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HomeMy WebLinkAboutS&J Builders and Restoration Services Inc; 2022-12-01; PWM23-2019FACDocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF 1st December CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT FARADAY ROOM 207 OFFICE SPLIT PWM23-2019FAC This agreement is made on the ______ day of ___________ , 2022, by the City of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and S&J Builders and Restoration Services, Inc., a California corporation whose principal place of business is 10815 Wheatlands Ave., Suite J, Santee, CA 92071 (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 Brian Bacardi (City Project Manager) PAYMENT. The City shall withhold retention as required by Public Contract Code Section 9203. 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. Faraday Room 207 Office Split Cont. No. 44872 Page 1 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF PWM23-2019FAC 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. 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 (5) years and that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcontractor from participating in contract bidding . Signature: Print Name: Gracie Wilson 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 Faraday Room 207 Office Split Cont. No. 44872 Page 2 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF PWM23-2019FAC 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 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 LI ABILITY. 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. 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 thirty (30) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within sixty (60) working days after receipt of Notice to Proceed. Ill Ill Ill Ill Ill Ill Faraday Room 207 Office Split Cont. No. 44872 Page 3 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF CONTRACTOR'S INFORMATION. S&J Builders and Restoration Services, Inc. (name of Contractor) 689944 (Contractor's license number) Class B, C36 2/9/2024 (license class. and exp. date) 1000018498 / 6/30/2023 (DIR registration number/exp. date) PWM23-2019FAC 10815 Wheatlands Ave., Suite J (street address) Santee, CA 92071 (city/state/zip) 619-449-2014 (telephone no.) swilson@sandjbuild.com (e-mail address) 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 S&J BUILDERS AND RESTORATION SERVICES, INC., a California corporation CITY OF CARLSBAD, a municipal corporation of the State of California By: By: ~ ~ ----~_,_,,t:,_,__A--___,,a...._____ __ _ By: (sign here) Gracie Wilson, President, CEO, & Secretary (print name/title) ~~ (print name/title) Paz Gomez, Deputy City Manager, Public Works, as authorized by the City Manager If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney Faraday Room 207 Office Split Cont. No. 44872 Page 4 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF PWM23-2019FAC EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each subcontractor 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 subcontractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a subcontractor 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 Type of Work to Business Name and Address DIR License No., % of be Subcontracted Registration Classification & Total No. Expiration Date Contract 1-::t-c:. ,h,: ~ rr:t/lJl,A.~ • / ooooo~ I$"' t:(fiJZ?. Z. ~-S- Pevc..l of~~ ~-c.. C-10 'j~-Z.1./ f;,S Total% Subcontracted: ______ _ The Contractor must perform no less than 50% of the work with its own forces. Faraday Room 207 Office Split Cont. No. 44872 Page 5 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF PWM23-2019FAC EXHIBIT B Faraday Room 207 Office Split Contractor to provide all materials, tools and labor necessary to modify the existing room 207 office which measures approximately 213 square feet, and reconfigure that space into two separte offices measureing approximately 100 square feet each . All work shall be consistant with the contractors proposal dated November 8, 2022, and is attached to this agreement as Exhibit "D". JOB QUOTATION ITEM UNIT QTY DESCRIPTION NO. 1 LS 1 Office reconfiguration. *Includes taxes, fees, expenses and all other costs. Ill Ill Ill Ill Ill , Ill Ill Ill Ill Ill Ill Ill Ill Ill Faraday Room 207 Office Split Cont. No. 44872 ,. Page 6 of 20 PRICE $40,053.86 TOTAL* $40,053.86 .cc , 11 • City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF Premium Subject to Adjustment Based on Final Contract Price EXHI BIT C LABOR AND MATERIALS BOND PWM23-2019FAC Bond No. 100699985 Premium: $801.00 WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to S&J Builders And Restoration Services, Inc., a California corporation (hereinafter designated as the "Principal"), a Contract for: FARADAY ROOM 207 OFFICE SPLIT 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, S&J Builders And Restoration Services, Inc., a California corporation, as Principal, (hereinafter designated as the "Contractor"), American Contractors Indemnity Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of forty thousand fifty three dollars eighty six cents ($40,053.86), 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. Faraday Room 207 Office Split Cont. No. 44872 Page 7 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF PWM23-2019FAC 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. SIGNED AND SEALED, this _18_th ___ day of __ N_o_ve_m_b_e_r _________ , 2022 S & J Builders and Restoration Services, Inc. (SEAL) By:. (Pri~ -~e) American Contractors Indemnity Company (Sf-AL) (Surety) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY -ATTACH ATTORNEY-IN- FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney By: City Attorney Faraday Room 207 Office Split Cont. No. 44872 Page 8 of 20 City Attorney Approved 8/2/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF 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 thi s certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange On /\) D'-'{,f'l\. ~ I & , '7o1l-'1---before me, ______ A_n_g_el_a_K_im_,_N_o_tar_·_y _P_ub_l_ic ___ ~--1 Date Here Insert Name and Title of the Officer personally appeared _____________ A_r_ie_l_T_. _H_e_re_d_i_a ____________ _ Name(s) of Signer(s) 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. 1············ 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. ---------------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: Bond# / tJO & Cf°lq J ) Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: _A_rie_I_T_. H_e_r_ed_ia ________ _ I Corporate Officer -Title(s): ______ _ I_, Partner -1 Limited LJ General Individual 0\ttorney in Fact J Trustee I Guardian or Conservator _J Other: ____ _ Signer Is Representing: _________ _ Signer's Name: ____________ _ _J Corporate Officer -Title(s): I I Partner -I_] Limited 1 1 General Individual 1 I Trustee 0 Other: 1 1 Attorney in Fact 0 Guardian or Conservator Signer ls Representing: __________ _ ©2014 National Notary Association · www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF TOKIO MARINE HCC KNOW ALL MEN BY THESE PRESENTS: POWER OF ATTORNEY That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, ARIEL T. HEREDIA its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number ______ 10_0_6_9_9_9_8_5 ______ , issued in the course of its business and to bind the Company thereby, in an amount not to exceed One hundred thousand and 00/100 $100,000.00 ). This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1st day of September, 2011. "Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 18th day of April, 2022. ,,,,,,';,'.~•~·~·~;,,,,,, ~::~,:f o~~:::::eles ~~/;;:{~) AMERICAN CONT By: ,,.,,,,r,;'4iiFOR~\~,,,"' ,,,,,.,111111\\ 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, accurac , or validit of that document. On this 18th day of April, 2022, before me, Sonia 0 . Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under 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.. SigoaMe ~ (seal) I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 18th day1of ___ ..:..N'""o'-'v-=e.:..:.m""'b'""e"""r __ _ Bond No. Agency No. 100699985 4046 2022 HCCSOZZPOAACICD4/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF EXHIBIT D S&.J Builders and Restoration Services Inc 10815 Whca1lands Ave Suite J Sanlec, CA 92071 619-449-201 4 6 I 9-449-0887 fax Lie 689944 Jnsured: City of Cnrlsbad Properly: 1635 Fnraday Ave Corlsbud, CA 92008 Cluim Rep.: Eslimator: Scan Wilson Compnny: S&J Builders Business: .10~15 Wheallands Ave Suite J Santee, CA 92071 Reference: Company: City of Carlsbad Contractor: Company: Busine~s: S&J 1luildcrs and Resorlation Services Inc 10815 Wheatlunds Ave Suite J Sanrcc. CA 92071 Claim Number: •><•*•* Policy Number: •**••·•· Date Conrncted: 8/5/2022 12:00 PM PWM23-2019FAC Cellular: (760) 585-8076 E-mnil: Briun.Bacardi@cnrlsb11dcn.g,,v Business: (619) 449-2014 x 106 E-mui l: swilson@sundjbuild.com Business: (619) 449-2014 Type or Loss: Tennnr rmprovemcnt Date of Loss: Date Received: 8/5/2022 12:00 PM Date Inspected: 8/15/2022 10:00 A;\11 Price List: SJSDPWPWSJSO2I Restoration/Scr.•ice/Remodel Estimate: CITYOFCARLS!lADTl207E Faraday Room 207 Office Split Cont. No. 44872 Dale Entered: 11/8/2022 :I: 12 PM Page 9 of 20 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&.J Builders and Restoration Services Inc I 08 I 5 Wheatlunds Ave Suite J Santee. CA 92071 6 I 9-449-2014 619-449-0887 fux Lie 689944 PWM23-2019FAC We would like to thank you for the opportunity to provide you with this COST PROPOSAL FOR 207 Office Tl and new office the total cost for the repairs detailed in th~ following proposal is$ 40,053.86 Proposal includes prevailing wuges. The attached estimate details the specific work 10 be completed. Additional work outside of that spcc.ilied in this estimate will he through separate proposal(s) and/or change order(s) detailing the additional/changed scope of work as well as the terms and pricing of those changes. Repairs will be scheduled after a signed conlrnct is received by S&J Builders and a PO is issued by U1c city. Unless noted otherwise, the customer is required lo provide heat, water and electricity on-site for the duration of this project. The customer is responsible for providing continuous access to the project area during normal business hours, Monday -Friday. 7:30 am -4:00 pm. Where an ilem is being replaced. we will be matching !he existing item's quality. color, finish, texture or material as close as possible where applicable unless noted otherwise. there is no guaranty either specified or implied on exact matches. This estimate docs not indudc haznrdous material testing or abatement unless specifically detailed in the. following estimate. This estimate is valid for 30 uays from 11/08/22. If you have nny questions about this estimate. please contuct Sean Wilson ID discuss those questions. Respectfully, Sean Wilson CITYOPCARLSBADTl207E Faraday Room 207 Office Split Cont No. 44872 11/8/2022 Page 10 of 20 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&.J Builders and Restoration Services Inc I 08 I 5 Whentlands Ave Suite J Santee. CA 92071 619-449-2014 6 I 9-449-0887 fux Lie 689944 CITYOFCARLSBADTI207E Existing Floor Pinn Ortic207 DESCRIJ"l'ION I. Floor protection -self-adhesive plastic film 2. Remove Modular glass wall system 3. Remove Suspended ceiling tile -Premium grade -2' x 2' 4. Remove Suspended ceiling grid -Premium grade -2' x 2' 5. Remove Batt insulation -6" -Rl9 -unfaced ball 6. Remove Fluorescent -acousric grid fixture SA VE FIXTURE FOR THE CITY 7. llcat, Vent, & Air Conditioning (BY TllE CITY VENDOR) I EXCLUDED RELOCATION AND REPAIRS BY THE CITY HVAC VENDOR 8. Fire Protecrion Systems (BY THE CITY VENDOR) I EXCLUDED I RELOCATION ANT) REPAIRS BY THE CITY FIUE PROTECTION VENDOR 9. Carpet -per hour Cut back existing carpet for new wall slcel track 10. Remove Cove base molding -rubber or vinyl. 4" high 11. Metal studding, 3 5/8" wide. 16" OC New dividing wall and two front return walls t 2. Aco11sricnl/firc-saflng insulation Pro1>0sed Floor Plan NewOITie 207 OESCRIPTION 13. l.n noor closer fill repair 14. Rewire -average office -copper wiring wilh conduit Separate light wiring and new wall electrical 15. Empty conduit runs for future use 16. Outlet -tamper resistant -Commercial 17. Occupancy sensor -switch 18. Blank cover 19. 5/8" drywall -hung, taped, ready fortexture '20. Tape joint for new to existing drywall -per LF 2 L Tex lure drywall -smooth/ .~kim coal 22. Seal the surface area w/latex based stain blocker -one coal crrYOFC'ARLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 Page 11 of 20 PWM23-2019FAC 11/8/2022 Height: 9' QTY 317.01 SF 133.97 LF 49.67 SP 49.67 SF 49.67 SF 1.00 EA I.ODEA 1.00 EA 1.00 HR 42.29 LF 319.17 SF 154.1 7 SF Height: 9' QTY 1.00 BA l02.44 SF 20.00 LF 4.00 EA 1.00 EA 1.00 EA 221.67 SP 18.00 LF 260.00 SF 260.00 SF Page: 1 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&J Builders and Restoration Services lnc I 08 I 5 Wheat lands Ave Suite J Santee, CA 9207 t 619-449-2014 6 I 9-449-0887 fax Lie 689944 DESCRIPTION 23. Paint the walJs • two coats 24, Steel door frame -8' opening CONTINUED -New011ie 207 25. French door, 8' • Interior -Maple. wi th single duel glaze clear glass -slab only 5" side and top JO" bottom 26. Door hinges -(set of 3) 27. Finish door slab only (per side) 28. Sen I & paint metal door trim & jamb -(per side) 29. Seal & paint window opening (per side) 30. 3/8" x 3' x7' temp clear glass 31. Lockset -Heavy duty • Commercial grade 32. Cove base molding -rubber or vinyl. 4" high 33. Suspended ceiling grid -2' x 2' 34. Install Suspended ceiling tile -2' x 2' 35. Arnusticul Treatments lnstuller -per hour Additional labor to tie in g1·id and tile.s to new wall. 36. Material Only Window blind -PVC -3.5" 37. Window Treatments Installer -per hour 3R. Carpet Installer-per hour Labor In cut in new carpet tile SUJ>plied by the city 39. Final cleaning· constrnction -Commercial New Office DESCRIPTION 40. Rewire • average ol'ficc • copper wiring with conduit Separate light wiring and new wall electrical 41. Outlcl -tamper resistant -Commercial 42. Occupancy sensor• switch 43. Blank cover 44. Empty conduit runs for future use 45. 5/8" drywall -hung, mped, ready for 1exlllre 46. Tape joint for new ro existing dryw.ill -per LF 47. Texture drywall -smooth/ skim coat 48. Seal the s1u-face area w/latex based stain blocker -one coat 49. Painr the walls -two coats 50. Steel door frame -8' opening 51. French door, 8' -Interior -Maple with single duel glaze clear glass -slab only 5" side and lop IO" bollom 52. Finish door slab only (per side) 53. Door hinges -(set or 3) 54. Locksct -Heavy duty -Commercial grade 55. Seal & paint metal door trim & jamb -(per side) PWM23-2019FAC QTY 288.82 SF 1.00 EA 1.00 EA I.ODEA 1.00 EA 1.00 EA 1.00 EA 1.00 EA 1.00 EA 38.33 LF 49.67 SF 52.00 SF 6.29 HR 1.00 EA 1.00 HR 2.00 HR I 02.44 SF Height: 9' QTY 102.44 SF 4.00 EA 1.00 EA 1.00 EA 20.00 LF 224.17 SF 18.00 LF 260.00 SF 260.00 SF 322.93 SF 1.00 EA 1.00 EA 1.00 EA 1.00 EA 1.00 EA LOO EA CITYOf'CARLSBADTl207E 11/8/2022 Page: 4 Faraday Room 207 Office Split Cont. No. 44872 Page 12 of 20 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&J Builders and Restoration Services Inc 10815 Wheatlands Ave Suite J Santee. CA 92071 619-449-2014 619-449-0887 fux Lie 689944 CONTINUED · New 0111cc DESCIUPTION 56. Seal & paint window opening (per side) 57. 3/8" x 3' x7' temp cleur gla.ss 58. Cove base molding • rubber or vinyl. 4" high 59. Suspended ceiling grid -2' x 2' 60. Install Suspended ceiling tile -2' x 2' 61. Acoustical Treahllents Installer -per hour Additional labor to tie in grid and tiles to new wall. 62. Material Only Window blind -PVC - 3.5" 63. Window Trentments Installer • per hour 64. Final cleaning -constntction -Commercial Hallway DESCRIPTION 65. Floor protection -self-adhesive plastic film 66. 5/8" drywall -hung. taped. remly for texture 67. Tape joint for n.:w to existing drywall -per LF 68. Texture drywall -smooth/ skim coat 69. Seal the surf.tee area w/latex based stain blocker -one cout 70. Paint the walls -two coats 71. Finish door slnb only (per side) 72. Seal & paint metal door trim & jamb • (per side) 73. Seal & paint window opening, (per sitle) 74. Paint the surface area -iwo coals Rlcnd inlo existing paint 75. Cove base molding -rubber or vinyl. 4" high 76. Pinal cleaning -constrnction -Commerci:tl General DESCRIPTION 77. Custom matched paint -Jambs :tnd frames 78. Commercial Supervision / Project Management -per hour 79. Dumpster load -Approx. 30 yards 80. Architectural/Drafting -CITY [ EXCLUDED J 81. Permits & fees-CITY L EXCLUDED J 82. Bond CITYOPC ARLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 Page 13 of 20 PWM23-2019FAC 11/8/2022 QTY 1.00 EA 1.00 EA 38.33 LP 49.67 SF 52.00 SF 6.29 I-IR 1.00 EA I.OD HR 102.44 SF Height: 9' QTY 127.74 SF 170.00 SF 20.00 LF 200.00 SF 20.00 SF 442.00 SF 2.00 EA 2.00 EA 2.00 EA 132.25 SF 20.00 LF 127.74 SF QTY 1.00 EA 12.00 I-IR 1.00 EA 1.00 EA 1.00 EA 1.00 EA Page: 5 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&J Builders and Restoration Services Inc I 08 I 5 Wheat lands Ave Suite J Santee, CA 92071 6 I 9-449-2014 6 I 9-449-0887 fux Lie 689944 Grnnd Total PWM23-2019FAC $40,053.86 ~ SeanWil'n Grand Total Areas: 1,38736 SF Walls 541.63 SI.-Floor 0.00 SF Long Wull 541.63 Floor Arca I.228.19 Exterior Wall Aren 0.00 Surface Area 0.00 Total Ridge Length CJTYOFC J\RLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 541.63 60.18 0.00 599,60 147.33 0.00 o.oo SF Ceiling 1.928.99 SF Walls and Ceiling SY Flooring 170.96 Lr Floor Perimeter SF Short Wnll 199.17 LF Ceil. Perimeter Total Arcn 1,387.36 Jntcrior Wall Arca Exterior Perimeter of Walls Number of Squares 0.00 Total Perimeter Length Tomi Hip Length 11/8/2022 Page: 6 Page 14 of 20 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF mi S&J Huilders and Restoration Services Inc ....... ~~- 3 5 7 I 0815 Wheatlunds Ave Suit' J Santee, CA 92071 619-449-2014 6 I 9-449-0887 fax Lie 689944 CITYOrCARLSl3ADTl207E Faraday Room 207 Office Split Cont. No. 44872 2 4 6 8 Page 15 of 20 PWM23-2019FAC 11/8/2022 Page: 7 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF mi S&J Builders and Restoration Services Inc ....... ,.,..._,.., ... 9 I I 13 15 10815 Wheatlancls Ave SuiteJ Santee, CA 92071 619-449-20 I 4 619-449-0887 fax Lie 689944 CITYOFCARLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 10 12 14 16 Page 16 of 20 PWM23-2019FAC 11/8/2022 Page: 8 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&J lluilders and Restoration Services Inc 17 19 21 23 108 15 Whentl11nds Ave SuiteJ Santee, CA 9207 1 619-449-2014 619-449-0887 rax Lie 689944 crrvorCARLS0ADT1207E Faraday Room 207 Office Split Cont. No. 44872 18 20 22 24 Page 17 of 20 PWM23-2019FAC 11/8/2022 Puge:9 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF S&J Huilders and Restoration Services Inc 25 108 I 5 Whea1lnncl · Ave Suite J Santee, CA 92071 619-449-2014 619-449-0887 fax Lie 689944 CITYOf-CARLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 Page 18 of 20 PWM23-2019FAC I I/IS/2022 Page: 10 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF E~is1ing Floor Plun 1---------------17' 6"----------------i - - crrvor-CARLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 16' 10" Offie 207 "' "' ~ t:::'.... Page 19 of 20 PWM23-2019FAC Exislin e Floor Pinn I I/R(20n P11ge: 11 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF Propnsetl Floor Pinn 1-----s· 9"------+-----s· 9" ____ .,. 8' 3" 8' 3" •n ~ NewOffie 207 New Office "' "' -- t-2•9"- ~ ~ ~----f--4•--I -2·7" 17' 2" 3'10"1 Hollwoy fn r ~3• 7'' 1---------------24•3•·----------------l Cll-YOrCARLSBADTl207E Faraday Room 207 Office Split Cont. No. 44872 Page 20 of 20 PWM23-2019FAC r Prooosed Floor Plan 11/8/2022 Page: 12 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 COMPENSATION AND 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 IN ACCORDANCE 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 on this 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 10/25/2022 12203 S & J Builders And Restoration Services, Inc. 10815 Wheatlands Ave. Ste. J Santee, CA 92071 22268 12537 10855 11260 31453 A 1,000,000 X 00122993 1 10/15/2022 10/15/2023 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000B 504610170151001 3/1/2022 3/1/2023 C BTN2229374 10/15/2022 10/15/2023 2,000,000 D X SJWC350306 1/1/2022 1/1/2023 1,000,000 1,000,000 1,000,000 E Contractors Pollutio ENP0006552 02 10/15/2022 $4MIL/Occ/Agg 4,000,000 F Property 60497187 10/10/2022 10/10/2023 Bailees 250,000 Deductible for Contractors Pollution Liability is $5,000 per claim | Deductible for Professional liability is $5,000 per claim Re: All Projects with the City As respects General Liabiliy 'The City of Carlsbad' is additional insured when required by written contract per attached endorsements. Cancellation Clause applies per attached policy language. Waiver of Subrogation applies with respects to Workers Compensation. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 S&JBUIL-01 SCARLILE JPL Insurance Group, Inc. 3033 Fifth Ave. #325 San Diego, CA 92103 Amy Brinkley amy@jplinsurance.com James River Insurance Infinity Insurance Company United Specialty Insurance Co. Cypress Insurance Company Lloyds of London Financial Pacific Insurance Co 2,000,000 X 10/15/2023 X X X X X X DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF ACORD" I ~ I ~ □ □ ~ ~ ~ □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ ~~ I POLICY NUMBER: 00122993-1 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 †† ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Where required by written contract or written agreement All operations of the Named Insureds Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF POLICY NUMBER: 00122993-1 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 †† ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Opera- tions Where required by written contract or written agree- ment All operations of the Named Insureds Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property 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". DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF 7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< $386 3DJHRI &2002132/,&<&21',7,216 $OO&RYHUDJH3DUWVLQWKLVSROLF\DUHVXEMHFWWRWKHIROORZLQJ&RQGLWLRQV  &$1&(//$7,21$1'1215(1(:$/ $ 7KHILUVW1DPHG,QVXUHGVKRZQLQWKH'HFODUDWLRQVPD\FDQFHOWKLVSROLF\E\PDLOLQJRUGHOLYHULQJ WRXVDGYDQFHZULWWHQQRWLFHRIFDQFHOODWLRQ % :HPD\FDQFHOWKLVSROLF\E\PDLOLQJRUGHOLYHULQJWRWKHILUVW1DPHG,QVXUHGZULWWHQQRWLFHRI FDQFHOODWLRQDWOHDVW  GD\VEHIRUHWKHHIIHFWLYHGDWHRIFDQFHOODWLRQLIZHFDQFHOIRUQRQSD\PHQWRISUHPLXPRU  GD\VEHIRUHWKHHIIHFWLYHGDWHRIFDQFHOODWLRQLIZHFDQFHOIRUDQ\RWKHUUHDVRQ & :HZLOOPDLORUGHOLYHURXUQRWLFHWRWKHILUVW1DPHG,QVXUHG¶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¶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¶V3UHVLGHQW RUKLVQRPLQHHDWWKHDGGUHVVVKRZQRQWKH'HFODUDWLRQVSDJHRIWKLVSROLF\DQGWKDWLQDQ\VXLW LQVWLWXWHGDJDLQVWDQ\RQHRIWKHPXSRQWKLVSROLF\WKLV&RPSDQ\ZLOODELGHE\WKHILQDOGHFLVLRQRI 3ROLF\ 1 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF Endorsement Effective: Policy No.: Insured: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manualpremium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculatedcharge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver – Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium (prior to adjustments) 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 No.: Premium $ Insurance Company: WC 99 04 10 C Countersigned by ______________________________________ (Ed. 01-19) Job Description All CA Operations Cypress Insurance Company SJWC350306 1789.00 01/01/2022 DocuSign Envelope ID: F7250EDC-1B03-49E9-86DC-F255F011F7AF