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HomeMy WebLinkAboutA7145 - DEL'S FLOORING CONTRACTORSA,1ry5, This is not a lien. This notice is given pursuant to California civil code section 3097. This form is designed for a private work project. For a public work project, use a "California Preliminary 20-day Notice" (Public Works) form. NOTICE TO PROPERTY OWNER If bills are not paid in full for the labor, services, equipment, or materials furnished or to be furnished, a mechanic's lien leading to the loss, through court foreclosure proceedings, of all or part of your property being so improved may be placed against the property even though you have paid your contractor in full. You may wish to protect yourself against this consequence by (1) requiring your contractor to furnish a signed release by the person or firm giving you this notice before making payment to your contractor or (2) any other method or device which is appropriate under the circumstances. Other than residential homeowners of dwellings containing fewer than five units, private project owners must notify the original contractor and any lien claimant who has provided the owner with a preliminary 20-day lien notice in accordance with Section 3097 of the Civil Code that a notice of completion or notice of cessation has been recorded within 10 days of its recordation. Notice shall be by registered mail, certified mail, or first-class mail, evidenced by a certificate of mailing. Failure to notify will extend the deadlines to record a lien. You are hereby notified: That the undersigned has furnished or will furnish labor, services, equipment, or material of the following description: Del's Flooring Contractors, Inc 42-120 State St. Individual Palm Desert CA 92211 or Firm Ca License# 486540 By %ilGl C �� RA7- TitleQMM Description Furnish and Install Tile Jobsite Palm Springs City Hall Kitchen 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 The name and address of the person who contracted for the purchase of such labor, service, equipment, or material is PUB Construction, Inc. 23545 Palomino Dr. #104, Diamond Bar, CA 91765 To: N/A NOTICE construction TO CONSTRUCTION LENDER ONLY lender or J U N 0 4 2024 Estimated total price for the labor, services, reputed equipment, or materials described hereon construction lender OFFICE OF THE CITY CLERK g 11,537.67 To: City of Palm Springs owner 3200 E. Tah uitz Canyon Wa or q y y reputed owner Palm Springs CA 92263 To: PUB Construction, Inc. original 23545 Palomino Dr., #104 contractor or Diamond Bar CA reputed 91765 contractor Trust funds to which supplemental fringe benefits are payable NAME ADDRESS NAME ADDRESS NAME ADDRESS M^'I DECLARATION OF SERVICE I,QtC l!i ��declare that I served the above Preliminary Notice by first class registered/certified mail postage prepaid I,de�c e under the lty of perjury of the laws of the State of California that the foregoing is true and correct on Executed on Signature of person making at Riverside Co ATTACH RECEIPTS OF CERTIFIED OR REGISTERED MAIL WHEN RETURNED California 0r0 s0000 0O0No 4LTi LM t) Nationwide Named Insured & Mailing Address DELS FLOORING CONTRACTORS INC 42120 STATE ST PALM DESERT, CA 92211-5148 Date Printed: Policy Number: Insuring Company: Policy Type: Policy Period: NOTICE OF PREMIUM INCREASE Agency Number: 29438 CDS INSURANCE SERVICES 2001 E FINANCIAL WAY STE 200 GLENDORA, CA 91741-4600 RECEIVED 12-19-2023 ACP GLD03110318316 NATIONWIDE GENERAL INSURANCE COMPANY 1100 LOCUST ST DEPT 1100 DES MOINES, IA 50391-2000 GENERAL LIABILITY 02-22-2024to 02-22-2025 JAN 0 2 2024 Office of the City Clerk Thank you for choosing Nationwide® to help protect what's important to you. We value your business and want to ensure you have important information regarding your policy. What you need to know We wanted to notify you in advance that your policy premium will increase at the upcoming renewal. What you need to do No further action is needed. Your renewal policy and billing will reflect the new premium amount. For more Information If you have any questions about this notice, or would like to investigate other policy coverage options with Nationwide, please contact your agent at (626) 610-9500. NI 00 92 0120 RECEIVED JAN 0 2 2024 City Hall Reception Desk Pane 1 of 1 ® DATE(MMIDD/YYYY) FCORO CERTIFICATE OF LIABILITY INSURANCE 02/27/2024 4� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ;ERTIFICATE 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). PRODUCER CONTACT Polly Riordan CRIS James G. Parker Insurance PHONE (559) 222-7722 n/c, No : (559) 222-1724 AlC No Ext : License #0554959 ADDREAIL SS: Pollyr@jgparkeccom P O Box 3947 INSURER(S) AFFORDING COVERAGE NAIC # Fresno CA 93650 INSURER A: Mesa Underwriters Specialty Ins Co 36838. INSURED INSURER B : United Financial Casualty Co 11770 Del's Flooring Contractors Inc INSURER C : Palomar Excess and Surplus Ins Co 16754 42-120 State St INSURER D : Technology Ins Co Inc 42376 INSURER E : Westchester Surplus Lines Ins Co 10172 Palm Desert CA 92211 INSURER F CERTIFICATE NUMBER' [v-Zo VLOAvvUU1V10F L mmvialUIY "U"" L . COVERAGES CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence 100,000 $ CLAIMS -MADE F OCCUR MED EXP (Any one person) $ 5,000 A Y Y MP0082001007549 02/22/2024 02/22/2025 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPA.GG $ 2,000,000 POLICY PRO ❑ LOC JECT $ OTHER COMINED LIMIT $ 1,000,000 AUTOMOBILE LIABILITY(Ea accidentSINGLE BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ B OWNED X SCHEDULED Y Y 977960527 02/26/2024 08/26/2024 AUTOS ONLY AUTOS HIRED NON -OWNED X X PROPERTY DAMAGE Per accident $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE PESXS011229 02/22/2024 02/22/2025 X AGGREGATE $ 5,000,000 DIED I I RETENTION $ $ H WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 1,000,000D ANY PROPRIETOR/PARTNER/EXECUTIVE NIA Y TWP4310168 08/31/2023 08/31/2024 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 oFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L. DISEASE - POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below E Pollution Liability G2840850A004 02/22/2024 02/22/2025 Aggregate $2,000,000 Ea. Pollution Condition $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Purchase blanket orders for FY 2021-2022 The City of Palm Springs. its officials, employees and agents are includedas additional insured as respects General Liability per attached endorsement CG2033 0413. Primary & Non -Contributory Wording applies per form CG2001 0413. includedas additional insured on the auto policy per the attached endorsement form MCA851 0081 7-CA to follow includes Primary & Non -Contributory and Waiver of subrogation wording. Waiver of subrogation applies to the General Liability and Work Comp per attached forms CG2404 1093 & WC040306 0484. CERTIFICATE HOLDEK Kf l f 1 V 1 LJ 1 MAP 0 4 2(�24 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ^ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs Attn City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2743 City Nall Reception Desk AUTHORIZED REPRESENTATIVE / Palm Springs CA 92263 A%� Z45 V IUt121-LUID At, URIJ l.Unrummi iUii. ran 1191— 1-] Vc ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 4 0 Policy Number: MP0082001007549 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILII Y COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 61 Policy Number: MP0082001007549 COMMERCIAL GENERAL LIABILITY CG 20 33 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. 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 agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 04 13 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. © Insurance Services Office, Inc., 2012 Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment 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 b. 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 of the 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 you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 04 13 POLICY NUMBER: MP0082001007549 COMMERCIAL GENERAL LIABILITY CG24041093 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization to which you are obligated by virtue of a written contract to provide insurance such as is afforded by this policy, but only with respect to (1) occurrences taking place after such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period, or occurrences resulting from the conduct of your business during the policy period. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 s i r WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 8/31/2023 Policy No. TWP4310168 Endorsement No. 0 Insured Del's Flooring Contractors, Inc Premium $ 67,763 Insurance Company Technology Insurance Company, Inc. Countersigned by WC 04 03 06 (Ed. 04-84)