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HomeMy WebLinkAboutGolden State Labor Compliance LLC; 2021-01-11; PSA21-1365UTILPSA21-1365UTIL General Counsel Approved Version 6/12/18 1 AGREEMENT FOR RECYCLED WATER PHASE III PIPELINE EXPANSION SEGMENT 5 SERVICES, PROJECT NO. 5208-B GOLDEN STATE LABOR COMPLIANCE, LLC THIS AGREEMENT is made and entered into as of the _____________________ day of _________________________________, 2021, by and between the Carlsbad Municipal Water District, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, ("CMWD"), and Golden State Labor Compliance, LLC, a limited liability corporation, ("Contractor”). RECITALS CMWD requires the professional services of a labor compliance company that is experienced in comprehensive labor compliance program administration support fo the Recycled Water Phase III – Pipeline Expansion Segment 5 Services, Project No. 5208-B. Contractor has the necessary experience in providing these professional services, has submitted a proposal to CMWD and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, CMWD and Contractor agree as follows: 1. SCOPE OF WORK CMWD retains Contractor to perform, and Contractor agrees to render, those services (the “Services”) that are defined in Exhibit “A”, attached and incorporated by this reference in accordance with the terms and conditions set forth in this Agreement. 2. TERM This Agreement will be effective for a period of one (1) year from the date first above written. The Executive Manager may amend the Agreement to extend it for one (1) additional one (1) year period. Extensions will be based upon a satisfactory review of Contractor’s performance, CMWD needs, and appropriation of funds by the CMWD Board of Directors. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 3. COMPENSATION The total fee payable for the Services to be performed will be nine thousand four hundred two dollars ($9,402). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. CMWD reserves the right to withhold a ten percent (10%) retention until CMWD has accepted the work and/or the Services specified in Exhibit “A.” 4. STATUS OF CONTRACTOR Contractor will perform the Services as an independent contractor and in pursuit of Contractor’s independent calling, and not as an employee of CMWD. Contractor will be under the control of CMWD only as to the results to be accomplished. 5. INDEMNIFICATION Contractor agrees to indemnify and hold harmless CMWD and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorney’s fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC 11th January PSA21-1365UTIL General Counsel Approved Version 6/12/18 2 The parties expressly agree that any payment, attorney’s fee, costs or expense CMWD incurs or makes to or on behalf of an injured employee under the CMWD’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 6. INSURANCE Contractor will obtain and maintain policies of commercial general liability insurance, automobile liability insurance, a combined policy of workers' compensation, employers liability insurance, and professional liability insurance from an insurance company authorized to transact the business of insurance in the State of California which has 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, in an amount of not less than one million dollars ($1,000,000) each, unless otherwise authorized and approved by the Risk Manager or the City Manager. Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. The insurance will be in force during the life of this Agreement and will not be canceled without thirty (30) days prior written notice to CMWD by certified mail. CMWD will be named as additional insured on General Liability which shall provide primary coverage to CMWD. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. Contractor will furnish certificates of insurance to CMWD with endorsements to CMWD, prior to CMWD’s execution of this Agreement. 7. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of CMWD and on behalf of Contractor under this Agreement. For CMWD: For Contractor: Name David Hull Name Victor Conklin Title Associate Engineer Title Project Manager Dept Utilities Department Address 38733 9th Street East, Suite W City of Carlsbad Palmdale, CA 93550 Address 5350 El Camino Real Phone 661-267-0940 Carlsbad, CA 92008 Email vconklin@goldenstatelc.com Phone 760-603-7322 Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. 8. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. Yes No DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC PSA21-1365UTIL General Counsel Approved Version 6/12/18 3 9. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. 10. TERMINATION CMWD or Contractor may terminate this Agreement at any time after a discussion, and written notice to the other party. CMWD will pay Contractor's costs for services delivered up to the time of termination, if the services have been delivered in accordance with the Agreement. 11. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees it may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. Contractor further acknowledges that debarment by another jurisdiction is grounds for CMWD to terminate this Agreement. 12. JURISDICTIONS AND VENUE Contractor agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Agreement is the State Superior Court, San Diego County, California. 13. ASSIGNMENT Contractor may assign neither this Agreement nor any part of it, nor any monies due or to become due under it, without the prior written consent of CMWD. 14. AMENDMENTS This Agreement may be amended by mutual consent of CMWD and Contractor. Any amendment will be in writing, signed by both parties, with a statement of estimated changes in charges or time schedule. /// /// /// /// /// /// /// /// /// /// /// DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC PSA21-1365UTIL General Counsel Approved Version 6/12/18 4 15. 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 CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad GOLDEN STATE LABOR COMPLIANCE, LLC, a limited liability corporation By: By: (sign here) Vicki V. Quiram, General Manager, as authorized by the Executive Manager Vic Conklin, Vice-President & Secretary (print name/title) If required by CMWD, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups. Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President 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, General Counsel By: _____________________________ Assistant General Counsel DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC PSA21-1365UTIL EXHIBIT “A” SCOPE OF SERVICES Monthly labor compliance support for Recycled Water Phase III Pipeline Expansion Segment 5, Project No. 5208-B Jan. 1, 2021 – Jan. 31, 2021 $1,567 Feb. 1, 2021 – Feb. 28, 2021 $1,567 March 1, 2021 – March 31, 2021 $1,567 April 1, 2021 – April 30, 2021 $1,567 May 1, 2021 – May 31, 2021 $1,567 June 1, 2021 – June 30, 2021 $1,567 TOTAL $9,402 Stipulated, Lump Sum Fee, includes all costs of any kind reasonably required for the operation of a State approved labor compliance program. DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC November 27, 2018 Cathy Nhothsavath Cathy.Nhothsavath@carlsbadca.gov Assistant Engineer City of Carlsbad Public Works 5950 El Camino Real Carlsbad, CA 92008 Re: Proposal for Labor Compliance Services – Project No. 5208-B Recycled Water Phase III Pipeline Expansion Segment 5 Cathy, Golden State Labor Compliance is pleased to provide you and the City of Carlsbad this proposal for the provision for labor compliance support for the above named projects, as follows: Scope: The scope of GSLC services attendant to this proposal is further detailed within the attached Exhibit A. The provisions of this letter and attached scope of services are intended to represent everything and anything reasonably required to provide comprehensive labor compliance administration for the project, which in this instance, includes collection of all documents for the LCP file to assure that all of the federal and state requirements have been met and adhered to. GSLC will file the PWC-100 on each location for the City and work with all contractors to assure compliance with the Clean Water State Revolving Fund and Public Works requirements. Golden State will verify that compliance was conformed to prior to release of any Application for Payment presented to the City. GSLC will conduct all City LCP responsibilities. This project will be eligible for the Clean Water State Revolving Fund financing. Project Information: 1)The Recycled Water Phase III Pipeline Expansion Segment 5 Project #5208-B, is part of the Phase III RecycledWater Program to expand recycled water services throughout the district.2)The Project consists of furnishing and installing approximately 31,684 linear feet of 6” Recycled Water Pipeline;8,000 linear feet of 8” recycled water pipeline; 4,370 linear feet of 6” potable water; and 1,685 linear feet of 8”potable water with all valves and appurtenances.3)Construction Value + or - $9,487,655.00 4)Duration approximately 375 working days, anticipated to be December 2018 through June/July 2020 Compensation: We propose a Stipulated, Lump Sum Fee, which includes all costs of any kind reasonably required for the operation of a State approved LCP. Project No. 5208-B Recycled Water Phase III Pipeline Expansion Segment 5 Thirty-five Thousand Dollars ($35,000.00) This covers any and all reasonable actions required to implement and enforce the LCP, to include audits, investigations (if necessary), and DLSE hearings (if necessary), site visits (interviews) per federal and state requirements. DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4 PSA21-1365UTIL Exhibit A (Con't.) DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC GSLC will also advise if all LCP documents have been received monthly and advise the City that it is okay to release payment applications as having met the LCP requirements for the current billing month as required by the terms of a state approved LCP and regulations requiring holding of contractor payments for missing or inadequate documents. Please contact me if additional information is required. Very truly yours, Terry M. Zinger President Golden State Labor Compliance Switchboard (661) 267-0940 Fax (661) 267-0981 Cell (818) 254-7201 Direct (661)270-1379 tzingergslc@gmail.com DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC EXHIBIT A BASIC AND ADDITIONAL SERVICES LABOR COMPLIANCE SUPPORT PROJECTS SUBJECT TO STATE OR FEDERAL COMPLIANCE REQUIREMENTS NOTE: THE FOLLOWING SCOPE OF SERVICES IS INTENDED TO CHARACTERIZE ALL OF THE ACITIVITES AND DUTIES THAT MAY BE REQUIRED ON ANY GIVEN PROJECT. SOME PROJECTS, ESPECIALLY THOSE THAT ARE TAKEN UNDER ADMINISTRATION AFTER THE START OF CONSTRUCTION OPERATIONS MAY NOT REQUIRE ALL OF THE ACTIVITIES LISTED HEREIN. WHERE IT IS FEASIBLE TO UNDERTAKE ANY TASK OR DUTY SET FORTH BELOW, THAT TASK OF DUTY WILL BE UNDERTAKEN. I. BASIC SERVICES A. State and/or federal Program Start-up Services (Occurs once, at the initiation of services to each Client) GSLC shall: 1. City of Carlsbad is currently, shown to have an approved LCP (LCP ID# 2015.00295). 2. Conduct an initial briefing and workshop for and with Client’s then employed by the Client who are or may be regularly engaged, on behalf of the Client, in the control, administration or management of new construction or modernization activities that are subject to potential funding which would require labor compliance enforcement. Presentation and discussion will include, but is not necessarily limited to: (a) Public works subject to Prevailing Wage Laws. (b) Types of contracts to which Prevailing Wage Requirements apply. (c) Limited exemptions from requirement to pay Prevailing Wage. (d) Applicable dates for enforcement of Labor Commissioner requirements, where applicable. (e) Overview of DIR’s current program and requirements, where applicable. (f) Duties and responsibilities of the Client, the Labor Compliance Consultant, the Labor Commissioner, Program/Project/Construction Managers, general contractors, prime trade contractors and subcontractors. (g) Enforcement, withholding and forfeiture. Rights and procedures. (h) Investigative rights and responsibilities. (i) Forms and procedures specific to the projects anticipated to be undertaken by Client and, in general, GSLC’s procedural requirements. 3. Provide, to all parties attending the briefing/workshop identified in Item A.2 above, a permanent reference package covering all subjects discussed at the briefing/workshop. “Project” is defined as being any body of construction services intended to be advertised, bid, awarded and constructed pursuant to a single bid process. Where a single bid process incorporates more than one physical location where the work at each location constitutes separate funding or budget accountability, the work at each location may, in some cases, constitute a separate project. In the case of Multiple-Prime project delivery, a “Project” means a single advertised set of bids or, in the case of a split bid process, not more than two sets of bids for the same project location. B. Post-Bid Activities 1. Provide two (2) copies (1 for the field office, 1 for Client Office) of California Prevailing Wage Determinations and Important Notices applicable to the specific Project, based on the date of first advertising for bids or equivalent. 2. Where federal Davis-Bacon requirements apply to a project, GSLC shall, in addition to or instead of state requirements, as applicable, make a finding as to the applicable generation of federal Wage Determinations for each Project. 3. Receive from the Client, record and retain a copy of the first advertisement for bids for the Project. DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC 4. Provide the Client (or its authorized representative) with a copy of all forms required for post-bid document collection from the bidders (DAS-140, Contractor’s Acknowledgement, DAS-142 and CAC-2). 5. Provide, if requested by Client, a brief familiarization for contractors, covering current DIR requirements and the resources being made available by the Client, through GSLC, for guidance and support of contractors of all tiers in complying with program and DIR requirements. 6. For each Project undertaken by the Client, GSLC shall: 1.1 Gather necessary project information and, on behalf of Client, complete and, on behalf of Client, upload Form PWC 100 for each project, in compliance with Labor Code sec. 1773.3 and 8 Cal.Code Reg. sec. 16451(a). 1.2 On behalf of Client, upload all required project-specific data to the DIR website, to include authorized Client users for that project, list of trade classifications applicable to the prime contract (block 23), listing of sub-contractors, license numbers and associated trade classifications for each subcontractor. 1.3 If required by DIR, obtain and, on behalf of Client, upload copies of required project documentation, such as copies of bid advertisement, prime contract, subcontractor listing, and any other documentation requested by the CMU. 1.4 Provide prime contractors with appropriate, laminated jobsite posting materials, as required by state and, if applicable, federal law. 1.5 Conduct, as part of a Pre-Construction Conference with the prime contractor(s) and listed subcontractors having been awarded contracts, a briefing with questions and answers, covering all required aspects of labor compliance, prevailing wage and apprenticeship requirements as they will apply to the Project. 1.6 Provide each contractor and subcontractor, in the course of the Pre-Construction Conference, all forms required for post-bid document submissions by the bidders (DAS-140, DAS-142 and CAC-2). 1.7 In the course of the Pre-Construction Conference, Distribute Pre-Construction Checklist of Labor Law and Requirements to all prime contractor(s) and listed subcontractors having been awarded contracts, requiring that each sign and submit the checklist, acknowledging receipt and understanding of materials describing those requirements and their obligations under Labor Law. Collect and secure, within the permanent Project files, all signed checklists. 1.8 Receive and record required company data on all prime contractor(s) and listed subcontractors having been awarded contracts. 1.9 Support, advise and assist, as necessary, prime contractor(s), subcontractors and sub-subcontractors of every tier, in familiarizing themselves with the DIR on-line CPR upload system, registering themselves on the DIR storage system for each project and uploading required company and user data as well as any required documents. Key data for upload will be information equivalent to the “Fringe Benefit Statement”. 1.10 Follow up with prime contractors to confirm that they have registered and uploaded required information to the DIR on-line system and assist them in any manner necessary to facilitate a timely completion of this process. 1.11 Follow up with prime contractors and with all subcontractors to ensure that they have registered with the CMU on-line system and uploaded all required information and that they, in turn , have followed up with their sub- subcontractors in the same regard. 1.12 Verify contractor licensure status of each contractor or subcontractor listed or identified as intending to work on the project. When requested by Client, confirm each prime and listed subcontractor’s registration status with DIR, allowing them to bid and be awarded public works contracts. 1.13 Verify that each contractor or subcontractor listed or identified as intending to work on the project is listed by the State Contractors License Board as having Worker’s Compensation Insurance. 1.14 Verify that each contractor or subcontractor listed or identified as intending to work on the project is listed as having registered with DIR for work on public works projects. 7. For each Project undertaken by the Client that is subject to specific federal requirements, to include DBRA, GSLC shall, in addition to any duties set forth elsewhere within this Agreement: DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC 2.1 Verify federal apprenticeship registration of all workers listed as an apprentice on the project. 2.2 Include, as part of any Pre-Construction Conference held with the prime contractor(s) and listed subcontractors having been awarded contracts, a briefing on any legal or procedural requirements or any forms peculiar to federal compliance requirements. 2.3 Provide consultation and support to contractor(s), subcontractors and sub-subcontractors of every tier who encounter difficulties or alleged deficiencies in complying with DBRA requirements in order to facilitate understanding of their requirements and a resolution of any alleged violations. 2.4 Address all Awarding Agency (Client’s) duties and responsibilities in regard to interfacing with governing federal agencies, to include the Department of Labor. C. Post-NTP Services 1. Receive and record Weekly Superintendent’s Reports. 2. Receive, from the Client or its contractors, on a monthly basis, Certified Payroll Reports (CPRs) for all contractors or subcontractors of every tier who are required to submit such reports. Verify receipt of all required CPRs and report clearance for progress payment to all contractors or subcontractors who’s CPRs comply with basic submittal requirements. 3. Issue and track “Requests for Certified Payroll Records” (GS Form 06) for any contractors or subcontractors for which complete CPRs were required but have not been received or have been found to be incomplete. 4. Notify the Client and its Project Manager if the deficiency involves a subcontractor, any contractor or subcontractor who fails to properly render or correct any missing or incomplete CPRs following a request by the LCP. Such failure is grounds for withholding contract payments until resolution of the deficiency is achieved. 5. Review all CPRs submitted for payment of the proper prevailing per-diem wage rate for the listed classification, to include payment of the proper prevailing per-diem wage rate for overtime and/or holidays. 6. Conduct regular, random audits of Certified Payroll Reports for proper worker classification as well as proper classification and use of registered apprentices. 7. Facilitate confirmation, on a weekly basis, that proper jobsite postings and applicable wage determinations are available at the jobsite. 8. Conduct regular, random field inspections (not less than one per month), at the jobsite, for the purpose o f : (a) Confirming proper jobsite postings and availability of wage determinations, as required by the LCP. (b) Conducting random interviews of workers on the jobsite to confirm Labor Law compliance and worker awareness of their rights under such law. (c) Consulting with the jobsite Superintendent regarding any questions, issues or concerns within the scope of the LCP. 9. 2 Support, advise and assist, as necessary, prime contractor(s), subcontractors and sub-subcontractors of every tier, in electronically submitting Certified Payroll Reports through the DIR on-line system. 10. Provide consultation and support to contractor(s), subcontractors and sub-subcontractors of every tier who encounter difficulties or alleged deficiencies in making on-line submittals or who have difficulty understanding DIR responses or direction. DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC D. On an As-Needed Basis: 1. GSLC will take cognizance of any apparent violation of Labor Law that is within the purview of the Labor Compliance Program and will fully investigate and seek resolution of any apparent violations through administrative procedures. Any reported violation or substantive complaint received will always be treated as a potential violation. 2. Upon taking cognizance of an apparent violation, GSLC, to the degree necessary to resolve the issue, will: 2.1 Assign a case number and a qualified investigator to investigate the circumstances, extent and apparent cause of any apparent violation. 2.2 Request and collect additional Payroll Records, as required, to establish the circumstances, extent and apparent cause of any apparent violation. 2.3 Audit all Payroll Records pertinent to the case to establish the facts pertaining to an apparent violation. 2.4 Request, from all pertinent parties, copies of all records that would support the filing of a request for forfeiture with the Labor Commissioner. 2.5 Notify the subcontractor who may have committed a violation of the LCP’s initial findings, offering the opportunity to explain any apparent discrepancies and to provide additional records in support of its position. 2.6 Notice and conduct an informal interview with the subcontractor who may have committed a violation for the purpose of reviewing evidence and allowing the contractor or subcontractor the opportunity to prove that a violation has not taken place or was inadvertent. 2.7 Provide notice to the Client of all investigations initiated and all informal conferences scheduled to be conducted. 2.8 In the event that the investigation and informal conference procedures fail to resolve an apparent violation, prepare, for submission, an appropriate case file and application for the Labor Commissioner’s review. Preparation of the case file will include calculation of the apparent amount of underpayment and penalty applicable to the violation. 2.9 Counsel Client and Client’s CMs concerning actions that may be taken by to attempt to achieve restitution by the offending subcontractor and, by doing so, mitigate liability on the Part of the general for the sub’s violation(s). 2.10 Preparation of all documentation, testimony and evidence necessary to satisfy the Client’s obligations in the course of any hearing(s) before the Labor Commissioner in order to achieve administrative adjudication of violations not resolved through informal procedures. Attend such hearings and present testimony in support of the case against the offending contractor, including any and all travel or expenses attendant to such preparation and testimony. E. Other Basic Services GSLC will: 1. Provide general administration and management of the Labor Compliance Program 2. Provide unlimited phone consultation or, if scheduled to be on-site for other purposes, in-person consultation with the Client on any matters pertaining to the LCP. 3. Respond to all records requests received by the Client within statutory time limits and in a manner that promotes positive relations with requestors. Review all records requests, prior to responding, to ensure that the request is legal and proper. In the event that a request is improper, coordinate with the requestor to modify the request so as to be consistent with law, regulation and accepted practice. 4. In the event that the Client receives a written complaint or allegation of violation(s) on a project, GSLC shall make an initial evaluation as to appropriate action on the part of the Client and, on behalf of Client, take such action as is appropriate and necessary 5. Provide secure storage of all received payroll records for a Project throughout the course of that Project DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC and for three calendar years from completion of the Project. 6. Receive, review and record copies of jobsite daily sign-in logs in order to determine that all contractors or subcontractors of every tier are accounted for within labor compliance activities. F. Additional Services Any services or costs not reasonably involved in the initiation, enforcement, administration or defense of labor compliance activities. END Exhibit A Scope of Services Agreement for Labor Compliance Services State and/or Federal Requirements DocuSign Envelope ID: BD696432-A208-46C9-BBE9-A67C73AB26B4DocuSign Envelope ID: 85F77559-875B-4EB5-B03D-B75CCD93CFEC ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD PRODUCER CONTACTNAME:FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A(Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 5/14/2020 (310) 709-1518 11000 Golden State Labor Compliance38733 9th Street East, Ste W Palmdale, CA 93550 22357 37478 25895 A 2,000,000 X 72SBAAE3944 5/11/2020 5/11/2021 1,000,000 10,000 2,000,000 4,000,000 4,000,000 1,000,000B 72UECCB7405 1/10/2020 1/10/2021 1,000,000A 72SBAAE3944 5/11/2020 5/11/2021 1,000,000 10,000 C X 72WECIY1749 6/1/2020 6/1/2021 1,000,000 1,000,000 1,000,000 D Errors & Omissions SP1013152M 5/11/2020 Occurence 1,000,000 D Errors & Omissions SP1013152M 5/11/2020 5/11/2021 Aggregate 2,000,000 City of Carslbad/Carlsbad Municipal Water District (CMDW), Its officers, officials, employees, agents and volunteers are named as Additonal Insured per form SS41710611 and SS41710611 attached to the policy. *10 Days notice of cancellation due to non-payment of premium. *30 Days notice for all other. Waiver ofSubrogation applies to the Workers Compensatsion per form attached City of Carlsbad or Carlsbad Municipal Water District City of Carlsbad/CMWD ATT: Contract Administration 1635 Faraday Avenue Carlsbad, CA 92008 GOLDSTA-17 MHARO Cumbre Insurance Services, LLC3110 E. Guasti RoadSuite 500Ontario, CA 91761 Rafe Shoup shoupr@cumbreins.com Sentinel Insurance Company, Ltd Hartford Accident and Indemnity Company Hartford Insurance Company of the Midwest United States Liability Insurance Company X 5/11/2021 X X X X X X X X THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:04/22/20 Policy Expiration Date:06/01/21 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:72 WEC IY1749 Endorsement Number: Effective Date:06/01/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:GOLDEN STATE LABOR COMPLIANCE 38733 9TH ST E STE WPALMDALE CA 93550 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 Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us