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A8498-PAVEMENT COATINGS CO.
AGREEMENT (CONSTRUCTION CONTRACT) THIS AGREEMENT made this _ day of , 20_, by and between the City of Palm Springs, a charter city, organized and existing in the County of Riverside, under and by virtue of the laws of the State of California, hereinafter designated as the City; and Pavement Coatings Co.; 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: 2020 SLURRY SEAL . CITY PROJECT NO. 19-02. The Work includes: application of weed killer to all pavement cracks or joints; cleaning, routing, and installation of crack -sealant or asphalt pavement in all pavement cracks or joints'/4" or wider; uniform micro -milling of existing asphalt concrete pavement; construction of Rubber Polymer Modified Slurry (RPM% removal and replacement of .existing traffic striping and markings; and all appurtenant work on various City streets.. 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. 2020 SLURRY SEAL AGREEMENT FORM CITY PROJECT NO. 19-02 AGREEMENT AND BONDS - PAGE 1 NOVEMBER 2019 Termination Prior to Expiration of . Tenn: City may, terminate this Agreement for its . convenience at anytime, without cause; in whole or impart,, uponglving 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 shorterfim'd as may be determined by the City. Upon such notice, City shalt pay Contractor for Services performed through the date of termination in accordance with -the'Contract'Documents. 'Upon ;receipt of such ,notice, Contractor shall imrriediately cease all worktinder this Agreemeni, 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 tenriinationof the Agreement under this section, Contractor shell;submit to the City an invoice-for.work- and services-perfonried prior to the date of. termination. -ARTICLE 3 CONTRACT.PRICE The City shall paythe Contractorfor the'completion :ofAhe Work, in accordance with the Contract Document's, in current funds the ContracfPrice(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 One, Million Eight. Hundred Thirty Thousand Eight. ; u....a.....a c:.......6.`^_. nd11.. .�...19I.Afe'M4 QIA R74' 5A% ' 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 coverall expenses; losses,'damages, and consequences arising out of the nature of the Work,dunng'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 ali other unknowns or -risks of any= description connected with the Work: ARTICLE 4 =THE CONTRACTbOCUMENTS . Thebontract.Documents consistbf the Notice,Inviting,Bids; lnstructions.to, Bidders, the prevailing rate of per diem. wages. as determined y' ahe- 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; thebrawings, 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. 2020 SLURRY SEAL . AGREEMENT FORM CITY.PROJECTNO: 19-02 AGREEMENT AND BONDS "- PAGE 2 NOVEMBER2019 - ARTICLE 6 -r MUTUAL OBLIGATIONS For' and inconsideration of'the payments and agreeme , nts to be made and performed by the I City, the Contrai. , tor agrees to-fimish"all materials and, peil6mi-all work required for.the above stated project; and to fulfill p1l'o'thdr OligationsOs'set forth in the.afordsaid Contract, Documents. City' hereby, agrees, to employ, and does hemb.�'employ, Contractor. to. provide the materials,. ;complete the Work, a . nd fuilfill the oblij6tiohs according to the terms and d conditions herein Contained and referred: to, for. the Contract Price herein identified; and hereby 'by contracts to Ray the same at.th the . time, . in the manner, and; Upon the Condit! set ere forth. in the Contract Documents. s ' and ConiractoContractorspecifically acknowledges and'ag"ries to be'bound by the Wage Raten Labor Code eit t specified in thontract.Do6umbrits, including the.reqqirement reqqiremen s ppec to fumish electronic Certified payroll.rdcdirds-dir6cilv to the Labor Commissioner (via the Division of Labor Standards Enforcement), ,and shall pay the general prevailing: rate of per', them wages - as dete milined by the Director of the b6b0ment of Industrial Relations. of the State of California. ARTICLE 6 — PAYMENT PROCEDURES The Contractor, shall submit Applications for. Payment-ifi: accordance: with the Standard Specifications as -amend . dd . by the Special Provisions. 'Apoli.catib ns for- Payment Will be processed by theCity.Engineer as provided in the Contract DobumentsL ARTICLE i — NOTICES Whenever any provision of the Cofitr act Documents requires the giving of a.written Notice. be , twe6n the parties, , s, it shall bp'deemed to have 6 been Validly given if delivered in person to the' individual or to a member of th6.firffi'6r to an:oAcer of the'dorporafliph for whom. it is - 0: 9 6 int6nd6d,.orif delivered at or sent by-'r!.?'giste-re�d.-or.de.rt'ifle-d mail, postage prepaid, t th last business address known to the giver of -the Notice.' ARTICLE 8'—'INDEMNIFICATION The Cont : ractor a I geees I to inderhhif 6' d ail of its officers and y and hold harmless thie'City, n agents from . any . demands, . s, I � or'of action, 'including *'relat6*d'e expenses, x Qsl ettomeys feet, . and,,dosis,'based on, arising.,qut'of, or. in: any w&y'r-piated to the Work undertaken . by the` Contractor Hereunder, This Article 8 incorpo I rates the provisions . of Section 7 15 ulndemnification,'� of the,Sp6l6iiil Provisions, Which are hereby referenced and made de a par t hereof. - Prevailing Wades. Contractor agr ees to f6ily Comply With all applicable f6deral and state labor laws -including; without limitation California Labor Code Section 1720, et seq. and 17 , 70, et seq".; as well as Californi - a Code of -Regulations, . Title 8,:Sectio6 16000.,'etsdq.. ("Pre'vaii1figNage Laws"), Contractor shall bbar'611 risks of payment or non-payment of prevailing wages I under California ldw, 'and Contractor' hereby agrees to defend, indemnify, and hold t . he City; officials;:6ffi6eri;employees; agehts and volunteers, free 2020 SLURRY SEAL AGREEMENT FORM bITY PROJECT NO. 19-02 • AGREEMENT AND BONDSPAGE3 NOVEMBER 2019 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 perfomiance. urider'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 Citys lawfulcapacityto enterthis 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;'Yecruitinent'or recruitment advertising; layoff.or:termination; rates of. pay or other forms of'compensation;' and selection for. training, including .apprenticeship; and further, that 1.Contractor is in .full compliance with'the provisions of Palm Springs . Municipal Code Section 7.b9.o4o, 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 aghts;under or interests_ in. the Contract Documents will be binding on another party hereto without the.writteri consent of the party sought to be bound; and specifically, but without.limitatibn, monies that may 'become due and monies that'are due may not'be'assigned Without such consenf(except, to the eixt6rifthat the effect of this restriction may 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 anyduty 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 coveriants, agreements; and;obligations contained in the Contract. Documents. SIGNATURES ON NEXT PAGE 2020 SLURRY SEAL , .. AGREEMENT FORM CITY,P,ROJECT NO, 19-02 AGREEMENT -AND BONDS - PAGE 4 NOVEMBER 2019- - 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 APPROVED BY THE CITY COUNCIL: Date r -G 211 By David H. Ready City Manager Agreement No. ATTEST: By Anthony is C ty Clerk APPROVED AS TO FORM: BQ .4U �3.� J ffrey S - allinger, City Attorney RECOMMENDED: By Marcus L. Fuller, P.E., P.L.S. Assistant City Manager/City Engineer APPROVED BY CITY COUNCIL 2020 SLURRY SEAL AGREEMENT FORM CITY PROJECT NO. 19-02 AGREEMENT AND BONDS - PAGE 5 NOVEMBER 2019 ANT 1 r ' 3 ' tYt Arm . - r .y Y -, +'.. .. � ,, . , her ,i". •i t +,' Apm t OV ml 1 jot CONTRACTOR By: Pavement Coatings Co. a California corporation LZBy: _ Signature (notarized) By: Signature (notarized) Name: Doug Ford Name: Tom Mucenski President Title: Secretary 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. Agreement must be signed in the above by one having authority to bind the actor to the terms of the Agreement.) of 1 y of )SS before personally peared who proved o me on the basis of satisfactory evidenceto be he person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to a that he/she/they executed the same in his/her/th 'r authorized capacity(ies), and that by his/her/their ' natures(s) on the instrument the person(s), or the a tity upon behalf of which the person(s) acted, execi]l(ed the instrument. I certify under PENALTYPERJURY under the laws of the State of Calif is that the foregoing paragraph is true and come . WITNESS my hand and Notary Signature: Notary Seal: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 1is Agreement must be signed in the above space one having authority to bind the Contractor to the ms of the Agreement.) Of 1 :y of )SS before\acted personeared who adto me on the basis of satisfactory evidee the person(s) whose name(s) is/are subscto the within instrument and acknod to me that he/she/they executed the sameer/their authorized capacity(ies), and that btheir signatures(s) on the instrument the pe, r the entity upon behalf of which the persoed executed the instrument. I certify under PE�TY OF PERJURY under the laws of the State California that the foregoing paragraph is true an correct. WITNESS my hand and\official seal. Notary Signature: Notary Seal: AGREEMENTFORM AGREEMENT AND BONDS - PAGE 6 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 sir.�c.�rcewrs�e�e�rccarrrcc�.cwrnncr.�sccKxcces:c��.nerccccc�rescs.�ccr,.:r<:ece�cce�ccx�su 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 Califomia County of Riverside On _ March 4 2020 before me, Melissa Renee Ailshie, Notary Public Date Here Insert Name and Title of the Officer personally appeared Doug Ford Name($) of Signer($) who proved to me on the basis of satisfactory evidence to be the person(b) whose name(A) is/dre subscribed to the within instrument and acknowledged to me that he/she/thley executed the same in his/hbr/thbir authorized capacity(i@s), and that by his/hkr/tftbir signature(i) on the instrument the person(d), or the entity upon behalf of which the person(b) 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. y�I _. MEtagPu ic-CI ", Signature G `u"is. Notary PohGc-CaNade � RversldeCounry i Signature of Notary Public Commission A 22291911 My Comm EX0f0 Jan 28.2W 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: Agreement (Construction Contract) Document Date: 03/04/2020 Number of Pages: t 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 or Conservator Other: _ Signer Is Representing: Signer's Name: Corporate Officer — Title(s): Partner — Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 :rA.rA ��..rcrcncc�csstxc�crr�^-,.•,-•� —-,crescsccc.,c.�ssscc6rcc.�s�-- .ctFx�.r.cr ,-_••M,..•••••�„^. 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 Riverside On _ March 4, 2020 before me, Melissa Renee Ailshie, Notary Public Date Here Insert Name and Title of the Officer personally appeared Tom Mucenski Name($) of Signer($) who proved to me on the basis of satisfactory evidence to be the person(k) whose name(A) is/Efre subscribed to the within instrument and acknowledged to me that he/stye/they executed the same in his/hbr/thbir authorized capacity(i6s), and that by his/hkr/thbir signature(i) on the instrument the person(E), or the entity upon behalf of which the person(t) 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. MELISSA RENEE AILSHIE WITNESS my hand and official seal. No Pot�c-Callorria i .} RiveZ11 County Commission%2229730 L Signature My Comm. Expims Jr 2e,2022 g "—Sing urge of NolkyPublic 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: Agreement (Construction Contract) Document Date: 03/04/2020 Number of Pages: f Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signers) Signer's Name: Corporate Officer — Title(s): Partner — 1 Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing Signer's Name: _ Corporate Officer — Title(s): Partner — Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 WORKER'S COMPENSATION CERTIFICATE (AS REQUIRED BY SECTION 1861 OF THE CALIFORNIA LABOR CODE) I am aware of the provisions of Section 3700 of the California Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self-insurance in accordance with the provisions of said Code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Contract avem nt Coatings Co. By -, Title Doug Ford, President 2020 SLURRY SEAL CITY PROJECT NO, 19-02 WORKER'S COMPENSATION CERTIFICATE NOVEMBER 2019 AGREEMENT AND BONDS - PAGE 7 'a Bond No.: 24243114 Premium: $9,088.00 PERFORMANCE BOND — PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor'), an agreement for the work described as follows: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 (hereinafter referred to as the "Public Work"); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract"), which Contract is incorporated herein by this reference; and WHEREAS, the Contractor is required by said Contract to perform the terms thereof, and to provide a bond both for the performance and guaranty thereof. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: The Ohio Casualty Insurance Company a corporation organized and existing under the laws of the State of New Hampshire , and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City In the SUM of one Million, Eight Hundred Thirty Thousand, Eight Hundred Seventy One Dollarsand Twenty Four Cents Dollars ($ 1,830,871.24 ), 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. 2020 SLURRY SEAL PERFORMANCE BOND CITY PROJECT NO. 19-02 AGREEMENT AND BONDS - PAGE B NOVEMBER2019 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 4th day of March 2020. CONTRACTOR: Pavement Coatings Co. Check one: individual, partnership, x corporation (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: By: Pavement in Co. signature (NOTARIZED) Print Name and Title: Douo Ford, President By: signature (NOTARIZED) Print Name and Title: Tom Mucenski, Secretary SURETY: By: The Ohio CasuaIt I surance Wompany 1 9 signa e (NOTARIZED) Print Name and Title: Richard L. Wells, Attorney -in -Fact 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. 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 PERFORMANCE BOND AGREEMENT AND BONDS - PAGE 9 PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ Tiered per thousand. The total amount of premium charged: $ 9,088.00 (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) The Ohio Casualty Insurance Company 625 Maple Avenue Keene, NH 03431 (Name and Address of Agent or Liberty Mutual Representative for service of process in California if 2710 Gateway Oaks Drive Suite 150N different from above) Sacramento, CA 95833 (Telephone Number of Surety and 866-547-9071 Agent or Representative for service of process in California) Attn: Karissa Lowry 2020 SLURRY SEAL PERFORMANCE BOND CITY PROJECT NO. 19-02 AGREEMENT AND BONDS - PAGE 10 NOVEMBER2019 PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of California County of Orange On March 4, 2020 before me, Sandy Staley, Notary Public Date Name, Title of Officer personally appeared Richard L. Wells 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 capacily(ies), and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. under PENALTY OF PERJURY under the laws of the State identified herein, that the foregoing paragraph is true and my .F".... E. 6810 zalifornia =NCotoaa otyMne 18, 202.^P ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could prevent fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages_ DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s) Other Than Named Above 2020 SLURRY SEAL PERFORMANCE BOND CITY PROJECT NO. 19-02 AGREEMENT AND BONDS- PAGE 11 NOVEMBER2019 This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Mutual. SURETY Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8201397 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Stale of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, all of the city of Placentia slate of CA each individually if there be more than one named, its true and lawful attomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this I Ith day of June , 2019 . PV INSU/y� P�ZY INSU � \NSUHq j °oN W�o1'cia vJ3°o�o��Fogyn ¢��3oo�o�roym bHy1912a � o �_ 1919 � � 1991 3 r 4 cA � Z P� O G O .� ApNUS" da ONAMPS�dL rs �NplPar' da of PENNSYLVANIA ss Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company c On this I10t day of June 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o Company, —The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes —� therein contained by signing on behalf of the Corporations by himself as a duly authorized officer. u w IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. yp PASl 0� 45oaw P� COMMONWEALTH OF PENNSVLVANIA n �4/ titr `sus y G NOrIal Seal OF Teresa PNotaNotary PubOc Upper Merion Twp., Mcataomery Count' By: 2 v>`fP6 My commission Expires Me" 29.2021 Teresa Pastella, Notary Public gAFiv .t.) Member, Penns}1vania Assodadoa N NONnes This Power of Attorney is made and executed pursuant to and by authority of the fallowing By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV— OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys4n-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such affomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney, shag have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys-m- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous Consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same farce and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, We and correct Copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 4d1 day of March , 2020 . �Yl rMBUq� P 1NSUq� (040(9 0J ooMoWr `p2 4P coWo2ar 'tC+ ��e3 "o m ¢-3 Fo ca - 0 1919 1991 ffp�Gy` 4 Coo a o _° 0"an:es'"P a� rs xouar• da By. Renee C. Llewellyn, Assistant '\H! „ 1-e>d ''M : F� Y , Secretary LMS-12873 LMIC OCIC WAIC Multi Co 062018 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 .��^Gfxce,ecess('.c.ec.r,.rc:c,GcrsGscccseEcrcresacscrcC.crc:c:eres�f�P.ce - - - - - 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 Riverside ) On March 4, 2020 before me, Melissa Renee Ailshie, Notary Public Date Here Insert Name and Title of the Officer personally appeared Doug Ford Name($) of Signer(G) who proved to me on the basis of satisfactory evidence to be the persona) whose name($) is/dre subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/hbr/thbir authorized capacity(iEs), and that by his/hbr/tttbir signature(i) on the instrument the person(i), or the entity upon behalf of which the person(6) acted, executed the instrument. MELISSA RENEE AILSNIE� Notary Public- California Rwmde County Commission 0 2229730 My Comm. Expires Jan 28, n22 Place Notary Seal 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 Signature of Votary Public 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: Performance Bond Document Date: 03/04/2020 Number of Pages: 1 Signer(s) Other Than Named Above: Capacity(fes) Claimed by Signer(s) Signer's Name: Corporate Officer — Title(s): _ Partner — " Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other: _ Signer Is Representing Signer's Name: Corporate Officer — Title(s): Partner — Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other Signer Is Representing: ---- ^szvr,�au�c^�c^rc.^szsesz+zcs�R 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item N5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 snAcecelrr.LrceszCcr.LC.cccsesc�`dsercreceP.cS,cresaGCC,ce,•,•,.•^••••••••• 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 Riverside ) On March 4, 2020 before me, Date personally appeared Melissa Renee Ailshie. Notary Public Here Insert Name and Title of the Officer Tom Mucenski Name(t) of Signer(;) who proved to me on the basis of satisfactory evidence to be the person(A) whose name(i) is/dre subscribed to the within instrument and acknowledged to me that he/she/tNey executed the same in his/hbr/thUr authorized capacity(iEs), and that by his/hbr/thkir signature(i) on the instrument the person(i), or the entity upon behalf of which the person(5) acted, executed the instrument. MELISSA RENEE AILSRIE Noun Public -Caltlama , y.ypr In - Riverside County S Commission p 2229M My Comm. Expires Jan 28, 2022 Place Notary Seal 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 Signature of Notary Flublic 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: Performance Bond Document Date: 03/04/2020 Number of Pages: 1 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 or Conservator Other: Signer Is Representing: 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.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907 Bond No.: 24243114 Premium: Included in Performance Bond PAYMENT BOND — PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 (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: The Ohio Casualty Insurance Company , a corporation organized and existing under the laws of the State of New Hampshire , 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 One Million, Eight Hundred Thirty Thousand, Eight Hundred Seventy One Dollars and Twenty Four Cents Dollars ($ 1,830,871.24 ), 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. 2020 SLURRY SEAL PAYMENT BOND CITY PROJECT NO. 19-02 AGREEMENT AND BONDS - PAGE 12 NOVEMBER2019 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 ath day of March , 2p20. CONTRACTOR: Pavement Coatings Co. Check one: _ individual, _ partnership, X corporation (This Payment Bond must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Payment Bond.) EXECUTED FOR THE CONTRACTOR: By: Paveme atings Co. signat e (NOTARIZED) Print Name and Title: Doug Ford, President By: signature (NOTARIZED) Print Name and Title: Tom Mucenski, Secretary EXECUTED FOR THE SURETY: By: The Ohio ssalty InsuA nce®�Commppany s gnature (NOTARIZED) Print Name and Title: Richard L. Wells, Attorney -in -Fact 2020 SLURRY SEAL PAYMENT BOND CITY PROJECT NO. 19-02 AGREEMENT AND BONDS - PAGE 13 NOVEMBER 2019 PAYMENT BOND — PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ Tiered per thousand. The total amount of premium charged: $ Included in 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) The Ohio Casualty Insurance Company 625 Maple Avenue Keene, NH 03431 (Name and Address of Agent or Liberty Mutual Representative for service of process in California if 2710 Gateway Oaks Drive Suite 150N different from above) Sacramento, CA 95833 (Telephone Number of Surety and 866-547-9071 Agent or Representative for service of process in California) Attn: Karissa Lowry 2020 SLURRY SEAL CITY PROJECT NO. 19-02 PAYMENT BOND NOVEMBER 2019 AGREEMENT AND BONDS - PAGE 14 PAYMENT BOND — PUBLIC WORKS (CONTINUED) ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of California County of Orange On March 4, 2020 before me, Sandy Staley, Notary Public Date Name, Title of Officer personally appeared Richard L. Wells 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 signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State identified herein, that the foregoing paragraph is true and correct. LSANDY STALEY COMM.42246810 z Nolary Public -California o Orange County My Comm. Expires June 18, 2022 ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could prevent fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages _ DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s) Other Than Named Above 2020 SLURRY SEAL WARRANTY BOND CITY PROJECT NO. 19-02 AGREEMENT AND BONDS -PAGE 15 NOVEMBER 2019 This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein staled. QLiberty Mutual° SURETY Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8201397 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Slate of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the'Companies'), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, all of the city of Placentia stale of CA each Individually It mere be more man one names, Its true ana lawtlll anomey-m-tact to maze, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this IIth day of June , 2019 . liberty Mutual Insurance Company P\, \Nsup4 P\-tY INSU \NsuHq The Ohio Casualty Insurance Company ooNPOr+nr�ym v ooN°ORar� y° oP°oNpOl+sr y° West American Insurance Company 1912 ° 1919 f 1991 ° BY: rd 9�s+°NN50�D ZO �r-/r4MY5H aaY� rs �H°IPNP dD pp% 2s%�2 dHir �� "�Hl ti0 H41 : t`N ❑avidM f`.arav Ascislanl FFrretary State of PENNSYLVANIA SS County of MONTGOMERY On this llth dayof June 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the Corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. PA �gP°Mw SrF COMMONWEALTH OF PENNBYLVANV\ �WQ oN'o^y`v Nogrlal Seal OF Teresala,Notary/Y Upper Merion Twp.Twp., Montgomery Caunry By: YPsy.P4 My Commission E+pims Mar 2e,2021 Teresa Pastella, Notary Public �q�' �gv Member, PenmsyNanu0.cnta4on of Noraric This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV— OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such altomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative a attomey4n-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE All — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizanoes and other surety obligations. Such altomeys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoinlsuch attomeysin- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surely any and all undertakings, bonds, reoognaances and other surety obligations. Authorization — By unanimous Consent of the Companys Board of Directors, the Company Consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified Copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, We and Correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 4th day of March 2020 . V INSU By: . a Renee �C� . Llewellyn, Assistant Secretary Secretary WS-12873 LMIC OCIC WAIC Muni Co 062018 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 .r,.r2:c..r.�ccres�ser,�.rcoc:c.�cc:ncxcc,�.c.. �<.ruressxcccsccctta'cns:c�-:cuszc - - 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 Riverside ) On March 4, 2020 before me, Melissa Renee Ailshie, Notary Public Date Here Insert Name and Title of the Officer personally appeared Doug Ford Name($) of Signer(G) who proved to me on the basis of satisfactory evidence to be the person(k) whose name(!;) is/afre subscribed to the within instrument and acknowledged to me that he/site/they executed the same in his/hbr/ttlkir authorized capacity(i@s), and that by his/hkr/thkir signature(t) on the instrument the person(i), or the entity upon behalf of which the person(g) acted, executed the instrument. MRISSA RENEEAILSHIE Notary Pubic - Caloorrvy I l Riverside County commission 0 2229730 My comm, Erpirea Jan 28, 2022 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature J /" Lo%%,—r: Signature of Notary Plublic Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: payment Bond Document Date: 03/04/2020 Number of Pages: t Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Corporate Officer — Title(s): Partner — Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: Signer's Name: Corporate Officer — Title(s): _ Partner — Limited General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 y',rc.�:�..rcrcc�cGrs:.ccrcccrc:c.creccccrcrccu-cer�scs�csr - A notary public or other officer completing this certificate verifies only the identity of hdividual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Riverside On March 4, 2020 before me, Date personalty appeared Melissa Renee Ailshie. Notary Public Here Insert Name and Title of the Officer Tom Mucenski Name(#) of Signer($) who proved to me on the basis of satisfactory evidence to be the person(A) whose name(9) is/dre subscribed to the within instrument and acknowledged to me that he/she/tNey, executed the same in his/hbr/thtir authorized capacity(iks), and that by his/hibr/thbir signature(t) on the instrument the person(i), or the entity upon behalf of which the person(A) acted, executed the instrument. MELISSA RENEE AILSHIE Notary Public - Cellorma Riverside Count +� Commission 022297M My Comm. Expires Jan 28, 2022 Place Notary Seal 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 Signature of Notary Public 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: payment Bond Document Date: 03/04/2020 Number of Pages: f Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Corporate Officer — Title(s): Partner — Limited IGeneral Individual Attorney in Fact Trustee Guardian or Conservator Other, Signer Is Representing: Signer's Name: Corporate Officer — Title(s): Partner — Limited _1 General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: 02014 National Notary Association • www.Nationa[Notary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 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 Schedule 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. 2020 SLURRY SEAL CITY PROJECT NO. 19-02 COVER SHEET NOVEMBER 2019 BID FORMS -PAGE 1 BID PROPOSAL BID TO: CITY OF PALM SPRINGS, CALIFORNIA The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with the City in the form included in the Contract Documents (as defined in Article 4 of the Agreement) to perform the Work as specified or indicated in said Contract Documents entitled: 2020 SLURRY SEAL CITY PROJECT NO.19-02 Bidder accepts all of the terms and conditions of the Contract Documents, including without limitation those in the Notice Inviting Bids and the Instructions to Bidders dealing with the disposition of the Bid Security. This Bid will remain open for the period stated in the Notice Inviting Bids, unless otherwise required by law. Bidder will enter into an Agreement within the time and in the manner required in the Instructions to Bidders, and will furnish the insurance certificates, Payment Bond, Performance Bond, and all Permits required by the Contract Documents. Bidder has examined copies of all the Contract Documents, including the following Addenda (receipt of which is hereby acknowledged): Number N0nG Date Number Date Number Date Number Date Number Date Number Date Number Date Bidder has familiarized itself with the nature and extent of the Contract Documents, the Work, the site, the locality where the Work is to be performed, the legal requirements (federal, state, and local laws, ordinances, rules, and regulations), and the conditions affecting cost, progress, or performance of the Work, and has made such independent investigations as Bidder deems necessary. 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 BID PROPOSAL 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: i % -Z�Z"-) Bidder: Pavement Coatings Co. By: (Signature) Title: Doug Ford- President 2020 SLURRY SEAL BID PROPOSAL CITY PROJECT NO. 19-02 BID FORMS - PAGE 3 NOVEMBER 2019 THIS PAGE HAS INTENTIONALLY BEEN LEFT BLANK BASE LUMP SUM BID SCHEDULE NOT UTILIZED 2020 SLURRY SEAL CITY PROJECT NO. 19-02 BASE LUMP SUM BID SCHEDULE NOVEMBER 2019 BID FORMS - PAGE 4 BID SCHEDULE A Schedule of Prices for Construction of the: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 Item Description Estimated Unit Unit Amount No. Quantity Price 1. Mobilization - - - LS $ 2�po 00 . co 2. Temporary Traffic Control --- LS $ W' 000 .00 3. Water Pollution Control --- LS $ 5iD00 . o 0 4 Uniform Micro-Milling''/4" of Existing Asphalt Concrete Pavement 3,377,620 SF $D I I $ Crack -sealing and crack -filling, construction of Rubber Polymer 5. Modified Slurry (RPMS), 15 to 18 3,377,620 SF pounds per square yard, pneumatic rolling, and all appurtenant work. I $ o. Crack -sealing and crack -filling, construction of Rubber Polymer 6. Modified Slurry (RPMS), 12 to 15 573,331 SF pounds per square yard, pneumatic a- 31 rolling, and all appurtenant work. $ $ Removal of all existing traffic striping and pavement markings; installation of 7. new thermoplastic traffic striping; - - - LS installation of thermoplastic pavement �� markings and pavement markers $ i 8. Caltrans Double Permit --- AL $5,000.00 9. Field Orders --- AL $40,000.00 TOTAL OF ALL ITEMS OF THE BID SCHEDULE: $ l 93O.,k71.2y (Price in figures) one M;Ifioln 61, aw+hkKA-d thir+r f-cLows0_Ka/ e' is kmdr.'l 5'-K4ni� O z (Price in words) Gta �yTvkr ccw�-s. QUANTITIES OF WORK: The quantities of work or material stated in the unit price items of the Bid Schedule are supplied only to give an indication of the general scope of the Work. The City does not expressly nor by implication agree that the actual amounts of work or material will correspond therewith, and reserves the right after award to increase or decrease the quantity of any unit price bid item, by an amount up to 25 2020 SLURRY SEAL CITY PROJECT NO. 19-02 May 2019 DEDUCTIVE LUMP SUM BID SCHEDULE NO. 5 BID FORMS - PAGE 5 M M• yv percent of increase or decrease, without a change in the unit prices, and shall have the right to delete any bid item in its entirety, and receive full credit in the amount shown in the Bid Schedule for the deleted item of Work. SPECIAL NOTE: In the event of any "missing" bid items or scope of work not otherwise included or identified in the Bid Schedule, but indicated or required by the Plans and Specifications, the Contractor shall prosecute the work as required by the Plans and Specifications, and payment for any "missing" bid items or scope of work shall be included in the various bid items of work, and no additional payment will be allowed therefore. Pavement Coatings Co. Name of Bidder or Firm 2020 SLURRY SEAL CITY PROJECT NO. 19-02 May 2019 DEDUCTIVE LUMP SUM BID SCHEDULE NO. 5 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 9- 1 . Name of Prime Contractor: Pavement Coatings Co. 2. Bid Items / Portion of Work to be Self -Performed (if less than 100% of the contract): -0 1 % MOBIL- 17.AT1oJ j 1: TEMPV"e-Y T/24fGt'IG "147r-V- P0077o1/ OF C�04Z201L_# . w4-clev- P.. Ortc• j 3t d.: M(C_4D - M1r L, F4 G ; 5 1�T2feee�--�F' WVHS pjg;rklJ o�Lj i o ( (LAMS (1JQl(tM1 ONLJ� 3. Dollar Amount of Work Self- 4. Percentage of Work Self- 5. Date: Performed: Performed: 9. Z 7o I 17�?A It y3 )172ti.zy 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) ZFirst Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: A) I AN d rf CzLiv\ As t1a. t 3. Address: 1 q00 E. 6 1 5+. eoronoL,, CA `1Z97 4. Bid Items/Portion of Work: 5 3 6 CraGk42 Il -v i+kASPkoH- ( Porftovt 04) 5. Phone No.: Contractors License No.: 7. Annual Gross Receipts: �51-736-7600 067073 0<$1M 11<$5M ❑<$10M ❑ < $15M ltd > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor 3% o o o. o o Registration No: lO000D 1OS 10. Percentage of Contracted Work: 2.1 % No 11. DBE Firm? ❑ YesIVIA 12. DBE Certification No.: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 LIST OF SUBCONRACTORS NOVEMBER 2019 BID FORMS - PAGE 7 BIDDER'S LIST OF SUBCONTRACTORS - (Continued) Copy this page as needed to provide a complete listing. Page %i of 1. Type of Subcontractor (Check One) First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: - 5 WC I Vic. 3. Address: ? () Lj 0 E• S+c>;I ( co %ov l CA 9133 Z4-% 4. Bid Items/Portion ofWor 7 c�}riPi'tt�l/✓IGrf��n`�� /vlolrfGGrsv Ycrtvva.l i n5i-a.11 -Fio 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 909-FS8Ll-717o 6953,57 0<$1M 0<$5M 0<$10M ❑<$15M &K>$15M 8. Amount of Contracted Work: 1 g31 0 30 . o o 9. DIR Public Works Contractor Registration No:I00000 I100 10. Percentage of Contracted Work: 11 DBE Firm? ❑Yes �o 12. DBE Certification No.: 10 1. Type of Subcontractor (Check One) P/Mrst Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) / 2. Subcontractor Name: 121ntij%Grl GY�G f< �t I�Cr S c� �kYIT I ✓\G. 3. Address, JFw� 1111A+ avc. F+ 117�40n,, CA clzx31 4. Bid Items/Portion of Work: Por-ho�L o� �5 (� C►'rv;fc szc.! t'n� 5. Phone No.: 6. Contractor's License No.: 7. Annual Grosss eceipts: 71�1-81-f3 51gZ 9`9977 0<$1M Iid'<$5M 0<$10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: z)6 11�-00 9. DIR Public Works Contractor Registration No: 6X0/07Z& 10. Percentage of Contracted Work: 11. DBE Firm? ❑Yes l�lo 12. DBE Certification No.: l n / 114 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: 0<$1M ❑<$5M 0<$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.: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 LIST OF SUBCONRACTORS NOVEMBER 2019 BID FORMS - PAGE 8 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS CITY PROJECT NO. 19-02 Bid Opening Date 1-9-2020 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: Local firms that will furnish materials or supplies to the Bidder for this project: Coachella Valley Aggregates 88120 Fargo Canyon Road Indio, CA 92203 760-342-8704 2020 SLURRY SEAL LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 19-02 GOOD FAITH EFFORTS NOVEMBER 2019 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 The Weekly Bid Flash January 6, 2020 * Publishing affidavits attached to this proposal* 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 Coachella Valley Aggregates 1/6/2020 Phone Call: Spoke to Jeri to request materials. * Note- There are no subcontractors within the Coachella Valley to provide construction with the scope of work for this contract. There are copies of ads that were sent on January 6 via weekly bid flash. 2020 SLURRY SEAL LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 19-02 GOOD FAITH EFFORTS NOVEMBER 2019 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 Normally Performs Item Breakdown of Items Amount Percentage M Of Contract ,54wlier&f Slum Sedl AJ PDrft n of )MnOs SEG 36,709-oo Z A4Are4 04es 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 bidde ' ecticq of the local firms: � 39 M,nrn S+. N Names, addresses and phone numbers of firms selected for the work above: Coachella Valley Aggregates- 88120 Fargo Canyon Rd. Indio, CA - Phone No: 760-342-8704 Coachella Valley Aggregates are a material supplier to provide type II slurry aggregate. NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 LOCAL BUSINESS PREFERENCE PROGRAM GOOD FAITH EFFORTS BID FORMS - PAGE 11 Corbin Pierce From: The Weekly Bid Flash <support@theweeklybidflash.com> Sent: Monday, January 6, 2020 8:31 AM To: Corbin Pierce Subject: Weekly Bid Flash DBE Ad Affidavit - 2020 Slurry Seal City Project No. 19-02 Proof of Publishing Affidavit To Whom It May Concern Be it known that this is a swom affidavit that Pavement Coatings Co. did place an advertisement we published on 102020 in our nationwide publication, The Weekly Bid Flash, seeking Certified Disadvantaged subcontractors and/or material suppliers for the project 2020 Slurry Seal City Project No. 19-02 . A copy of the advertisement is below: Date Of Advertisement Pavement Coatings Co. An Equal Opportunity Employer, is requesting quotations from all qualified LBE sub -contractors and material suppliers for the following project: 2020 Slurry Seal City Project No. 19-02 City/Location: Palm Springs County: Riverside Owner: Palm Springs Public Works Bid Date: Thursday 1/9/2020 at 3:00 PM We are requesting bids for the following trades and/or supplies: Pavement Coatings is looking for qualified local business enterprises in the Coachella Valley region. We are looking to receive quotes on the following categories of work SWPPP, Aggregate Hauling, Emulsion Hauling, Striping, crack sealing, and asphalt crack filling. NAICS Classifications Sector 23—Construction . Highway, Street, and Bridge Construction CSI Classifications DIVISION 1 - GENERAL DIVISION 2 - SITE WORK . TRANSPORTATION/FREIGHT. ASPHALT CONCRETE PAVEMENT AND BASE . TRUCKS — DUMP[TRAILERS . ASPHALT PAVING . PAVEMENT MARKING . PAVING/SURFACING Bid documents can be viewed at or obtained from: For plans and specs please contact Corbin Pierce at Cpierce@pavementrecycling.com or call 714-826-3011 Ext. 2260 All "Union" subcontractors to maintain insurance, licenses, and bonding throughout the duration of this project. If there is any assistance needed in order to participate in this contract, please contact Pavement Coatings Co. estimating department using the information attached. Pavement Coatings Co. 10240 San Sevaine Way Jurupa Valley, CA 91752 Corbin Pierce cpierce@pavementrecycling.com Published on 1/6/2020 by The Weekly Bid Flash a Trade and Focus Publication located at www.theweeklybidflash.com Phone:1.800.479.5314 Fax:1.619.688.0586 This solicitation Ad will run until the bid date Our publication is a listed approved source by the State of CA , Dept. of General Services, Office of Small Business Certification & Resources, in its Resource Packet. Since, 1989 our fine has been proud to help businesses reach Certified Disadvantaged firms statewide. If you should need any further information, please do not hesitate to contact us at 800-479-5314. Thank you again! Construction Bidboard Inc. 11622 El Camino Real, Suite 100 San Diego, CA 92130 www.theweeldybidflash.com 800-479-5314 NON -COLLUSION DECLARATION The undersigned declares: I am the President of Pavement Coatings Co. the (Title of Officer) (Firm/Company) party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full 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 / - b - Zs�Z4n�, , at Jurupa Valley CA (Date) (City) (State) Signature Doug Ford- President 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 NON -COLLUSION DECLARATION BID FORMS - PAGE 12 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 :r,csaszr�.r.Lrcc�r�,�szr..xcrxsccc:�:rescrcrs.r�.rzrsx�rur�e.exzN;�cux.�raxeu�sscsct.cc,�.rcccrcesa See Attached Document (Notary to cross out lines 1-6 below) See Statement Below (Lines 1-6 to be completed only by document signerfs), not Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 Riverside JULIA R. VALENZUELAA Notary Public - California RNerside County Commission 9 My comet. Expires Nav 5.20Tt Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 6th day of January 20 2. by Date Month Year (1) Doug Ford (and Name(o of Signer(s) proved to me on the basis of satisfactory evidence to be the person(i) who appeared before me. Signature AjLL(iuurl4k_ Signature of N tary Public 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: Non crnu�wn araOoo-Qy of Palm spmgs Document Date: lanuary@h, 2020 Number of Pages: — Signer(s) Other Than Named Above: 02014 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910 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. 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. To take affirmative steps to hire minority employees within the company. Pavement Coatings Co. NAME OF PERSON SIGNI TITLE OF PERSON SIGNING DATE I G - 2t' Ford President Please include any additional information available regarding equal opportunity employment programs now in effect within your company. Pavement Coatings Co. is a equal opportunity employer. All services and subcontractors are welcome to participate in the Pavement Coatings contracts Further information can be given at request. 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NON-DISCRIMINATION CERTIFICATION NOVEMBER 2019 BID FORMS -PAGE 13 EQUAL EMPLOYMENT OPPORTUNITY POLICY PRS Holdings, Inc., and all subsidiaries (herein referred to as the "Company") is an equal opportunity employer and makes employment decisions on the basis of merit, qualifications, abilities, and business needs. The Company does not unlawfully discriminate in employment opportunities or practices on the basis of race, color, religion, creed, religious dress or grooming practices, gender, sex, gender identity, gender expression, sexual orientation, marital/domestic partner status, national origin, citizenship, ancestry (including language use and protected use of driver's licenses granted under the California Vehicle Code), age, mental or physical disability, pregnancy, childbirth, breastfeeding (including related medical conditions to pregnancy, childbirth or breastfeeding), military or veteran status, medical condition, including cancer and genetic information or characteristics (or those of a family member), status as a victim of domestic violence, sexual assault, stalking, use of any legally protected leave, or any other characteristics protected under federal or State law or local ordinance. This policy governs all aspects of employment at the Company, including but not limited to hiring, assignments, training, promotions, compensation, employee benefits, employee discipline and discharge. The Company also prohibits discrimination based on the perception that anyone has any of the aforementioned characteristics or is associated with a person who has or is perceived as having any of those characteristics. This commitment applies to all persons involved in the operations of the Company and prohibits unlawful discrimination by any employee of the Company, including supervisors and coworkers. The Company will not discriminate against or allow harassment of any employee, applicant, unpaid intern, or volunteer for associating with individuals in a protected category or because the employee sympathizes with, encourages, or participates in groups organized for the protection or assertion of rights related to a protected category. In addition, the Company prohibits the harassment of any individual on any of the basis listed above. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitation of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship would result, and would enable the individual to apply for, or perform the essential functions of, the position in question. This policy governs all aspects of employment, including selection, job assignment, compensation, discipline, termination, and access to benefits and training. The Company will also endeavor to reasonably accommodate the religious beliefs of our employees to the extent such accommodation does not pose an undue hardship on the operation of its business. If an employee believes he/she needs an accommodation to perform the job duties because of a religious belief, the employee should submit a written request to Human Resources. Employees with questions or concerns about discrimination in the workplace are encouraged to bring these issues to the attention of their supervisor and Human Resources. Employees can raise concerns and make reports without fear of reprisal. The Company's anti -retaliation policy also prohibits retaliation against any individual who requests an accommodation for his or her disability or religious belief, regardless of whether the accommodation was granted. It is the obligation of every employee to comply with this policy. Anyone found to be engaging in Rev.04/30/2019 unlawful discrimination will be subject to disciplinary action, up to and including termination of employment. The Company will take appropriate corrective action up to and including formal discipline against any employee when an investigation has found that misconduct has occurred. Employees and applicants may file formal complaints with the appropriate agency listed below. Individuals who wish to pursue filing with these agencies should contact them directly to obtain further information about their processes and time limits. U.S. Equal Employment Opportunity Commission 450 Golden Gate Avenue 5 West P.O Box 36025 San Francisco, CA 94102-3661 1-800-669-4000 or 510-735-8909 (Deaf/hard-of-hearing callers only) http://www.eeoc.gov/employees California Department of Fair Employment and Housing 2218 Kausen Drive, Suite 100 Elk Grove, CA 95758 800-884-1684 (voice), 800-700-2320 (TTY) or California's Relay Service at 711 contact.center@dfeh.ca.gov https://www.dfeh.ca.gov Arizona Governor's Office of Equal Opportunity 100 North Fifteenth Avenue, Suite 401 Phoenix, Arizona 85007 1-602-542-3711 equalopportunity@az.gov https:Heo.azgovernor.gov Nevada Equal Rights Commission http://www.nvdetr.org Southern Office 1820 East Sahara Avenue, Suite 314 Las Vegas, Nevada 89104 (702)486-7161 Northern Office 1674 East Prater Way, Suite 103 Sparks, Nevada 89434 (775)688-1292 Rev.04/30/2019 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: Pavement Coatings Co. 10240 San Sevaine Way Jurupa Valley, CA 91752 Telephone Number: ( 714) 826-3011 Facsimile Number: ( 714 ) 826-3129 E-Mail: Dford@pavementrecycling.com Tax Identification Number: 952916670 2. TYPE OF FIRM Individual Partnership X Corporation (State CA ) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Disadvantaged Business (SDB) Veteran Owned Business Disabled Veteran Owned Business 3. CONTRACTOR'S LICENSE: Primary Classification Class A State License Number(s) 303609 Supplemental License Classifications C-32 4. BUSINESS LICENSE: Yes No No License No.: N/A 5. Surety Company and Agent who will provide the required Bonds: Name of Surety The Ohio Casualty Insurance Company Address 790 The City Drive South , Suite 200 Orange, CA 92868 Surety Company Adamson and McGoldrick Telephone Numbers: Agent(714) 257-9644 Surety(714 ) 634-3311 2020 SLURRY SEAL BIDDER'S GENERAL INFORMATION CITY PROJECT NO. 19-02 BID FORMS - PAGE 18 NOVEMBER 2019 1.1 7 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). Doug Ford ItT1 LTJIRMM, M Nathan Beyler President Secretary Treasurer Number of years experience as a contractor in this specific type of construction work: _ 45 8. List at least three related projects completed to date: a. Owner County of Riverside Address 4080 Lemon St. 8th Floor, Riverside, CA 92501 Contact Hector Davilla Class of Work Slurry Seal, Microsurfacing, and Chip Seal Phone 951-955-6740 Contract Amount $2,022,613 Slurry Seal Project FY 19/20 Project, Districts 4 and 5 Date Completed 6/30/19 Contact Person Hector Davilla Telephone number 951-955-6740 b. Owner Caltrans Address 73-800 Dinah Shore Dr. Suite 104 Palm Desert, CA 92211 Contact Chigo Dike Class of Work Type II Slurry Seal Phone 951-232-8642 Contract Amount $ 2,698,821 ou a 62 and Z41 ban ProjectBernardino County Date Completed 1o/31/18 Contact Person Chigo Dike Telephone number 951-232-8642 C. Owner City of Camarillo Address 601 Carmen Dr. Camarillo, CA 93010 Contact Thang Tran Class of Work Type II Slurry Seal Phone 805-388-5345 Contract Amount $1,954.954 ST 5012 Annual Slurry Seal Project Program Date Completed 8/28/17 Contact Person Thang Tran Telephone number 805-388-5345 9. Name of Project Manager/Superintendent: Tom Mucenski/ Project Manager 10. Name(s) of person(s) who inspected job site: James Wu- Estimator 2020 SLURRY SEAL BIDDER'S GENERAL INFORMATION CITY PROJECT NO. 19-02 BID FORMS - PAGE 19 NOVEMBER 2019 PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM 1. Name of Entity Pavement Coatings Co. 2. Address of Entity (Principle Place of Business) 10240 San Sevaine Way Jurupa Valley, CA 91752 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? 0 Yes 0 No 5. Type of Entity X Corporation 0 Limited Liability Company D Partnership 0 Trust 0 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 otherfiduciaries forthe member, manager, trust or otherentity Doug Ford- President X Officer 0 Director 0 Member 0 Manager [name] ❑ General Partner D Limited Partner ❑ Other Tom Mucenski- Secretary IX Officer 0 Director 0 Member 0 Manager [name] ❑ General Partner 0 Limited Partner ❑ Other Nathan Beyler-Treasurer 9 Officer ❑ Director 0 Member 0 Manager [name] ❑ General Partner 0 Limited Partner ❑ Other 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 CITY OF PALM SPRINGS— PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 1 of 2 AGREEMENTFORM AGREEMENT AND BONDS - PAGE 1 7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity A. None None [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP A, EXPLANATION OF THE RELATIONSHIP: B. None None [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP B, EXPLANATION OF THE RELATIONSHIP: C. None None [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP C, EXPLANATION OF THE RELATIONSHIP: I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Disclosing Party, Printed Name, Title Date Doug Ford- Presid — 2c-- CITY OF PALM SPRINGS —PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 2 of 2 2020 SLURRY SEAL AGREEMENTFORM CITY PROJECT NO. 19-02 AGREEMENT AND BONDS — PAGE 2 NOVEMBER 2019 - R 6 GRAMTE 1111111 11111 A January 9th, 2020 TO: Pavement Coatings Co SCOPE OF WORK: 38000 Monroe Street 1 Indio, CA 92203 P 760.775.7500 1 F 760.775.8227 REFERENCE: Palm Springs 2020 Slurry Seal Project #19-02 We are pleased to provide you with the following proposal to perform the delineated sitework improvements for the referenced project. We have based this proposal upon the phone conversation with Corbin Pearce and follow up email with the plans and specs. BASE BID: CRACK FILL WITH SHEET MIX This is a daily rate for the following items necessary to perform this work: 1 super 10 load of sheet mix per day. Labor and Equipment to install sheet mix in specified locations. Traffic control setup and removal for our work only. $ 14,200 Per Day 1. CRACK FILL DAILY RATE $ 14,200.00 2. MOBILIZE EQUIPMENT $ 1,500.00 Submitted to: Cahuilla Band of Indians Page I I r ` GRANITE CLARIFICATIONS: 1. Site access will be established and arranged by Pavement Coatings Co. 2. Project working hours 7 AM to 4 PM Monday thru Friday. 3. Premium time in excess of an 8-hour workday, 5 days per week is not included. 4. Use of conventional paving equipment utilizing standard noise reduction equipment. 5. Use of standard vibratory compaction equipment. 6. Mobilization is $1500.00. Job to be completed one move in. Each additional Mobilization will be an additional $1,500.00 7. Water source for compaction equipment to be available to Granite at no additional cost and within 1500 feet of work area. EXCLUSIONS: • All permits, fees and engineering • Compaction observation & testing • Construction Survey & Staking • Temporary Facilities • Cutting, patching and demolition other than shown on the civil drawings • Electrical and Mechanical demolition removal and salvage • Removal or relocation of utilities to remain or in conflict with proposed improvements other than specified • Removal and or handling of materials deemed unsuitable (for whatever reason) • Removal and or handling of any hazardous materials • Removal and or handling of spoils generated by others • Processing of native materials of over -optimum moisture content as defined by the Project Geotechnical Engineer • Metals • Preparation and staging for access to work for other trades or subcontractors • Excavation and backfill of site utilities not in our scope of work • Fencing (temporary or permanent) • Erosion Control and erosion control maintenance • Any special equipment or equipment modifications needed for sound, dust and or vibration suppression or abatement CONTACT INFORMATION Steven Walters Estimator/Project Manager, Desert Cities Region Direct Number (760) 625-6657 steven.walters@gcinc.com GRAni ft 38000 Monroe Street I Indio, CA 92203 P 760775,7500 1 F 760,775.8227 DATE: January 9th, 2020 TO: REFERENCE: Pavement Coatings Co Palm Springs 2020 Slurry Seal Project #19-02 SCOPE OF WORK: We are pleased to provide you with the following proposal to perform the delineated sitework improvements for the referenced project. We have based this proposal upon the phone conversation with Corbin Pearce and follow up email with the plans and specs. BASE BID: CRACK FILL WITH SHEET MIX This is a daily rate for the following items necessary to perform this work: 1 super 10 load of sheet mix per day. Labor and Equipment to install sheet mix in specified locations. Traffic control setup and removal for our work only. B A S E B I D- Our delineated work only : $ 14,200 Per Day 1. CRACK FILL DAILY RATE 2. MOBILIZE EQUIPMENT $ 14,200.00 $ 1,500.00 Submitted to: Cahuilla Band of Indians GRAr11TE CLARIFICATIONS: 1. Site access will be established and arranged by Pavement Coatings Co. 2. Project working hours 7 AM to 4 PM Monday thru Friday. 3. Premium time in excess of an 8-hour workday, 5 days per week is not included. 4. Use of conventional paving equipment utilizing standard noise reduction equipment. S. Use of standard vibratory compaction equipment. 6. Mobilization is $1500.00. Job to be completed one move in. Each additional Mobilization will be an additional $1,500.00 7. Water source for compaction equipment to be available to Granite at no additional cost and within 1500 feet of work area. EXCLUSIONS: • All permits, fees and engineering • Compaction observation & testing Construction Survey & Staking • Temporary Facilities • Cutting, patching and demolition other than shown on the civil drawings • Electrical and Mechanical demolition removal and salvage • Removal or relocation of utilities to remain or in conflict with proposed improvements other than specified • Removal and or handling of materials deemed unsuitable (for whatever reason) • Removal and or handling of any hazardous materials • Removal and or handling of spoils generated by others • Processing of native materials of over -optimum moisture content as defined by the Project Geotechnical Engineer • Metals • Preparation and staging for access to work for other trades or subcontractors • Excavation and backfill of site utilities not in our scope of work • Fencing (temporary or permanent) • Erosion Control and erosion control maintenance • Any special equipment or equipment modifications needed for sound, dust and or vibration suppression or abatement CONTACT INFORMATION Steven Walters Estimator/Project Manager, Desert Cities Region Direct Number (760) 625-6657 steven.walters@gcinc.com GRA ITE'" �,wWw's�,_ N PINAFL .,-. From: Corbin Pierce <CPierce@pavementrecycling.com> Sent: Thursday, January 9, 2020 11:42 AM To: Walters, Steven <Steven.Walters@gcinc.com> Subject: Palm Springs CAUTION: This email originated from outside of Granite Good Afternoon, We are bidding Palm Springs- 2020 Slurry Seal City Project No. 19-02 Bids- Thursday January 9, 2020 at 3:00 PM We are looking to get prices on the Crack Filling portions of this project. I have attached the plans and specs below. We need a daily rate- 1 load a day with material and install with your traffic control. https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS°/u3A2db8323e- 6c11-4d67-84f5-8aa11a432162 Please let me know if you're going to send us a price. Thank you Corbin Pierce Estimator Pavement Coatings Co. avement 10240 San Sevaine Way Jurupa Valley, CA 91752 oatings Co. Phone: 951-790-6687 Fax: WOW www. oavementrecvcl i nq. com ST=P2 5•1X.r. 1v ccrcv Z=RO Safety, Takes Every Person ZEWO UMM zoror s ZMU)%n" Disclaimer: This email and any attachments to it may be confidential and are intended solely for the use of the individual to whom it is addressed. Any views or opinions expressed are solely those of the author and do not necessarily represent those of Pavement Recycling Systems, Inc. If you are not the intended recipient of this email, you must neither take any action based upon its contents, nor copy or show it to anyone. Please contact the sender if you believe you have received this email in error. Granite Propos... s.docx 100% Emnlovee Owned From: Corbin Pierce CPierce@pavementrecyciing.com Subject: Fwd: Palm Springs Date: January 9, 2020 ffi 2:43 PM To: clucker@luckeranderson.com Sent from my Venzon. Samsung Galaxy smanphone Pavement Coatings Co. 100% Employee Owned Corbin Pierce Estimator Pavement Coatings Co. 10240 San Sevaine Way J urupa Valley, CA 91752 Phone:951-790-6687 Fax: www. avementrecyclin .corn gTM 2 S.T.E.P. TO ZERO 2M6 Safety Takes Every Person mroncoQas gaOl SRDtas67111E Disclaimer^. This email and any attachments to it maybe confidential and are intended solely for the use of the individual to whom it is addressed. Any views or opinions expressed are solely those of the author and do not necessarily represent those of Pavement Recycling Systems, Inc. If you are not the intended recipient of this email, you must neither take any action based upon its contents, nor copy or show it to anyone. Please contact the sender if you believe you have received this email in error. -------- Original message -------- From: Maurice Ramirez<Mramirez@allamedcanasphalt.com> Date: 1/9/20 1:24 PM (GMT-08:00) To: Corbin Pierce <CPierce®pavementrecycling.com> Cc: James Wu <JWu@pavementrecycling.com> Subject: Palm Springs Corbin, For he crack filling, our daily rate for the patch crew and AC is $6,500.00 per day. That includes a 5 man crew and the AC Material. Excludes posting, layout, sweeping and water/water meter. Maurice Ramirez Project Manager All American Asphalt 400 E. 6th Street, P.O. Box 2229, <x-apple-data-detectors://0/1> Corona CA 92879<x-aonle-data-detectors://0/1 > 0: 951-736-7600<tel:951-736-7600> Ex.242 C: 714-395-7044 W: www.allamericanasQhalt.com<httl)://www.allamericanasphaLQQmZ> E: mramirez@allamericanasphalt.com<mailto:mramirez@allamericanasphalt.com> From: Corbin Pleroe CPierce@pavementrecycling.com (f Subject: Fwd: Palm Springs Date: January 9, 2020 at 2:42 PM To: clucker@Wckeranderson. com Sent from my Vedzon, Samsung Galaxy smanphone Corbin Pierce Estimator Pavement Coatings Co. avement 10240 San Sevaine Way Jurupa Valley, CA 91752 coatingsCol Phone:951-790-6687 Fax: UIPF www.lmvemcntrecycling.com 100% Employee Owned IST_P 2 S.T.E,P. TO ZERO ZERO Safety Takes Every Person EP Disclaimer: This email and any attachments to it may be confidential and are intended solely for the use of the individual to whom it is addressed. Any views or opinions expressed are solely those of the author and do not necessarily represent those of Pavement Recycling systems, Inc. If you are not the intended recipient of this email, you must neither take any action based upon its contents, nor copy or show it to anyone. Please contact the sender if you believe you have received this email in error. -------- Original message -------- From: "Wafters, Steven' <Steven.Wafters0gcinc.com> Date: 1/9/20 1:02 PM (GMT-08:00) To: Corbin Pierce <CPierce@pavementrecycling.com> Subject: RE: Palm Springs Daily Crack Fill pricing attached. Let me know if you need anything else. Steven Walters Estimator Desert Cities Region Office 760-391-6259 Direct 760-625-6657 seven walters angcinc.com wwww,g[aniteconstruction com W COPY BID BOND KNOW ALL MEN BY THESE PRESENTS, That Pavement Coatings Co. as Principal, and The Ohio Casualty Insurance Company as Surety, are held and firmly bound unto the City of Palm Springs, California, hereinafter called the "City" in the sum of: Ten Percent of Amount Bid (10% of Amt Bid) 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: 2020 SLURRY SEAL CITY PROJECT NO. 19-02 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 attorneys fee to be fixed by the court. SIGNED AND SEALED, this 3rd day of January 2020. Pavement Coatings Co. EXECUTED FOR E PRINCIPAL: By Signature (NOTARIZED) Print Name and Title: By Signature (NOTARIZED) Print Name and Title: The Ohio Casualty Insurance Company EXECUTED FOR THE SURETY: By Signature (NOTARIZED) Print Name and Title: Richard L. Wells, Attorney -in -Fact 2020 SLURRY SEAL CITY PROJECT NO. 19-02 NOVEMBER 2019 BID BOND (BID SECURITY FORM) BID FORMS - PAGE 14 14 O m W Liberty Mutual. SURETY This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company Ia felzrk PrA Certificate No. 8201397 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a caporabon duly organized under the laws of the State of Indiana (herein collectively called the'Companies'), pursuant to and by authority herein set forth. does hereby name, constitute and appoint, Hope Conley, Brigid Lopez, David Madden, Brian A. McGoldrick, Sandy Staley, Richard L. Wells all of the city of Placentia state of CA each individually if there be more than one named, his hue and lawful attomey-in-fad to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its ad and deed, any and all undertakings, bonds, recognaanoes and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as d they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this I Ith day of June , 2019 . Liberty Mutual Insurance Company PV INSUg4 'ySY INSxy rN3Uq' The Ohio Casualty Insurance Company tiJ os°OWr6hOi" e 3°o"POw,�Rtyo �v ,o"P°+.,� n� West American Insurance Company +car° XAMv D A' 'You" D ` cur) r P� 3N1 r 1-Na ''M " Fa By: David M Carey Assisrant Ser•retary of PENNSYLVANIA ss On this 1 lth day of June , 2019 before me personalty appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duty authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. PA e�S woxw aTFY COMMONWEALTH OF PENNSYLVANIA N°IarW seat iesll s v CF Teresa Pwuea. Sawry PUDik LGo+L� Urger Me,ion Teq., M°,ngomny eounry By: My C eaa iuion Eapres Marl, 28, Ml easy patella, Notary Public 5qy pUev�G MmMer, Pennsylvania As —awn ef Wanes This Paver of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows- ARTICLE IV -OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -tact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizancee and other surety obligations. Such atiomeys-in-fact, subject to the limitations set forth in their respective powers of adomey, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power a authority granted to any representative or attomeyAn-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power a authority. ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman a the president, and subject to such limitations as the chairman a the president may prescribe, shall appoint such attomeys-in-tact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective pavers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company. acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to ad on behalf of the Company to make, execute, seal, aoknowdedge and deliver as surety any and all undertakings, bonds, recognizanoes and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile a mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same face and effect as though manually affixed. I, Renee C. Uewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full face and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seas of said Companies this 3rd day of January , 2020 OC) VV INSU�o"POWr01919° �kXarmseR D;l • 1-tla C a`o�OW6 � s 1991 O a e� 'rssyM°."*�aDe y Renee C. Llewellyn, Assistant Secretary LMS-12873 WiC OCIC WAIC Mufti Co m62a18 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 Califomia County of Orange On January 3, 2020 Date personally appeared before me, Sandy Staley, Notary Public Hen: Insert Name and Title of the Officer Richard L. Wells Name(s) of Signers) 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. SANDY SM Y _ COMM. #2246810 z a;� Notary Public • California o z ': Orange County MX Comm. Expires June 18, 2022 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS y hand nd offci eat. Signature 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 Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Corporate Officer — Title(s): Partner — E! Limited ❑ General Individual Attorney in Fact Trustee = Guardian or Conservator Other: Signer Is Representing: Signer's Name: Corporate Officer — Title(s): [-1 Partner — ❑ Limited ❑ General Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator n Other. Signer Is Representing: - 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL .. A rotary 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 Caldomia County of Riverside ) On January 6th, 2020 before me, Julia R. Valenzuela, Notary Public Date personally appeared Here Insert Name and Title of the Officer Doug Ford Name(b) of Signer(A) who proved to me on the basis of satisfactory evidence to be the person(A) whose name(!;) is/dre subscribed to the within instrument and acknowledged to me that he/she/Way executed the same in his/h6r/thlair authorized capacity(ik), and that by his/hbNth&ir signature(g) on the instrument the person(i), or the entity upon behalf of which the person(is) acted, executed the instrument. JLIUA R. VALENNElA Notary Public - California ` - Riverside County { Commission p 2220825 My Cnrnm. Expires Nov 5. 2021 Place Notary Seal 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_ Vtau Signature of N ry Public 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: Id Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(es) Claimed by Signerfs) Signer's Name: Corporate Officer — Title(s): Partner — __ Limited t 1 General Individual Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: January W. 2020 Signer's Name: Corporate Officer — Title(s): Partner — Limited _' General Individual Attorney in Fact Trustee _ Guardian or Conservator Other: Signer Is Representing: F _ �k'_ A`J ®® CERTIFICATE OF LIABILITY INSURANCE GATE (MM OO YYYO 3/4/2020 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 REPRESENTATIVEORPRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have,ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to lhocertificale holder In lieu of such endorsement(s). PRODUCER CIBC Insurance. Services LLC License #OK19767 32Old Slip - CON NAME:CT Yvonne Galvan. PHONE mc. No. Eau, 800-221-5830 Fq�ic No:800-383.1852 EMAIL AODREss: onne. alvan alliant.com New York NY 10005 INSURERS AFFORDING COVERAGE NAICP INSURERA: Travelers Prop Casualty Cc of America 25674 INSURED PAVERE INSURERS: St. Paul Surplus Lines Insuren 30481 Pavement Coatings Co. 10240.San Sevaine Way NSURERC: Jurupa Valley, CA 91752 INSUREao: NSURER: E INSURERF:. COVERAGES CERTIFICATE NUMBER: 845109568 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING. ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. UISR LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER. POUCYEFF MMRR1fYYYY POUCYEXP MM/UD -LIMITS A X COMMERCUILGENERALUU3ILRY Y VTC2JCO9325B35ATIL19 10/1/2019 10/12020 EACH OCCURRENCE. S2,000000 CLAIMSMADE IT OCCUR Pg WOE TO RENTED REMSES Ee neeme.osi s300,000 MED EXP An one person $10.000 PERSONAL B ADV INJURY $2.000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4000000 POLICY � JET F—ILOC PRODUCTS-COMP/OPAGG S4,000000 $ OTHER: A AUTOMOBILELIABILITY Y VTC2JCAP9325B361TIL19 10I72019 10/12020 COMBINED SINGLE LIMIT IF. ae6de t S2,000,000 BODILY INJURY(Parpenton) _ S X ANY AUTO - OWNED SCHEDULED AUTOS ONLY '' AUTOS BODILY INJURY (Per aradenl) S PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOSONLY AUTOS ONLY - $ A X UMBRELLALMS X OCCUR CUP,-9058X9701925 10/12019 10/12020 EADH OCCURRENCE S3,000000 AGGREGATE S3,000,000 EXCESS LIAR C.0 &U:.E DEO I X I RETENTIONS in nnn S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EY(MUDED7 (Mandatory In NH) NIA Y UB9K16850A1925K 10/12019 10/12020 X STATUTE .ERA E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE-. EA EMPLOYEE S1,000,000 EJ_DISEASE-POUCYUMIT S1000000 Ups. describe under DESCRIPTION OF OPERATIONSbel. B Professional Liability Pollution Liability ' ZCE-21P37857 - 1/312020 V312021 Each Ad, UO Limit Eetlt condition Policy Aggregate 2,000.000 2,090.000 4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom space is required) RE: City Project No. 19-02-2020 Sluny Seal. PJCO01110. The City of Palm Springs, its officials, employees, and agents are named as an additional insured as respects Liability arising out of work performed by the Named Insured. The insurance provided shall be primary and any other insurance maintained by the Additional Insured is excess and non-contributory. Umbrella follows forms as respects to the additional insureds. Waiver of subrogation in favor of City, its elected officials, officers, employees, agents, and - volunteers as respects to Workers Compensation/Employers Liability. 30 days' notice of cancellation or non -renewal will be provided to Certificate Holder, except 10 days' notice for Cancellation for non-payment of premium. 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. 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 AUTNOROEDREPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registeredmarks of ACORD V � j POLICY NUMBER: VTC2JCAP9325B361TIL19 ISSUE DATE: 10/1/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14.DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: If we cancel this policy .for any statutorily permitted above. We will mail such notice to the address shown reason other than nonpayment of premium, and a In the schedule above at least the number of days number of day"s is shown for cancellation in the shown for cancellation in the schedule above before schedule above, we will mail notice of cancellation to the effective date of cancellation. the person or organization shown in the schedule IL T4 05 03 11 02011 The Travelers Indemnity Company. All dghts reserved. Page 1 Of 1 Policy #VTC2J-CAP-9325B361-TIL-19 Effective: 10/01/2019 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I ;J:ZGIr169 Pli! 1..1 1. The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered 'Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. CA T4 74 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance services Office, Inc. with its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. A. Covered Autos Liability Coverage is changed as follows: 9. Paragraph a. of the Pollution Exclusion ap- plies only to liability assumed under a con- tract or agreement. 2. With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply. B. Changes In Definitions For the purposes of this, endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "in- sured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants'; or 2. Any claim or "suit" by or on behalf of a governmental authority for damages be- cause of testing for, monitoring, cleaning up, removing, containing, treating, detoxi- fying or neutralizing,. or in any way re- sponding to or assessing the effects. of "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dis- persal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any prop- erty in which the "pollutants" are con- tained are moved from the place where they are accepted by the "in- sured" for movement into or onto the covered "auto"; or b: After the "pollutants" or any property in which the "pollutants" are con- tained are moved from the covered "auto" to the place where they are fi- nally delivered, disposed of or aban- doned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from prem- ises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (1) The "pollutants" or any property in which the "pollutants" are con- tained are upset, overturned or damaged as a result of the main- tenance or use of a covered "auto"; and (2) The discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused di- rectly by such upset, overturn or damage. CA 99 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: VTC2JC09325B35ATIL39 ISSUE DATE: 10/1/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 PERSON OR ORGANIZATION: Any person or organization to whom you have agreed in a written contract that notice of cancellation of this policy will be given, but only if: 1. You send us a written request to provide such notice, including the name and address of such person or organization, after the first Named insured receives notice from us of thecancellation of this policy; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement. ADDRESS: The address for that person or organization included in such written request from you to us. PROVISIONS: If we cancel this policy for any statutorily permitted above. We will mail such notice to the address shown reason other than nonpayment of premium, and a in the schedule above at least the number of days number of days is shown for cancellation in the shown for cancellation in the schedule above before schedule above, we will mail notice of cancellation to the effective date of cancellation. the person or organization shown in the schedule IL T4 05 03 11 @2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 -a 61 POLICY NUMBER:VTC2J-CO-9325B35A-TIL-19 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization. that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organiiation. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury', "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: I. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement, However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will riot share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", .whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" or offense took place; it. The names and addresses of any injured persons and witnesses; and it!. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit" and the date received; and tt. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. 4) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ante provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) POLICY NUMBER: UB9K16850A1925K NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX _ CONDITIONS: Notice Of Cancellation To Designated Persons Or Organizations If we cancel this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organiza- tion before the cancellation is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of can to a designated person or organization because the name or address of such designated person or organization provided to us Is not accurate & complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation: SCHEDULE Number of Name and Address of Designated Persons or Organizations: Days Notice 30 DATE OF ISSUE: 10 -01 -2019 ST ASSIGN: Page 1 of 3 © 2013 The Travelers Indemnity Company. All rights reserved. TRAVELERS J k WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) POLICY NUMBER: UB9K16850A3925K Number of Name and Address of Designated Persons or Organizations: Days Notice 30 DATE OF ISSUE:10 -01 -2o1e ST ASSIGN: Page 2 of 3 O 2013 The Travelers Indemnity Company. All rights reserved. TRAVELERSJ� WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) POLICY NUMBER: UB9K16850A1925K Name and Address of Designated Persons or Organizations: All other terms and conditions of this policy remain unchanged Number of Days Notice 30 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 10 -01 -2019 ST ASSIGN: Page 3 of 3 © 2013 The Travelers Indemnity Company. All rights reserved. /� WORKERS COMPENSATION TRAVELERS AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-9K16850A-19-25-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS 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. Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 10-01-19 ST ASSIGN: Page 1 of 1 CITY OF PA} M SPRINGS, CALIFORNIA PRocuRFMF MNTRA[TINC, nNISInN t%_'p_ /4--4 - Ii BI ABSTRACT BID# G)� Z ii Bidder: rnD�N B G3 763 Bidder SIBBiidder:. f. 'S MADE ,un al38% 26E Bidder: All Bidder: V,4V e A� rifiArl P34&� Bidder: Bidder: PROLE AME: DUE DATE: l�C7SI Description: Sa O I:I I Ii I 1 I I I I I I I I I I I Total of all "Schedule Items: $ Witnessed h f Date: Home A& PeN0. CONTRACTORS STATE LICENSE BOARD -^ 1 OContractor's License Detail for License # 303609 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. r 61ammpblatdtsclesme is remltled by & W ?Li4.0 IFthis eney bsublem to t1h:.,aim tlisdearm, a Vnkler mmPlax,disslnwrewivaopeu bi o ChAon dm lnkerbueOn teabvinaxeshilmaM/Or 4planim Inrorma,bn. , F,erwm71.1T,ohly cemovarareDbd Gdlled8menn mported to the Outoe disdmed. s armoamrsare not lived.nlmtnemnuamrWesto mmvHwim,M temuoltheaNitratian , Weuwmklead, them maybemlevonlrnloimamthis has nhtrl been moved Ohio the Booth'slsma daubase. This Ucense is current and active. All information below should be reviewed. e C32- PARKING AND HIGHWAYIMPROVEMENT Data current as of 2/25/2020 5:12:41 PM Business Information PAVEMENT COATINGS CO 102,10SAN SEVAINE WAY JURUPAVALLEY,CA91752-Ilan Business Phone Numbenlr4) 0&3011 Entity CarpOmUOn Issue Date 03/0311975 Expira Date 0913012MO License Status Vassifications Bonding Information Contractor's Bond This license filed a Contractors Bond with FIDEMAND DEPOSIT COMPANY OF MARYLAND. Bond Number. U21M Bosh Amount S15,000 Effective Date: 01/01/2016 Contractor's Bond History Bond of Qualifying Individual This license filed Band of Qualifying Individual number 6481014 for DOUGtAS MAR FORD in the amount of $11,500 with FIRST NATIONAL INSURANCECOMPANYOFAMERICA Effective Date: N/D2/2008 BQI's Bond Fusion, Workers' Compensation This license has workers cmapermum Insumnoe with the TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Policy NumbenUB9H3685DA1MK Effective Data: 10/01/2019 Expire Data: 10/01/2020 Workers' Compensation History Other F Personnel0stedonthis Ucense(<unemordl a ciated)amlistedan Otherricemes. Back to Top Conditions of Use Privacy Policy Accessibility Accessibility Certification City of Palm Springs Engineering Services Department Z1/FORM Memorandum To: Office of the City Clerk From: Engineering Services Department Subject: CP 19-02 — 2020 SLURRY SEAL Date: March 9, 2020 Attached are the following documents: Contract Abstract documents by ✓ 2 sets of contract executed Contractor and notarized Performance Bond Payment Bond Original Bid Copy of Bid Bond Certificates of Insurance for the required policies Copy of Bid Abstract Confirmation of status of contractor's license