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HomeMy WebLinkAbout2018 CON Golden Bell Products - Sanitary Sewer Insecticide ServicesSHORT FORM SERVICES AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND GOLDEN BELL PRODUCTS, INC. THIS AGREEMENT is entered into this 1st day of November, 2018, by and between the CITY OF NATIONAL CITY, a municipal corporation (the "CITY"), and GOLDEN BELL PRODUCTS, INC., a California corporation (the "CONTRACTOR"). NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set forth herein in accordance with the following terms and conditions: 1. Description of Services. CONTRACTOR shall provide services to coat 200 sanitary sewer manhole covers with an insecticidal latex coating for sewer roach control, as more particularly described in Exhibit "A", as directed by the City's Wastewater Crew Chief, currently Jeffrey Rouston. 2. Length of Agreement. The schedule is set forth below: The duration of this Agreement is from November 1, 2018 through June 30, 2019. This Agreement may be extended by mutual agreement upon the same terms and conditions for three additional one (1) year terms. Any extension of this Agreement must be approved in writing by the City Manager. 3. Compensation. The total compensation to CONTRACTOR for providing the services set forth herein shall not exceed an annual total cost of $4,900. The compensation for CONTRACTOR'S work shall be based upon and not exceed the rates stated in Exhibit "A" without prior written authorization from CITY. 4. Payment Schedule. CITY will make payment within thirty (30) days of receiving and approving a billing statement for the satisfactorily completed services of CONTRACTOR. 5. Termination. CITY may terminate this Agreement at any time by providing a one (1) day written notice to CONTRACTOR. 6. Independent Contractor. It is agreed that CONTRACTOR is an independent Contractor, and all persons working for or under the direction of CONTRACTOR are CONTRACTOR'S agents, servants and employees, and said persons shall not be deemed agents, servants, or employees of CITY. 7. Insurance. CONTRACTOR shall obtain: A. ❑ If checked, Professional Liability Insurance (errors and omissions) with minimum limits of $1,000,000 per occurrence. B. Automobile insurance covering all bodily injury and property damage incurred during the performance of this Agreement, with a minimum coverage of $1,000,000 combined single limit per accident. Such automobile insurance shall include owned, non -owned, and hired vehicles ("any auto"). The policy shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and a separate additional insured endorsement shall be provided. C. Commercial General Liability Insurance, with minimum limits of either $2,000,000 per occurrence and $4,000,000 aggregate, or $1,000,000 per occurrence and $2,000,000 aggregate with a $2,000,000 umbrella policy, covering all bodily injury and property damage arising out of its operations, work, or performance under this Agreement. The policy shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and a separate additional insured endorsement shall be provided. The general aggregate limit must apply solely to this "project" or "location". The "project" or "location" should be noted with specificity on an endorsement that shall be incorporated into the policy. D. Workers' compensation insurance in an amount sufficient to meet statutory requirements covering all of CONTRACTOR'S employees and employers' liability insurance with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a waiver of subrogation in favor of the CITY. Said endorsement shall be provided prior to commencement of work under this Agreement. E. The aforesaid policies shall constitute primary insurance as to the CITY, its officers, employees, and volunteers, so that any other policies held by the CITY shall not contribute to any loss under said insurance. Said policies shall provide for thirty (30) days prior written notice to the CITY's Risk Manager, at the address listed in subsection G below, of cancellation or material change. F. Said policies, except for the professional liability and workers' compensation policies, shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and separate additional insured endorsements shall be provided G. The Certificate Holder for all policies of insurance required by this Section shall be: City of National City c/o Risk Manager 1243 National City Boulevard National City, CA 91950-4397 H. If required insurance coverage is provided on a "claims made" rather than "occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years after expiration of the term (and any extensions) of this Agreement. In addition, the "retro" date must be on or before the date of this Agreement. I. Insurance shall be written with only insurers authorized to conduct business in California which hold a current policy holder's alphabetic and financial size category rating of not less than A:VII according to the current Best's Key Rating Guide, or a company of equal financial stability that is approved by the City's Risk Manager. In the event coverage is provided by non -admitted "surplus lines" carriers, they must be included on the most recent California List of Eligible Surplus Lines Insurers (LESLI list) and otherwise meet rating requirements. J. This Agreement shall not take effect until certificate(s) or other sufficient proof that these insurance provisions have been complied with, are filed with, and approved by Standard Short Form Agreement Page 2 of 5 City of National City and Revised August 2017 Golden Bell Products, Inc. FY19 the CITY's Risk Manager. If the CONTRACTOR does not keep all of such insurance policies in full force and effect at all times during the terms of this Agreement, the CITY may elect to treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the Agreement as provided herein. K. All deductibles and self -insured retentions in excess of $10,000 must be disclosed to and approved by the CITY. CITY reserves the right to modify the insurance requirements of this Section 7, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. L. If the CONTRACTOR maintains broader coverage or higher limits (or both) than the minimum limits shown above, the CITY requires and shall be entitled to the broader coverage or higher limits (or both) maintained by the CONTRACTOR. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the CITY. 8. Indemnification and Hold Harmless. The CONTRACTOR agrees to defend, indemnify and hold harmless the City of National City, its officers, officials, agents, employees, and volunteers against and from any and all liability, loss, damages to property, injuries to, or death of any person or persons, and all claims, demands, suits, actions, proceedings, reasonable attorneys' fees, and defense costs, of any kind or nature, including workers' compensation claims, of or by anyone whomsoever, resulting from or arising out of the CONTRACTOR'S performance or other obligations under this Agreement; provided, however, that this indemnification and hold harmless shall not include any claims or liability arising from the established sole negligence or willful misconduct of the CITY, its agents, officers employees, or volunteers. CITY will cooperate reasonably in the defense of any action, and CONTRACTOR shall employ competent counsel, reasonably acceptable to the City Attorney. The indemnity, defense, and hold harmless obligations contained herein shall survive the termination of this Agreement for any alleged or actual omission, act, or negligence under this Agreement that occurred during the term of this Agreement. 9. Acceptability of Work. The CITY shall, with reasonable diligence, determine the quality or acceptability of the work, the manner of performance, and/or the compensation payable to the CONTRACTOR. 10. Business License. CONTRACTOR must possess or shall obtain business license from National City Finance Department before beginning work. 1 1. Miscellaneous Provisions. A. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which, together, shall constitute but one and the same instrument. B. Captions. Any captions to, or headings of, the sections or subsections of this Agreement are solely for the convenience of the parties hereto, are not a part of this Agreement, and shall not be used for the interpretation or determination of the validity of this Agreement or any provision hereof. C. No Obligations to Third Parties. Except as otherwise expressly provided herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon, or obligate any of the parties hereto, to any person or entity other than the parties hereto. Standard Short Form Agreement Page 3 of 5 City of National City and Revised August 2017 Golden Bell Products, Inc. FY19 D. Exhibits and Schedules. The Exhibits and Schedules attached hereto are hereby incorporated herein by this reference for all purposes. To the extent any exhibits, schedules, or provisions thereof conflict or are inconsistent with the terms and conditions contained in this Agreement, the terms and conditions of this Agreement will control. E. Amendment to this Agreement. The terms of this Agreement may not be modified or amended except by an instrument in writing executed by each of the parties hereto. F. Waiver. The waiver or failure to enforce any provision of this Agreement shall not operate as a waiver of any future breach of any such provision or any other provision hereof. G. Applicable Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California. The venue for any action shall be in either state or federal court in the County of San Diego, State of California. The CONTRACTOR shall comply with all laws, including federal, state, and local laws, whether now in force or subsequently enacted. H. Entire Agreement. This Agreement supersedes any prior agreements, negotiations and communications, oral or written, and contains the entire agreement between the parties as to the subject matter hereof. No subsequent agreement, representation, or promise made by either party hereto, or by or to an employee, officer, agent, or representative of any party hereto shall be of any effect unless it is in writing and executed by the party to be bound thereby. I. Successors and Assigns. This Agreement shall be binding upon and shall inure to the benefit of the successors and assigns of the parties hereto. J. Subcontractors or Subconsultants. The CITY is engaging the services of the CONTRACTOR identified in this Agreement. The CONTRACTOR shall not subcontract any portion of the work, unless such subcontracting was part of the original proposal or is allowed by the CITY. In the event any portion of the work under this Agreement is subcontracted, the subcontractor(s) shall be required to comply with and agree to, for the benefit of and in favor of the CITY, both the insurance provisions in Section 7 and the indemnification and hold harmless provision of Section 8 of this Agreement. K. Construction. The parties acknowledge and agree that (i) each party is of equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and negotiation of this Agreement, (iii) each such party has consulted with or has had the opportunity to consult with its own, independent counsel and such other professional advisors as such party has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv) any rule or construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in the interpretation of this Agreement, or any portions hereof, or any amendments hereto. [Signature page to follow] Standard Short Form Agreement Page 4 of 5 City of National City and Revised August 2017 Golden Bell Products, Inc. FY19 IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR on the date and year first above written. CITY OF NATIONAL CITY Leslie Deese, City Manager APPROVED AS TO FORM: Angil P. Morris -Jones • Attorney By: oberto M. Contreras Deputy City Attorney CONTACT INFORMATION CITY OF NATIONAL CITY 1243 National City Boulevard National City, CA 91950-4397 Phone: (619) 336-4574 Fax: (619) 336-4397 Contact: Jeffrey Rouston Title: Wastewater Crew Chief Dep.: Engineering & Public Works Email: jrouston@nationalcityca.gov Standard Short Form Agreement GOLDEN BELL PRODUCTS, INC. a California Corporation (Signatures of two corporate officers required) By: (Name) tur( MaiinG (Print) P resiJetnt I OwYlei' (Title) (Name) Mcxxi ltNn Iscdla vns (Print) ec,r e .r6, 17-mu-s w e-,i- (Title) Golden Bell Products, Inc. 952 N Batavia Street Orange, CA 92867 Phone: 714-363-3985 Fax: 714-997-4807 Contact: Michelle Webster Title: Program Manager Email: info@goldenbellproducts.com Taxpayer I.D. No.: 330144674 Page 5 of 5 City of National City and Revised August 2017 Golden Bell Products, Inc. FY19 � Aikk Gp N PRODUCTS, INC. EXHIBIT A B� 952 N Batavia Street, Orange, CA 92867- PHONE (714) 363-3985/ FAX(714) 997-4807 www.gcldenbellproducts.com Tuesday, November 06, 2018 City of National City Jeff Rouston 1243 National City Blvd. National City, CA 91950 Dear Jeff: Golden Bell Products to provide all labor, material and supplies required to coat sanitary sewer manholes with INSECTA, insecticidal latex coating for sewer roach control. SCOPE OF WORK Golden Bell Products to perform the following items: • Apply INSECTA, an approved product for sewer roach control application in sanitary manholes. • Treat to depth of seven feet or less, with an approximate area of 100 square feet per manhole. • Will prepare and treat according to manufacturer's specifications for preparation instructions. • Apply coating based on the manufacturers recommended label rates, five (5) manholes per gallon, not to exceed three (3) pints per manhole. • Remove existing sewer manhole covers, sweep and clean the inside of the cover area, spray Insecta, reseat the cover and mark the reinstalled cover with a painted white line extending from the manhole cover to the adjoining pavement, indicating that the cover has been reseated properly and firmly. Liability for damage caused by covers that have been reinstalled and marked is limited to 24 hours. Covers that are damaged or will not reseat properly will be immediately reported to the customer. Customer assumes all liability for damages caused by covers that fail to properly reseat. • Mark each manhole cover with an identifying white dot after being treated. • Provide proper supervision at the job site during all phases of work. • Be responsible for coordinating the work to be done. Work will take place in accessible alleys, parking lots, and streets. • Guarantee the application for eighteen (18) months from the date of treatment. If more than 50 living roaches are found in a manhole during the warranty period, the manhole must then be retreated by Golden Bell Products at no additional charge or obligation to Customer. Golden Bell Products will retreat any manhole which inspections with photographs report live roaches within sixty (60) calendar days after notification; providing more than 50 live roaches are found inside the manhole during two inspections occurring two days apart.* • Will report number of manholes treated when submitting billing invoices. Golden Bell Products will indicate in writing on each quarter section map, the number of manholes treated, applicators name initials with the date of completion. This will serve as the record of application for the necessary Agencies and warranty information. • Customer will supply quarter section maps indicating exact locations of manholes and cleanouts. • Customer will make accessible all designated manholes to be coated. If not accessible Golden Bell Products will notify Customer. • Customer will provide inspection and assistance where necessary. • No more than 90 calendar days will elapse between date of notice to proceed and completion of the application. A reasonable time for potentially unfavorable weather will be mutually agreed upon by Customer and Golden Bell Products • Requirements may be added or deleted from the above Scope of Work, however these must be agreed upon by both parties prior to the commencement of work. • The cost of additional permits and/or licenses, other than those already required by the state, required within city limits to perform work within that city will be assumed by the Customer. Special Note: Some assistance with traffic control in heavily traveled areas may be required. *NOTE: The Insecticidal -latex coating is not a repellent and therefore, will not repel roaches. They must rest on it to eliminate them! Insecta is not a spot treatment product: for warranty to be in effect and for the best results all manholes must be treated in the same area of the sewer system! Pricing per Manhole Application costs: For less than 1000 Manholes is $24.50 ea. For more than 1000 Manholes is $23. 00 ea. Pricing for 200 Manholes $24.50 each is $4, 900. 00 (NO Sales tax as it is a service) • There is a 150 manhole minimum for all jobs. This proposal is good through June 30, 2019. Thank you for this opportunity. If you have any questions please contact Michelle Webster at 714/363-3985. Sincerely, Michelle Webster Program Manager lei PRODUCTS, INC. 952 N Batavia Street Orange, CA 92867- PHONE (714) 363-3985 FAX (714) 997-4807 www.goldenbellproducts.com Sole Source Justification Within the State of California Golden Bell Products has the sole source right for the application and distribution of Insecta. Golden Bell Products has provided the service and product that is used in sewer manholes for the control of cockroaches since October of 1998, when the first test area was treated in the State of California. Insecta is the only registered product of its type and active ingredient labeled for use in sewer manholes. The product is a formulated product, which is produced in an EPA approved establishment. The product comes ready to use and since it is a polymerized product there is no field mixing required, (which is not the case with any additive type product). Insecta has been tested and applied by Orange County Sanitation Districts and has proven to be effective standing up to the 2 year guarantee provided by Golden Bell and the product manufacturer. Additionally this product is used and approved by Los Angeles County Sanitation District and approximately 60 other cities and agencies within the state of California. Over the past 18 years Golden Bell Products has provided this service with minimal price increases. Finally Golden Bell Products is a local vendor that holds the correct licensing for application of pesticides in sewer manholes. Golden Bell Products is licensed by the California Agricultural Department of Pesticide Regulation. Holding a QAL license with the required categories A, C and N and a Pest Control Business License. Golden Bell carries and maintains all current registrations with all the County Agricultural Commissioners in each of the counties they apply the Insecta pesticide in. The accompanying letter from the manufacturer of Insecta shows Golden Bell Products as the sole source to the application and distribution of Insecta in the State of California. JABco 16410 Shore Oaks Court Noblesville, IN 46060 July 21, 2015 To Whom It May Concern: Office: (317) 776-9375 Toll Free: (888) 781-6955 Cell: (727) 365-6995 Fax: (317) 776-9376 Email: jimmer777@verizon.net I, Jim Lawrence, President of JABco, the manufacturing company for Insecta, EPA registration number 45600-1, have granted Golden Bell Products the sole distribution and application rights within the State of California. Golden Bell Products has proven its expertise in selling and applying Insecta 45600-1 since 1997 and will maintain the sole source to Insecta until the year 2040, Any California City, County or State Municipality, District and or Water company that would use Insecta or Insecta Liquid for self -application is required to purchase the material from Golden Bell Products. If any bids were received indicating otherwise, the bidding company is misrepresenting itself. All Insecta 45600-1 product used for manhole cockroach control in sewer manholes is sold or applied through Golden Bell Products. Sincerely ,. . im Lawrence President WORLD LEADER IN SEWER COCKROACH CONTROL ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/18/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. the terms and conditions of the policy, certain policies may require an endorsement. A statement on t certificate holder in lieu of such endorsement(s). PRODUCER Van Beurden Ins. Serv, Inc. - Kingsburg PO Box 67 Ringsburg CA 93631 INSURED Golden Bell Products, Inc. P.O. Box 366 Atwood CA 92811 (714) 630-3861 CONTACT NAME: If SUBROGATION IS WAIVED, subject to is certificate does not confer rights to the Jeanette Heilnrichs NE IA/No. EMI. (559) 897-297 E-MAIL ADDRESS; 5 INSURER(S) AFFORDING COVERAGE INSURER A: Evanston Insurance Company INSURER B : (A/C, No): (559) 897-4070 NAIC B 35378 INSURER C: INSURER D: INSURER E INSURER F : • REVISION NUMBER: loll V Cr\MVLJ va-... s. ..... . ... ..�...__. .. __ _ _ -- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, ILTR TYPE OF INSURANCE ADOL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/00(YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MKLV5ENV101253 10/25/2018 EACH OCCURRENCE $ 1,000,000 20/25/201 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X CPL PERSONAL BADVINJURY $ 1,000,000 X 10,000 SIR GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OPAGG $ 2,000,000 AUTOMOBILE UABIUTY AUTO ALL OWNED - _ _ SCHEDULED AUTOS NON -OWNED AUTOS CO eBINED SINGLE LIMIT (EaANY $ BODILY INJURY (Per person) $ BODILY INJURY (Per accdent) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE MKLV5EFX100304 10/25/201810/25/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENTION$ 10,000 WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under Y / N N-/ A PER STATUTE OERH E.L. EACH ACCIDENT $ - E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A A Cont. Pollution Liab. Environ. Impairment Liab. MKLV5ENV101253 MKLV5ENV101253 10/25/2018 10/25/201810/25/201 10/25/2019$25,000 SIR $ 1,000,000 $25,000 SIR $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of National City, its elected officials, officers, agents, employees and v named as additional insured as respect to General Liability per the attached form(s required by written contract. lunteers are only when CERTIFICATE HOLDER CANCELLAT City of National City c/o Risk Manager 1243 National City Blvd. National City CA 91940-4397 1 SHOULD ANY OF THE ABOVE ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE T EREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLITY PROVISIONS. AUTHORIZED REPRESENTATIVE 4-4 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01) CERTIFICATE COVERAGES OVERFLOW DATE(MM/DD/YYYY) 10/18/2018 PRODUCER Van Beurden Ins. Serv, Inc. - Kingsburg PO Box 67 Ringsburg CA 93631 INSURED Golden Bell Products, Inc. P.O. Box 366 Atwood CA 92811 CONTACT NAME: Jeanette Beinrichs PHONE (A/C, No, Ext): (559) 897-2975 PHONE (A/C, No, Ext): (714) 630-3861 ADDITIONAL COVERAGES CERTIFICATE NUMBER: Cert ID 31691 EVISION NUMBER: _. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY E 'f (MM/DD/YYYY) P OMITS A Incid.Prof.Services Liab. MKLV5ENV101253 10/25/2018 10/25/2019 $ 1,000,000 $ $ $ $ $ $ $ $ $ Certificate Coverages Overflow (11/2010) n MARKEL° Policy Number: MKLV5ENV101253 COMMERCIAL GENERAL LIABILITY EVANSTON INSURANCE COMPANY . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ T. CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL'GENERAL LIABILITY COVERAGE FORM A. Section II Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom the insured agrees to provide additional insured status on a primary and non-contributory basis in a written contract, provided such written contract is signed by both parties and execut,d prior to the commencement of operations, but only with respect to liability for "bodilyinjury"," ro damage" •r "personal and advertising injury" pe , Y P Y "property g Pe 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agree ent to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following a• ditional exclusions apply: This insurance. does not apply to "bodily injury", "property damage", or "person - I and `advertising injury" occurring after: ' 1. All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations, including materials, parts or equipment furnished in connection with such work,. has been completed; or 2. That portion. of "your work" .out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged In 'performing operations for a principal as a part ofthe same project. C.. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is Tess. This endorsement will not increase the applicable Limits Of Insurance shown in the Declarations. MEGL 1543 05.16 Includes copyrighted material of Insurance Services Office, with its permission. Inc., Page 1 of 2 D. With respect to the coverage provided by this endorsement, the following is add under Section IV — Commercial General Liability Conditions: Primary And Noncontributory Insurance This .insurance .is primary to and will not seek contribution from any other insu organization(s) qualifying as an additional insured by this endorsement provided t (1) The additional insured's a Named Insured under such other insurance; and (2). You have agreed in writing In a contract or agreement that this insurance w contribution from any other insurance available to the additional insured. All other terms and conditions remain unchanged. MEGL 1543 05 16 d to Paragraph 4. Other Insurance ance available to any person(s) or at: uld be primary and would not seek Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. POLICY NUMBER: MKLV5ENV101253 COMM RCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. :ADDITIONAL INSURED - OWNERS, L CONTRACTORS - COMPLETED OP'. This endorsement modifies Insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE SSEES OR RATIONS Name Of Additional Insured Person(s) Or Organizaiionjs) Location And Description Of Completed Operations Any person(s) or organization(s) to whom the' insured.agrees to provide Additional Insured status in a•written contract signed by both parties and executed prior to the commencement of operations • Not Applicable . Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(S) shown in the Schedule, but only -with respect to liability for "bodily Injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that • additional insured and included in the "products -completed operations hazard". However: • • 1.. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, •the InsUrance afforded to such additional insured • will not be broader than that which you are required by . the contract or agreement to provide for such additional insured. • B. With respect to the additional Insureds, Section III — Limits C� If coverage provides required by a contra will pay on behalf of amount of insurance: 1. Required by the cc 2. Available under Insurance shown i whichever is less, This endorsement sh Limits of Insurance sh insurance afforded. to these the following Is added to f Insurance: to the additional insured Is t or agreement, the most we the additional insured Is the ntract or agreement; or the applicable Limits of c the Declarations; all not increase the applicable own in the Declarations. Page 1 of 1 CG.20.37 04.13 • • © Insurance Services Office, Inc., 2012 Policy Number: MKLV5ENV101253 C MMERCIAL GENERAL LIABILITY 11111 PO ICY NUMBER: MKLV5ENV100373 MARKEL° EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ T CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE •Name Of Person Or Organization: Any person(s). or organization(s) with whom the Named Insured agrees, In executed prior to the "occurrence", to waive rights of recovery. Additional Premium: $ Included a written contract The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organizati n shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services with its permission. ffice, Inc., Page 1 of.1 STATE COMPENSATION I N S U R A N C E FUND HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP D1 1714034-18 RENEWAL SP 4-21-89-9 PAGE 1 EFFECTIVE NOVEMBER 8, 2018 AT 12.01 A.M. AND EXPIRING OCTOBER 4, 2019 AT 12.01 A.M. GOLDEN BELL PRODUCTS, INC 952 N BATAVIA ST ORANGE, CA 92867 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF NATIONAL CITY WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, GOLDEN BELL PRODUCTS, INC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION , OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: NOVEMBER 9, 2018 2570 AUTHORIZED REPRESENTP1fIVE PRESIDENT AND CEO SCIF FORM 10217 IREV.4-20181 OLD DP 217 Form W-9 (Rev. November 2017) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification ► Go to www.irs.gov/FormW9 for instructions and the latest information. Give Form to the requester. Do not send to the IRS. 1 Name (as shown on your Income tax retum). Name Is required on this line; do not leave this line blank. Golden, Be.M. Prod u_c 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. ❑ Individual/sole proprietor or single -member LLC ❑ Limited liability company. Enter the tax classification (C=C corporation. S=S corporation, P=Partnership) ► Note: Check the appropriate box in the Iine above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑ Other (see instructions) ► C Corporation El S Corporation ❑ Partnership 5 Address (number, street, and apt. or suite no.) See instructions. 952 N "Bata Ui a rest 6 City, state, and ZIP code Q ro_v,o�e , G(9 9 2 S h 7 List account number(s) he (optional) ❑ Trust/estate 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts rrwntained outside toe 'J.S.I Requester's name and address (optional) Part Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Social security number or Employer identification number 3 3 0 4 4. l2 7 Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that 1 am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. Sign Here Signature of U.S. person) 6,141 ader:b Date. 5 1 $ lapis General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information retum the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950 619-336-4228 Michael R. Dalla, CMC - City Clerk December 12, 2018 Ms. Michelle Webster Program Manager Golden Bell Products, Inc. 952 N. Batavia Street Orange, CA 92867 Dear Ms. Webster, On November 1st, 2018, an Agreement was entered into between the City of National City and Golden Bell Products, Inc. We are enclosing for your records a fully executed original Agreement. T-6-j Michael R. Dalla, CMC City Clerk Enclosure