auto• you lease, hire, rent or borrow; and (2) My covered •auto• hlrad or rented under a wrtu.n contract or wrltan agreement ll'lt919d Into by an "employee" ar elected or ippolnted official with your perm1Mi011 while being operatad within the course and scope of that "employee's" employment by you or that elected or appointed ofllclal's dutlu •• l'Npect their obligations to you. HoMver, any •auto" that Is leased; hired, 19n~d or borrowed with II driver Is not a covered •auto•. R. UnJntenllonal Failure to Dlaclole Hazards The fol~ Is added 1D the Concealment, lllerepreNntation Or Fraud Condllon: HowlMlr, we wll not deny coverage under this Coverage Form If you unlntanlanaly: (1) Fu 1D disclose any hazards exlatlng at lh1 inception dam rA this Covtraga Form; or (2) Make an error, omlltlon, Improper deacrlptlon of "autos· or olher mlntatament of Information. You muet nofify us at 10on a posslble after the di1cove,y of any hazards or any. other lnfonnatlon that was not provided to ua prior to-th• acceptance of this policy. s. Hind Auto -World Wide Coverage Para51"1Ph 7a.(5) of the PoRcy Period, Cove19ga Tanttory Condlllon ii replaced by the following: (8) Anywhere In the world If I cowrec:I "auto" Is leased, hll'9d, rented or borrowed for a period of60 days or less, T. Bodlly ~ury Redeftntcl The definllon of ''bocllly injury" In the Detln111o .. Seotlon Is replaced by the following: "Boclty lnjwy" means bodily Injury, alcknen or dlsea1e, sustained by a penon lndudlng death or mental angulah, l'8Sllftlng from any of thes~ at any time. Mental anguah means any type of mental or emotional llineu or dlaeMe. lnc:luda copytlghtlld mllallat or l1111.1r111C11 SINlcM Olllae, Inc., wllh lil_permllllon. . IJ.CA--424-F cw (04-1-4) PIQt6of9 U. Expected Or Intended Injury The Expectad Or Intended-Injury Exclusion In Paragraph B. Exclmlonil under Section II _; Covered Auto Llabluty Covtr1111• la replaced by the followlng: Expected Or lrarided Injury "Bodily injury'' or "property damage• expected or Intended from the atandpolnt of the '1neured". This exclusion does not apply to "bodily Injury• or "property damage• resulting from the use of realDl'lable force to protect p .. ona or properly. V. Php~I Damage -Addlllona_l Temporary Tramportatlon Exp-• Coverage Paragraph A.4.L of Section Ill--: Phyalcal ~age Coverage 18 repfl(;ed by the following: 4. Coverage Exttrwlon• L Transportation Expenses We WIii pay up to $50 per day to a maximum of $1,000 for temporary lran1partatlon expense lncurrad by vou because of the total theft of a covered "auto• of the prfvate paHenger type. We win pay only for thDN co119111d •autos• for which you airry either Comprehensive or Specified Causes of Lou Coverage. We will pay for temporary tranaportallon expenl88 ncurrad during the period beginning 48 houra after the theft and ending; ragardleas of the. policy's expiration, when tlie covel'lld "auto" Is returned 110 use or we pay for ltl "loeeu, w. Replac:anent of a Prtvate Panenger Auto with a Hybrid or AIIBmatlve Fuel lcuce Auto The followlng la added to Paragraph A. Coverage of the Physical Damage Covemge Section: In the event.of a total "Iola" to a covered •auto• of the private passenger type that 11 replaced with a hybrid •auto" or "auto• powered by an alternative fuel source of the private paaenger type, we wift pay an additional 10% of the cost rl the replacement -.uto", excluding tax, t111e, llcenM, olher feea and any aftermaiket vehicle upgrades, up to a maximum of $2600. The covered •auto• must be replaced by a hybrid "auto" or an ''auto" powered by an aHamatlve fuel IOll'C8 within 60 calendar days of the payment of the "loss" and evidenced by a bHI of sale or new whlcle lease agreement To qualify as a hybrid "auto•, the •auto• mutt be powered by a convanilonal ga10lln1 engine and another 10urce of propulsion power. The alhtr source of propulelon power muet be eleclrk;, hydrogen, propane, aolar or natural gas, either compresHd or liquefied. To qualify u an -.uto· powered by·an allemlltive fuel source, th• •auto• mLl8t be powered by a 10urce of propulsion power -other then a conventlor.l gasollne engine. An •auto• eolely propelled by blofuel, gasoline or diesel fuel or any blend thereof la not an •auto" pawarad by an alternative llel 1ouroe. X, Retum of Stolen Automobile The folowing la added to the Coverage Extenalan Provlelon of the Physical Damage Coverage Section: If a covered "auto" la stolen and 19COV91'8d, we will pay the coat of transport to return the •auto" to you. We will pay only for those,covei'ed "autos" for which you carry either Comprehensive or Specified Causes of Lose Coverage. All olhertenna, conditions, provl8lo1'19 and exclu9ionl ofthia policy remain the same. lncludel copyilghlid mlllar1al of lnlurance Servloea Olllce, Inc., with Ila parmlulon. U-CA.424-F CNV (04-1'4) Page 8 ate Notification to Others of Cancellation or Non renewal Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. BAP 5513802-01 10/01/2017 10/01/2018 02/23/2018 71133000 Add'l. Prem INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part G ZURICH Return Prem. A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 1 O days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of other Person(s) / Organization(s): The City of Carlsbad, it's officials, employees and volunteers 1635 Faraday Avenue Carlsbad, CA 92009 All other terms and conditions of this policy remain unchanged. Includes copyrighted material of Insurance Services Office, Inc, with its penmission. Number of Days Notice: 30 U-CA-810-A CW (05/10) Page 2 of2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL NOTICE OF CANCELLATION (AMENDMENT OF CANCELLATION CONDITION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section IV -Commercial General Liability Conditions is amended to include the following additional condition: In the event that we cancel this policy for any reason, other than for the nonpayment of premium, we will provide advance written notice of such cancellation to the entity(ies) or individual(s) shown in the Schedule below in accordance with the number of days stated. SCHEDULE Number of Days Advance Written Notice of Cancellation (Other Than Nonpayment Entity or Individual Address of Premium) The City of Carlsbad, its officials, employees and volunteers 1635 Faraday Avenue 30 Carlsbad, CA 92009 (Eff:11 /03/17) GL 00068 00 (03/11) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS WC 99 06 33 A. If we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Number of Days Notice: Organization(s): The City of Carlsbad, its officials, employees and volunteers 30 1635 Faraday Avenue Carlsbad, CA 92009 All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 11-03-2017 Policy No. WC 5513803-01 Insured: NU LI NE TECHNOLOGIES, LLC Insurance Company: Zurich American Insurance Company Endorsement No. 002 Premium: $INCL. WC 99 0633 (Ed. 05-10) Includes copyrighted material of Natiaial Council on Compensation Insurance, Inc. with its permission. Page 1 of 1