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HomeMy WebLinkAboutKoppl Pipeline Services Inc; 2023-02-09; PWM23-2058UTILPWM23-2058UTIL Insertion Valve Installations; Cont. No. 3904 Page 1 of 8 General Counsel Approved 8/2/2022 CARLSBAD MUNICIPAL WATER DISTRICT MINOR PUBLIC WORKS CONTRACT INSERTION VALVE INSTALLATIONS CONT. NO. 3904 This agreement is made on the ______________ day of _________________________, 2023, by 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, California, hereinafter referred to as “CMWD”, and Koppl Pipeline Services, Inc., a California Corporation, whose principal place of business is 1228 Date Street, Montebello, CA 90640 (hereinafter called "Contractor"). CMWD 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: Matt Jacobs (CMWD Project Manager). PAYMENT. CMWD 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 CMWD’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. DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 February 9th DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 PWM23-2058UTI L 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 CMWD 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 CMWD to disqualify the Contractor or subcontractor from participating in contract bidding. Signature: Ctt~ .1:&~l C,_Gu Print Name: l1o...{ul S(.o..,y)~ REQUIRED INSURANCE. The successful contractor shall provide to CMWD, 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 CMWD 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 30 days written notice shall be given to CMWD prior to such cancellation. The policies shall name CMWD as additional insured . The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. Insertion Valve Installations; Cont. No. 3904 Page 2 of 8 General Counsel Approved 8/2/2022 PWM23-2058UTIL Insertion Valve Installations; Cont. No. 3904 Page 3 of 8 General Counsel Approved 8/2/2022 WORKERS COMPENSATION AND EMPLOYER’S LIABILITY. Worker’s 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 CMWD and the City of Carlsbad, and its officers, officials, employees and volunteers, 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 CMWD or City of Carlsbad. 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 three (3) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within eight (8) working days after receipt of Notice to Proceed. CONTRACTOR’S INFORMATION. Koppl Pipeline Services, Inc. 1228 Date Street (name of Contractor) 844802 (street address) Montebello, CA 90640 (Contractor’s license number) C34-Pipeline; C60-Welding 8/31/24 (city/state/zip) 323-888-2211 (license class. and exp. date) 1000000314 6/30/23 (telephone no.) asanchez@koppl.com (DIR registration number & exp. date) (e-mail address) /// /// /// /// /// /// /// /// DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 PWM23-2058UTI L 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 KOPPL PIPELINE SERVICES, INC., a California corporation By: ~6~ Cr,c>½~ '-(sign here) CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad By : Vicki V. Quiram, General Manager, as authorized by the Executive Manager ~~~~E::~-~(2-t~ {print name/title) If required by CMWD, proper notarial acknowledgment of execution by Contractor must be attached. !!..§. corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A 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: CINDIE K. McMAHON, General Counsel BY: __ o_·IA,_t_·L-_k_. ~--IA,- General Counsel Insertion Valve Installations; Cont. No. 3904 Page 4 of 8 General Counsel Approved 8/2/2022 PWM23-2058UTIL Insertion Valve Installations; Cont. No. 3904 Page 5 of 8 General Counsel Approved 8/2/2022 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 be Subcontracted Business Name and Address DIR Registration No. License No., Classification & Expiration Date % of Total Contract Total % Subcontracted: _______________ The Contractor must perform no less than 50% of the work with its own forces. None 0% DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 PWM23-2058UTIL Insertion Valve Installations; Cont. No. 3904 Page 6 of 8 General Counsel Approved 8/2/2022 EXHIBIT B Three Insertion Valve Installations JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LS 1 Contractor to provide all labor, equipment & all work necessary to complete a 6” Mueller Permaseal valve insertion installation to AC pipe on Chinquapin Avenue near Garfield Street 8,110.00 2 LS 1 Contractor to provide labor, equipment & all work necessary to complete a 12” Mueller Permaseal valve insertion installation to AC pipe on Chinquapin Avenue near Garfield Street 10,783.00 3 LS 1 Contractor to provide labor, equipment & all work necessary to complete a for 12” Mueller Permaseal valve insertion installation to AC pipe on Garfield Street near Chinquapin Avenue 10,783.00 4 EA 1 Labor & Materials Bond 750.00 TOTAL NOT TO EXCEED AMOUNT* $30,426.00 *Includes taxes, fees, expenses, and all other costs. CONTRACTOR PROVISIONS Work to be done during regular hours Monday through Friday. Subject to certified payroll to DIR and prevailing wage rates. CMWD PROVISIONS Two 12” Mueller Permaseal insertion valves. One 6” Mueller Permaseal insertion valve. Concrete to secure valve body. All necessary and/or required permits, safe access to the site, traffic control, ladders, shoring (if needed), lifting equipment. Excavate a pit for the insertion valves per Koppl’s instruction at a minimum of 5’ of pipe exposed with 2 ½’ of clearance from the pipe to the side of the excavation, and 24” under the pipe. Responsible for backfill and trench resurfacing per City of Carlsbad Standards. DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 Bond No:1001030828 Premium: $761.00 Premium is for contract term and subject to adjustment based on final contract price PWM23-2058UTI L EXHIBITC LABOR AND MATERIALS BOND WHEREAS, the Board of Directors of the Carlsbad Municipal Water District has awarded to Kopp! Pipeline Services, Inc. (hereinafter designated as the "Principal"), a Contract for: INSERTION VALVE INSTALLATION CONTRACT NO. 3904 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 th is reference. WHEREAS, Principal has executed or is about to execute sa id 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. *Inc. NOW, THEREFORE, WE, Koppl Pipelin e Services,* as Principal, (hereinafter designated as the "Contractor"), and U.S. Specialty Insurance Company as Surety, are held firmly bound unto CMWD in the sum of thirty thousand four hundred twenty-six dollars ($30,426), said sum being an amount equal to: 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, suppli es, 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 Civi l 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. Insertion Valve Installations; Cont. No. 3904 Page 7 of 8 General Counsel Approved 8/2/2022 DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 Bond No: 1001030828 PWM23-2058UTI L 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 ___ 3_0_th ___ day of ___ ~J_a_n_u_ary~------' 20_1L Koppl Pipeline Services Inc. ______________ (SEAL) (Principal) By ~ ~%ee\~ .. t0-(0L Sa-:oc,,,kl.---e ~ (Name/Title) l U.S. Specialty Insurance Company (SEAL) s,Jw~u~ ,r~fynaure) Audrey Rodriguez, Attorney-in-fact (NamefTitle) (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY-ATTACH ATTORNEY-IN-FACT CERTIFICATE) APPROVED AS TO FORM: CINDIE K. McMAHON, General Counsel By: General Counsel Insertion Valve Installations; Cont. No. 3904 Page 8 of 8 General Counsel Approved 8/2/2022 DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } } County of San Diego On January 30, 2023 before me, Elba McCullou Public personally appeared _A_u_d_r_e.._y_R_o_d_r-=igc.....u_e_z _______________ _ 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. WITN ESS my hand and official seal. (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or descrtption of attached document) (Title or description of attached document continued) Number of Pages __ Document Date ___ _ CAPACITY CLAIMED BY THE SIGNER □ Individual (s) □ Corporate Officer (Title) □ Partner(s) 0 Attorney-in-Fact □ Trustee(s) □ Other _________ _ 2015 Version www.NotaryClasses.com 800-873-9865 INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, if needed, should be completed and al/ached to the document. Acknolwedgentsfrom other states may be completed for documents being sent to that state so long as the wording does not require the California nota,y lo violate California notary law. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. ❖ Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. ❖ Indicate title or type of attached document, number of pages and date. ❖ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 11 89 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 Los A "V\t}~ } On 2 /I/ Z,3 . before me, -~--ab_~_i-_F'u....c~.c...c..c..----"-----"'-------L-,, -'--;(l;------'----o-.f-t_lir---1'1'------'--;},.-"-u--=c.b"-'-b-=·c ____ _ Date Here Insert Name and Title of the Officer personally appeared ~G~a_v_o~/~$~£!.._V'l_e.,_/;i_e,_c ____________________ _ 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. Place Notary Seal and/or Stamp Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature~~ Signature of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ____________________________ _ Document Date: _______________________ Number of Pages: ____ _ Signer(s) Other Than Named Above: _______________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: □ Corporate Officer - Title(s): ______ _ □ Corporate Officer -Title(s): ______ _ □ Partner -□ Limited □ General □ Partner -□ Limited □ General □ Individual □ Attorney in Fact □ Individual □ Attorney in Fact □ Trustee □ Guardian or Conservator □ Trustee □ Guardian or Conservator □ Other: □ Other: Signer is Representing: __________ _ Signer is Representing: __________ _ ©2019 National Notary Association DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 TOKIO M ARINE HCC KNOW ALL MEN BY THESE PRESENTS: POWER OF ATTORNEY That, U.S. SPECIAL TY INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint, AUDREY RODRIGUEZ its true and lawful Attorney-in-fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver bond number 100718647 issued in the course of its business and to bind the Company thereby, in an amount not to exceed Ten million and 00/100 ( $10,000,000.00 ). Said appointment is made under and by authority of the following resolutions of the Board of Directors of U.S. Specialty Insurance Company: "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." Adopted by unanimous written consent in lieu of meeting on September 1•t, 2011. 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, U.S. Specialty Insurance Company has caused its seal to be affixed hereto and executed by its Senior Vice P:~::•:•;:,::~ day of April, 2022. /;J~Z~ County of Los Ange~s SS \!::<~~-:}$ By ,,,,,, * ,,,,,, Adam S. Pess 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, Senior Vice President of U.S. Specialty Insurance 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. • Stgnatme ~ (seal) I, Kio Lo, Assistant Secretary of U.S. Specialty Insurance 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. Bond No. Agency No. 100718647 18276 2023, Visit tmhcc.com/surety for more information HCCSOZZPOAUSSIC04/2022 6" & 12" insertion valve location 12" insertion valve location DocuSign Envelope ID: FEC8CDF5-37BC-4B5E-A980-94FDA45245C7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 12/28/2022 Venbrook Insurance Services6320 Canoga Avenue, 12th Floor Woodland Hills, CA 91367 818-598-8942 www.venbrook.com CA Lic No. 0D80832 Windy West Windy West wwest@venbrook.com Koppl Pipeline Services, Inc. DBA: Koppl Services American Hot Tap; Hot Tap, Ltd 1228 Date St. Montebello CA 90640 72166989 3 3 Certificate Holder is named as Additional Insured under the General Liability policy if required by written contract with the Named Insured but *10 Days Notice of Cancellation for Non-Payment of Premium, 30 Days All Others. City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta CA 92564 RE: All Projects with the City only for coverage and limits provided by the policy and the additional insured endorsement. Waiver of Subrogation applies to Workers' Compensation. A 1,000,000US00090775LI22A5/1/2022 5/1/2023 500,000 3 5,000 3 1,000,000 2,000,000 2,000,000 3 3 $5,000 Deductible B AS2-Z91-467294-012 5/1/2022 5/1/2023 1,000,000 3 3 3 Comp/Coll Ded.1,0003PIP Included - HI Only B WC2-Z91-467294-022 5/1/2022 5/1/2023 3 1,000,000Y 1,000,000 1,000,000 Indian Harbor Insurance Company 36940 Liberty Mutual Fire Insurance Company 23035 72166989 | 22-23 GL/AL/XS/WC/POLL/IM/S&M | Windy West | 12/28/2022 2:36:58 PM (PST) | Page 1 of 2 ~ LJ □ - ~ R □ □ ~ ..__ - -~ ..__ ..__ ..__ R I I I I I □ Koppl Pipeline Services, Inc. WC2-Z91-467294-022 05/01/2022 Liberty Mutual Fire Insurance Company 72166989 | 22-23 GL/AL/XS/WC/POLL/IM/S&M | Windy West | 12/28/2022 2:36:58 PM (PST) | Page 2 of 2 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT • CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. · The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$ 250 per policy Person or Organization Where required by contract or written agreement prior to loss and allowed by law. Issued by For attachment to Policy No. Issued to we 0403 oa Ed: 04/1984 Job Description Effective Date Premium$ Page 1 of 1