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HomeMy WebLinkAboutA8501 - ABC LIOVIN DRILLING, IncBABCLAB-01 SGONZALEZ l ,4�0/20 CERTIFICATE OF LIABILITY INSURANCE �2I2z6za 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(les) 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 endomement(s). PRODUCER License # 0757776 HUB International Insurance Services Inc. RECEIVED '�' PO Box 5345 Riverside, CA 92517 JAN V 6 2025 INTACT Bea Alanis PaMOF"N ER: 951 779-8702 1FAX.No. 951 231-2572 E' L . Cal.cpu@hubintemational.com INSURERS AFFORDING COVERAGE NAIC0 INSURERA:The Continental Insurance Corn 35289 INSURED FICE OF THE CITY SORERe:Transportation Insurance Company 20494 REac:Technolo Insurance Company 42376 Babcock Laboratories, Inc. CLER Edward S. Babcock & Sons, Inc. P.O. Box 432 INSURER D INSUREa E : Riverside, CA 92502 INSURER F : COVFRAGFS CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR T"a I TYPE OF INSURANCE AODL SUER INVO POLICY NUMBER POLICYEFF POLICYEXP LDS A X COMMERCIALGENERAL1-A6ILITY CINM$-MADE ❑X OCCUR X 6071825747 512812024 5128/2025 EACH OCCURRENCE S 1,000,000 DAMAGETOF," r S 100,0gg MED EXP (Any one 15,000 PERSONAL S ADV INJURY S 1,000,000 GENT AGGRE��C y1TJ EppLIRRMr.r APPLES PER: POLICY I-JECp7 ❑X LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOP AGO 2,000,000 B ALROMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY X XAAUTOSS AS ONLY AµOSIX X BOT1825750 5128/2/24 5/28/2025 COMBINED SINGLE LNAn 1,000,000 BOOILYIWURY Per BOOLY INJURY Per Dodd" eAMAGE IAIBRELU LAB EXCESS LAB OCCUR CALM EACH OCCURRENCE DEO 1 1 RETENTIONS C WORIG.RS COMPENSATION AND EMPLOYERS' LABIU7Y ANY PROPRIETO(LPARTNEH/E%ECUTIVE YIN opFFICERRdEM6W) EXCLUDED? 'MandeWry in NH) If ym tlesruiEe uder DESCRIPTION OF OPERATIONS W. NM X C4547795 1/2/2025 1/2/2026 X PER OT14 E.L. EACH ACCIDENT 1,000,000 El. DISEASE- EA EMPLOYEE 1,000,000 EL. DISEASE- POLICY OMIT 1 000 000 DESCRPTION OF OPERATIONS I LOCATONS I VEHICLES (ACORD I Ot, Ad Moral Remarks SOodula, mry b nreched a more space Is repaid) The City of Palm Springs is Additional Insured with regard to General Liability when required by written contract per the attached endorsement form CNA15079)0(03/12, Primary & Non -Contributory included. Additional Insured with regard to Auto Liability when required by written contract per the attached endorsement form CNA71527XX 10112, Primary wording included. Waiver of Subrogation applies with regard to the Workers' Compensation when required by written contract, per attached endorsement WC040306 04194. CFRTIFICATF HOLDFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs WILL BE DELIVERED IN THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 Palm Springs, CA 92263 AUTHORIZED REPRESEWATNE ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA .CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations subject to such written contract; or B. In the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. The written contract requires you to provide the additional insured such coverage; and 2. This Coverage Part provides such coverage; and C. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: 1. Coverage broader than what you are required to provide by the written contract; or 2. A higher limit of insurance than what you are required to provide by the written contract. Any coverage granted by this Paragraph I. shall apply solely to the extent permissible by law. If. If the written contract requires additional insured coverage under the 07-04 edition of CG2010 or CG2037, then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required -by written contract to add as an additional insured on this Coverage Part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations subject to such written contract; or B. In the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. The written contract requires you to provide the additional insured such coverage; and 2. This Coverage Part provides such coverage. s III. But if the written contract requires: A. Additional insured coverage under the 11-86 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. Additional insured coverage with "arising out of language; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. CNA75079XX (3-22) Policy No: 6071825747 Page 1 of 3 Endorsement No: 12 The Continental Insurance Co. Effective Date: 05/28/2024 Insured Name: BABCOCK LABORATORIES, INC. Copydght CNA All Rights Reserved. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement IV. But if the written contract requires additional insured coverage to the greatest extent permissible by law, then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. V. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities; or B. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. VI. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this Coverage Part: Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. Primary and non-contributing with other insurance available to the additional insured; or 2. Primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. Give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. Send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. Make available any other insurance, and endeavor to tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to other insurance under which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. CNA75079XX (3-22) Page 2 of 3 The Continental Insurance Co. Insured Name: BABCOCK LABORATORIES, INC. Policy No: 6071825747 Endorsement No: 12 Effective Date: 05/28/2024 Copyright CNA All Rights Reserved. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement VIII.Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage Part, provided the contract or agreement: A. Was executed prior to: 1. The bodily injury or property damage; or 2. The offense that caused the personal and advertising injury; for which the additional insured seeks coverage; and B. Is still in effect at the time of the bodily injury or property damage occurrence or personal and advertising injury offense. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (3-22) Policy No: 6071825747 Page 3 of 3 Endorsement No: 12 The Continental Insurance Co. Effective Date: 05/28/2024 Insured Name: BABCOCK LABORATORIES, INC. Copynght CNA All Rights Reserved. CNA Business Auto Policy Policy Endorsement It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section 11 - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident' for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71527XX (10-2012) Policy No: BUA 6071825750 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 05/28/2024 Endorsement No: 14; Page: 1 of 1 Policy Page: 69 of 120 Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 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 Insured Insurance Company WC 04 03 06 (Ed. 04-84) 1/2/2025 Policy No. TWC4547795 Endorsement No. 0 Babcock Laboratories, Inc. Premium $ 54,556 Technology Insurance Company, Inc. Countersigned by Recording Requested By: City of Palm Springs - 2020-0572725 When Recorded Mail To: 11/17/2020 10:48 AM Fee: $ 0.00 Name Page 1 of 2 Anthony J. Mejia, City Clerk Recorded in Official Records Street County of Riverside Peter Aldana ®�� Address 3200 E. Tahquitz Canyon Way Assessor —County Clerk —Recorder City & State palm Springs, CA 92262 SPACE ABOVE THIS LINE FOR RECORDERS USE NOTICE OF COMPLETION (CA Civil Code §§ 8180-8190, 8100-8118, 9200-9208) NOTICE IS HEREBY GIVEN THAT: 1. The undersigned is an owner of an interest of estate in the hereinafter described real property, the nature of which interest or estate is: Fee (e.g. fee, leasehold, joint tenancy, etc.) 2. The full name and address of the undersigned owner or reputed owner and of all co -owners or reputed co -owners are: Name Street and No. City State City of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 3. The name and address of the direct contractor for the work of improvement as a whole is: ABC Liovin Drilling Inc., 1180 E. Burnett Street, Signal Hill, CA 90755 4. This notice is given for (check one): 0 Completion of the work of improvement as a whole. 11 Completion of a contract for a particular portion of the work of improvement (per CA Civ. Code § 8186). 5. If this notice is given only of completion of a contract for a particular portion of the work of improvement (as provided in CA Civ. Code § 8186), the name and address of the direct contractor under that contract is: Not Applicable 6. The name and address of the construction lender, if any, is: Not Applicable 7. On the 10th day of September , 20 20 , there was completed upon the herein described property a work of improvement as a whole (or a particular portion of the work of improvement as provided in CA Civ. Code § 8186) a general description of the work provided: City Project 19-20, Groundwater Monitoring Wells for the Wastewater Treatment Plant 8. The real property herein referred to is situated in the City of Palm Springs County of Riverside State of California, and is described as follows: Golf course driving range off Crossley, parking lot of 3601 Mesquite, across water park on Gene Autry Rd, 1885 Golf Club Dr, Brentwood/Cherry Hill 9. The street address of said property is: 4375 E. Mesquite Avenue, Palm Springs CA 92264 and various locations in the City of Palm Springs 10. If this Notice of Completion is signed by the owner's successor in interest, the name and address of the successor's transferor is: Not applicable I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: _ 4 By: Signature of Owner or Owner's Authorized Agent Joel Montalvo/City Engineer City of Palm Springs Page 1 of 2 VERIFICATION I, Joel Montalvo , state: I am the City Engineer _ ("Owner', "President", "Authorized Agent', "Partner", etc.) of the Owner identified in the foregoing Notice of Completion. I have read said Notice of Completion and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 9 `/ S , 2.024 (date), at Palm Springs (city), CA (state) Signature of Owner or Owner's Authorized Agen Joel Montalvo/City Engineer City of Palm Springs 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. JOHN PAUL MAIER Notary Public - California Z San Luis Obispo County i Z Commission S 2165677 '— M Comm. Expires Sep 24, 2020 STATE OF CALIFORNIA COUNTY OF _ Jer,_; IQ On (date), before me, A Notary Public (name and title of officer) personally appeared 1-9. ;10 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 PENALTY OF PURJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. C-1,/ lie Page 2 of 2 Signature AGREEMENT CONSTRUCTION CONTRACT) THIS AGREEMENT made this Al day of MQx-CV\ 2020, by and between the City of Palm Springs, a charter city, organized and existing in the County of Riverside, under and by virtue of the laws of the State Of California, hereinafter designated as the City, and ABC Liovin Drilling. Inc.. a California corporation, hereinafter designated as the Contractor. The City and the Contractor, in consideration of the .mutual covenants hereinafter set forth, agree as follows: ARTICLE 1 —THE WORK For and in consideration of the payments and agreements to be made and performed by City, Contractor agrees to furnish all materials and perform all work required to complete the Work as specified in the Contract Documents, and as generally indicated under the Bid Schedule(s) for the Project entitled: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING, CITY PROJECT NO. 19-20 The Work comprises of furnishing all labor, materials, tools, and equipment necessary to construct three (3) monitoring wells, modify two (2) existing wells, decommission one (1) monitoring well, and perform other related work as necessary to provide a complete project; all in accordance with the Standard Specifications,general conditions/specifications, plans, and these Special Provisions. ARTICLE 2 —COMMENCEMENT AND COMPLETION The Work to be performed under this Contract shall commence on the date specified in the Notice to Proceed by the City, and the Work shall be fully completed within the time specified in the Notice to Proceed. The City and the Contractor recognize that time is of the essence of this Agreement, and that the City will suffer financial loss if the Work is not completed within the time specified in Article 2, herein, plus any extensions thereof allowed in accordance with applicable provisions of the Standard Specifications, as modified herein. They also recognize the delays, expense, and difficulties involved in proving in a legal proceeding the actual loss suffered by the City if the Work is not completed on time. Accordingly, instead of requiring any such proof, the City and the Contractor agree that as liquidated damages or delay (but not as a penalty), the Contractor shall pay the City the sum specified in Section 6-9 of the Special Provisions for each calendar day that expires after the time specified in Article 2, herein. In executing the Agreement, the Contractor acknowledges it has reviewed the provisions of the Standard Specifications, as modified herein, related to liquidated damages, and has made itself aware of the actual loss incurred by the City due to the inability to complete the Work within the time specified in the Notice to Proceed. Termination Prior to Expiration of Term. City may terminate this Agreement for its convenience at any time, without cause, in whole or in part, upon giving Contractor thirty 30) days written notice. Where termination is due to the fault of Contractor and GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING AGREEMENT FORM CITY PROJECT NO. 19-20 AGREEMENT AND BONDS-PAGE 1 JANUARY 2020 constitutes an immediate danger to health, safety, and general welfare, the period of notice shall be such shorter time as may be determined by the City. Upon such notice, City shall pay Contractor for Services performed through the date of termination in accordance with the Contract Documents. Upon receipt of such notice, Contractor shall immediately cease all work under this Agreement, unless stated otherwise in the notice or by written authorization of the Contract Officer. After such notice, Contractor shall have no further claims against the City under this Agreement. Upon termination of the Agreement under this section, Contractor shall submit to the City an invoice for work and services performed prior to the date of termination. ARTICLE 3 —CONTRACT PRICE The City shall pay the Contractor for the completion of the Work, in accordance with the Contract Documents, in current funds the Contract Price(s) named in the Contractor's Bid Proposal and Bid Schedule(s), and any duty authorized Construction Contract Change Orders approved by the City. The amount of the initial contract award in accordance with the Contractor's Bid Proposal is Three-Hundred Ninety Thousand Dollars 390,000). Contractor agrees to receive and accept the prices set forth herein, as full compensation for furnishing all materials, performing all work, and fulling all obligations hereunder. Said compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of the Work during its progress or prior to its acceptance including those for well and faithfully completing the Work and the whole thereof in the manner and time specified in the Contract Documents; and, also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the Work, suspension of discontinuance of the Work, and all other unknowns or risks of any description connected with the Work. ARTICLE 4 —THE CONTRACT DOCUMENTS The Contract Documents consist of the Notice Inviting Bids, Instructions to Bidders, the prevailing rate of per diem wages as determined by the Director of the Califomia Department of Industrial Relations, the accepted Bid and Bid Schedule(s), List of Subcontractors, Local Business Preference Program — Good Faith Efforts, Non- Discrimination Certification, Non-Collusion Declaration, Bidder's General Information, Bid Security or Bid Bond, this Agreement, Worker's Compensation Certificate, Performance Bond, Payment Bond, Standard Specifications, Special Provisions, the Drawings, Addenda numbers 1 to 2, inclusive, and all Construction Contract Change Orders and Work Change Directives which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto. ARTICLE 5 —MUTUAL OBLIGATIONS For and in consideration of the payments and agreements to be made and performed by the City, the Contractor agrees to furnish all materials and perform all work required for the above stated project, and to fulfill all other obligations as set forth in the aforesaid Contract Documents. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING AGREEMENT FORM CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 2 JANUARY 2020 City hereby agrees to employ, and does hereby employ, Contractor to provide the materials, complete the Work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the Contract Price herein identified, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Contract Documents. Contractor specifically acknowledges and agrees to be bound by the Wage Rates and Labor Code requirements specked in the Contract Documents, including the requirement to furnish electronic certified payroll records directly to the Labor Commissioner (via the Division of Labor Standards Enforcement), and shall pay the general prevailing rate of per diem wages as determined by the Director of the Department of Industrial Relations of the State of California. ARTICLE 6 — PAYMENT PROCEDURES The Contractor shall submit Applications for Payment in accordance with the Standard Specifications as amended by the Special Provisions. Applications for Payment will be processed by the City Engineer as provided in the Contract Documents. ARTICLE 7 -- NOTICES Whenever any provision of the Contract Documents requires the giving of a written Notice between the parties, It shall be deemed to have been validly given if delivered in person to the individual or to a member of the firm or to an officer of the corporation for whom it is intended, or if delivered at or sent by registered or certified mail, postage prepaid, to the last business address known to the giver of the Notice. ARTICLE 8 — INDEMNIFICATION The Contractor agrees to indemnify and hold harmless the City, and all of its officers and agents from any claims, demands, or causes of action, including related expenses, attorney's fees, and costs, based on, arising out of, or in any way related to the Work undertaken by the Contractor hereunder. This Article 8 incorporates the provisions of Section 7-15 "Indemnification," of the Special Provisions, which are hereby referenced and made a part hereof. Prevailing Wages. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation California Labor Code Section 1720, at seq., and 1770, at seq., as well as California Code of Regulations, Title 8, Section 16000, et seq. ("Prevailing Wage Laws"). Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, its officials, officers, employees, agents and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. ARTICLE 9 -- CONFLICT OF INTEREST Conflict of Interest. Contractor acknowledges that no officer or employee of the City has or shall have any direct or indirect financial interest in this Agreement nor shall Contractor GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING AGREEMENT FORM CITY PROJECT NO.19 20 AGREEMENT AND BONDS-PAGE 3 JANUARY 2020 enter into any agreement of any kind with any such officer or employee during the term of this Agreement and for one year thereafter. Contractor warrants that Contractor has not paid or given, and will not pay or give, any third party any money or other consideration in exchange for obtaining this Agreement. ARTICLE 10—NON-DISCRIMINATION In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin ( i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Contractor certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; and further, that Contractor is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. ARTICLE 11 --MISCELLANEOUS Terms used in this Agreement which are defined in the Standard Specifications and the Special Provisions will have the meanings indicated in said Standard Specifications and the Special Provisions. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and specifically, but without limitation, monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. The City and the Contractor each binds itself, its partners, successors, assigns, and legal representatives, to the other party hereto, its partners, successors, assigns, and legal representatives, in respect of all covenants, agreements, and obligations contained in the Contract Documents. SIGNATURES ON NEXT PAGE GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING AGREEMENT FORM CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 4 JANUARY 2020 IN WITNESS WHEREOF, the City and the Contractor have caused this Agreement to be executed the day and year first above written. CITY OF PALM SPRINGS, APPROVED BY THE CITY COUNCIL: CALIFORNIA Date 2' 2 7-20 By f David H. Ready 1CityManagerAgreementNo. ABSC ATTEST: APPROVED 8Y CITY COUNCIL f Y502 12 2 2 70 BY w An City Clerk' APPROVED AS TO FORM: By Jeffirely S. roger City Attorney RECOMMENDED: Marcus Fuller, P.E., P.L.S. Assistant City Manager/City Engineer GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING AGREEMENT FORM CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 5 JANUARY 2020 CONTRACTOR By: ABC Liovin Drilling, Inc. Firm/Company Name By: By: Signature(notarized) Signature(notarized) Name:Name: `V kn L104%4) Tllle: Title: 9"S;%ilff V 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. This Agreement must be signed in the above (This Agreement must be signed in the above space by one having authority to bind the space by one having authority to bind the Contractor to the terms of the Agreement.) Contractor to the terms of the Agreement.) State of Stateof Ca6Farytia 1 County of I County of Ln< IlimolulkS ss On Ong{rGh I f 2A2il before me, hi PrMI c personally appeared personally appeared 1VAn )^nvin— who proved to me on the basis of satisfactory who proved to me on the basis of satisfactory evidence to be the peson(s) whose name(s) evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and is/are subscribed to the within instrument and acknowledged to me that he/shetthey executed acknowledged to me that he/shetthey executed the same in his/her/their authorized capacity(ies), the same in his/her/their authorized capacily(ies), and that by his/herftheir signatures(s) on the and that by his/her/their signatures(s) on the instrument the person(s),or the entity upon behalf instrument the pemon(s), or the entity upon behalf of which the person(s) acted, executed the of which the person(s) acted, executed the instrument. instrument. I certify under PENALTY OF PERJURY under the I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing laws of the State of California that the foregoing paragraph is true and correct. paragraph is true and correct. WITNESS my hand and official seal. WITNESS my hand and^official seal. Notary Signature: Notary Signature: Notary Seal: Notary Seal. Val-M ' OVA LIBILIBIER MACHUCA Comminion No. 2281799 NpTMV 1FOp1N LO6 ANfELESLES CWNiY ' Erytomm EGMe MNiCH tB,am GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PAYMENT BOND CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 6 JANUARY2020 Premium: $8,800 Bond No. : 1001130360 PERFORMANCE BOND—PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO. 19-20 hereinafter referred to as the'Public Work'); and WHEREAS,the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named,(hereinafter referred to as the"Contract'j, which Contract is incorporated herein by this reference; and WHEREAS,the Contractor is required by said Contract to perform the terms thereof,and to provide a bond both for the performance and guaranty thereof. NOW,THEREFORE,we,the undersigned Contractor, as Principal, and: American Contractors Indemnity Company a corporation organized and existing under the laws of the State of California and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City in the sum of Three Hundred Ninety Thousand Dollars ($ 390,000.00 ), said sum being not less than 100 percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made,we bind ourselves,our heirs,executors, administrators,successors, and assigns,jointly and severally,firnly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH,that if the bounden Contractor,his or its heirs, executors, administrators, successors,or assigns,shall In all things stand to and abide by, and well and truly keep and perform the covenants,conditions and agreements in the said Contract and any alteration thereof made as therein provided,on his or its parts,to be kept and performed at the time and in the manner therein specified, and in all respects according to their intent and meaning; and shall faithfully fulfill the one year guarantee of all materials and workmanship; and indemnity and save harmless the City, its officers and agents, as stipulated in said Contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. The said Surety,for value received,hereby 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 thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change,extension of time,alteration of addition to the terms of the Contract, or to the Public Work or to the Specifications. No final settlement between the City and the Contractor shall abridge the right of any beneficiary hereunder,whose claim may be unsatisfied. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PERFORMANCE BOND CITY PROJECT NO.19,20 AGREEMENT AND BONDS-PAGE B JANUARY 2020 Bond No. : 1001130360 PERFORMANCE BOND—PUBLIC WORKS CONTINUED) Contractor and Surety agree that N the City is required to engage the services of an attorney in Connection with enforcement of the bond,each shall pay City's reasonable attorney's fees incurred, with or without suit, in addition to the above sum. SIGNED AND SEALED, this 9thday of March Y020. CONTRACTOR: ABC Liovin Drilling, Inc. Check one:_individual,_partnership, X corporation This Performance Band must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Performance Bond.) CONTRACTOR: SURETY: ABC LioyixL Drilling, Inc.American Contractors Indemnity Company By: By ff signature signature NOTARIZED)NOTARIZED) Print Name and Title:Print Name and Title: Ivun Pre 5y,IGt'-"Blake A Pfister,Attorney—in—fact By: signature NOTARIZED) Print Name and Tide: By submitting this Performance Bond,the Contractor and Surety acknowledge the provisions of the Contract Documents with regard to Section 64"Default by the Contractor", as further amended by the Special Provisions. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PERFORMANCE BOND CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 10 JANUARY 2020 CAU/ORMIA ALL-PtIRVOSE ACKNOWLEDGMENT CML CODE 61189 A May pubic a glthe office completing the certificate verifies only alb idemity of tie individual who sared the docnanMrht b wlieJn thle nxnifieate is attached,and not the tMMWress,accuracy,a validity of that doamtent, state of California Calntyof nranac On March 4 , 2020 beforeme, Lianne Nahina, Notary Public pate Here Insert Nana and Title of the Officer personelty, appeared Blake A. Pfister Names)of signer(s) who proved to me on the basis of satisfactory evidence to be the person(# whose name(s) Is/AV subscribed to the within instrument and acknowledged to me that helle aWAV executed the same in his/010ii authorized capwityW,and that by his/RWpIE(sy)natureal)on the instrument the person, or the entity,Upon behalf of which the Pason(N acted.a%eCuted the instrument. I ce"wxfa PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph Is true and comect LIANNE NAXINA WITNESS my hared and offic;isl eat... / COMM.a 2314283 A s NDORANG COUN0eMA.ORANGE COUNN MY COMM.EXR DEC e,2027N Signahse SignafuB of Notary Public Piece Notary Sorel Above 00777O1111A1 Though this section is optional, completing this information can deter aheation of the document or fraudulent reattachment of this form to an unintended document. Damon of Attached DocBtoiainIt 1130360 March 9, 2020 This or Type of Cowmenb Document Date Number of Pages: Signer(s) Other Than Named Above: N/A Now_ Capacity(fes) Claimed by Siprwr(y SignseSName: Blake A. Pfister Signers Nape: O Corporate Officer — TRIe(s): O Corporate Officer — TM*): 11 Partner — n Umfted ®General O Partner — O UmRed O Generd 0 Individual Attorney In Fact O Individual 0 Attorney In Fact U Trustee 0 Guardian or Conservator O Trustee Guardian or Conservator r1 Other. 11 Otte: Signer Is RepreseMir: American Signer Is Representing: ontractors n emnii7y oC mpany 02014 National Notary Association•www.NationalNotary.org-1-800•US NOTARY(1-800-876.6827) Rem s59D7 Bond No. : 1001130360 PERFORMANCE BOND—PUBLIC WORKS CONTINUED) The rate of premium on this bond is$ 22.56 per thousand. The total amount of premium charged: $ 8,800.00 The above must be filled in by Corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and If the work or project is financed, in whole or in part,with Federal, grant, or loan funds, it must also appear on the Treasury Departments most current list(Circular 570 as amended).THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: American Contractors Indemnity Company Name and Address of Surety) 801 S Figueroa Street, #700 Los Angeles, CA 90017 Name and Address of Agent or Representative for service of process in California if same different from above) telephone Number of Surety and Surety: 310-649-0990 Agent or Representative for Agent: 949-248-1543 service of process in California) GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PERFORMANCE BOND CRY PROJECT 140.19-20 AGREEMENT AND BONDS-PAGE 11 JANUARY 2020 Bond No. : 1001130360 PERFORMANCE BOND—PUBLIC WORKS CONTINUED) ALL-PURPOSE 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 County of On before me, Date Name,Title of Officer personally appeared 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 helshelthey executed the same in hismerrtheir authorized capacity(les),and that by hisrherttheir signatures(s) on the instrument the person(s), or the entity upon behalf of which the person($)aced, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State identified herein,that the foregoing paragraph is true and correct. Wdness my hand and official seal. Signature of Notary ATTENTION NOTARY: Although the Information requested below,is OPTIONAL,it could prevent fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number at Pages_DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s)Other Than Named Above GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PERFORMANCE BOND CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 12 JANUARY 2020 TOKIOMARINE HCC POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS:That American Contractors Indemnity Company, a California corporation,Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company,a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively,the'Companies*),do by these presents make, constitute and appoint: Blake A. Pfister of Mission Viejo, California its true and lawful Attomey(s)-in-fact, each in their separate Capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to Include riders, amendments, and consents of surety, providing the bond penalty does not exceed Five Million""' Dollars 5,000,000.00— J.This Power of Attorney shall expire without further action on April 23rd,2022.This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: 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 Afforney(s)-in-Fad to represent and act for and on behalf of the Company subject to the following provisions: Attomey-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• recognc antes, 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 Aftorney-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 W valid and binding upon the Company with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 1"day of June,2018. AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED S'ATP SURETy. eaQ§IMPANY " ECIA •INSURANCE COMPANY fit Y a'o M e State of CaliforniaUN CountyAngelesAguilar,Vice PresidentCourtofLos A Notary Public or other officer completing this certificate vanillas 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 On this 1 e1 day of June,2018,before me,Sonia O.Carrejo,a notary public,personally appeared Daniel P.Aguilar,Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and 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 PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. w",o.uanr,o met, . v,wn Signature seal)wrm..aa wr.mr I, Kio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Companies,which is still in full force and effect;furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this 4th day of March s,^ 2020 Corporate Seals E ""v s+"e "•?Bond No. 1001130360 of A Agency No. 3076 S. • ' µ, - rr v - t .. - Kio La, Assi Secretary 4. art'Tat hN"+ R*+ M..'.,,. "`+«.,:m„..f HCCSMPNPOR06'0n19 visit tmhoc.coMsurely for more information CALIFORNIA 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 Los Argeles On ItUrco 4. -Lo=before me, M.e.m,, pf.a c a:naa..as-.p personally appeared l,oac^ Li-'A^ who proved to me on the basis of satisfactory evidence to be the person(4 whose name(6) is/are subscribed to the within instrument and acknowledged to me that he/sqe/they executed the same in his/i*/*ir authorized capacity(ie§), and that by his/hVjtt*r signature(g)on the instrument the person(%), or the entity upon behalf of which the person(iq acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Lss MA . UCA 2281 aESS my hand and official seal. COp,M' i,` "u LOS NIC£LEBCgMlV ' 799 M Caron.EyY rINCX tot,IaM ry Public Signature Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THUS FORM Thu form eomplia with %wren(Caly mia stases,regarding non,warding and. DESCRIPTION OF THE ATTACHED DOCUMENT ifoeeded.shouldbe compleredandatmehed to the document Achnowledgmeme from other sales may be emnyletedfo,documen s being sent to thetsat,so long as the nnrding does not segaire the California notary a violas Colombo.nomry PfW[)¢laA"CE lam. tole or description dasarhM doamda) State and County information mart b,the State and County where the document f' YCaU stpere)pinarnally appeared before the notary public for sknmelarMent. fobadescripumn d. mamcem command) Daze of notterimtion mum be the date that the atipen(s)personally appmred which must also be the same date the acknowledgment is complaudi The notary public must print his or her time be it appear within his or her Number of Pages_Document Date commission followM by a comma and then your title(nomry public). e Print the remelt)of document sigrwr(s) who pasorelly appear m the time of noncumtn. CAPACITY CLAIMED BY THE SIGNER Indicate the correct sthgola or plural forms by crossing off brcar,ct forms(I.,. Wahe/Nw),, is late)or circling the correct forms.Failure to corractly indicate Wes Individual (a)information may lead to rejection of document recording. Corporate Officer The notary sral impression must be clear and photographically reproducible. Impression most not cover text or lines.If seal impression smudgs,re-seal if a It a sufficient area permits,otherwise complete a different ocknowtedgmen form. Partner(s) Signature of the notary public most match the signature on fide with the office of the awry clerk. Attomey-in-Fact fi Additional information is not requires but could help to arsur, this Tri steels) ackmowledMand s nmmisusesimatteclted madiffaemdocumeot. Other fi Indicate title or type ofauechW document.number ofpages and data 4 Indicate the capacity claimed by the signer.9 the claimed capacity is a entrance,office,indicate the the(i.e.CFI,CFO,Secretary), 20If Version www.NotaryCmsses cam 800-073-9865 Securely match this document to the signed document with a simple. Bond No. : 1001130360 PAYMENT BOND—PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city; organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the"City'),has awarded to the undersigned Contractor, hereinafter referred to as the"Contractor"), an agreement for the work described as follows: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO. 19-20 hereinafter referred to as the"Public World;and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement(Construction Contract)for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract"),which Contract is Incorporated herein by this reference; and WHEREAS, said Contractor is required to furnish a bond in connection with said Contract and pursuant to Section 9550 of the California Civil Code. NOW,THEREFORE,we,the undersigned Contractor,as Principal, and: American Contractors Indemnity Company a corporation organized and existing under the laws of the State of Calif orniaand duly authorized to transact business under the laws of the State of California, as Surety,are held and firmly bound unto the City,and to any and all persons, companies, or corporations entitled to file stop payment notices under Section 9100 of the California Civil Code, in the sum of Three Hundred Ninety Thousand Dollars ($39 0,000.00 ), said sum being not less then 100 Percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators,successors,and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that, if said Contractor, his or its heirs, executors, administrators,successors,or assigns, or Subcontractors,shall fail to pay for any materials,provisions or other supplies,implements,machinery,or power used in,upon,for,or about the performance of the Public Work contracted to be done,or to pay any person for any work or labor of any kind,or for bestowing skills or other necessary services thereon, or for amounts due under the Unemployment Insurance Code with respect to such work or labor,or for any amounts required to be deducted,withheld,and paid over to the Employment Development Department from the wages of employees of paid Contractor and his Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to such work and labor as required by the provisions of Sections 9550 through 9560 of the Civil Code,the Surety or Sureties hereon will pay for the same in an amount not exceeding the sum specified in this bond, otherwise the above obligation shall be void. In addition to the provisions herein above, it is agreed that this bond will inure to the benefit of any and all persons, companies, and corporations entitled to serve stop payment notices under Section 9100 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PAYMENT BOND CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 13 JANUARY 2020 Bond No. : 1001130360 PAYMENT BOND-PUBLIC WORKS CONTINUED) The Surety,for value received, hereby stipulates and agrees that no change,extension of time,alteration, or additions to the terms of the said Contract or to the work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration, or addition to the terms of the Contract or to the work or to the Specifications. No final settlement between the City and the Contractor hereunder shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. Contractor and Surety, an admitted surety insurer, further agree that if the City or any entity or person entitled to file stop payment notices is required to engage the services of an attorney in connection with the enforcement of this bond, each shall be liable for the reasonable attorneys fees incurred, with or without suit, in addition to the above sum. SIGNED AND SEALED,this 41th day of March 20 20 CONTRACTOR: ABC Liovin Drilling, Inc. Check one:_individual,_partnership, X corporation This Payment Bond must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Payment Bond.) EXECUTED FOR THE CONTRACTOR: EXECUTED FOR THE SURETY: ABC L Drilling, Inc. American Contractors Indemnity Company BY: By C signature signature NOTARIZED) NOTARIZED) Print Name and Tale, J Print Name and Title: V(trl uOt)l P/ezJ Blake A Pfister, Attorney-in-fact By: signatureNOTARIZED) Print Name and Title: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING PAYMENT BOND CITY PROJECT NO.19-20 AGREEMENT AND BONDS-PAGE 14 JANUARY 2020 CALEl0MKA AL4PURPOSE ACKNOWLUMMEENT CML CODE;1189 A notary Puck or 09sa officer completing INS OmftdO vendee orgy the War"of the individual who slpned the doasnent to~his cwWWW is attached,and not the trulhhhwrss,accuracy.arvak*of that documem. State of California rigmtyof Or- I On March 4 , 2020 hefOne mg, Lianne Nahina, Notary Public Date Fare Insert Name and TWO of the Offlmr persooaily appeared Blake A. Pfister Name(s)of Slgner(s) who proved to me on the basis of sstisfactory evidence to be the person(4) whose names) IslARV subscribed to the within instrument and acknowledged to me that he/sdeA04Y executed the same in or the upon, behalf of stai P which and that b acted,executed ieW on the tree m*, I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct WITNESS my hand and official seal. y`°"w, LIANNE NAHINA whCOMM.#2314283 M Sgnahr i = NOTARY PIIBUCCAUFORNIA 70 Signature of Notary Public ai ORANGE COUNTY N MYCOMM.EXP.DEC s,te73 Pace Notary Seel Above OPTIONAL Though this section is optional, completing this finfonnation can deter akera#on of the document or fraudulent reattachment of this form to an unintended documenDeeffliptionofAttached t wnert Tice Of D u Bond 10011 30360 Document Date: March 4 Number of Pages: Signers) Other Than Named Above: N rA n' n Capad"")Claimed by SOWN Signer's Name: Blake A. Pfister Signets Name: Corporate Officer — Tkb(s): 0 Corporate Officer — Tite(s): O Partner — 0 Limited General 0 Partner — 0 Linked 0 General O Individual 0 Attorney in Fact 0Individual Attorney in Fact O Trustee 0 Guardian or Corhservator 0 Trustee Guardian or Conservator Other: Other: nor Is Representing: American Signer Is Representing: contractors Indemnity Company OW14 National Notary Association'wwwAstionelNoteny.og•1-800-US NOTARY(1-800.87&6927) kem#W Bond No. : 1001130360 PAYMENT BOND-PUBLIC WORKS CONTINUED) The rate of premium on this bond is$ 0.00 per thousand. Premium included in the P rformance Bond) The total amount of premium charged: $ $•00 The above must be filled in by Corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part,with Federal,grant, or loan funds, it must also appear on the Treasury Departments most current list(Circular 570 as amended).THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: Name and Address of Surety) American Contractors Indemnity Company 801 S Figueroa Street, #700 Los Angeles, CA 90017 Name and Address of Agent or Representative for service of process in California if same different from above) Telephone Number of Surety and Surety: 310-649-0990 Agent or Representative for Agent: 949-248-1 543 service of process in California) GROUNDWATER MONITORING WELL CONSTRUCTION PAYMENT BONDANDDECOMMISSIONING CITY PROJECT NO.19.20 AGREEMENT AND BONDS-PAGE 15 JANUARY 2020 Bond NO. : 1001130360 PAYMENT BOND—PUBLIC WORKS CONTINUED) ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer competing 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 County of On before me, Date Name,Thle of Officer personally appeared NAMES)OF SIGNER(S) who proved to me on the basis of satisfactory evidence to be the pemon(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/sheMey executed the same in his/hedtheir authorized cepacity(les),and that by hismer/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State identified herein,that the foregoing paragraph is We and correct. Witness my hand and official seal. Signature of Notary ATTENTION NOTARY: Although the information requested below is OPTIONAL,it could prevent fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Me or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages_DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s)Other Than Named Above GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING WARRANTY BOND CITY PROJECT NO.1a-20 AGREEMENT AND BONDS-PAGE 16 JANUARY 2020 TOKIOMARINE HCC POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS:That American Contractors Indemnity Company,a California corporation,Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company, a Maryland corporation and U.S. Specialty Insurance Company,a Texas corporation (collectively,the"Companies"), do by these presents make, constitute and appoint: Blake A. Pfister of Mission Viejo, California its true and lawful Attorney(s)-in-fact, each in their separate capacity if more than one is named above,with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other Instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed Five Million-- Dollars 5,000,000.00""' 1.This Power of Attorney shall expire without further action on April 230,2022.This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: 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 Attomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Affomey-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, inducing 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 Aftorney-in-Fact shall be binding upon the Company as f signed by the President and sealed and~ad 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 certifcate relating thereto by facsimile,and any power of attorney or certNcate 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. IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 1"day of June, 2018, AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED?S f,Jf$SURET y'4'4ttd,PANY JA Fa*FECIASTlf4N$URANCE COMPANY State of California 5~ i1 s tf eJK. ',y=_ County of Los Angeles t i k f}' By:Daniel P.Aguilar,Vice President A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness accuracy, or validity of that document On this 1° day of June,2018,before me, Sonia 0.Camejo,a notary public, personally appeared Daniel P.Aguilar,Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty Insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the wfthin instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person,or the entity upon behalf of which the person acted,executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. oa.w ws-rw.,w Signature D! seal) l car BondnrI, Kio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Companies,which is still in full force and effect;furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this 4th day of March 2020 Corporate Seals w$ .+'. `qa 9.* "_, t .t:' Bond No. 1001130360 J Agency No. 3074 Kio Lo, Assi Secretary HCLSMANPOTW2019 visit tmhcc.com/surety for more information CALIFORNIA 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 lost AiMeW; On PhcpGM It, before me, L.b\er Much rc, tw.y A bfc Ir m aaw as a al personally appeared li aan L-nvlun who proved to me on the basis of satisfactory evidence to be the person(s)whose name(V) ishWe subscribed to the within instrument and acknowledged to me that he/sbe/they executed the same in his/tWltheir authorized capacity(ift), and that by his/tier/thoir signature(s) on the instrument the person(9,1, or the entity upon behalf of which the person(AL) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. LIBIER MACHUCA 7UEmy hand and official seal. c;tormyiO"NOL,' „Z,e. aosutcEtEecwny ' ly Cgmm Ema YMGa N.3Sb ry Public Signature NWary Public Seaq A INS7RUCTIONSFORCOMPLETINGTHISFORM ADDITIONAL OPTIONAL INFORMATION yhuform mmplus with rumen,Call ismsmmres regaMingnomry wording and. DESCRIPTION OF THE ATTACHED DOCUMENT ifersded.shou(dbe compleredaMmmched to he document.Ac.Mow/edgmena from other scores maybe rnmylewd for document/being sent in that sure so long as the wording does not require the California mmry to violate Colifamio mmry PkIMEKC BOND \00\\3o3trD cow. fide or besaipgm distributed locum ou Suite and County information must be the Suite hied County where the document Lvovwls.Arrahs(s WeU (dsSHtsetlthn siuer(s) sersonilly appeared before the notary public Pot selnowledgshent. Oats of orientation must be the datethat the signer(s)personally appeared which fineormerriptlonotatlscheddocvmmtcmonuedl must also be the some dale the mknowledgmentis oompletd. The nomry public must print his or her time as it appecrs within his or her Number of Paget_Document Date commission followed by a comma and then your title(rotary public). print the bushels) of document signals) who personally appear m the time of iwfanmlim. CAPACITY CLAIMED BY THE SIGNER ledicate the erred singular cr plural entire by crossing off incorrect forms(i c. Individual a hetshdMry;is/me)m6scingthe correct loons.Failureto comedlyindicate this information may l®si in Meceon ofmnttment recording. Corporate Officer The notary soul impression must be clear and photrgmphieally reproducible. Impression most nor cover tent or lines. If seal impassion smudges,reseal if a It a sumcient area permits,otberesse complete a different sckn wshu gment Porm. Paraler(e) Signature of the notary public most match the sigrceture on file with the once of the county clerk. Attomey-in-Fact a Additional information is not required but could help to ensure this Trustee(s) acknowledgment is nor misueed or attached to a different document. Other a Indicate tine or type of attached dmmnem,numb cotnumberofpagesand e. J Indicate the capacity claimed by the signer. If the claimed capacity is s curyomte officer,indicate the title fie,CEO,CFO,Sartary). 2015 Vermont..N.tr,,Cli Burn 800-8739885 Securely aaach this documemmthe signed document wiW asuiple. WORKER'S COMPENSATION CERTIFICATE AS REQUIRED BY SECTION 1861 OF THE CALIFORNIA LABOR CODE) I am aware of the provisions of Section 3700 of the California Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self-insurance in accordance with the provisions of said Code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Contractor ABC Liovin Drilling, Inc By Ivan Liovin Title President GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING WORKER'S COMPENSATION CERTIFICATE CITY PROJECT NO.19 20 AGREEMENT AND BONDS-PAGE 8 JANUARY 2020 BID DOCUMENTS Only the following listed documents, identified in the lower right corner as "Bid Forms" shall be fully executed and submitted with the Bid at the time of opening of Bids. Bid (Proposal) Bid Schedules List of Subcontractors Local Business Preference Program Good Faith Efforts Non-Collusion Declaration Non-Discrimination Certification Bid Bond (Bid Security Form) Bidder's General Information Public Integrity Disclosure Form Failure of a Bidder to fully execute and submit all of the listed documents with the Bid will render a Bid as non-responsive and subject to rejection. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO. 19-20 COVER SHEET JANUARY 2020 BID FORMS-PAGE 1 BID PROPOSAL BID TO: CITY OF PALM SPRINGS, CALIFORNIA The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with the City in the form included in the Contract Documents (as defined in Article 4 of the Agreement)to perform the Work as specified or indicated in said Contract Documents entitled: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO. 19-20 Bidder accepts all of the terms and conditions of the Contract Documents, including without limitation those in the Notice Inviting Bids and the Instructions to Bidders dealing with the disposition of the Bid Security. This Bid will remain open for the period stated in the Notice Inviting Bids, unless otherwise required by law. Bidder will enter into an Agreement within the time and in the manner required in the Instructions to Bidders, and will furnish the insurance certificates, Payment Bond, Performance Bond, and all Permits required by the Contract Documents. Bidder has examined copies of all the Contract Documents, including the following Addenda receipt of which is hereby acknowledged): Number 1 Date 1/27/20 Number 2 Date 2/10/20 Number Date Number Date Number Date Number Date Number Date Bidder has familiarized itself with the nature and extent of the Contract Documents, the Work, the site, the locality where the Work is to be performed, the legal requirements (federal, state, and local laws, ordinances, rules, and regulations), and the conditions affecting cost, progress, or performance of the Work, and has made such independent investigations as Bidder deems necessary. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING BID PROPOSAL CITY PROJECT NO.1&20 BID FORMS-PAGE 2 JANUARY2020 In Conformance with the current statutory requirements of California Labor Cade Section 1860, et seq.,the undersigned confirms the following as its certification: I am aware of the provisions of Section 3700 of the Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self- insurance in accordance with the provisions, before commencing the performance of the Work of this Contract. To all the foregoing, and including all Bid Schedule(s), List of Subcontractors, Non-Collusion Declaration, Bidder's General Information,and Bid Bond contained in these Bid Forms,said Bidder further agrees to complete the Work required under the Contract Documents within the Contract Time stipulated in said Contract Documents, and to accept in full payment therefor the Contract Price based on the Lump Sum or Unit Bid Price(s) named in the aforementioned Bidding Schedule(s). Dated: 2/11/20 Bidder: ABC Liovin Drilling, Inc By:f11- Signature) Title: President GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING BID PROPOSAL CITY PROJECT NO.18 20 BID FORMS-PAGE 3 JANUARY 2020 BID SCHEDULE Schedule of Prices for the Construction of the: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO. 19-20 Description The Work comprises of furnishing all labor, materials, tools, and equipment necessary to construct three (3) monitoring wells, modify two (2) existing wells, decommission one (1) monitoring well, and perform other related work as necessary to provide a complete project; all in accordance with the Standard Specifications, general conditions/specifications, plans, and Special Provisions. TOTAL BID PRICE For the lump sum price of: 390 , 000 . 00 Price in figures) Three Hundred Ninety Thousand Dollars and No Cents Price in words) SPECIAL ACKNOWLEDGEMENT: The Lump Sum Price identified in this Bid Schedule identifies and commits the Bidder to a "Firm Fixed Price' cost, and all other incidental or additional costs required to complete the work as identified in the technical specification requirements. The Lump Sum Pr ce is inclusive of all other costs, including all materials,supplies, labor,vehicles,equipment and ancillary costs required to complete the work. ABC Liovin Drilling, Inc Name of Bidder or Firm GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO.19-20 JANUARY 2020 BID SCHEDULE BID FORMS-PAGE 4 BIDDER'S LIST OF SUBCONTRACTORS As required under Section 4104 of the Public Contract Code, the Bidder shall list below the name and the location of the place of business of each subcontractor who will perform work or labor or render service to the prime contractor in or about the construction of the work or improvement, or a subcontractor licensed by the State of California who, under subcontract to the prime contractor, specially fabricates and installs a portion of the work or improvement, in an amount in excess of one-half of 1 percent of the prime contractor's total bid or, in the case of bids for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the prime contractor's total bid or ten thousand dollars ($10,000), whichever is greater. After the opening of Bids, no changes or substitutions will be allowed except as otherwise provided by law. The listing of more than one subcontractor for each item of Work to be performed with the words "and/or" will not be permitted. Failure to comply With this requirement will render the Bid as non-responsive and may cause its rejection. Special Note: The Prime Contractor shall perform not less than 50% of the Work identified in this Bid. In the event a Bidder lists subcontractors who will perform Work under this Bid in excess of 50%of the Work identified in this Bid, the Bid shall be considered non-responsive. A. BIDDER'S PORTION OF WORK Page 1 of 1. Name of Prime Contractor: ABC Lionin Drilling, Inc 2. Bid Items/Portion of Work to be Self-Performed(if less than 100%of the contract): 3. Dollar Amount of Work Self- 4. Percentage of Work Self- 5. Date: Performed: 390 , 000 . 00 Performed: 2/11/20 By signing the Bid Form,Contractor hereby certifies that it will perform not leas than 50%of the Contract Work with Its own forces. B. LIST OF SUBCONTRACTORS 1. Type of Subcontractor(Check One) First Tier: Second Tier, Supplier, X Service Contractor(e.g. Trucking) 2. Subcontractor Name: Belstlire 3. Address: 25971 Towne Centre Drive, Foothill Ranch, CA 92610 4. Bidltems/Portion of Work: Disposal 5. Phone No.: 6. Contractors License No.: 7. Annual Gross Receipts: 949-460-5200 808313 0 <$1M 0<$5M 0 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor <$ i5M >$15M 11nkn050KRegistraflonNo:1000010287 10. Percentageof Contracted Work: 11 DBE Finn? Yes H No 12. DBE Cn a tion No.: BIDDER'S LIST OF SUBCONTRACTORS—(Continued) GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO.19-20 LIST OF SUBCONRACTORS JANUARY 2020 BID FORMS-PAGE 5 Copy this page as needed to provide a complete listing. Page 2 of 2 1. Type of Subcontractor(Check One) First Tier; Second Tier; Supplier; CKSBnim Contractor(e.g. Trucking) 2. Subcontractor Name: pacific Surveys 3. Address: 1785 W.Arrow Route Bldg D,Suite 3&4 Upland, CA 91786 4. Bid Items/Portion of Work: Survey 5. Phone No.: 6. Contractors Lice se No.: 7. Annual Gross Receipts: 800-919-7555 n/a 1M <$5M 11 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor <$ 15M >$15M 10K Registration No: 1000014306 unknoty 10. Percentage of Contracted Work: 11 DBE Finn? O Yes X No 12. DBE Certification No.: 38 n/a 1. Type of Subcontractor(Check One) First Tier, Second Tier; Supplier, IIN Service Contractor(e.g. Trucking) 2. Subcontractor Name: Babcock Laboratories Inc 3. Address: 6100 Quail Valley Court Riverside CA 92507 4. Bid ItemslPortion of Work: Testing 5. Phone No.: 6. Contractors icense No.: 7. Annual Gross Receipts: 951-653-3351 nA 0 <$11M 0 <$5M 0<$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Cl <$15M >$15M 35K Registration No: 1000041205 unkno 10. Percentage of Contracted Wok: 11 DBE Firm? O Yes H No 12. DBE Cenfication No.: 08% n/a 1. Type of Subcontractor(Check One) First Tier; Second Tier; Supplier; Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Dld Items/Pordon of Work: 5. Phone No.: 6. Contractors License No.: 7. Annual Gross Receipts: 13 <$1M 0 <$5M 0<$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor 13 <$15M 0>$15M Registration No: 10. Percentage of Contracted Wok: 11. DBE Firm? O Yes No 12. DBE Certification No.: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO.19-20 LIST OF SUBCONRACTORS JANUARY 2020 BID FORMS-PAGE 6 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS City Project No. 19-20 Bid Opening Date 2/12/2020 The contract for this project is subject to the provisions of Palm Springs Ordinance No. 1756, and Section 7.09.030 of the Palm Springs Municipal Code, "Local Business Preference Program", subsection (5) "Local Preference in Public Works Contracts (Sub-Contracting)", which states: The prime contractor shall use good faith efforts to sub-contrail the supply of materials and equipment to local business enterprises and to sub-contract services to businesses whose work force resides within the Coachella Valley.The prime contractor shall submit evidence of such good faith efforts at the time of submission of bids. Good faith efforts may be evaluated by placing advertisements inviting proposals in local newspapers, sending request for proposals to local sub- contractors, or by demonstrating that no local sub-contracts are qualified to perform the work or supply the materials or equipment. Any notice inviting bids which may require the use of sub- contractors shall include notification of this subsection. The City Council or Director may reject as non-responsive the bid of any contractor proposing to use subcontractors that fail to comply with the requirements of this subsection. FAILURE TO IDENTIFY GOOD FAITH EFFORTS ON THESE FORMS MAY BE SUFFICIENT CAUSE TO FIND THE BID NON-RESPONSIVE. BIDDERS SHALL ENSURE ALL APPROPRIATE GOOD FAITH EFFORTS ARE IDENTIFIED. Bidders shall provide sufficient information to demonstrate that they have made good faith efforts to comply with Palm Springs Ordinance No. 1756. In the event no local firm (as defined in Ordinance No. 1756) is listed as a subcontractor on the "List of Subcontractors" submitted with its Bid, Bidders shall identify local subcontractors not required to be identified on the List of Subcontractors, and/or shall identify local firms with whom the Bidder has solicited to furnish materials and supplies for incorporation into the work of this project. Local Subcontractors not listed on the List of Subcontractors: none Local firms that will furnish materials or supplies to the Bidder for this project: none GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO.1620 GOOD FAITH EFFORTS JANUARY 2020 BID FORMS-PAGE 7 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS CONTINUED) In the event no local firms (as defined in Ordinance No. 1756) will provide services, or furnish materials and supplies to the Bidder for this project, the Bidder shall provide information sufficient to demonstrate good faith efforts to do so. Examples of information accepted by the City to demonstrate good faith efforts shall be included below: A. The names and dates of each publication in which a request for participation by local firms for this project was placed by the bidder(please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement 1/21/20 Construction Bid Source 2/5/20 Desert Sun Local Newsletter B. The names and dates of written notices sent to local firms soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the local firms were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of Date of Follow Up Methods firms Initial and Dates Solicited Solicitation Minority Business 1/21/20 Email 1/24/20 Development Agency GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO.19-20 GOOD FAITH EFFORTS JANUARY 2020 810 FORMS-PAGE 8 C. The items of work which the bidder made available to local firms, including, where appropriate, any breaking down of the contract work items(including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate participation by local firms. Items of Work Bidder Breakdown of Items Amount Percentage Normally M Of Performs Item Contract Y/N 3 fj d D. The names, addresses and phone numbers of rejected local firms, the reasons for the bidder's rejection of the local firms, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each firm if the selected firm is not a local firm: Names, addresses and phone numbers of rejected local firms and the reasons for the bidder's rejection of the local firms: none Names, addresses and phone numbers of firms selected for the work above: none NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO.19-20 GOOD FAITH EFFORTS JANUARY 2020 BID FORMS-PAGE 9 NON-COLLUSION DECLARATION The undersigned declares: lamthe president of ABC Liovin Drilling, Inc , the Title of Officer) Firm/Company) party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, Communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof,to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full powerto execute,and does execute, this declaration on behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on February 11 2020 , at Signal Hill CA Date)City) State) Signature GROUNDWATER MONITORING WELL AND CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO.15 20 NON-COLLUSION DECLARATION JMUARY 2020 BID FORMS-PAGE 10 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS As suppliers of goods In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to their race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Such actions shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. We agree specifically: 1. To establish or observe employment policies, which affirmatively promote opportunities for minority persons at all job levels. 2. To communicate this policy to all persons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large. 3. To take affirmative steps to hire minority employees within the company. FIRM ABC Liovin Drilling, Inc NAME OF PERSON SIGNING Ivan Liovin TITLE OF PERSON SIGNING President DATE 2/11/20 Please include any additional information available regarding equal opportunity employment programs now in effect within your company. GROUNDWATER MONITORING WELL AND CONSTRUCTION AND DECOMMISSIONING NON-DISCRIMINATION CERTIFICATION CITY PROJECT NO.19-20 BID FORMS-PAGE 11 JANUMY2020 BIDDER'S GENERAL INFORMATION The Bidder shall furnish the following information. Failure to complete all Items will cause the Bid to be non-responsive and may cause its rejection. 1. BIDDER/CONTRACTOR'S Name and Street Address: ABC Liovin Drillinc, Inc 1180 East Burnett Street Signal Hill CA 90755 Telephone Number: (5621981-8575 Facsimile Number: (562-)981-9594 E-Mail: ivan@abcdrilling. com Tax Identification Number: 33-0498383 2. TYPE OF FIRM Individual Partnership X Corporation (State CA ) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Disadvantaged Business (SDB) Veteran Owned Business Disabled Veteran Owned Business 3. CONTRACTOR'S LICENSE: Primary Classification C-57 State License Number(s)422904 Supplemental License Classifications will obtain prior to commencement of the work 4. BUSINESS LICENSE: Yes No License No.: 5. Surety Company and Agent who will provide the required Bonds: Name of Surety Blake Pfister Address PO Box 4164 , Dana Point, CA 92629 Surety Company Bond Connection Telephone Numbers: Agent(809-298-4826Surety (800 298-4826 GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING BIDDER'S GENERAL INFORMATION CITY PROJECT NO.18 20 BID FORMS-PAGE 13 JANUARY 2020 BIDDER'S GENERAL INFORMATION (Continued) 6. List the names and addresses of the principal members of the firm or names and titles of the principal officers of the corporation or firm; also include those who has greater than $2,000 interest in the corporation or fine. Ivan Liovin, President 7. Number of years experience as a contractor in this specifctype of construction work: 36 8. List at least three related projects completed to date: Please see attached for detailed list a. Owner Address Contact Class of Work Phone Contract Amount Project Date Completed Contact Person Telephone number b. Owner Address Contact Class of Work Phone Contract Amount Project Date Completed Contact Person Telephone number C. Owner Address Contact Class of Work Phone Contract Amount Project Date Completed Contact Person Telephone number Ivan Liovin 9. Name of Project Manager/Superintendent: 16. Name(s) of person(s)who inspected job site: Ryan Reynolds GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING BIDDER'S GENERAL INFORMATION CITY PROJECT NO.19-20 BID FORMS-PAGE 14 JANUARY 2020 ABC Liovin Drilling Inc Project Specific References/ Key Projects owNn Prolezt Nemeaw canofaueers Wpk ONrM1 b floh Parlorl of Performance Work COMan Name contact Phan Comact Email MsmptionofBidleiaWIXk East Newport Mesa Groundwater drill( 3) monitoringwells110ftdeepand(1) Orange County May 22- 26, 30, 714- 378- Water District Investigation June 1- 2, 12, 2017 $ 57, 053. 00 David Field 3237 Mield@ocwd. com monitoring well 50ftdeepwithcasingIn10" Monitoring Well boreholes using hollowstemaugers Irvine CA Monitoring Wells at Orlando 559- 621- orlando. gonzalez@fmsno. g 540 N Brawley( 43597) July 9- 14, 17- 19, Gonzales/ drill( 4) monitoringwells125-200ftdeepwith4" City of Fresno N Brawley Ave& W 23- 28, 2017 96, 936. 00 Michael 621- / ( 559) ov/ casing in 10" boreholeusingdirectrotary Nieken Ave, Fresno CA Brown 21- 3165 Mike. Brown@fresno. gov Drill sample and install(1)4"SCH40PVCWellsto 140ft bgs, Mud Rotary. Soil samples collectedusingaBESSrSimulprobe• SheIILAR 2101EPCH, September6- 9, 14 714- 689- sampler at 5- foot Intervalsstartingat100ftto145ft AECOM Wilmington 15, 19- 21, 2016 $ 40, 302. 50 Joe Liles 7262 joe. liles@aecom. com bgs,( Sampler will collectgroundwaterandsoil samples from the samedepthsimultaneously) Install a 4" SCH 40PVCWellsto150ftwith10to15ft of screen PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM 1. Name of Entity ABC Liovin Drilling, Inc 2. Address of Entity (Principle Place of Business) 1180 East Burnett Street, Signal Hill CA 90755 3. Local or California Address (if different than#2) 4. State where Entity is Registered with Secretary of State CA If other than California, is the Entity also istered in California? Yes No 5. Type of Entity Corporation Limited Liability Company Partnership Trust Other(please specify) 6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify) Note: If any response is not a natural person, please identify all officers, directors, members, managers and otherliiduciadesforthe member,manager,trustorotherentity Ivan Liovin Officer Director Member Manager[name] al Partner Limited Partner Other Officer Director Member Manager[name] General Partner Limited Partner Other Officer Director Member Manager[name] General Partner Limited Partner Other CITY OF PALM SPRINGS—PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 1 of 2 7. Owners/investors with a 5% beneficial Interest in the Applicant Entity or a related entity GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING BIDDER'S GENERAL INFORMATION CITY PROJECT NO.19-20 BID FORMS-PAGE 15 JANUARY 2020 A. N/A name of owner/investor] name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP A, EXPLANATION OF THE RELATIONSHIP: B. name of owner/investor] name of official with whom ownerfinvestor has material financial relationship] FOR RELATIONSHIP B, EXPLANATION OF THE RELATIONSHIP: C. name of owner/investor] name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP C, EXPLANATION OF THE RELATIONSHIP: I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. Signs f Disclosing Party, Printed Name,Title Date Iva) L'tovie)) Pre,rde, ,--2/11/20 CITY OF PALM SPRINGS—PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 2 of 2 AGREEMENT GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING BIDDER'S GENERAL INFORMATION CITY PROJECT NO.19-20 BID FORMS-PAGE 16 JANUARY 2020 Data OfAdver iaemenc Jan 21,2020 ABC Liovin Drilling, Inc. An Equal Opportunity Employer is requesting quotations from all qualKied DBE,DVBE,MBE,WINE,SBE,USE,VSBE subcontractors and/or material suppliers for the following prajed: Palm Springs Monitoring Wells Located in Riverside County,CA Owner:City of Palm Springs GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO.19-N Bid Data:Feb 12,2020 at 03 00 PM We are requesting bids for the following trades and/or material suppliers: We ere seeking diverse participation:US Department Of Transportation Disadvantaged Business Enterprise(DBE),Small Disadvantaged Business(SDB)Women Owned Small Business(WOSB),Hubzone Small Business(HUBZSB)Veteran Owned Small Business(VOSS),Historically Black Collages and Universities and Minority Institutions(HSCU S MI)Other Small Business-Service- Disabled Veteran-Owned Small Business(SD-VOSB) Bid documents can be viewed at or obtained from: See documents on City of Palm Springs website: https://www.paimspdngsca.gov/gmernmenUdepariments/p rementoontmding/bids- proposals or mixed Ivan Liovin via email info@abrdrilling.o n We are seeking firms to provide equipment,supplies and other services.Firms in City of Palm Springs Local Business Preference program are encourage to apply which includes business owned by disabled veterans,disadvantaged,women-owned,and minority business enterprises.All sub must have an active DIR Public Works Contractor Registration cart.Upon request,ABC Liovin Drilling,Inc will provide assistance with bonds,lines of credit,or insurance to meet contract requirements.ABC Dove Drilling, Inc is an Equal Opportunity Employer and selection will be made without regartl to once, color,creed,or gender. ABC Llovin Drilling,Inc 1180 East Burnett Street Signal Hill,CA 90755 Phone:(M2)981-85T5 Fax:(562)981-9594 Email:van@abodrilling.corn Ivan Liovin Published Jan 21,2020 on ConsWclion Bid Source a Trade and Focus Predication located at hdpWwww.constructionbidsource.com Phone:1-888-186-9450 Fax 209.772.3573 This solicitation Ad will be archived 30 days after the bid date 0 1992-2020 Construction Bid Source I rosiness:(866)7BB-9450 The Desert Sun Publication Name: The Desert Sun Publication URL: www.thedesensun.com Publication City and State: Palm Springs,CA Publication County: Riverside Notice Popular Keyword Category: Notice Keywords: portable toilet Notice Authentication Number: 202002051125097173713 791220208 Notice URL: Back Notice Publish Date: Wednesday,February 05,2020 Notice Content We are seeking a portable toilet and security services for the City of Palm Springs-Groundwater Monitoring Well Construction Project which bids on Wednesday February 12th 2020 at 3:00 PST. We are seeking: US Department Of Transportation Disadvantaged Business Emeryrise (DBE) Small Disadvantaged Business (SDB) Women Owned Small Business(WOSB) Hubzone Small Business(HUBZSB) Veteran Owned Small Business(VOSB) Historically Black Colleges and Universities and Minority InsntaUohs(HBCU&MI) Other Small Business Service-Disabled Veteran-Owned Small Business SD-VOSB) Pub: 2/5/2020 @,agk Van Phan From: Gannett Legals Public Notices <GanLegPubNotices@gannett.com> Sent: Monday, February 3,2020 1:38 PM To: Van Phan Subject:RE: Desert Sun - Receipt Post Ad for Palm Springs Monitoring Wells Bids Possible 81.40 2-3-20.pdf Attachments ReceiptJPG Thank you for your payment. Please find your receipt attached and your proof below. The notice is scheduled for Feb 5"in the Desert Sun. We are seekinq a portable toilet and security services for the City of Palm Springs - Groundwater Monitoring Well Construction Project which bids on Wednesday February 12th 2020 at 3:00 PST. We are seeking: US Department Of Transportation Disadvantaged Business Enterprise (DBE) Small Disadvantaged Business(SDB) Women Owned Small Business (WOSB) Hubzone Small Business (HUBZSB) Veteran Owned Small Business(VOSB) Historically Black Colleges and Universities and Minority Institutions (HBCU & MI) Other Small Business Service-Disabled Veteran-Owned Small Business SD-VOSB) Pub: 2/5/2020 l Thor Public Notice Representative Desert Sun I LOCAM PART OF THE USA TODAY NETWORK Office: 760-322-2222 option 3 leoals(dthedesertsun.com desertsun.com From:Van Phan<van@abcdrilling.com> Sent:Thursday,January 30,2020 6:43 PM To:Gannett Legals Public Notices<GanLegPubNotices@gannett.com> Subject:4034277 Re:4031038 RE: Desert Sun-Post Ad Please proceed with ad and let me know how I can go about making payment. On Wed,Jan 29,2020 at 12:30 PM Gannett Legals Public Notices<GanLeePubNotices@gannett.com>wrote: The total cost would be$81.40. t Van Phan From: Van Phan <van@abcdrilling.com> Sent: Tuesday,January 21,2020 2:13 PM To: dmendoza@fresnombdacenter.com' Subject:City of Palm Springs -Groundwater Monitoring Well Construction Project David, We are seeking a portable toilet and security services for the City of Palm Springs-Groundwater Monitoring Well Construction Project which bids on Wednesday February 12"2020 at 3:00 PST. We are seeking: US Department Of Transportation Disadvantaged Business Enterprise(DBE) Small Disadvantaged Business(SDB) Women Owned Small Business(WOSB) Hubzone Small Business(HUBZSB) Veteran Owned Small Business(VOSS) Historically Black Colleges and Universities and Minority Institutions(HBCU&MI) Other Small Business Service-Disabled Veteran-Owned Small Business SD-VOSB) Please let us know if you can help us. Thank you, SA Van Phan I Office Manager LIOVIN ABC Liovin Drilling, Inc. 1Y7 ° II 1180 East Burnett Streetc Signal Hill, CA 90755 c,e•,_,.,,; van0abcdri11ina.com 3 wwwAbodrill 5Office fu 562-981-8575 Office 562-981-9594 Fax 562-714-9198 Cell C-57 CA Contractors License # 422904 1982-2018 C-23 NV Contractors License # 0081445 Stay connected with us on LankedIB! 1 0 COPY Bid Bond 11-516-110 BID BOND KNOW ALL MEN BY THESE PRESENTS, That ABC Liovin Drilling. Inc. as Principal, and American Contractors Indemnity Company as Surety, are held and firmly bound unto the City of Palm Springs, California, hereinafter called the"City'in the sum of: ten percent of the amount bid in dollars 10%) not less than 10 percent of the total amount of the bid) for the payment of which sum, well and truly to be made,we bind ourselves, our heirs, executors, administrators, successors, and assigns,jointly and severally,firmly by these presents. WHEREAS,said Principal has submitted a Bid to said City to perform the Work required under the Bid Schedule(s) of the City's Contract Documents entitled: GROUNDWATER MONITORING WELL CONSTRUCTION AND DECOMMISSIONING CITY PROJECT NO. 19.20 NOW THEREFORE, if said Principal is awarded a Contract by said City, and within the time and in the manner required in the"Notice Inviting Bids"and the"Instructions to Bidders"enters into a written Agreement on the Form of Agreement included with said Contract Documents, furnishes the required Certificates of Insurance, and furnishes the required Performance Bond and Payment Bond,then this obligation shall be null and void, otherwise it shall remain in full force and effect. In the event suit is brought upon this Bond by said City, and City prevails, said Surety shall pay all costs incurred by said City in such suit, including a reasonable attorney's fee to be fixed by the court. SIGNED AND SEALED,this 11 2th day of February P020 ABC Liovin Drilling, Inc. U.S. Specialty Insurance Company EXECUTED FV--- OCHE PRINCIPAL: EXECUTED FOR THE SURETY: BY By Ll Signature Signature NOTARIZED) NOTARIZED) Print Name and Title: Print Name and Title: Wcty11+Ov1n , 9"a4d nt Blake A Pfister Attorney-in-fact By Signature NOTARIZED) Print Name and Title: GROUNDWATER MONITORING WELL AND CONSTRUCTION AND DECOMMISSIONING BID BOND(BID SECURITY FORM) CITY PROJECT NO.19-20 BID FORMS-PAGE 12 JANUARY 2020 COPY CALIFORNIA ALLPURiOSE ACKNOWLEDONiNT CML CODE$11N A notary P'Nc Or Other officer corripe"thus certificate verifies only the Idartity of the urdividual who signed the doanrent to which this oft icate is aftadW,and not the 6u##u Tess,accuracy,a vafift of that dopnrrsnt. State of CadNomla Cotaayof Orange On February 41 2020 b9fperip, Lianne Nahina, Notary Public QM# Mere Insert Name and Tltle of the Officer PINaoINIVY aPPeW Blake A. Pfister Nama(s)of Slgner(s) who Proved to me on the basis of satisfactory evidence to be the person(4) whose names) is/AW subscribed to the within instrument and acknowledged to me that he/a 10W executed the same in aulfadzed capacityW,and that by WIN~sgiatr rero)on the instrument the persorio, or the entity upon beW of which the person(!)acted,executed the inetrumeM. I certify under PENALTY OF PERJURY under the laws of the State of California Hurt the foregoing paragraph is true and correct. WITNESS my—hand and official{seeaJ. Signatu c. 1 LIANNE NAHINA Signature ofN y Public COMM. #2314283 M s "_, NOTARY PLO LIOCALIPORMAX K= ORANGECOUNtt MY COMM.EXP.DEC I,2023N Place Notary Seal Above OPTIONAL Though this section Is optional, completing this Information can deter a/taatfon of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Bid Bond 11 -516-110 February 14, 2020TitreorTypeofDocumentDocumentDate; Number of Pages: 1 Signer(s) Other Than Named Above: N/A, None Cepachy(es)Claimed by Sig wa(s) Signers Name: Blake A. Pfister Signer's Name: O Corporate Officer - TNles): Corporate Officer - TMe(s): O Partner - O Limited General O Partner - O Limited General 9 Individusi Attorney in Fact 0 Individual O Atiomey in Fact O Trustee O Guardian or Conservator O Trustee O Guardian or Conservator Other: Other. Si{2nere American Signer Is Representing:Contractors a bBlpany- 02014 Natiorai Notary Association•wwwMatlortallotary.tdg•1-wo-US NOTARY(1-soo-s7&Ss27) item#5g07 TOKIOMARINE COPY HCC POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company,a California corporation,Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company,a Maryland corporation and U.S. Specialty Insurance Company,a Texas corporation(collectively,the*Companies"), do by these presents make,constitute and appoint: Blake A. Pfister of Mission Viejo, California its true and lawful Attomey(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby confened in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other Instruments or contracts of suretyship to Include riders, amendments, and consents of surety, providing the bond penalty does not exceed Five Million••"' Dollars 55,000,000.00"' ).This Power of Attorney shall expire without further action on April 23ni,2022.This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: Be it.Resehed,that the President,any NAce-president any Assistant Vise-President,any Secretary or any.Assistant Secrefar,shall-be and is hereby vested with full power and authority to appoint any one or more suitable persons as Abomey(s)-in-Fact to represent and,ad for and on behalf of the Company subject to the following provisions: Attomey-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, recognaances,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 Aftorney-in-Fact shall be binding upon the Company as ff 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 certBcete relating thereto by facsimile,and any power of attorney or certficete bearing facsimile signature or facsimile seal shall be valid and binding upon the Company wtth respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 1-day of June, 2018. AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED 3/7a,Tfg SURE7Y.G000,vPANY U.$r C1A IDI$URANCE COMPANYewes,-a Slate of California A e 5 c County of Los Angeles By: Aguilar,Vim President 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 validityof that document On this 1st day of June,2018,before me,Sonia O.Camso,a notary public,personally appeared Daniel P.Aguilar,Vice President of American Contractors Indemnity Company,Texas Bonding Company, United States Surety Company and 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 PENALTY OF PERJURY under the laws of the State of Calitomia that the foregoing paragraph is true and correct. WITNESS my hand and official seal. awo.wun Signature f" (seal)w y""xrawn1 I, Kio Lo, Assistant Secretary American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect;furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. In f4tnsss Whereof_ebivareunto set my tlarfd and affixed the seals of said Companies at Los Angeles, California this1144ttdayofyLOLU Corporate Seals Bond No. 11 —51 6-11 0 ` i- \$ ram7 1;` s WAgencyNo. 3074 a' J v"...Kio Lo, Assilloult Secretary AGUMANFOAOS7019 visit tmhcc.comisurety for more information COP CALIFORNIA 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 LoSRraelaS On Fabrvo.y M,202o before me, Lxb'cr µacuwot, ttol ' VU,Kasen avrea , o wa r—' personally appeared bray\ Liao n who proved to me on the basis of satisfactory evidence to be the person(lir}whose name*) is/Me subscribed to the within instrument and acknowledged to me that he/sbe/ttyey executed the same in his/her/tpxir authorized capacity(ilt6), and that by his/t*r/HWir signature(* on the instrument the person(, or the entity upon behalf of which the persons) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. M LIBIER MAC WITNESS my hand and official seal. t Commutation No. 22817118 F.i xo..wyPuxrcca\traana 1a841GElEB CWNty ' a u_y MI Lamm.E awwiaCN ta.aala Nilluary Public Signature Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Thisforncomplies with c enr Calfrnionmarer rrgardin8 rorary hoarding and DESCRIPTION OF THE ATTACHED DOCUMENT Iaeeded,ahculd be con lvedandarmchedm ohe doaamene Actorowledgmems from orhersmrer maybe comple ctifordocmnents bcm,,om in du e.some so long Fi\O 1tAa0\-S\b %to or(he woeding does not require the California notary m cuthine California rotary TAe ar desagAmdattaded dowmmt) State and County information mum he the State and County where the document LSQows+v avCE¢ How CWRtwsG si or(s)pemomi appeared before the notary public for acknowledgment. iNe or desedphon of attached dommenl mnanued) Oate of ostentation must be the date that the signers)personally appwred which must also be the same time the acknowledgment is completed. Number of P 4 o • The notary public must print his or be name as a appears within bit or her Pages Document Da/e i commismmfollow byacammamdthenyour title(notary public). Print the morels) of document signers) who Normally appear m the time of nomiem., CAPACITY CLAIMED BY THE SIGNER Indicate the comesit singular on plural forms by crossing off iocorrwt farms ire. NelsheRMn;-a/arc)or circling the cmrtt1 forms.Failure to conectly indicate NisIIndividual(s)inr ationmay lead to Menionofdocumentrecmding. Corporate Officer no notary seal impression most be clear and phoon mr bically reproducible. Impression must not cover text ar lines.If owl impression smudges,re-seal if a Tlfle) sutficiem area pennim,otherwise complete a different ecknuwledgmnent form Partner(s) Signature of me notary public mum match the sigmenue on file with the office of the county clerk. El a Mdu m ul information is not requaml but could help to ensure this Trustee(s) acknowledgment is nor misused or attached to a different document. Other O Indicate title or type ofamched document number of Eagw and date. J Indicate the capacity claimed by the signer. If the claimed capacity is a corpomte officer,indicate the title(i.e.CEO,CFO,Secretary). 2015 Version www.NotaryClassesmmfl00-870-8856 Securely attach this document to the signed document with a maple. AcoRH CERTIFICATE OF LIABILITY INSURANCE M°° ' III zoz0 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(les)must have ADDITIONAL INSURED provisions or W endorsed. If SUBROGATION IS WAIVED,subject to the temw and conditions of tee Policy,certain policies may require an endorsement A statement on this car locate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTAcr Risk Stratagides Company NAME. Risk Stral idea Coma. 2040 Main Street, Suite 450 PXONE 939-zaz-923o FAXryd xn:Irvine, CA 92614 EMAILIinchures s un risk-stret ies.com ww 9 AFF(IR9alq OplIERAOE NAGS wesfrisk-strategies.com CA 001 License No.OF06675 INSURERA: Start Surplus Lines Insurance Company1 INWMD IawRm a: Stan Indemnity&1-tabifirty Company36318 ABC Liovin Drilling Inc. 1180 East Burnet Street 1HXURa'C' Signal Hill CA 90755 INwR U: INSURER E: IxsuRER F: COVERAGES CERTIFICATE NUMBER 5 HUESS30 REVISION NUMBER: 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 NTH 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. INW TYPE OF INSUMXCE AM SUM Ims armpglCywY9EA POUIEFF POUCYEF MYn$ A / COMMERLIALOENESULl1VaRY 1MON7029191 7IM019 '7/112020 FACHOCCURRENCE a10000co CWMSKIDE OOCCUR Pp MI 50000 MFD EXP I 35000 PERSONµ4AWINx1RV 31OD( OOD GEN'L AGGREGATE JUST APPIJES PER'.GNIERALAGGIREGATE s2.000ODD g PCLICV O,IECT PRODUCTS w COMP"AGS $2000000 OTHER: s B AMToaoeaELUMu1r SISIPCA06299719 7/1)2019 T/12020 ITSe kw0tl SINGLE UNIT $ 1000000 ANYAUTO EMAY INJURY(Per pnrn 3 GAINEDAUlONLY WTC6 LED ECaLY INJURY IPe-ausam $ ARUTCe ONLY J AUTOGI ONLY PROPERrvOPMA(£3 s A uYalmuwlue I Dccuir 1=337351191 7112019 71120M EACHOCCURREHCE $10000000 IX aWe CLAMS. AGGREGATE a1D000,MD CEO I V I RETENTI 0 3 B w KERMCDMMUnON 10000286402 7/12o1g 7y1202o PTR H- ANDEMPL°vERSuAE TY YIN CAd NV ANYPROPRIETOWPARTNERIE%ECU9VE EL FACNACGCENT 31000000 OFFICER,MEMBEREXCWOEO± xIA Wanakry In aH) EL.paEASE-EA EMPLOYED s 1" UMRe and DESCnMIONOFWERhTIONSCetx E.L.DSEASE-POLICY LIMIT 1 a1000O00 A Contractors Pollution Liability 1000067029191 7/12019 7/12020 $1,000,000 Oa/31,000,000 Agg A Professional Liability 1000067029191 7/1/2019 T/12020 $1,000,000 Claim 1$1,000,1100 All DESCRIPTIONOPOPPRAIICNSILOCATIONsr .ICIEs wcatDIOI,AcSA0ha X—r,f SdvOUM.m yteamcMEHmon Fpe-larisawn Re:Project 19-20-Groundwater Monitoring Well Contraction and Decommissioning. The City of Palm Spl:n9s,its Officials,employees and agents are named as additional insureds and primarylnon-contd Wtory cause applies to the general liability policy and a waiver of subrogation in favor Of the CIty of Palm Springs,iN elected officials,officers, employees,agents and wlunteers applies to the work comp policy.3"W notice r non-renewal S cencellation,10-dW notice kr non-payment applies.Excess liability follows form to the geneml,auto,employeh liability,cpVpl policies. CERTIFICATE HOLDER CANCELLATION C of rin S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Palm s p g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ARn:Vonda Teecl, Engineering Services Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E.Tahquitz Can on Way Palm Springs CA 92262 AUTHORMEDREDRESENTA The b Cam` Mike Christian IS 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 59186430 1 1940 OL-AL-XL-WC-CPL-PL I eNery Young 1 ]16/ID20 8.36:38 IN IPSTI I Page 1 of ABC Liovin Drilling, Inc. POLICY NUMBER: 1000067029191 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATE: 7/1/2019 CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 a Of Covered Operations where required by wntren conbad. Where required by wnben contract. Information required to complete this Schedule if not shown above will be shaven in the Declarations. A. Section II — Who Is An Insured is amended to This insurance does not apply to "bodily injury" or include as an additional insured the person(s) or property damage"occurring after: organization(s) shown in the Schedule, but only 1. All work, including materials, parts orwithrespecttoliabilityfor"bodily injury", "property equipment furnished in connection with such damage" or "personal and advertising injury.. work, on the project (other than service,caused, in whole or in part,by: maintenance or repairs) to be performed by or 1. Your acts or omissions; or on behalf of the additional insured(s) at the 2. The acts or omissions of those acting on your location of the covered operations has been behalf; completed;or in the performance of your ongoing operations for 2. That portion of 'your work" out of which the the additional insured(s) at the location(s) injury or damage arises has been put to its designated above. intended use by any person or organization However: other than another contractor or subcontractor engaged in performing operations for a 1. The insurance afforded to such additional principal as a part of the same project. 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 insurance afforded to these additional insureds, the following additional exclusions apply: CG 20 10 0413 Insurance Services Once, Inc.,2012 Page 1 of 2 541B6OD J9-21 GL-AL-et-NCCP4PL I " -, x0-, >/6/SOSD B66::B AN IPTTI I Page 1 01 1 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement;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 O Insurance Services Office, Inc.,2012 CG 2010 0413 saaeeaa i is-.o co-a-co-xo-rev-Pv i m.«v .a s i vzixoxo e.ze..e iesn i ee o , ABC Liovin Drilling, Inc. POLICY NUMBER: 1000067029191 COMMERCIAL GENERAL LIABILITY 7/1/2019 CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Aa requnetl by in.mnnad. M required by wdnen conmia 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 persons) 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. CG 20 37 0413 Insurance Services Office, Inc.,2012 Page 1 of 2 51<66ao 1 19-20 G -xL-E—C-Cep-et I SO—y 11119 I 3/6/20Zo 6.26.:9 N 1PSTI I P,9. 4 u[ 7 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement,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 less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ISO Properties, Inc.,2012 CG 20 37 04 13 f44PS41C 1 19 20 GL-ALELWc-CPI-Pa I Shelly vnunq 1 3/6/2020 e1e3e M win I P490 5 ,f 7 Starr Surplus Lines Insurance Company Chicago, IL 1-646-227-6300 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number:INOW7029191 Effective Date:o7rotnm9 Named lnsured:ABC uo in Drilling.Inc. This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies)Carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage form Products/Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE All as required by written,signed or executed Contract. A. SECTION II-WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of"your work"for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage"arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this Coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of"your work"done under a written Contract with the additional insured. 3. The tens insured is used separately and not Collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual Copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STA,R,RRSSURPLUS LINES INSURANCE COMPANY YC,'2.t:la i,,. zE gyKws Charles H.Dangslo,-President Nehemiah E.Ginsburg,Generall',f;ounsel SL-023(06/11) Page 1 of 1 Copyright®C.V.Starr S Company and Start Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of ISO Propertles,Inc.,used with its permission. 5<6966]0 19-30 OL-A:.4e-K-cetre6 1 .1-1 oune 1 1"..0 066:30 AM IPSiI 1 I.e. 6 .[ : WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 04-64) 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.oa of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contract Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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:07iol act 9 Policy No.10000266402 Endorsement No.: Insured Premium: ABC liovin Dulling,Inc.I /j .,f=•` Insurance Company: Countersigned by: // ( may Starr Indemnity 4 Liability Company WC 04 03 06 Ed. 04-84) Page 1 of 1 sueeazo I s-zo I s1.1- ,0,.., i CITY OF PALM SPRINGS, CALIFORNIA PROCUREMENT CONTRACTING DIVISION UU U BID ABSTRACT BID# Bidder: Bidder: Bidder: Bidder: Bidder: Bidder: 11011 NAME: _( 96 ye flow DUE DATE: DQ-; It'" L CD- Description: 39v OOU y T 1 o all Bid Schedule Items: $ Witnessed by Date: a! Z 20 Le Dome A CONTRACTORS STATE LICENSE BOARD OContractor's License Detail for License #422904 DISCL&IMER:ADmineahtuscheak pruyidea information takenham the fSLg Daanw Oa6WSe.gebm wising on this informHian,you ahcow M swam el ike bib Want pmiW iana. nNgexlwpnux XMumtibl:mEjanmpuaYvunpxln:eu0wmvummammpuimeimlvunxai opw• fines.coos en ue M1nt er fiwen u ame mmpmm ampr Iwl xam nbmwlon. v w.awaovr3r.onx.+nprvnien MpNnrpl'M^a^uusegemxeslnvenN.m.ee. v emuvnvmvarwtuaeeonlm:M1emmamrM1Nwmmp%xiNAawmaNWannntlu. Data current as of 2/13120201:28:0e PM Basnesa lNb: M, eCUW NDRIwxGDIC IIWEnGRNETTSTREET SIGN.LLXILL.Gmiss Business PMne Huminas@i963ds15 FMILy COPoIr. 11YuapaYn3oRehwa0e4DaRnO upm DM. wuanwX License StRUS T11e11nnee Ia...... ulinrom,.u.nn.I.,ranauMs....ia..a. Ia6irifahar, C9-WELLDRILLING enntlm9lnlGmlaYGn M1bna Tniali14—fi : M41632 o:YOaMxM WESTERN SVPEIYCOMMNY.aaM.aa .. 6ma1633ReM6maunl:$15.IX0 E.rl.ua a.,,301nn16ConlnRalzeontlN151ory Mnah...nsynpe nt auMTheauauMnelMNNualvMslulLpNxmrtifiNtnatnehneuanal. pemntwmorcuttnew:inS MrcpJmemae:anlpinMrtnullNvma .p paaM MQmllifnemeirieu,I isnMrepmrctl.E3r.Wh.D.n:Wn:naaD Mr,a,Compen6"aG TM1IZIi¢nxbsmo mwmwnu:kninauranru Mtn LM1e STMRINDEMNIW&LIAMUL MMMW PouryX,anNn30PoM06101 Elraat..., rtava6plwDab:O]tDIna30 WaMes Campenvllon Mismry Macelim:eous lnfiarma4r, I NnocOaa-UCENSEREISsUEDToallomERENon Back to Top Conditions of Lse Privacy Policy accessibility Acassibibty Certification Copyright 02020 State of Califomia A 05-01 BABCLAB-01 SGONZALEZ ACORo' CERTIFICATE OF LIABILITY INSURANCE DATE 0 1110/2012023 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsements . PRODUCER License # 0757776 cNRIJDT Tonia Miller HUB International Insurance Services Inc. PO Box 5345 Riverside, CA 92517 PHONE FAX uc, Na, Ext): (951) 779$598 AIC, No : 951 231-2572 Wp&ss. cal.cpu@hubintemational.com INSURER(SI AFFORDING COVERAGE NAICt INSURER A: Valley Forge Insurance Company 20508 INSURED INSURERS: Transportation Insurance Company 20494 Bab cock Laboratories, Inc. Edward S. Babcock & Sons, Inc. INSURMC:TechnolotiV Insurance Company 42376 P.O. Box 432 INSURER D : INSURER E : Riverside, CA 92502 INSURER F: COVERAGES CERTIFICATE NUMBER' REVISION NUMBER - 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. INSR TYPE OF INSURANCEADDL SUM POLICYNUMBER POLICY EFF POLICY EXPLTIR UNfB A X COMMERCIALGENERALLIABILITY CLAIMS -MADE ❑X OCCUR X 6071825747 5/28/2022 5/2812023 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES Ma occumemal MED EXP (Any on 100,000 15,000 PERSONAL &ADV INJURY 1,000,000 GEN7. AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECT LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOPAGO S 2,000,000 B AUTOMOBILELUJIMLITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS wNEp AUTOS ONLY Ix AUTOS ONLY X 6071825750 5/2812022 5128/2023 COMBINED SINGLE LIMB III S 1,000,000 X BODILY INJURY (Perpersodl S BODILY INJURY acdderd X PR�gdm AMAGE PP UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS4AAOE EACH OCCURRENCE AGGREGATE S DELI I I RETENTION E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTME YIN %FFFICER/M�MBEREXCLUDEDP IN ""`ntl81o�' ^ I Hyee, describe under DESCRIPTION OF OPERATIONS below NIA X 204470 1/2/2023 1/212024 X I PER OTH- E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEES 1,000,000 E.L. DISEASE - POLICY UNIT 1,000,00 g 11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) The City of Palm Springs is Additional Insured with regard to General Liability when required by written contract per the attached endorsement form CNA75079XX 10116, Primary & Non -Contributory included. Additional Insured with regard to Auto Liability when required by written contract per the attached endorsement form CNA71527XX 10/12, Primary wording included. Waiver of Subrogation applies with regard to the Workers' Compensation when required by written contract, per attached endorsement WC040306 04184. CERTIFICATE HOLDER CANCELLATION RECEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs JAN 17 2023 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 Palm Springs, CA 92263 City Hall AUTHORIZED REPRESENTATIVE Receotion Desk ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CHA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: 1. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. It. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage Page 1 of 2 The Continental Insurance Co. Insured Name: BABCOCK LABORATORIES, INC. dorsement No: a Effective Date: 05/28/2022 Copyright CNA All Rights Reserved. Includes copyrighted tnatedal of Insurance services Office, Inc., With its permission. 7 Primary and Noncontributory Insurance CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the tern of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10-16) Policy No: 6071825747 Page 2 of 2 Endorsement No: a The Continental Insurance Co. Effective Date: 05/28/2022 Insured Name: BABCOCK LABORATORIES, INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA Business Auto Policy s'olicy Endorsement It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section 11 - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71527XX 110-20121 Policy No: BUA 6071825750 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 05/28/2022 Endorsement No: 16; Page: 1 of 1 Policy Page: 66 of 109 Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 c Copyright CNA All Rights Reserved. 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 1/2/2023 Policy No. TWC4204470 Endorsement No. 0 Insured Babcock Laboratories, Inc. Premium $ 47,350 Insurance Company Technology Insurance Company, Inc. Countersigned by WC 04 03 06 (Ed. 04-84)