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A8560 - TRUELINE CONSTRUCTION & SURFACING
A~RD 9 CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/00/YYYY) 7/16/2025 ~ THIS CERTIACATE 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 B Y 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the t erms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate h older In lieu of such endorsement(•). PROOUCER ~f"'' Nancy Baraja s Foundation Risk Partners dba Millennium R isk Mgmt & Ins Services 11J~!, "vtl• 818-844-4 107 J r~ Nol• 818-638-7907 301 E Colorado Blvd S te 205 Pasadena CA 91101 RECEIVED ~~~ss: nanc~mcsins.com IHSURERISl AFFORDING COVERAGE NAICf , .,_,,.,.#'. nu 93?9!l INSURER A : Mt. Hawley Insurance Comoany 37974 INSURED JUL z 1 LUZ~ TRUECON-01 INSURER B : Ohio Security Insurance Company 24082 Trueline Construction & Surfacing, Inc. INSURER c : Everest Premier Insurance Company 16045 P .O . Box 70269 Riverside CA 92513 OFFICE OF THE CITY CLER~ INSURER D : American Fire and Casualty Company 24066 INSURERE : INSURERF : COVERAGES CERTIFICATE NUMBER: 1969913576 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 BE EN REDUCED BY PAID CLAIMS. i:i:: TYPE OF INSURANCE !~!'~ 1= .,:'?JJ~ POLICY EXP LIMITS POLICY NUMBER IMM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY y MGL0201449 7'25/2025 7'25/2026 EACH OCCURRENCE S 1 000,000 ,__ □ CLAI Ms-MAOE 0 OCCUR ~es't.:-.;~ .. ,= $50,000 X S5K de<l-81/PDIPI MED EXP JAn~ one person) $5,000 >--PERSONAL & N:IV INJURY S 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2000,000 R POLICY 0 ~ □ LOC PROOUCTS -COMP/OP l>GG $2000,000 OTHER: E-Beneffts S 1,000,000 D AUTOMOBIL E LIABILrrY -y BAA (26) 56 94 56 05 7/25/2025 7'25/2026 n,C;~~l lNult LIMI 1 S 1,000,000 X ANY ALrTO BOOIL Y INJURY (Pe< person) s -OWNED -SCHEDULED BOOIL Y INJURY (Pw acadent) $ ._ ALrTOSONLY ,__ AUTOS PROPERlY DAMAGE X HIRED X NON-OWNED s ALrTOSONLY ALrTOS ONLY IPer aooidenll ._ I- X COMP-$1K X COLL-$1K s A X UMBRELLA LIAB IH OCCUR MXL0443073 7'25/2025 7'25/2026 EACH OCCURRENCE '4,000,000 EXCESSUAB CUJMs-MADE AGGREGATE $4,000,000 DED I X I RETENTION$ ~n $ C WOIIKERS COMPENIATIOH 7600016618251 7'25/2025 7'25/2026 X I STATUTE I I '€.RH· AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNERIE.XECUTIVE □ E.L EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N /A (Mand-.ylf,NH) E.L DISEASE • EA EMPLOYEE S 1,000,000 ~m~ ~OPERATIONS-E.L DISEASE · POLICY LIMIT S 1000000 B But!MH Personal Propeny BKS (26) 56 94 56 05 7'25/2025 7'25/2026 Limit Deductible 89,907 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Retnartl• Sc:IMGlle, may be lltlacMd 11,-. •-la rtqul,wd) Subject to all policy terms, exclusions and conditions. . Re : Project 20-11 -Picldeball Court & Tennis Court Resurfacing Resurfacing The City of Palm Springs, its officials, employees and agents and agents and all other entities where re~uired by written contract are named as add itional insured with primary and non-contributorx wording as respects Genera l Liability per forms CG20100413 , C 2037041 3, CG200 1041 3. Additional insured applies per Auto Liability per form AC854 30 18 attached . Waiver of Subrogation applies to GL, Auto & WC per the attached . 30 day notice of cancell ation with 10 days for non-pay. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Palm Springs Attn: Vonda Teed 3200 E Tahquitz Canyon Way AUTHORIZED REPRESENTATIVE Palm Springs CA 92262 W11.vt5~ I C 1988-2015ACORD CORPORATION . All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGEN CY CUSTOMER ID: __________________ _ LOC #: ________ _ ADDITIONAL REMARKS SCHEDULE AGENCY NAMED IISURED Minennium Risk Management & Insurance Services TRU EI.INE CONSTRUCTION I SURFACING POLICY NU MBER CARRIER I NAIC COOE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TI TLE: Certificate of Liability Insurance : Notes Rented/Leased Equipment Carrier: Ohio Security Ins Company I Policy#: BKS56945605 I Term: 0712512025 1D 07125120261 Limij: $25,000 with $1,000 deductible Pollution Liability: Carrier: Hanover Specialty Ins Brokers, Inc. I Policy Term : 712512025 -712512026 / Pol#: RO-SPEC207-03 / Limit: $2 ,000,000 Per Occurrence I $2,000,000 Aggregate wl $5 ,000 deductible Page o f ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reaerved. The ACORD name and logo are registered marks of ACO RD Recording Requested By: City of Palm Springs When Recorded Mail To: Name Anthony J. Mejia, City Clerk Street Address 3200 E. Tahquitz Canyon Way Sta a Palm Springs, CA 92262 NOTICE IS HEREBY GIVEN THAT: 2021 0007819 01/06/2021 04:08 PM Fee: $ 0.00 Page 1 of 2 l Recorded in Official Records County of Riverside Peter Aldana Assessor-County Clerk-Recorder 111IF : YI�S411 SPACE ABOVE THIS LINE FOR RECORDERS USE NOTICE OF COMPLETION (CA Civil Code ys' § 8180-8190, 8100-8118, 9200-9208) 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: Trueline Construction & Surfacing, Inc., 12897 Doherty Street, Riverside, CA 92508 4. This notice is given for (check one): 0 Completion of the work of improvement as a whole. ❑ 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 21st 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 20-11, Pickleball and Tennis Court Resurfacing 8. The real property herein referred to is situated in the City of Palm Springs County of State of California, and is described as follows: Ruth Hardy Park, DeMuth Park 9. The street address of said property is: 700 Tamarisk Road, Palm Springs, CA 92262, 4200 E Mesquite Avenue, Palm Springs, CA 92264 Riverside 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: l .3 Zo 2 v 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 14 -1 3 , Z02-o (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. TERRI HINTZ NotaryPublic- California Z Riverside County > Commission # 2202861 My Comm. Expires Jun 26, 2021 STATE OF CALIF RNIA COUNTY OF /�/��'�/�� - — (date), before me, Notary Public (name and title of officer) personally appeared Dl 7 UU 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. Page 2 of 2 Signature AGREEMENT (CONSTRUCTION CONTRACT) THIS AGREEMENT made this day of , 20z,'by and between the City of Palm Springs, a charter city, organized and isting in the County of Riverside, under and by virtue of the laws of the State of Californisrfiereinafter designated as the City, and Trueline Construction & Surfacing, 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: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 The Work comprises the resurfacing of eight pickleball courts located on the westerly two tennis courts at Demuth Park, and resurfacing of eight tennis courts at Ruth Hardy Park, consisting of: preparation of existing surfaces (patching, grinding, sand finish); surfacing playing areas with new acrylic systems, re -striping court areas, and all appurtenant work. 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. PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 AGREEMENT FORM AGREEMENT AND BONDS - PAGE 1 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 written notice, pursuant to Section 6-8 of the Special Provisions. Where termination is due to the fault of Contractor and 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 duly 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 Sixty -Five Thousand Six Hundred Dollars and Zero Cents ($65,600.00). Contractor agrees to receive and accept the prices set forth herein, as full compensation for furnishing all materials, performing all work, and fulfilling 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 California 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 issued during bidding (if any), 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. PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 AGREEMENT FORM AGREEMENT AND BONDS - PAGE 2 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. 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 specified 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, et seq., and 1770, et 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, PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 AGREEMENT FORM AGREEMENT AND BONDS - PAGE 3 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 -- 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 10 -- 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. �7Tf ►rl`T_'Y/17�►��1►`L�/�:frJL�l PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 AGREEMENTFORM AGREEMENT AND BONDS - PAGE 4 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, CALIFORNIA By, David H. Read City Mana r Z W ATTES W iA = By Anthony J. Mejia, MMC City Clerk APPROVED AS TO FORM: By Jeffry 6. Bal ' ger, City Attorney RECOMMEN Marcus L. Fuller, P.E., P.L.S. Assistant City Manager/City Engineer PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 APPROVED BY THE CITY COUNCIL: Date �-2S lG Agreement No. �O PROVED BY COUNCIL .Z>15--ZD AGREEMENTFORM AGREEMENT AND BONDS - PAGE 5 CONTRACTOR By: Trueline Construction & Surfacing, Inc., a California corporation Firm/Company Name By: Signature (notarized) Name: a Y1 r V 4.f, Title: �gnature (noized}f�/G�' Name: 0 ek Title: t Et�' 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 space by one having authority to bind the by one having authority to bind the Contractor to the Contractor to the terms of the Agreement.) terms of the Agreement.) State of ) County of )ss X before me, personally appeared who proved ",� me basis of satisfactory State of County of tir-r-. t do )ss On Acv usf" 5 �Z� before me, A'r (J;.� ld < < personally appeared who proved to me on the basis of satisfactory evidenc to a the per (s) whose name(s) is/are evidence to be the rs (s) whosealZiT (s)®/are Fbywithin instrument and subscribed to the within instrument and at he/she/they executed the acknowledged to me that he�i Ithey executed the uthorized capacity(ies), and same in hi�/their authorized a ac (ies), and natures(s) on the instrument that by his/their(s) on the instrument the person(s), or the entity upon behalf of which the th ers s), or the entity upon behalf of which the person(s) acted, executed the instrument. rs s) acted, executed the 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. WITNESS my hand and official seal Notary Signature: Notary Seal: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 paragraph is true and correct. WITNESS my hand nd official seal. Notary Signature:--'�-�1"� Notary Seal: 0*y 7 ""��•••••....... RMA MARTINEZ gCommission No. 2225012 NOTARY PUBLIC-CALIFORNIA RIVERSIDE COUNTY Comm. Ey1us6 DECEMBER 11, 2021 AGREEMENT F AGREEMENT AND BONDS — PAGE 6 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ' ,. I �/ ,, 1 County of `[,[i ,yx_rc c—o`er" J} Ok 2 L '2-b� before me,Gla'l- Date Here Insert Name and Title of the Officer personally appeared V-1r V' Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. "(,:z (!,D YY-L' ry-L ASS c I V� JANET AILEEN BANGS COMM. #2144650 z z Notary Public • Catifomis x Los Angeles County My Comm. Tres Mar. i, 2021i Place Notary Seal and/or Stamp Above 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. Signature OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: Premium Subject To Adjustment Based on Final Contract Price PERFORMANCE BOND — PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, Bond No. 100503898 Premium: $1,312.00 WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 (hereinafter referred to as the "Public Work"); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract'), which Contract is incorporated herein by this reference; and WHEREAS, the Contractor is required by said Contract to perform the terms thereof, and to provide a bond both for the performance and guaranty thereof. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: American Contractors Indemnity Company a corporation organized and existing under the laws of the State of California and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City in the sum of Sixty -Five Thousand Six Hundred and 00/100 Dollars ($ s5,s00.00 ), 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, firmly 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 indemnify 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. PICKLEBALL & TENNIS COURT RESURFACING PERFORMANCE BOND CITY PROJECT NO. 20-11 AGREEMENT AND BONDS - PAGE 8 FEBRUARY2020 PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) Contractor and Surety agree that if 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 1st day of CONTRACTOR: Check one: individual, _ partnership, ✓ corporation 2020. (This Performance Bond 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: Trueline Construction & Surfacing, Inc. By: "`\ (NOTARIZED) Print Name and Title: By: ,►-, 0-- signature (NOTARIZED) SURE : Ameri Co a ors Indemnity Company By _ signature (NOTARIZED) Print Name and Title: Paul S. Dito, Attorney -in -Fact Print Name a Title: �J,/6/lG�DA By submitting this Performance Bond, the Contractor and Surety acknowledge the provisions of the Contract Documents with regard to Section 6-4 "Default by the Contractor", as further amended by the Special Provisions. 0--'My M. CAN,ERO Notar Public - California Los Angeles CountyCommission N 2262411 Comm. Expires Oct 12, 2022 PICKLEBALL & TENNIS COURT RESURFACING PERFORMANCE BOND CITY PROJECT NO.20-11 AGREEMENT AND BONDS - PAGE 9 FEBRUARY 2020 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 ANGELES On /—/6— Zc/ before me, M. CAMERO NOTARY PUBLIC ` 'n (insert name and title of the officer) personally appeared �' t�� � N Y NN �- 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 PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature M. CAMERO Notary Public - California �ra {%0. Los Angeles County �- Commission p 2262411 My Comm. Expires Oct 12, 2022 (Seal) PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ 20.00 per thousand. The total amount of premium charged: $1,312.00 (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 Department's 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) (Name and Address of Agent or Representative for service of process in California if different from above) (Telephone Number of Surety and Agent or Representative for service of process in California) PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 American Contractors Indemnity Company 625 The City Drive S., Suite 205 Orange, CA 92868 Same as Above 714-740-7000 PERFORMANCE BOND AGREEMENT AND BONDS - PAGE 10 se-c-, A 4ache6 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 uthfulness, accuracy or validity of that d ument. State of County of On before me, Date personally appeared Name, Title of Officer NAME(S) OF SIGNER(S) who proved to me on the basis of satisfactory evidence to a the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they execut the same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s) on the instrument the person(s), or a entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State i entified herein, that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature of Notary ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could preI nt fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Title 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 PICKLEBALL & TENNIS COURT RESURFACING PERFORMANCE BOND CITY PROJECT NO. 20-11 AGREEMENT AND BONDS - PAGE 11 FEBRUARY2020 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California Oran County of e g..----- ___....__......----- On before me, ate personally appeared Angela K. Kim, Notary Public Here Insert Name and Title of the Officer Paul S. Dito Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ,E4 WITNESS my hand and official seal. eu-- ANGELAK.KIM NotaryPublic- California Orange County �Signature._. Commission N 2190918 tnatofNO ry Public My Comm. Expires Apr 11, 2021 y a°i.2�LdF. Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Bond# j O0a)? Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name:. Puu'_S. Dito II Corporate Officer — Title(s): I I Partner -- I I Limited 1 1 General I ) Individual �ci Attorney in Fact f . l Trustee I. ) Guardian or Conservator 1 1 Other: Signer Is Representing: Signer's Name I Corporate Officer — Title(s): r7 Partner — I 1 Limited 1-1 General .I Individual I Attorney in Fact I I Trustee I 1 Guardian or Conservator f I Other: Signer Is Representing: 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 TOKIOMARINE HCC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, PAUL S. DITO its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number 100503898 issued in the course of its business and to bind the Company thereby, in an amount not to exceed One hundred thousand and 00/100 ( $100,000.00 ). This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 111 day of September, 2011. "Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 1s' day of June, 2018. "WIM-14"''o ` 4o�atR..........Z '% State of California Q:` `��' AMERICAN CON T CTO S INDEMNITY COMPANY County of Los Angeles sErT.:s.tssu ;� B • •. - * Ada S. Pessin, 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 1st day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under 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.. C0RE10 Notary pwit • CaiHvnfa " ° L. Ang.t., County i Signature seal Comm ssipn/22i947i I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 1st_, day of July 2020 ACTO Bond No. 100503898 Agency No. 9007 ! � SEPT. ORnTeo Kio Lo, AskstAnt Secretary g� -. p _:: *'o,,4L IFORO HCCSZZPOAACIC06/2018 visit tmhcc.com/surety for more information Premium Subject To Adjustment Based on Final Contract Price PAYMENT BOND — PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, Bond No. 100503898 Premium Included on Performance Bond 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: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 (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'), 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 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, 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 Sixty -Five Thousand Six Hundred and 00/100 Dollars ($ 65,600.00 ), 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, 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. PICKLEBALL & TENNIS COURT RESURFACING PAYMENT BOND CITY PROJECT NO. 20-11 AGREEMENT AND BONDS - PAGE 12 FEBRUARY2020 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 attorney's fees incurred, with or without suit, in addition to the above sum. SIGNED AND SEALED, this 1st day of July , 2020 CONTRACTOR: Check one: individual, _ partnership, a 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: EXEgU THE SURETY: Trueline Construction & Surfacing, Inc. Ame can racto Indemnity Company � By �� ) BY (NOTARIZED) Pme and Title: r' 4 ot�- 6Xj"Ae'/, BY: _. /I A (NOTARIZED) Print Name and Title: Paul S. Dito, Attorney -in -Fact signature (NOTARIZED) Prin N a tla wo PICKLEBALL & TENNIS COURT RESURFACING h M. CAMEO PAYMENT BOND CITY PROJECT NO. 20-11 W # Notary Public - California AGREEMENT AND BONDS - PAGE 13 FEBRUARY 2020 Los Angeles County `gae_ W. Commission # 2262411 My Comm. Expires Oct 12, 2022 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 ANGELES On / ✓�b� Z-0 before me, M. CAMERO NOTARY PUBLIC '^ 666(� inserttname and title of the officer) personally pp appeared f� t �� 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 PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature J VJ (/"NWL U (Seal) 2 Z }' M. CAM,ERO Notary Public - California Los An N Count Angeles 4 y Commission # 22624�2022 'a ,•; My Comm. Expires Oct 12 PAYMENT BOND — PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ NA per thousand. Premium Included on The total amount of premium charged: $ NA Performance Bond (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 Department's 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) (Name and Address of Agent or Representative for service of process in California if different from above) (Telephone Number of Surety and Agent or Representative for service of process in California) PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 American Contractors Indemnity Company 625 The City Drive S., Suite 205 Orange, CA 92868 Same as Above 714-740-7000 PAYMENTBOND AGREEMENT AND BONDS - PAGE 14 State of County of On Date personally appeared PAYMENT BOND — PUBLIC WORKS (CONTINUED) ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the dividual who signed the document to w ich this certificate is attached, and not the trut fulness, accuracy or validity of that this ent. before me, Name, Title of Officer NAME(S) OF SIGNER(S) who proved to me on the basis of satisfactory evidence to be tNQ instrument and acknowledged to me that he/she/they executed th his/her/their signatures(s) on the instrument the person(s), or the e the instrument. I certify under PENALTY OF PERJURY under the laws of the State correct. Witness my hand and official seal. Signature of Notary person(s) whose name(s) is/are subscribed to the within same in his/her/their authorized capacity(ies), and that by ity upon behalf of which the person(s) acted, executed herein, that the foregoing paragraph is true and ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could preventfraudulent attachment of this certificate to unauthorized document. �� THIS CERTIFICATE Title 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 PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 WARRANTY BOND AGREEMENT AND BONDS - PAGE 15 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) Count of Orange---_.........._.........._.__.. On before ate personally appeared Angela K. Kim, Notary Public ..... --- .... .--- - — - Here Insert Name and Title of the Officer Paul S. Dito Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 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. _ ANGELA P I(IM i <<C,::.� '�'`'_,' NotaryPublic-California z i Signature j;.,;`.� Orange County � g ? �i� Commission # 2190918 Si nature Nota Public My Comm. Expires Apr 11, 202 r Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Bond#�, ��_ Document Date: Number of Pages: Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(s) Signer's Name: Pau l.s. D9to Corporate Officer -- Title(s):_.._._._____._._.._.._._...__... _._ f I Partner — i..l Limited I I General Fl Individual NI Attorney in Fact f i Trustee I.] Guardian or Conservator I Other: Signer Is Representing: _.._ Signer's Name: ___.___..___..._....._..___ Corporate Officer — Title(s): l Partner — C_] Limited i..i General I Individual "€ I Attorney in Fact 1-1 Trustee Cl Guardian or Conservator H Other: Signer Is Representing: c@2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) item #5907 TOK10 MARI NE HCC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, PAUL S. DITO its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number 100503898 issued in the course of its business and to bind the Company thereby, in an amount not to exceed One hundred thousand and 00/100 ( $100,000.00 ). This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 151 day of September, 2011. Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: 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, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 151 day of June, 2018. .+ol"I"'o, :fix^ AMERICAN CONT CTO S INDEMNITY COMPANY State of California 'ai V : CICOAPOPATED ; ,y = County of Los Angeles may:. SEPT, 2& tm ; By: LA ,4 Ada S. Pessin, President �g�FORNgP+ L°+++ 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 151 day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under 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.. ?'-�• 1 wYU D: C{RUJO Koury Pub", • Eal:f.rma l03 A Signaturexpk (seal) i comp Ex "Az 8 My Comm.tn Apr i), SOi2 I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this_ 1st day of July 1 2020 . Bond No. 100503898 Agency No. 9007 U: =� @YORPORATED : —y W : SEPT. 25, 1990 : -< Kio Lo, As nt Secretary visit tmhcc.com/surety for more information HCC SZZPOAAC IC06/2018 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. PICKLEBALL & TENNIS COURT RESURFACING COVER SHEET CITY PROJECT NO. 20-11 BID FORMS - PAGE 1 FEBRUARY 2020 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: PICKLEBALL & TENNIS COURT RESURFACING Clydjl' PROJECT NO.20-11 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 forthe 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 2/20/2020 Number Number Number Number Number Number Date Date Date Date Date 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. PICKLEBALL & TENNIS COURT RESURFACING BID PROPOSAL CITY PROJECT NO. 20-11 FEBRUARY 2020 BID FORMS PAGE 2 In conformance with the current statutory requirements of California Labor Code 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: 2/28/2020 Bidder: Trueline Construction & Surfacing, Inc. (Sign Title: \4c6 President PICKLEBALL & TENNIS COURT RESURFACING BID PROPOSAL CITY PROJECT NO. 20-11 FEBRUARY 2020 BID FORMS -PAGE 3 BID SCHEDULE A PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO.20-11 Description Provide all labor, materials, tools, equipment, and services necessary to perform resurfacing of the eight (8) existing pickleball courts located on the westerly two tennis courts at Demuth Park, generally consisting of: 1. Waterblast 3500-5000 psi hydroblaster, diamond grind existing surface 2. Patch all cracks, visible pop outs and spalls, grind/sand flush 3. Surface playing area with acrylic system (clean and prepare surface, apply concrete primer, apply 1 coat of acrylic resurfacer, apply 3 coats of base layer, apply 2 coats of sand filled acrylic color) 4. Stripe pickleball courts using line primer per game specifications 5. Reset existing pickleball net posts/nets Total resurfacing area is approximately 14,200 square feet. Refer to technical specifications for further requirements. Price to include all labor at prevailing wage rates, material, supplies, any applicable sales tax, shipping and/or handling, equipment and mobilization fees needed to complete the scope of work. TOTAL BID PRICE For the lump sum price of: $15,680.00 (Price in figures) Fifteen Thousand Six Hundred Eighty Dollars ------ ---------- _-_---------------------------- _------------ (Price in words) The price per pickleball court is: $1960.00 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 Total Bid Price is inclusive of all other costs, including all materials, supplies, labor, vehicles, equipment and ancillary costs required to complete the work. Trueline Construction & Surfacing, Inc. Name of Bidder or Firm PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FBID SCHEDULE A EBRUARY 2020 BID FORMS -PAGE 4 BID SCHEDULE B PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO.20-11 Description Provide all labor, materials, tools, equipment, and services necessary to perform resurfacing of the eight (8) existing tennis courts located at Ruth Hardy Park, generally consisting of: 1. Waterblast 3500-5000 psi hydroblaster, diamond grind existing surface 2. Patch all cracks, visible pop outs and spalls, grind/sand flush 3. Surface playing area with acrylic system (clean and prepare surface, apply concrete primer, apply 1 coat of acrylic resurfacer, apply 5 coats of base layer, apply 2 coats of sand filled acrylic color) 4. Stripe pickleball courts using line primer per game specifications 5. Reset existing tennis court net posts/nets Total resurfacing area is approximately 56,800 square feet. Refer to technical specifications for further requirements. Price to include all labor at prevailing wage rates, material, supplies, any applicable sales tax, shipping and/or handling, equipment and mobilization fees needed to complete the scope of work. TOTAL BID PRICE For the lump sum price of: $ 49,920.00 (Price in figures) Forty Nine Thousand Nine Hundred Twenty Dollars -------- ---------------------------------------------- (Price in words) The price per tennis court is: $ 6240.00 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 Total Bid Price is inclusive of all other costs, including all materials, supplies, labor, vehicles, equipment and ancillary costs required to complete the work. Trueline Construction & Surfacing, Inc. Name of Bidder or Firm PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BID SCHEDULE B BID FORMS - PAGE 5 BASIS OF AWARD PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO.20-11 TOTAL BID PRICE (SUM OF BID SCHEDULE A + B): For the lump sum price of: $ 65,600.00 (Price in figures) Sixty Five Thousand Six Hundred Dollars ------------------------------------------------ (Price in words) Trueline Construction & Surfacing, Inc. Name of Bidder or Firm PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BASIS OF AWARD BID FORMS - PAGE 6 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: Trueline Construction & Surfacing, Inc. 2. Bid Items / Portion of Work to be Self -Performed (if less than 100% of the contract): 100% 3. Dollar Amount of Work Self- 4. Percentage of Work Self- 5. Date: Performed: Performed: 65,600.00 100% 2/28/2020 By signing the Bid Form, Contractor hereby certifies that it will perform not less 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; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: NONE 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1 M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 LIST OF SUBCONRACTORS FEBRUARY 2020 BID FORMS - PAGE 7 BIDDER'S LIST OF SUBCONTRACTORS - (Continued) Copy this page as needed to provide a complete listing. Page of 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1 M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1 M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1 M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 LIST OF SUBCONRACTORS FEBRUARY 2020 BID FORMS - PAGE 8 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS City Project No. 20-11 Bid Opening Date 3/3/2020 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 -contract 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 sub -contractors 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 PICKLEBALL & TENNIS COURT RESURFACING LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 20-11 FEBRUARY 2020 GOOD FAITH EFFORTS BID FORMS - PAGE 9 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 None 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 None PICKLEBALL & TENNIS COURT RESURFACING LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 20-11 GOOD FAITH EFFORTS FEBRUARY 2020 BID FORMS - PAGE 10 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 ($) Of Performs Item Contract (Y/N) None 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: n/a Names, addresses and phone numbers of firms selected for the work above: n/a NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. PICKLEBALL & TENNIS COURT RESURFACING LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 20-11 GOOD FAITH EFFORTS FEBRUARY 2020 BID FORMS -PAGE 11 NON -COLLUSION DECLARATION The undersigned declares: I am the Vice President (Title of Officer) party making the foregoing bid. of Trueline Construction & Surfacing, Inc. the (Firm/Company) 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 power to 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 28, 2020 at Corona California (Date) (City) (State) PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 NON -COLLUSION DECLARATION BID FORMS - PAGE 12 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS 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 an agreement with Contractor, 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. We agree specifically: 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 Trueline Construction & Surfacing, Inc. NAME OF PERSON SIGNING Janet Bangs TITLE OF PERSON SIGNING vice President DATE February 28, 2020 Please include any additional information available regarding equal opportunity employment programs now in effect within your company. PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 NON-DISCRIMINATION CERTIFICATION FEBRUARY 2020 BID FORMS -PAGE 13 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: Trueline Construction & Surfacing, Inc. 1651 Market Street, Suite B, Corona, CA 92880 Telephone Number: Facsimile Number: E-Mail: trueline40@gmail.com Tax Identification Number: 2. TYPE OF FIRM 0 4. 5. 951-817-0777 951-817-0770 46-2971549 Individual Partnership xx Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Disadvantaged Business (SDB) Veteran Owned Business Disabled Veteran Owned Business Corporation (State CA ) CONTRACTOR'S LICENSE: Primary Classification State License Number(s) 662625 Supplemental License Classifications A&C32 BUSINESS LICENSE: Yes 'x No License No.: Surety Company and Agent who will provide the required Bonds: Name of Surety HCC Surety Address HCC Surety, 625 The City Drive South, Irvine, CA 92868 Surety Company HCC Telephone Numbers: Agent ( 71+740-7000 Surety ( 714 )740-7000 PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BIDDER'S GENERAL INFORMATION BID FORMS - PAGE 18 0 7 0 a 10 BIDDER'S GENERAL INFORMATION (Continued) 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 all natural persons who have a financial interest greater than 5% in the Bidder's business entity. (Use additional sheet if required). Ed Kruse President Janet Bangs Vice President Number of years experience as a contractor in this specific type of construction work: 29+ List at least three related projects completed to date: a. OwnerCity of Santa Fe Spring;kddress Various Parks within the City Contact Art Cervantes Class of Work Resurface and Restore Courts Phone 562-868-0511 Contract Amount 69,860.00 Project Resurface Game Courbate Completed 12/15/2019 Contact Person Art Cervantes Telephone number 562-868-0511 b. Owner City of Fountain Valley Address Various Parks within the City Contact Kyle Hilton Class of Work Resurface and Restore Courts Phone 714-469-3852 Contract Amount 155,200.00 Project Restore, Resurface COEMe Completed 9/8/2019 Contact Person Kyle Hilton Telephone number 714-469-3852 C. Owner Chino Valley USD Address Various Schools throughout the District Contact Jonathan Campbell Class of Work Resurface Tennis Courts Phone 909-628-1201 Contract Amount 167,156.00 Project Resurface Tennis Coultte Completed 7/25/2019 Contact Person Jonathan CamP4*hone number 909-628-1201 Name of Project Manager/Superintendent: Janet Bangs Name(s) of person(s) who inspected job site: Ed Kruse PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BIDDER'S GENERAL INFORMATION BID FORMS - PAGE 19 PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM 1. Name of Entity Trueline Construction & Surfacing, Inc. 2. Address of Entity (Principle Place of Business) 1651 Market Street, Suite B, Corona, CA 92880 3. Local or California Address (if different than #2) 4. State where Entity is Registered with Secretary of State California If other than California, is the Entity also registered in California? ❑ Yes ❑ No S. Type of Entity [0 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 other fiduciaries forthe member, manager, trustorotherentity Ed Kruse ® Officer❑ Director ❑ Member ❑ Manager [name] ❑ General Partner ❑ Limited Partner ❑ Other Janet Bangs $] 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 PICKLEBALL & TENNIS COURT RESURFACING PUBLIC INTEGRITY DISCLOSURE FORM CITY PROJECT NO. 20-11 BID FORMS - PAGE 20 FEBRUARY 2020 7.Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity EXAMPLE JANE DOE 50%, ABC COMPANY, Inc. [name of owner/investor] [percentage of beneficial interest in entity and name of entity] A. Ed Kruse 75 [name of owner/investor] [percentage of beneficial interest in entity and name of entity] B. Janet Bangs 25 [percentage of beneficial interest in entity [name of owner/investor] and name of entity] C. [percentage of beneficial interest in entity [name of owner/investor] and name of entity] C. [percentage of beneficial interest in entity [name of owner/investor] and name of entity] I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. re ofqisglostrqj,Party, Printed Name, Title I Date Janet Bangs, Vice President 1 2/28/2020 PENALTIES Falsification of information or failure to report information required to be reported may subject you to administrative action by the City. CITY OF PALM SPRINGS — PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 2 of 2 PICKLEBALL & TENNIS COURT RESURFACING PUBLIC INTEGRITY DISCLOSURE FORM CITY PROJECT NO. 20-11 BID FORMS - PAGE 21 FEBRUARY 2020 City of Palm Springs Engineering Services Department # 3200 East Tahquitz Canyon Way • Palm Springs, California 92262 c411F0BN�P Tel: (760) 323-8253 • Fax: (760) 322-8360 • Web: www.palmspringsca.gov Addendum Number 1 PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 To all prospective bidders under Specifications for Pickleball & Tennis Court Resurfacing, City Project No. 20-11, which are to be received by the City of Palm Springs at the Office of the Procurement and Contracting Manager at 3200 E. Tahquitz Canyon Way, Palm Springs, CA 92262, until 3:00 P.M. on March 3, 2020. The intent of this Addendum No. 1 is to revise the revised the technical specifications for the court resurfacing, revise the required Contractor's license, revised the Bid Schedules, and to respond to certain requests for information. I. The following changes shall be acknowledged in Part I — Bidding and Contractual Documents and Forms: 1. Section N-2 "Description of the Work" of the Notice Inviting Bids is hereby revised to read: The Work comprises resurfacing of eight pickleball courts located on the westerly two tennis courts at Demuth Park, and resurfacing of eight tennis courts at Ruth Hardy Park, consisting of: preparation of existing surfaces (patching, grinding, sand finish); surfacing playing areas with new acrylic systems, re -striping court areas, and all appurtenant work. 2. Section N-6 "Contractor's License Classification" of the Notice Inviting Bids is hereby revised to read: The Contractor shall possess a valid Class A, C-12, or C-33 Contractor license at the time of submitting bids. Alternatively, if currently valid, a Class C61/D47 Contractor license will be accepted. 3. The Bid Schedule forms are hereby replaced in their entirety with the Bid Schedule forms included herewith this Addendum No. 1. Bidders shall use these revised Bid Schedule forms in submitting a bid. II. The following changes shall be acknowledged in Part III — Appendix: The technical specifications for the pickleball court and tennis court resurfacing are hereby replaced in their entirety with the technical specifications included herewith this Addendum No. 1. The intention is to reduce the required work from the premium cushion surfacing specifications requiring removal of existing surfaces, to the surface color coating system specifications to account for the current condition of the courts. Pickleball & Tennis Court City Project No. 20-11 Addendum No. 1 February 20, 2020 Page 2 III. The following response to Requests for Information shall be acknowledged: Question 1: There is approximately 720' of caulking on the courts that appears to be half filled with concrete. This will come out when the courts are stripped. Do you want this cost included? There is also another 360' that are under fences. It will be very difficult to caulk these joints and they will not be addressed when the courts are blasted, shot blast, water or however, as they cannot be reached. The fence would need to be raised and then put back in order to get to these areas. How do you want to address this? Answer 1: The Work will include addressing the 720 feet of caulking on the courts; the 360 feet caulking underneath the fences will be excluded from the Work. Question 2: You are calling for the removal of the existing surface, although it appears perfectly fine, with no existing peeling. Normally. we wouldn't remove the material unless it is peeling. Please advise. Answer 2: We are revising the specifications herewith this Addendum 1; the revised specifications do not require removal of existing surface. Question 3: Cushion systems generally call for the black resurfacer coat, then the cushion, then one additional coat of resurfacer over the cushion. You are referring to this as the filler coat, believe. Answer 3: A cushion system is no longer specified. Question 4: If you want removal of the existing surface, will you allow waterblasting at 10,000 psi as a method of removal? It is much faster and more economical. We would have to allow the water to go into the grass, but would dam off the particles and dispose of. Answer 4: Removal of the existing surface is not longer specified. Question 5: 1 also wanted to see what was meant by resetting posts? They seemed fine to me? Answer 5: Resetting of posts is only required to the extent the existing posts must be removed to perform the Work. Otherwise, posts may remain in place, with nets removed and replaced as required. Question 6: 1 We have a C61 /D47 license classification will that be allowed to bid? Answer 6: According to the Contractors State License Board website, a limited specialty C61/D47 contractor's license is now classified under C-12 or A. The required contractor's license has been updated pursuant to this Addendum No. 1. Question 7: Can I get a clarification on hydroblasting? You have 3500-5000PS1 and that will not remove the coatings properly and you do ask to remove the coatings in the bid. Normal "hydroblasting for removal is considered to be 10,000+PSI. Pickleball & Tennis Court City Project No. 20-11 Addendum No. 1 February 20, 2020 Page 3 Answer 7: The specifications are hereby revised; removal of existing surfaces is no longer required. Question 8: You do not have any products listed. Can we use Plexipave? Answer 8: We cannot list specific manufacturers; contractor should propose to use any product that meets the standards identified in the technical specifications. Question 9: The estimate is for $50,0004100,000. 1 estimate (higher). Answer 9: The scope of work has changed to align with the intended scope of work and the Engineer's estimate. Question 10: When are you planning to do the work? The weather is extremely important when putting down cushion and you get pretty hot pretty soon. Answer 10: It is our intention to schedule award of contract for the March 19 City Council meeting; work will be scheduled to commence by May 1, pending execution of contracts, receipt of bonds, insurance, and other required documents. Question 11: Also 30 days will be too tight to do this job. It is at least one day for removal and 3 days per court to do the coatings. 4 x 10 = a minimum of 40 days Answer 11: The scope of work has changed to align with the intended scope of work and the Engineer's estimate of the allowable working days. The Special Provisions as originally issued shall be used in submitting bids, and an acknowledgment of receipt of Addendum No. 1 shall be entered where required on the Bid forms. Failure to provide such acknowledgment may render the bid as non -responsive and subject to rejection. Date: February 20, 2020 BY ORDER OF THE CITY OF PALM SPRINGS -tom By Marcus L. Fuller, M.P.A, P.E., P.L.S Assistant City Manager/City Engineer RCE 57271 BID SCHEDULE A — REVISED ADDENDUM NO. 1 PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO.20-11 Description Provide all labor, materials, tools, equipment, and services necessary to install a court surface color coating system of the eight (8) existing pickleball courts located on the westerly two tennis courts at Demuth Park, in accordance with the Technical Specifications. Total resurfacing area is approximately 14,200 square feet. Refer to technical specifications for further requirements. Price to include all labor at prevailing wage rates, material, supplies, any applicable sales tax, shipping and/or handling, equipment and mobilization fees needed to complete the scope of work. TOTAL BID PRICE For the lump sum price of: $ 15,680.00 Fifteen Thousand Six Hundred Eighty Dol (Price in figures) (Price in words) The price per pickleball court is: $ 1,960.00 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 Total Bid Price is inclusive of all other costs, including all materials, supplies, labor, vehicles, equipment and ancillary costs required to complete the work. Trueline Construction & Surfacing, Inc. Name of Bidder or Firm PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BID SCHEDULE A BID FORMS - PAGE 1 BID SCHEDULE B — REVISED ADDENDUM NO. 1 PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO.20-11 Description Provide all labor, materials, tools, equipment, and services necessary to install a court surface color coating system of the eight (8) existing tennis courts located at Ruth Hardy Park, in accordance with the Technical Specifications. Total resurfacing area is approximately 56,800 square feet. Refer to technical specifications for further requirements. Price to include all labor at prevailing wage rates, material, supplies, any applicable sales tax, shipping and/or handling, equipment and mobilization fees needed to complete the scope of work. TOTAL BID PRICE For the lump sum price of: $ 49,920.00 (Price in figures) Forty Nine Thousand Nine Hundred Twenty Dol (Price in words) The price per tennis court is: $ 6,240.00 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 Total Bid Price is inclusive of all other costs, including all materials, supplies, labor, vehicles, equipment and ancillary costs required to complete the work. Trueline Construction & Surfacing, Inc. Name of Bidder or Firm PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BID SCHEDULE B BID FORMS - PAGE 2 BASIS OF AWARD — REVISED ADDENDUM NO. 1 PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO.20-11 TOTAL BID PRICE (SUM OF BID SCHEDULE A + B): For the lump sum price of: $ 65,600.00 (Price in figures) Sixty Five Thousand Six Hundred Dollars ------------------------------------------------ (Price in words) Trueline Construction & Surfacing, Inc. Name of Bidder or Firm PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 FEBRUARY 2020 BID SCHEDULE B BID FORMS - PAGE 3 CONCRETE PICKLEBALL COURT SURFACE COLOR COATING SYSTEM PART 1 GENERAL 1.1 SECTION INCLUDES A. Concrete pickleball court surface color coating system. 1.2 RELATED REQUIREMENTS None. 1.3 REFERENCE STANDARDS A. American Sports Builders Association (ASBA). B. United States of America Pickleball Association (USAPA) Rules of Pickleball. 1.4 SUBMITTALS A. Comply with Standard Specifications. B. Product Data: Submit manufacturer's product data, including surface and crack preparation and application instructions. C. Samples: Submit manufacturer's color samples of color coating. D. Test Reports: 1. Submit independent test results for solar reflectance index. 2. Submit independent test results for 2000 Hour ASTM G154, accelerated weathering UV test, to demonstrate long-term durability and fade resistance. 3. Submit independent test results for 2000 Hour, accelerated weathering ASTM G155 Xenon Arc test, to demonstrate long-term fade resistance and quality of pigment. E. Manufacturer's Certification: Submit manufacturer's certification that materials comply with specified requirements and are suitable for intended application. F. Manufacturer's Project References: Submit manufacturer's list of successfully completed concrete pickleball court surface color coating system projects, including project name, location, and date of application. G. Applicator's Project References: Submit applicator's list of successfully completed concrete pickleball court surface color coating system projects, including project name, location, type and quantity of color coating system applied, and date of application. H. Warranty Documentation: Submit manufacturer's standard warranty. 1.5 QUALITY ASSURANCE A. Manufacturer's Qualifications: 1. Manufacturer regularly engaged, for past 5 years, in manufacture of concrete pickleball court surface color coating systems of similar type to that specified. 2. United States owned company. 3. Member: ASBA. B. Applicator's Qualifications: 1. Applicator regularly engaged, for past 3 years, in application of pickleball court surface color coating systems of similar type to that specified. 2. Employ persons trained for application of pickleball court surface color coating systems. 1.6 DELIVERY, STORAGE, AND HANDLING A. Delivery and Acceptance Requirements: Deliver materials to site in manufacturer's original, unopened containers and packaging, with labels clearly identifying product name and manufacturer. B. Storage and Handling Requirements: 1. Store and handle materials in accordance with manufacturer's instructions. 2. Keep materials in manufacturer's original, unopened containers and packaging until application. 3. Store materials in clean, dry area indoors. 4. Store materials out of direct sunlight. 5. Keep materials from freezing. 6. Protect materials during storage, handling, and application to prevent contamination or damage. 7. Close containers when not in use. 1.7 AMBIENT CONDITIONS A. Do not apply concrete pickleball court surface color coating system when air or surface temperatures are below 50 degrees F during application or within 24 hours after application. B. Do not apply concrete pickleball court surface color coating system when rain is expected during application or within 24 hours after application. PART 2 PRODUCTS 2.1 MANUFACTURER A. Proposed suppliers of products who meet the standards provided in this specification. 2.2 MATERIALS A. Concrete Pickleball Court Surface Color Coating System: furnished by recommended supplier B. Crack Sealant: 1. 100 percent acrylic emulsion elastomeric crack sealant. 2. Seals cracks and expansion joints up to 1 /2 inch wide in concrete pavement. 3. Weight per Gallon at 77 Degrees F: 8.8 lbs., plus or minus 0.5 lbs. 4. Non -Volatile Material: 61 percent, plus or minus 5 percent. 5. Color: match existing C. Crack Filler: 1. 100 percent acrylic emulsion trowel -grade crack filler. 2. Fills cracks in concrete pavement up to 1 inch wide. 3. Chemical Characteristics, by Weight, Minimum: a. Acrylic Emulsion: 10.0 percent. b. Hiding Pigment: 0.2 percent. c. Mineral Inert Fillers: 78.0 percent. d. Film Formers, Additives: 1.8 percent. e. Water: 8.5 percent. 4. Weight per Gallon at 77 Degrees F: 15.2 lbs., plus or minus 1.0 lbs. 5. Non -Volatile Material: 80 percent, plus or minus 5 percent. 6. Color: match existing D. Patch Binder: 1. 100 percent acrylic emulsion liquid binder. 2. Mix on -site with sand and cement. 3. Levels and repairs low spots and depressions up to 3/4 inch deep in concrete pavement. 4. Fills Cracks in concrete up to 1" in width. 5. Weight per Gallon at 77 Degrees F: 8.8 lbs., plus or minus 0.5 lbs. E. Adhesion Promoter: 1. Acrylic emulsion primer. 2. Primes concrete surface and promotes adhesion of color coating system materials. 3. Weight per Gallon at 77 Degrees F: 8.7 lbs., plus or minus 0.5 lbs. F. Filler Course: 1. 100 percent acrylic emulsion resurfacer. 2. Mix on -site with silica sand. 3. Apply to adhesion promoter or previously colored acrylic surfaces in preparation of color coating system. 4. Chemical Characteristics, by Weight, Minimum: a. Acrylic Emulsion: 44.0 percent. b. Hiding Pigment: 2.0 percent. c. Mineral Inert Fillers: 5.0 percent. d. Film Formers, Additives: 0.2 percent. e. Water: 45.0 percent. 5. Weight per Gallon at 77 Degrees F: 8.5 lbs., plus or minus 0.5 lbs. 6. Non -Volatile Material: 27.5 percent, plus or minus 5.0 percent. 7. Color: [Black] or [Neutral]. G. Color Coating: 1. 100 percent acrylic emulsion coating. 2. Mix on -site with silica sand and water. 3. Color coats pickleball, tennis, and multipurpose courts. 4. Weight per Gallon at 77 Degrees F: 9.2 lbs., plus or minus 0.5 lbs. 5. Color: match existing. H. Line Markings Primer: 1. 100 percent acrylic emulsion primer, clear drying. 2. Primes line markings and prevents bleed -under for sharp lines. 3. Chemical Characteristics, by Weight, Nominal: a. Acrylic Emulsion: 38.0 percent. b. Hiding Pigment: 0.0 percent. c. Mineral Inert Fillers: 7.0 percent. d. Film Formers, Additives: 1.5 percent. e. Water: 50.0 percent. 4. Weight per Gallon at 77 Degrees F: 8.9 lbs., plus or minus 0.5 lbs. 5. Non -Volatile Material: 29 percent, plus or minus 5 percent. Line Paint: 1. Pigmented, 100 percent acrylic emulsion line paint. 2. Line marking on concrete pickleball courts. 3. Chemical Characteristics, by Weight, Nominal: a. Acrylic Emulsion: 25.89 percent. b. Pigment: 14.90 percent. c. Mineral Inert Fillers: 13.12 percent. d. Additives: 4.73 percent. e. Water: 41.36 percent. 4. Weight per Gallon at 77 Degrees F: 10.65 lbs., plus or minus 0.75 lbs. 5. Non -Volatile Material: 45.17 percent, plus or minus 5 percent. 6. Color: White. PART 3 EXECUTION 3.1 EXAMINATION A. Examine concrete pickleball court surfaces to receive color coating system. B. Verify: 1. Suitable vapor barrier beneath concrete slab. 2. Perimeter drainage to prevent moisture accumulation beneath concrete surface. 3. Curing compounds have not been used on concrete surface. 4. Concrete pickleball courts meet ASBA requirements. C. Notify Engineer of conditions that would adversely affect application or subsequent use. D. Do not begin surface preparation or application until unacceptable conditions are corrected. 3.2 SURFACE PREPARATION A. Protection of In -Place Conditions: Protect adjacent surfaces and landscaping from contact with concrete pickleball court surface color coating system. B. Prepare surfaces in accordance with manufacturer's instructions. C. Existing Concrete: 1. Sandblast, shotblast, or scarify smooth concrete surfaces to roughened texture similar to medium broom finish. 2. Acid etch surface per manufacturers specifications, then rinse thoroughly. D. Remove dirt, dust, debris, oil, grease, sealers, curing compounds, vegetation, loose coatings, loose materials, and other surface contaminants which could adversely affect application of concrete pickleball court surface color coating system. Pressure wash entire surface. E. Repair cracks, depressions, and surface defects in accordance with manufacturer's instructions before application of color coating. F. Repair spalled areas and level depressions 1/8 inch and deeper with patch binder in accordance with manufacturer's instructions. G. Apply adhesion promoter over entire concrete surface in accordance with manufacturer's instructions. H. Apply 1 coat of filler course to provide smooth underlayment for application of color coating. Ensure surface repairs are flush and smooth to adjoining surfaces. 3.3 APPLICATION A. Apply concrete pickleball court surface color coating system in accordance with manufacturer's instructions at locations indicated on the Drawings. B. Mix materials in accordance with manufacturer's instructions. C. Apply Filler Course and Color Coating with a 50-60 durometer, soft rubber squeegee. D. Filler Course: 1. Apply 1 coat on new concrete or existing acrylic surfaces with minimal repairs. 2. Apply 2 coats on existing acrylic surfaces with extensive cracks or low spot repair. E. Apply a minimum of 2 coats of color coating to prepared surfaces in accordance with manufacturer's instructions. F. Allow material drying times in accordance with manufacturer's instructions before applying other materials or opening completed surface to foot traffic. 3.4 LINE MARKINGS A. Lay out pickleball court line markings in accordance with USAPA Rules of Pickleball. B. Apply line markings primer, after masking tape has been laid, to seal voids between masking tape and pickleball court surface to prevent bleed -under when line paint is applied. C. Apply a minimum of 1 coat of line paint in accordance with manufacturer's instructions. 3.5 PROTECTION A. Allow a minimum of 24 hours curing time before opening pickleball courts for play. B. Protect applied concrete pickleball court surface color coating system to ensure that, except for normal weathering, coating system will be without damage or deterioration at time of Substantial Completion. END OF SECTION CONCRETE TENNIS COURT SURFACE COLOR COATING SYSTEM PART 1 GENERAL 1.1 SECTION INCLUDES A. Concrete tennis court surface color coating system. 1.2 RELATED REQUIREMENTS None. 1.3 REFERENCE STANDARDS A. American Sports Builders Association (ASBA). B. United States Tennis Association (USTA) Rules of Tennis. C. International Tennis Federation (ITF) 1.4 SUBMITTALS A. Comply with Standard Specifications. B. Product Data: Submit manufacturer's product data, including surface and crack preparation and application instructions. C. Samples: Submit manufacturer's color samples of color coating. D. Test Reports: 1. Submit independent test results for solar reflectance index. 2. Submit independent test results for 2000 Hour ASTM G154, accelerated weathering UV test, to demonstrate long-term durability and fade resistance. 3. Submit independent test results for 2000 Hour, accelerated weathering ASTM G155 Xenon Arc test, to demonstrate long-term fade resistance and quality of pigment. E. Manufacturer's Certification: Submit manufacturer's certification that materials comply with specified requirements and are suitable for intended application. F. Manufacturer's Project References: Submit manufacturer's list of successfully completed concrete tennis court surface color coating system projects, including project name, location, and date of application. G. Applicator's Project References: Submit applicator's list of successfully completed concrete tennis court surface color coating system projects, including project name, location, type and quantity of color coating system applied, and date of application. H. Warranty Documentation: Submit manufacturer's standard warranty. 1.5 QUALITY ASSURANCE A. Manufacturer's Qualifications: 1. Manufacturer regularly engaged, for past 5 years, in manufacture of concrete tennis court surface color coating systems of similar type to that specified. 2. United States owned company. 3. Member: ASBA. B. Applicator's Qualifications: 1. Applicator regularly engaged, for past 3 years, in application of tennis court surface color coating systems of similar type to that specified. 2. Employ persons trained for application of tennis court surface color coating systems. 1.6 DELIVERY, STORAGE, AND HANDLING A. Delivery and Acceptance Requirements: Deliver materials to site in manufacturer's original, unopened containers and packaging, with labels clearly identifying product name and manufacturer. B. Storage and Handling Requirements: 1. Store and handle materials in accordance with manufacturer's instructions. 2. Keep materials in manufacturer's original, unopened containers and packaging until application. 3. Store materials in clean, dry area indoors. 4. Store materials out of direct sunlight. 5. Keep materials from freezing. 6. Protect materials during storage, handling, and application to prevent contamination or damage. 7. Close containers when not in use. 1.7 AMBIENT CONDITIONS A. Do not apply concrete tennis court surface color coating system when air or surface temperatures are below 50 degrees F during application or within 24 hours after application. B. Do not apply concrete tennis court surface color coating system when rain is expected during application or within 24 hours after application. PART 2 PRODUCTS 2.1 MANUFACTURER A. Proposed suppliers of products who meet the standards provided in this specification. 2.2 MATERIALS A. Concrete Tennis Court Surface Color Coating System: furnished by recommended supplier B. Crack Sealant: 1. 100 percent acrylic emulsion elastomeric crack sealant. 2. Seals cracks and expansion joints up to 1/2 inch wide in concrete pavement. 3. Weight per Gallon at 77 Degrees F: 8.8 lbs., plus or minus 0.5 lbs. 4. Non -Volatile Material: 61 percent, plus or minus 5 percent. 5. Color: [Green] [Neutral] [Red]. C. Crack Filler: 1. 100 percent acrylic emulsion trowel -grade crack filler. 2. Fills cracks in concrete pavement up to 1 inch wide. 3. Chemical Characteristics, by Weight, Minimum: a. Acrylic Emulsion: 10.0 percent. b. Hiding Pigment: 0.2 percent. c. Mineral Inert Fillers: 78.0 percent. d. Film Formers, Additives: 1.8 percent. e. Water: 8.5 percent. 4. Weight per Gallon at 77 Degrees F: 15.2 lbs., plus or minus 1.0 lbs. 5. Non -Volatile Material: 80 percent, plus or minus 5 percent. 6. Color: [Green] [Neutral] [Red]. D. Patch Binder: 1. 100 percent acrylic emulsion liquid binder. 2. Mix on -site with sand and cement. 3. Levels and repairs low spots and depressions up to 3/4 inch deep in concrete pavement. 4. Fills Cracks in concrete up to 1" in width. 5. Weight per Gallon at 77 Degrees F: 8.8 lbs., plus or minus 0.5 lbs. E. Adhesion Promoter: 1. Acrylic emulsion primer. 2. Primes concrete surface and promotes adhesion of color coating system materials. 3. Weight per Gallon at 77 Degrees F: 8.7 lbs., plus or minus 0.5 lbs. F. Filler Course: 1. 100 percent acrylic emulsion resurfaces. 2. Mix on -site with silica sand. 3. Apply to adhesion promoter or previously colored acrylic surfaces in preparation of color coating system. 4. Chemical Characteristics, by Weight, Minimum: a. Acrylic Emulsion: 44.0 percent. b. Hiding Pigment: 2.0 percent. C. Mineral Inert Fillers: 5.0 percent. d. Film Formers, Additives: 0.2 percent. e. Water: 45.0 percent. 5. Weight per Gallon at 77 Degrees F: 8.5 lbs., plus or minus 0.5 lbs. 6. Non -Volatile Material: 27.5 percent, plus or minus 5.0 percent. 7. Color: [Black] or [Neutral]. G. Color Coating: 1. 100 percent acrylic emulsion coating. 2. Mix on -site with silica sand and water. 3. Color coats tennis and multipurpose courts. 4. Weight per Gallon at 77 Degrees F: 9.2 lbs., plus or minus 0.5 lbs. 5. Color: match existing. H. Line Markings Primer: 1. 100 percent acrylic emulsion primer, clear drying. 2. Primes line markings and prevents bleed -under for sharp lines. 3. Chemical Characteristics, by Weight, Nominal: a. Acrylic Emulsion: 38.0 percent. b. Hiding Pigment: 0.0 percent. c. Mineral Inert Fillers: 7.0 percent. d. Film Formers, Additives: 1.5 percent. e. Water: 50.0 percent. 4. Weight per Gallon at 77 Degrees F: 8.9 lbs., plus or minus 0.5 lbs. 5. Non -Volatile Material: 29 percent, plus or minus 5 percent. Line Paint: 1. Pigmented, 100 percent acrylic emulsion line paint. 2. Line marking on concrete tennis courts. 3. Chemical Characteristics, by Weight, Nominal: a. Acrylic Emulsion: 25.89 percent. b. Pigment: 14.90 percent. C. Mineral Inert Fillers: 13.12 percent. d. Additives: 4.73 percent. e. Water: 41.36 percent. 4. Weight per Gallon at 77 Degrees F: 10.65 lbs., plus or minus 0.75 lbs. 5. Non -Volatile Material: 45.17 percent, plus or minus 5 percent. 6. Color: White. PART 3 EXECUTION 3.1 EXAMINATION A. Examine concrete tennis court surfaces to receive color coating system. B. Verify: 1. Suitable vapor barrier beneath concrete slab. 2. Perimeter drainage to prevent moisture accumulation beneath concrete surface. 3. Curing compounds have not been used on concrete surface. 4. Concrete tennis courts meet ASBA requirements. C. Notify Engineer of conditions that would adversely affect application or subsequent use. D. Do not begin surface preparation or application until unacceptable conditions are corrected. 3.2 SURFACE PREPARATION A. Protection of In -Place Conditions: Protect adjacent surfaces and landscaping from contact with concrete tennis court surface color coating system. B. Prepare surfaces in accordance with manufacturer's instructions. C. Existing Concrete: 1. Sandblast, shotblast, or scarify smooth concrete surfaces to roughened texture similar to medium broom finish. 2. Acid etch surface per manufacturers specifications, then rinse thoroughly. D. Remove dirt, dust, debris, oil, grease, sealers, curing compounds, vegetation, loose coatings, loose materials, and other surface contaminants which could adversely affect application of concrete tennis court surface color coating system. Pressure wash entire surface. E. Repair cracks, depressions, and surface defects in accordance with manufacturer's instructions before application of color coating. F. Repair spalled areas and level depressions 1/8 inch and deeper with patch binder in accordance with manufacturer's instructions. G. Apply adhesion promoter over entire concrete surface in accordance with manufacturer's instructions. H. Apply 1 coat of filler course to provide smooth underlayment for application of color coating. Ensure surface repairs are flush and smooth to adjoining surfaces. 3.3 APPLICATION A. Apply concrete tennis court surface color coating system in accordance with manufacturer's instructions. B. Mix materials in accordance with manufacturer's instructions. C. Apply Filler Course and Color Coating with a 50-60 durometer, soft rubber squeegee. D. Filler Course: 1. Apply 1 coat on new concrete or existing acrylic surfaces with minimal repairs. 2. Apply 2 coats on existing acrylic surfaces with extensive cracks or low spot repair. E. Apply a minimum of 2 coats of color coating to prepared surfaces in accordance with manufacturer's instructions. F. Allow material drying times in accordance with manufacturer's instructions before applying other materials or opening completed surface to foot traffic. 3.4 LINE MARKINGS A. Lay out tennis court line markings in accordance with USTA Rules of Tennis. B. Apply line markings primer, after masking tape has been laid, to seal voids between masking tape and tennis court surface to prevent bleed -under when line paint is applied. C. Apply a minimum of 1 coat of line paint in accordance with manufacturer's instructions. 3.5 PROTECTION A. Allow a minimum of 24 hours curing time before opening tennis courts for play. B. Protect applied concrete tennis court surface color coating system to ensure that, except for normal weathering, coating system will be without damage or deterioration at time of Substantial Completion. END OF SECTION Bond No. BB2009688 BID BOND Bid Date: 03/03/2020 KNOW ALL MEN BY THESE PRESENTS, That Trueline Construction & Surfacing, 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 (10%) dollars (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: PICKLEBALL & TENNIS COURT RESURFACING CITY PROJECT NO. 20-11 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 12th day of February EXECUTED FOR THE PRINCIPAL: By Trueline Construction & Surfacing, Inc. Signature (NOTARIZED) Print Name and Title: By Signature (NOTARIZED) Print Name and Title: 2020. EXECUTED FOR THE SURETY: By American Contractors Ind m any Signature (NOTARIZED) Print Name and Title: Ted Lee, Attorney -in -Fact PICKLEBALL & TENNIS COURT RESURFACING BID BOND (BID SECURITY FORM) CITY PROJECT NO. 20-11 FEBRUARY 2020 BID FORMS -PAGE 14 ([Jl COPY CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 'Cf .'•: r�,:w1L�f�L. f�L.:�•..�L� ..�•.TS.T .:•..%:�5.. �S�'s�L�L/.� .i�S�Cs� .c>L '.� .�S {�• TN..�L 91,fCq s�✓T .�. {.TJs� �. ,T ,�Sl1eT .v2J:i . C! 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 Orange Ona z2c )C) before me, K. Ho, Notary Public Date Here Insert Name and Title of the Officer personally appeared Ted Lee Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(g) whose name(4 is/am subscribed to the within, instrument and acknowledged to me that he/so/th" executed the same in his/her/tixk authorized capacity(ben), and that by his/t)eK/D-" signatureW on the instrument the person(4, 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 of California that the foregoing paragraph is true and correct. WITNESS my hand a official seal. 00, K. HONotary Public -CaliforniaOrange County COMMIssion # 2262101 - Signature y Comm, Expires Nov 7, 2022 Sign ure of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Documen Title or Type of Document: Bond # t)2)IO ( �_q C Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacityjies) Claimed by Signer(s) Signer's Name: Ted Lee ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual KI Attorney in Fact O Trustee ❑ Guardian or Conservator ❑ Other: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 u - TO KI O MART N E HCC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, TED LEE its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number BB2009688 issued in the course of its business and to bind the Company thereby, in an amount not to exceed One hundred thousand and 00/100 ( $100,000.00 This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 15' day of September, 2011. "Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: 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, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 15' day of June, 2018. ; owit.TQRs;' ono• . ..............tio°'. State of California =Q; AMERICAN CONT CTOLRS INDEMNITY COMPANY County of Los Angeles SE"` �'m "_ B ;mod••.. :-.o,,.; y: C • Ada S. Pessin, President P.`��` 9rnreunna 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 15' day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under 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. SO1U0. CARREJ0 vomry Pub* • Gltlor"4 Signature (seal) j C`"tl1hiW922'°"4 My Conn. E*r. iD 23, Z022 ww� I, Kio Lot Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of Februa `.y„ur un,nnr. Bond No. BB2009688 Agency No. 9007 C '�: WOORPORATEO : y � . SEPT. 7S, 1920 : ••f visit tmhcc.com/surety for more information 2020 Kio Lo, Ask -Ant Secretary HC CSZZ P OAACI C0612018 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of PkV-c1"5� On ,_1 v ZD� before me, Cl ✓L "U y Da Here Insert Name and Title of the O /cer personally appeared boL ru5y Nome(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. JANET AILEEN BANES COMM. #2144650 z Notary Public • California z = Los Angeles County o 1 @my Comm. Ex Tres Mar. 1, 2020 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. OPTIONAL ial seal. of Completing this information can deter alteration of the document or fraudulent reattachment of this form to on unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: i e ,acoMEIP CERTIFICATE OF LIABILITY INSURANCE DA O;,,g 2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsement's). PRODUCER Millennium Risk Management 8 Insurance Services License 80M93299 RECHWED 301 E Colorado BI., Suite 205 Pasadena JUL"11022 CONTACT NAME: Kathy Macias-Ramimz PHHCONE No.Ext : (818) 8444100 Al(818) 638-7920 E-MAIL kath m mcsins.com ADDRESS: y INSURERS) AFFORDING COVERAGE NM INSURERA: Mt Hawley Insurance Co 37974 INSURED Office of the City Cler Trueline Construction 8 Surfacing, Inc. 12397 Doherty Street Riverside CA 92503 INSURER B: Ohio Security Ins Company 24082 INSURER C: Everest Premier Insurance Co. 16045 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2022 - 2023 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 CONTRACTOR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYY POLICY EXP M LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR PREMISES Ea a umirice f 50.000 NED UP (AM" pemon) s 5,000 $5,000 Dad - Per Occ PERSONAL S ADV INJURY S 1,000,000 A Y MGLO196158 07/25/2022 07/25/2023 GENL AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE 5 2.000,000 PRO- LOD POLICY ❑ JECT PRODUCTS-COMP/OP AGG f 2,000,000 Employee Barents S 1,000,000 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Pr Fenarl 5 ANY AUTO g OWNED SCHEDULED AUTOS ONLY AUTOS Y BAS (23) 56945605 07/25/2022 07/25/2023 BODILY INJURY Per axideml $ PROPERTY DAMAGE Per accident S HIRED NON-0NNED AUTOS ONLY AUTOS ONLY f COMP -$1K COLL-$1K UMBRELLA Use OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A I EXCESS LIAB CLUMSMADE Renewal of MXL0431710 07/26/2022 07125/2023 DELI>< RETENTION f 1.000 f C WORKERS COMPENSATION ANDEMPLOYERSLIABIUTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERNEMBER EXCLUDED? (14eruielory In NH) NIA Renewal of 7600018618211 07/25Y1022 07/25/2023 PER OTH- STATUTE ER E.L. EACHACGDEUT f I,ODO,000 E.L. DISEASE - EA EMPLOYEE f 1,000,000 If rasa lx, under DESCRIPTION OF OPERATIONS OeIon E.L. DISEASE -POLICY LIMIT f 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addhimal Remarks Schedule, may IH, M I,iHl N mom epau M required) Re. Project 20-11 - Pickleball Court 8 Tennis Court Resurfacing Resurfacing The City of Palm Springs, its officials, employees and agents and agents and all other entities where required by written contract are named as additional insured with primary and non-contributory wording as respects General Liability per forms CG20100413, CG20370413, CG20010413. Additional insured applies perAuto Liability per form AC85430818 attached. Waiver of Subrogation applies to GL, Auto 8 WC Per the attached. 30 day notice of cancellation with 10 days for non -pay. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Vonda Teed AUTHORIZED REPRESENTATIVE 3200 E Tahquitz Canyon Way Palm Springs CA 92262 9)1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Policy Number: MGLO196158 Mt. Hawley Insurance Company 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(s) Of Covered Operations: All persons or organizations where required All Locations by written contract executed prior to the commencement of your work. 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 in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However 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: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or re- pairs) to be performed by or on behalf of the addi- tional insured(s) at the location of the covered operations has been completed; or 1. The insurance afforded to such additional insured 2. That portion of "your work" out of which the injury only applies to the extent permitted by law; and or damage arises has been put to its intended use by any person or organization other than another 2. If coverage provided to the additional insured is contractor or subcontractor engaged in performing required by a contract or agreement, the in- operations for a principal as a part of the same surance afforded to such additional insured will project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 Insured 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 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 Insured Policy Number: MGLO196158 Mt. Hawley Insurance Company 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 All persons or organizations where required by written All Locations and All Projects contract executed prior to the commencement of your work. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" 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 "productscompleted operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law, and 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 re- quired 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. 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- This endorsement shall not increase the applicable ance afforded to such additional insured will not Limits of Insurance shown in the Declarations. not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Policy Number: MGL0196158 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or agree - and supersedes any provision to the contrary: ment that this insurance would be primary and would not seek contribution from any other in - Primary And Noncontributory Insurance surance available to the additional insured. This insurance is primary to and will not seek con- tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Policy Number: MGL0196158 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: All persons or organizations where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work' done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Insured POLICY NUMBER: BAS(23)56945605 COMMERCIAL AUTO AC 85 43 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGEINDEX SUBJECT PROVISION NUMBER ACCIDENTAL AIRBAG DEPLOYMENT 12 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 20 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 14 BODILY INJURY REDEFINED 24 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 2 EXTRA EXPENSE — BROADENED COVERAGE 10 GLASS REPAIR — WAIVER OF DEDUCTIBLE 16 HIRED AUTO COVERAGE TERRITORY 22 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 6 LOAN / LEASE GAP (Coverage Not Available In New York) 15 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 1 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 17 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE — ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 PHYSICAL DAMAGE DEDUCTIBLE — VEHICLE TRACKING SYSTEM 13 PRIMARY AND NON—CONTRIBUTORY — WRITTEN CONTRACT OR WRITTEN AGREEMENT 23 RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 TWO OR MORE DEDUCTIBLES 18 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 21 SECTION II — LIABILITY COVERAGE is amended as follows: 1. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION 11— LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an "insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. However, "insured" does not include any organization that: AC 85 43 06 18 © 2018 Liberty Mutual Insurance Page 1 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specifically to apply in excess of this policy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy. Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II — LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an "insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II — LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto" (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance. 4. SUPPLEMENTARY PAYMENTS SECTION II — LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. Page 2 of 9 © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II — LIABILITY, Exclusion B.S. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage is excess over any other collectible insurance. SECTION III — PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss". AC 85 43 06 18 © 2018 Liberty Mutual Insurance Page 3 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 7. TOWING AND LABOR SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks", we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 — 20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE— ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. Coverage Extensions, Transportation Expenses of SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500. 9. RENTAL REIMBURSEMENT SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident' or "loss", to an "auto' for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident' or "loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lesser vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto' of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11.B. Page 4 of 9 © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 10. EXTRA EXPENSE — BROADENED COVERAGE Under SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V —DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 13. PHYSICAL DAMAGE DEDUCTIBLE — VEHICLE TRACKING SYSTEM SECTION III — PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 14. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclusions 4.c. and 4.d. is deleted and replaced with the following: Exclusions 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto" and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. AC 85 43 06 18 © 2018 Liberty Mutual Insurance Page 5 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 15. LOAN / LEASE GAP COVERAGE (Not Applicable In New York) A. Paragraph C. Limit Of Insurance of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto' owned by or leased to you in any one "accident' is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss"; b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a 'Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto"; g. Security deposits not refunded by a lessor; h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto"; i. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the 'loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the 'loss". C. SECTION V — DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. Page 6 of 9 © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 16. GLASS REPAIR — WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 17. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto' of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto' is designed to carry while it is: a. In the charge of an "insured" b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 18. TWO OR MORE DEDUCTIBLES Under SECTION III — PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident', the following applies to Paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows: 19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV— BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. AC 85 43 06 18 © 2018 Liberty Mutual Insurance Page 7 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 20. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or "loss" took place; (b) The "insured's" name and address; and (c) The names and addresses of any injured persons and witnesses. 21. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph A.S. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 22. HIRED AUTO COVERAGE TERRITORY SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured's" responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. 23. PRIMARY AND NON—CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT The following is added to SECTION IV — BUSINESS AUTO CONDITIONS, General Conditions, B.S. Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". Page 8 of 9 © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. SECTION V — DEFINITIONS is amended as follows: 24. BODILY INJURY REDEFINED Under SECTION V — DEFINITIONS, Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. AC 85 43 06 18 © 2018 Liberty Mutual Insurance Page 9 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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 FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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.) Renewal of Endorsement Effective: 07/25/2022 Policy No. 7600016618211 Endorsement No. 001 Insured: Trueline Construction & Surfacing, Inc. Premium S INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999.