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PAL General Engineering Inc; 2018-02-20; PWM18-91TRAN
RECORDED REQUESTED BY CITY OF CARLSBAD DOC# 2018-0345900 111111111111 lllll 111111111111111 lllll 111111111111111111111111111111111 Aug 22, 2018 03:33 PM OFFICIAL RECORDS Ernest J. Dronen burg, Jr., SAN DIEGO COUNTY RECORDER FEES $0 00 (S82 Atkins $0.00) AND WHEN RECORDED PLEASE MAIL TO: City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 PAGES 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 223-180-08-00 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on June 8, 2018. 6. The name of the contractor for such work or improvement is PAL General Engineering, Inc. 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. 6502 (PWM18-91TRAN), Parking Lot Maintenance Program -La Costa Canyon Park & Fountain Lot. 8. The street address of said property is at Pueblo St. and Rana Court in the City of Carlsbad. CITY OF CARLSBAD &~ City Manager 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 Ou~ At= / Le , 20jg, accepted the above described work as completed and ordered that a Notic f Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on W JG, / J, 20.12, at Carlsbad, California. \~~ ~RBARA ENGLESON (I' City Clerk Q \Public Works\PW Common\CAPITAL-ACTIVE\6052 Parking Lot Maintenance (La Costa Canyon Park & Fountain Lot)\NOC.doc ) .. { ~' CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS PAL General Engineering, Inc. has completed the contract work required for Project No. 6052 (PWM18-91TRAN), Parking Lot Maintenance Program -La Costa Canyon Park & Fountain Lot. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS VALUE Grind, pave & stripe parking lots $42,986 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 directed to commence maintaining the above described improvements. Date APPROVED AS TO FORM: CELIA BREWER, City Attorney By ~ Deputy City Attorney Q:\Public Works\PW Common\CAPITAL-ACTIVE\6052 Parking Lot Maintenance (La Costa Canyon Park & Fountain Lot)IAPl.doc PWM 18-91 TRAN CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT PARKING LOT MAINTENANCE PROGRAM· LA COSTA CANYON PARK & FOUNTAIN LOT; CONT. NO. 6052 This agreement is made on the 2P ~ day of 'Fe..byvq ye/ , 20 IB by the City of Carlsbad, California, a municipal corporation, (hereinafter callid "City"), and PAL General Engineering, Inc., whose principal place of business is 10675 Treena St. Ste. 103, San Diego, CALIFORNIA 92131 (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: Emad Elias (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. PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 1 of 8 City Attorney Approved 9/27/16 PWM18-91TRAN 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 tae ontractor ay b prevented from further bidding on public contracts for a period of up to five years an }~:~~ebar ent another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or xtract r fro articipating in contract bidding. Signature: Print Name: Marla Jahshan 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. PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 2 of 8 City Attorney Approved 9/27/16 PWM 18-91 TRAN 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. PAL GENERAL ENGINEERING, INC., (name of Contractor) 916931 (Contractor's license number) A (license class. and exp. date) 1000004280 (DIR registration number) 06/30/2018 (DIR registration exp. date) 10675 Treena St. Ste. 103 (street address) San Diego, CALIFORNIA 92131 (city/state/zip) 858-638-71 00 (telephone no.) 858-860-5556 (fax no.) mgahoush@palsd.com (e-mail address) PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 3 of 8 City Attorney Approved 9/27/16 PWM18-91TRAN 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. By: (sign here) Marla Jahashan, President (print name/title) By: ~~~ (sign here) Abd Jahshan, Vice President (print name/title) Md Ye'~ /Cf[) CITY OF CARLSBAD, a municipal corporation of the State of California By: Elaine Lukey. Public Works Director If required by City, proper notarial acknowledgment of execution by Contractor must be attached. !f..§. 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: cf/~ Deputy City Attorney PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 4 of 8 City Attorney Approved 9/27/16 PWM 18-91 TRAN 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 ~()~ V Total % Subcontracted: __ O~-=o ..... ¼~-- The Contractor must perform no less than fifty percent (50%) of the work with its own forces PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 5 of 8 City Attorney Approved 9/27/16 PWM18-91TRAN EXHIBIT B Parking lot Maintenance Program -la Costa Canyon Park & Fountain lot Grind, pave, and stripe the entire parking lots at La Costa Canyon Park and the "Fountain Lot" on NW corner of State Ave. and Grand Ave. JOB QUOTATION 1 La Costa Canyon Park 22,250 2 LS Fountain Lot 20,736 TOTAL* $42,986 *Includes taxes, fee's, expenses and all other costs. PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 6 of 8 City Attorney Approved 9/27/16 EXHIBITC LABOR AND MATERIALS BOND PWM18-91TRAN Bond Number: 54-220392 Premium: $419 Premium will be adjusted based on final contract amount. WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to PAL General Engineering, Inc. (hereinafter designated as the "Principal"), a Contract for: PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONTRACT NO. 6052 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, PAL General Engineering, Inc. , as Principal, (hereinafter designated as the "Contractor"), and United Fire & Casualty Company _______________ as Surety, are held firmly bound unto the City of Carlsbad in the sum of Forty Two Thousand Nine Hundred Eighty Six and 00/100 _______________________ Dollars ($ 42,986 ). 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. PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 7 of 8 City Attorney Approved 9/27/16 PWM18-91TRAN In the event that Contractor is an individual, it is agreed that the death of any such Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this _'Z.:_A""""·_.\4.-i __ _ day of~~~ CONTRACTOR: (sign here) Executed by SURETY this ___ 27_t_h __ day of December , 20...11...... SURETY: United Fire & Casualty Company (name of Surety) 118 2nd Avenue SE, Cedar Rapids, IA 52407 (address of Surety) /11/ltl.l 4 cJ It /-k-;f(pj , ft fS (p rA/,-(319) 247-6144 (telephone number of Surety) (print name here) (tz_ ar ,./f /Z-l(z_ t NL?/ Alft/2/44.. I ,>Ltt -------------------(ti t I e and organization of signatory) By:_~-+·--f--"'-"-'....,.._)Q,..-.-..,·¢c:=:::::~----- (sign here) {t g D J:~n~tite ~e¾) Matthew C. Gaynor (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 cnyAtt~ By:~ Deputy City Attorney PARKING LOT MAINTENANCE PROGRAM -LA COSTA CANYON PARK & FOUNTAIN LOT CONT. NO. 6052 Page 8 of 8 City Attorney Approved 9/27/16 UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA UNITED FIRE & INDEMNITY COMP ANY, WEBSTER, TX FINANCIAL PACIFIC INSURANCE COMPANY, ROCKLIN, CA CERTIFIED COPY OF POWER OF ATTOR"l'EY ( original on file at Home Office of Company -See Certification) Inquiries: Surety Department 118 Second Ave SE Cedar Rapids, IA 52401 KNOW ALL PERSONS BY THESE PRESENTS, That UNITED FIRE & CASUALTY COMPANY, a corporation duly organized and existing under the laws of the State of Iowa; UNITED FIRE & INDEMNITY COMP ANY, a corporation duly organized and existing under the laws of the State of · Texas; and FINANCIAL PACIFIC INSURANCE COMP ANY, a corporation duly organized and existing under the laws of the State of California (herein collectively called the Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint DANIEL FRAZEE, KIM VASQOEZ, MATTHEW C. GAYNOR, EACH INDIVIDUALLY of SANTEE CA their tme and lawful Attorney(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds, undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $50,000,000. oo and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Companies and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirn1ed. The Authority hereby granted is continuous and shall remain in full force and effect until revoked by UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, AND FINANCIAL PACIFIC INSURANCE COMPANY. This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted on May 15, 2013, by the Boards of Directors of UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, and FINANCIAL PACIFIC INSURANCE COMPANY. "Article VI -Surety Bonds and Undertakings" Section 2, Appointment of Attorney-in-Fact. "The President or any Vice President, or any other officer of the Companies may, from time to time, appoint by written certificates attorneys-in-fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys-in-fact, subject to the limitations set forth in their respective certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach the seal of the Companies thereto. The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any attorney-in-fact. """""""'"'''' IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its §,._,., ~ .,,_ .,-'''itt·P\N0§;!.~:1i;:,,,_, vice president and its corporate seal to be hereto affixed this 7th day of November, 2017 ~ (', ,..,_,_. QP rf-1,>:"·'(C'-;. I& CORPORATE n fr:iv 'd·ci\ UNITED FIRE & CASUALTY COMPANY =~ -•->: ::::--: ~\}LY2o,; :0= %~ SEAL ~ff ff 1986 .J~ UNITED FIRE & INDEMNITY COMPANY ¾t;••,,.ts~~~/ \;j,-~-1l11;9_?<'i:-.'-"';.:t/ FINANCIAL PACIFIC INSURANCE COMPANY State oflowa, Count:,:;·::~, ss: ,,,,,,,,,,,"''""'"''''''' By: 9--~;--~President On 7th day of November, 2017, before me personally came Dennis J. Richmann to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa; that he is a Vice President of UNITED FIRE & CASUALTY COMPANY, a Vice President of UNITED FIRE & INDEMNITY COMPANY, and a Vice President of FINANCIAL PACIFIC INSURANCE COMPANY the corporations described in and which executed the above instrument; that he knows the seal of said corporations; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that he signed his nrune thernto plli"Swmt to like authority, and ,cknowledges ssme to be the act md deed. of sm_· d corporatio~ns. . • r Commission number 173041 Notary Public ~ 10:~d:~ri~~~i!a1 b A owa. My Commission Expires 04/23/2018 M --· 041231201 8 y comm1ss10n exprres: I, David A. Lange, Secretary of UNITED FIRE & CASUALTY COMPANY and Assistant Secretary of ITED FIRE & INDEMNITY COMPANY, and Assistant Secretary of FINANCIAL PACIFIC INSURANCE COMP ANY, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORA TIO NS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations this 27th day of necemher , 201..1__. Secretary, UF&C Assistant Secretary, UF&I/FPIC BPOA0049 0115 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 December 27, 2017 before me, Kathy Scheuerman, Notary Public (insert name and title of the officer) personally appeared Matthew C. Gaynor who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature /~ SUu1.10A11U/le.,...__ (Seal) CALIFORNIA ALL PURPOSE 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 _s_a_n_D_i_eg..;;.;.o __ ___.,, _ _,} On J~'"I ~ Public, ·29\ ~efore me , ___ -_,-+y_\,;_c_r __ CN"\_··-----'-_r_;·s._.-.._\_...-_~~i;."-1t..._Y'\.....;_ ____ ----'Notary personally appeared ___ ._¾_~_,_b-__ d=-:;_c,-.._·\--\...;..;;:;.S_"1_o_~ n_. __ ~-_· ________ _ who proved to me on the basis of satisfactory evidence to be the persony;) whose name(6/are subscribed to the within instrument and acknowledged to me that~he/they executed the same in~er/their authorized capacity(i¢s), and that by@§Jher/their signature(1) on the instrument the person(i, or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. I ~~ TYLER CHRISTENSEN l ~:ij··' ! · ,, COMM.# 2151238 ~ U, M~ ~-~ NOTARYPUBLIC•CALIFORNIA~ ,c( . SAN DIEGO COUNTY _.. } ~~c JI J My Commission Expires { ._ APRIL 29, 2020 .. Signature: ·-----,ji~ ~ (Seal) __________ OPTIONAL _________ _ Description of Attached Document Title or Type of Document: \) ·; l> J..<:;r IS ~ b1' "---Tc # o" Number of Pages: __ _ Document Date: _______ Other: _________________ _ CALIFORNIA ALL PURPOSE 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 Die.~o -} ,---- On "l0\ 'g / I h befqre me, __ -_\_,.y_\ __ <!.._r __ C_\",_r_, '.:>_\_q__r,_'f-0......_ _______ ---'Notary Public, personally appeared ____ M __ c-'_,_,o--;;.....;...._"---'----''x,-_;:;...,._\,-.,_~;;:;;..h_CJ'.._1"""1 __ · -_· ____ _ who proved to me on the basis of satisfactory evidence to be the personOO whose name¢™are subscribed to the within instrument and acknowledged to me that he~they executed the same in his@their authorized capacity(ie's), and that by Qis@their signature~ on the instrument the person(s}, or the entity upon behalf of which the person~ acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. . ------Signature: ' F ~ (Seal) __________ OPTIONAL _________ _ Description of Attached Document I /) -. -\. . 'j ~~ )'---I, Title or Type of Document: w.,..\:, or, 4le /'J\;j:_ t e.':',.J. S.('ls.c-" Number of Pages:-'-'--- !Document Date: _______ Other: I I ! PALGE-1 OP ID: WC ACORD-CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 01/17/2018 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 ~2:I~cT Rancho Mesa Ins. Services Inc. Rancho Mesa Insurance Services r.JJgNJo Extl: 619-937-0164 I r..ea Nol: 619-937-0168 250 Riverview Parkway #401 Santee, CA 92071 E-MAIL ADDRESS: INSURER(Sl AFFORDING COVERAGE NAIC# INSURERA ,Associated Industries Ins Co. 23140 INSURED PAL General Engineering, Inc. INSURER B: Ohio Casualty Ins Company 24074 10675 Treena St., Ste. 103 INSURER c: Endurance American Specialty San Diego, CA 92131 INSURER D: Everest National Insurance Co 10120 INSURER E: Lloyds of London INSURERF: COVERAGES CERTIFICATE NUMBER: 1 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 ADDL SUBR /OLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,.,en wvn POLICY NUMBER MM/DD/YYYYl IMM/DD/YYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C ~ 0 CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED 100,000 X X AES1020314 01/07/2018 01/07/2019 PREMISES /Ea occurrence\ $ x Bl/PD Ded $5,000 MED EXP (Any one person) $ Excluded ~ PERSONAL & ADV INJURY $ 1,000,000 ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 =l 0 PRO-DLOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 /Ea accident\ -B X ANY AUTO X X BA056481930 01/07/2018 01/07/2019 BODILY INJURY (Per person) $ -ALL OWNED ~ SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ x x NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS '1~6&~011 IPer accident\ x $1000 Comp x $ UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 10,000,000 C x EXCESS LIAB CLAIMS-MADE ELD30000554700 01/07/2018 01/07/2019 AGGREGATE $ 10,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X I PER I X I OTH-AND EMPLOYERS" LIABILITY STATUTE ER D Y/N X 7600018522181 01/07/2018 01/07/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) E.L DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 E Professional/ AE182439 01/07/2018 01/07/2019 Ea Claim 1,000,00C Pollution Aggregate 1,000,00C DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: OPERATIONS OF THE NAMED INSURED AS CERTIFICATE HOLDERS INTEREST MAY APPEAR SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CITY OF CARLSBAD IS INCLUDED AS ADDITIONAL INSURED PER FORM CG2010 11/85 ATTACHED. PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES. AUTO ADDITIONAL INSURED APPLIES PER ENDORSEMENTATTACHED.~pag~ CERTIFICATE HOLDER CANCELLATION CITYC10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF CARLSBAD/CMWD ACCORDANCE WITH THE POLICY PROVISIONS. c/o EXIGIS INSURANCE AUTHORIZED REPRESENTATIVE COMPIANCE SERVICES 'y~,AJ~ P.O. BOX 4668 -ECM #35050 NEW YORK NY 10163-4668 -© 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES1020314 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -(FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: All persons or organizations where written contract with the Named Insured requires 11/85 edition. This form does not apply to work on "residential property". {If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 D POLICY NUMBER: AES1020314 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 POLICY NUMBER: AES1020314 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: 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. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 D POLICY NUMBER: AES1020314 COMMERCIAL GENERAL LIABILITY NX GL 093 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT-AGGREGATE LIMITS OF INSURANCE (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Subject to an Overall Policy Aggregate Limit: Schedule $5,000,000 (Information required to complete this Schedule, if not shown above, will be shown in Declarations.) A. Paragraphs 2. and 3. of SECTION Ill -LIMITS OF INSURANCE are replaced by the following: 2. The Overall Policy Aggregate Limit is the most we will pay for the sum of a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and c. Damages under Coverage B. 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard" to each of your projects away from premises owned by or rented to you. B. The following is added to SECTION Ill -LIMITS OF INSURANCE: 8. Subject to Paragraph 2. and 3. above, the General Aggregate Limit is the most we will pay under for the sum Coverage A, Coverage B, or Coverage C to each of your projects away from premises owned by or rented to you. NX GL 093 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: AES1020314 IL 00 1711 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deli- vering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the f irst Named lnsured's last mailing address known to us. 4. Notice of cancellation will state the ef fective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the r efund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the ins urance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit y our books and records as they relate to this policy at any time dur- ing the policy period and up to thr ee years after- ward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to per form the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- surance inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordin- ances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Dec lara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL00171198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 0 re Policy Number: BAO56481930 COMMERCIAL AUTO CA 88 10 01 13 -= - 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 PROVISION NUMBER 3 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. BROAD FORM INSURED 12 19 5 13 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 2. 3. (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. 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 contrac/ 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". 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 B.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 CABB 100113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 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. 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. ;:: 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 CA88100113 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS W AIYER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 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: 01/07/2018 Insured: PAL General Engineering, Inc. Policy No. 7600018522181 Insurance Company: Everest National Insurance Company Endorsement No. 001 Premium $ INCL. Countersigned By: ___________________________ _ -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual -1999. 4