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A8338 - G&M CONSTRUCTION - CP 18-15 RAMON ROAD STORM WATER RETENTION BASIN
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 GNM Construction, Inc. dba G & M Construction, 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:. RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO. 18-15 The Work,comprises the Work comprises abandoning an existing 10-inch PVC pipe and backfilling with sand cement slurry. Removal and reconstruction of PCC sidewalk, curb & gutter, catch basin, and local depression. Construction and installation of a PCC driveway apron, PCC access road, standard pipe gate, and modified curb outlet and spill way. - Coordination with local airport. Coordination with applicable underground utility companies for line adjustments and relocations, trench excavation, and other appurtenant earthwork. 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. .Accord ingly, 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. RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BIDDER'S GENERAL INFORMATION DATE:May 2019 BID FORMS-PAGE 1 Termination Prior to Expiration of Term. City may terminate this Agreement for- .its convenience.at any time, without cause, in'whole or in part, upon giving Contractor thirty (30) days written notice. Where termination is due to the fault of Contractor and constitutes an immediate danger to health, safety, and general welfare, the period of notice shall be . such shorter time as,may be determined by the City. Upon.such notice, City shall pay Contractor for Services performed through the,date.of termination in accordance:with the Contract.Documents. Upon receipt of such notice, Contractor shall immediately cease all work under this Agreement, unless stated otherwise in the notice or by written authorization - of the Contract Officer. After such notice, Contractor shall have no further claims against the City under. this Agreement. Upon termination of the Agreement under this section, Contractor shall submit to the City an invoice for work and services performed prior to the date of termination. ARTICLE 3 --CONTRACT PRICE Bid Schedule.A The City shall pay the Contractor for the completion of the Work, in accordance with the Contract Documents,.in current funds the Contract Price(s) named in the Contractor's Bid Proposal and Bid Schedule(s), and any duly authorized 'Construction Contract..Change .Orders approved by the City. The amount of the initial contract award in accordance with the Contractor's Bid Proposal is One Hundred Eighty Two Thousand Fifty Nine and Zero Cents ($182,059.00). Contractor agrees to, receive and accept the prices set forth herein, as full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Said compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of the Work during its, progress or prior to its acceptance including those for well and faithfully completing the Work and the whole. thereof.in the manner and time specified in the Contract Documents; and, also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution-of the Work, suspension of discontinuance of the Work, and all other unknowns or risks of any description connected with the Work.. ARTICLE 4 --THE CONTRACT DOCUMENTS The Contract Documents consist of-the Notice Inviting Bids, Instructions to Bidders, the prevailing rate of per diem wages as determined by the Director of the California Department of Industrial Relations, the accepted Bid and . Bid Schedule(s), List of Subcontractors, Local Business Preference Program — Good- Faith Efforts, Non- Discrimination Certification, Non-Collusion Declaration, Bidder's General Information, Bid Security or Bid Bond, this Agreement, Worker's Compensation Certificate, Performance' Bond, Payment Bond, Standard Specifications, Special.Provisions, the Drawings,Addenda numbers to inclusive, and all Construction Contract Change Orders and Work Change Directives which may be delivered or issued after the Effective Date of the Agreement and are not attached-hereto. RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 AGREEMENT FORM DATE:May 2019 AGREEMENT AND BONDS-PAGE 2 ARTICLE 5 -- MUTUAL OBLIGATIONS For and in consideration of the payments and agreements to be made and performed by the City, the Contractor agrees to furnish all materials and perform all work required for the . above stated project, and to fulfill all other obligations as set forth in the aforesaid Contract Documents. City hereby agrees to employ, and does hereby employ, Contractor to provide the materials,- complete the Work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the Contract Price herein identified, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Contract Documents. .Contractor specifically acknowledges and agrees to be .bound by the Wage Rates and Labor Code,requirements specified in the Contract Documents, including the requirement to furnish electronic certified payroll records directly to the Labor Commissioner (via the Division of Labor Standards Enforcement), and shall pay the general prevailing rate of per diem wages as determined by the Director of the Department of Industrial Relations of the State of California. ARTICLE 6 - PAYMENT PROCEDURES The Contractor shall submit Applications for Payment in accordance with the Standard Specifications as amended by the.Special Provisions. Applications for Payment will be processed by the City Engineer as provided in the Contract Documents. ARTICLE 7 -- NOTICES Whenever any provision of the Contract Documents requires the giving of a written Notice between the parties, it shall be deemed to have been validly given if delivered in person to the individual or to a member of the firm or.to an officer of the corporation for whom it is .intended,-or if.delivered at or sent by registered or certified mail, postage prepaid, to the — last business address known to the giver of the Notice. ARTICLE 8 -- INDEMNIFICATION The Contractor agrees to indemnify and hold harmless the City, and all of its officers and . agents from any claims, demands, or causes of action, including related expenses, attorney's fees, and costs, based on, arising out of, or in any way related to the Work undertaken by the Contractor hereunder. This Article 8 incorporates the provisions of Section 7-15 "Indemnification," of the Special Provisions, which are hereby referenced and .made a part hereof. Prevailing Wages. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation California Labor Code Section 1720,et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq. ("Prevailing Wage Laws"). Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 AGREEMENT FORM DATE:May 2019 AGREEMENT AND BONDS-PAGE 3 defend, indemnify, and hold the City, its officials, officers, employees, agents and . volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. . ARTICLE 9 -- NON-DISCRIMINATION In connection with its performance under this Agreement, Contractor shall not discriminate against any..employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin (i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are'treated during their employment, without regard to any prohibited basis. As . .a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Contractor certifies that its actions and, omissions hereunder shall not incorporate any discrimination -arising from -or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination;-rates of pay or other forms-of.compensation; and selection for training, including apprenticeship; and further, that Contractor is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the 'provision of benefits, relating to non-discrimination in city-contracting. ARTICLE 10 -- MISCELLANEOUS Terms used in this Agreement which are defined in the Standard Specifications and the Special Provisions will have the meanings indicated in said Standard Specifications and the Special Provisions. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and specifically; but without limitation, monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically . stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. The City and the Contractor each binds itself,'-its partners, successors, assigns, and legal representatives, to the.other party hereto, its partners, successors, assigns; .and legal representatives, im respect of all covenants; agreements; and. obligations contained in the Contract Documents. SIGNATURES ON NEXT PAGE RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 AGREEMENT FORM DATE:May 2019 AGREEMENT AND BONDS-PAGE 4 . IN WITNESS WHEREOF, the City and the Contractor have caused this Agreement to be executed the day and year first above written. CITY OF PALM.SPRINGS,. APPROVED BY THE CITY COUNCIL: CALIFORNIA Date By David H. R _ City Manager Agreement No.,_ � ATTEST: By Anthon J. eji , M ity Cler APPROVED AS TO FORM: By City Attorney RECO WENDET B Marcus L. Fuller, P.E. P.L.S. Assistant City Manager/City Engineer APPROVED BY CITY COUNCIL RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 AGREEMENT FORM DATE:May 2019 AGREEMENT AND BONDS-PAGE 5 CONTRACTOR By: GNM Construction, Inc. dba G & M Construction, A California Corporation Firm/Company Name By: By: ;Signatu (notarized) Signature (notarized) Name Name: �Z Name: Title: Ot L e-r' Title: a - A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. (This Agreement must be signed in the above (This Agreement must be signed in the above space space by one having authority to bind the by one having authority to bind the Contractor to the Contractor to the terms of the Agreement.) terms of the Agreement.) State of 4,4- State of ) County of ss County of )ss On (®' 1g� � O before me. ielr'M� rCl I 1�• N r4 personally appeared rrVX Ez,personally appeared who proved to me on the asis of satisfactory who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and subscribed to the within instrument and acknowledged to me that he/she/they executed the acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s)on the instrument that by his/her/their signatures(s)on the instrument . the person(s),or the entity upon behalf of which the the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing laws of the State of California that the foregoing paragraph is true and correct. paragraph is true and correct. WITNESS my hand and official seal. WITNESS my hand and official seal. Notary Signature: ` Notary Signature: Notary Seal: ,� Notary Seal: RENEE S.®REILING Commission#2123982 z -i Notary Public-California, Riverside County My Comm.Ex Tres top 16,2019 RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 AGREEMENT FORM DATE: May 2019 AGREEMENT AND BONDS-PAGE 6 _-_ -----------__ . ` . ) < ' Executed in Two(2)Original . Counterparts Bond No. 100449885 � Premium: $3.277.00 Premium Subject ToAdjustment | Based on Final Contract Price � PERFORMANCE BONQ—PUBLICVVORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS. thei City ofPalm 8pringa, o charter city, organized and existing in the County of ''Riveruida. California, no Obligee, (hereinafter vaharnad to as the ^City^), has awarded to the undersigned Contractor, (hereinafter referred,to as the "Contractor"), an agreement for the work described as follows: RAQ8ON ROAD STORM WATER RETENTION BASIN , CITY PROJECT NO. 18-15 (hereinafter referred bonn the "Public VVodk'); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Cohtracd for the said Public Work awarded to the Contractor and approved by the City for the Project herainobovanamad. (henainafternafanadt000tha"Controut'). which Contract io inc(Oqporntad herein by this reference; and WHEREAS,the Contractor is required by said Contract to perform the terms thereof, and to provide o bond both for the performance and guaranty thereof. NOW THEREFORE,we, the undersigned Contractor, aa Principal, and: U.S. ia|t Insurance Company a c orpora.tion organized and existing under the laws of 'the State of Texas' an.d dul.y authorized to transact business under the laws of the State of California, as,Surety, are held and firmly bound unto the City In thesurn of one Hundred Eighty Two Thousand Fifty Nine and 00/100 . — Dollars ($182,059.00 ), said sum being not less than 100 percent.of the total arnount 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 DS SUCH,that if the bounden Contractor, his ur 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 a|hamdionthaneofmodeouthereinpnovided. onhioovibopartu.tobekoptandperforniedattheUhle 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 mobahe|o and workmanship; and indemnify and save hohn|ano 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 orto the work tob rfo adtharaunderurthe Specifications accompanying the same ahnU 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, urtothoPVb|iu Work orto the 8pec\ficabuno. No final settlement between the City and the Contractor shall abridge the right of any beneficiary hereunder,whose claim may beunsatisfied. mAMow ROAD STORM WATER nerswnowaAoIN PERFORMANCE BOND CITY PROJECT NO.18-1s AGREEMENT AND BONDS PAosu ti .._-------._...._......._._........................................_........_..-..........__.........................__....._.__..............................._.................................._.................................................................... ... .... ....................__..--..._......... _.._......_...._._._._---..._----- 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 18th day of .rune �2019. CONTRACTOR: George Arlen Marantz dba G&M Construction Check one: individual,_partnership, ✓ 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, SURETY: George Arlen Marantz dba G&M Construction U.S. Specialty Insurance Company, By: By signature signature (NOTARIZED) (NOTARIZED) P ' t Name and Title: Print Name and Title: Ted Lee,Attorney-in-Fact By: signature (NOTARIZED) Print Name and Title: 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. RAMON ROAD STORM WATER RETENTION BASIN PERFORMANCE BOND .CITY PROJECT NO.18-15 AGREEMENT AND BONDS-PAGE 9 DATE:May 2019 ........... .............................. _ ....... ............... ____.............................._ ........................_-__ ....... .......'.......... ....... .......... ` � | ` PERFORMANCE BOND—PUBLIC WORKS ! (CONTINUED) | The rate nf premium on this bond |o 10 UO per thousand. The total amountof premium charged: 327701 (The above must be filled inbv corporate auraty\. IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California |nuunmloe Commissioner authorizing them tuwrite surety insurance defined in Section 105of the California Insurance Code, and |f the work or project ioYinonoed. |nvxho|eor in part,with Federal,grant,or loan funds, it must also appear on the Treasury Department's most current list(Circular 57Ooommendad).THIS |SA REQUIRED FORM. Any claims under this bond may bo addressed to: (Name and Address cf Sunyh/ U.S.Specialty Insurance Company - 825 The City Drive S, Suite 205 Orange, CA92D0O HUB International |nuuenuoGom�es|n� UHan�oandAddneoaofAoerdor Representative for service cf process in California if 77564 Country Club Drive.Suite B401 different from above) P ' (Telephone Number ofSurety and Ag*nt:7V0.8004713 Agent or Representative for service ofpnucenoinCalifornia) G"m�y�714J4o�7oo0 namow ROAD STORM WATER RETENTION eaaIN PERFORMANCE BOND CITY PROJECT NO.18-1* AGREEMENT AND BONDS'PAGE 10 _______ ______ _ _________ _____________............__ ...... ............ ..._ ........... ...._............__...... _......... ________ ' ' 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 State of County of LID I? On before mied, ee S. �5feiknq , Wb6r�L Date Name Title of Oft6r U personally appeared :G� Q U 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 helsheithey.executed the same in hisiher/their authorized capacity(les), 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 Witness and an]r2 1,eal - - - - - - - - Signature of Notary Notary Public-California, z 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 TO THE DOCUMENT Number of Pages DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s)Other Than Named Above mywnw ROAD STORM WATER RETENTION BASIN PERFORMANCE BOND CITY PROJECT NO.10-1s AGREEMENT AND BONDS'PAGE 11 DATE:May uo1u CALIFORNIA ALL-PURP®SE ACKNOWLEDGMENT CIVIL CODE§1189 A notary"public or other officer completing this certificate verifies only the identity.of the individual who signed the documerntto which this certificate is attached,and not the"truthfulness,accuracy;or validityofi'thaf docurnenf. .State of California ) County of . Orange ) On t�l?mil before me,,. K. Ho, Notary Public Date Here Insert Name-and Title of the Officer- personally. appeared . Ted Lee Na,inb(s) of Signer($). who proved to .me on the basis of.,satisfactory evidence'to be.the.person O whose name(M .is/am subscribed :to the-within: instrument and°acknowledged to me that he% /tMq executed the same. in :his/For/tk authorized capacity("),and that by hisIbW,%&sigpature'o:on::the,instrument the;person(N-); or"the entity"Upon behalf of which the.'person(s),acted;.executed the instrument:, I.certify.uiider.PENALTY OF PERJURY;.nder the"laws of the:State of'California,that'the foregoing;paragraph is true,anal`correct,. WITNESS my hand and official seal:" K.HO Notary Public-California Si nature Orange County _ g .. Commission N 2262101 Sig. to f_Notary Public: < o�My Comm.Expires Noy 7,2022 �= ,Place Notary Seal Above, OPTIONAL Though1his sections optional, completing this nformatron can deter,alteration of the document or fraudulent reattachment of this-form-to.an unintended document... Description of Attached Document Title or Type of Document: Bond B O D Cf cJ -9 S Document Date: Number-of Pages: Signer(p) Other Than Named Above: .. CaPacity(ies) Claimed by Signer(s) 'Signer!s.Name:,.Ted Lee Signer's.Name".; .0 Corporate Officer — Title(s)' .0Corporate'Officer Title($):- ❑Partner _ Cl Limited L7 General 0 Partner LDL mited 0 General 0".Individual KI Attorney in Fact D Individual ❑Attorney in Fact ,.0 Trustee ❑Guardian or Conservator U Trustee: ❑Guardian.or"Conservator J:Other: 0 Other:.. Signer Is",Representing: Signer:Is`Representing: ©20.14 National Notary-Association •.w.w:w:NationalNotary:org 1=800-US NOTARY(t-8.00-876=6827) Item#5907 TOKIOMARINE H—CC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That, U.S. SPECIALTY INSURANCE COMPANY(the "Company"), a corporation duly organized and existing under the laws of the State of Texas,and having its principal office in Houston, Harris County,Texas, does by these presents make, constitute and appoint, TED LEE its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name, place and stead,to execute, acknowledge and deliver bond number 100449995 , issued in the course of its business and to bind the Company thereby, in an amount not to exceed Two hundred thousand and 001100 ( $200,000.00 ). Said appointment is made under and by authority of the following resolutions of the Board of Directors of U. S. Specialty Insurance Company: "Be it Resolved,that the President,any Vice-President, any Assistant Vice-President,any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver,any and all bonds,recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved,that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached."Adopted by unanimous written consent in lieu of meeting on September 1s1,2011. The Attorney-in-Fact named above may be an agent or a broker of the Company.The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF,U.S.Specialty Insurance Company has caused its seal to be affixed hereto and executed by its Senior Vice President on this 181h day of December 2017. ,`d"'��Su "'•,, State of California '�?` U.S. SPECIALTY INSURANCE COMPANY County of Los Angeles ='' s 't By: - ` Adam S. Pes in, Senior Vice President A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document. On this 1s1 day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, Senior Vice President of U.S.Specialty Insurance Company,who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted,executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS my hand and official seal.. seaiAa.aacla F \ Notary F.W,•Ca:ifarna 1 Los Assga:H{vuaty F Ccrvrtlon:22 i4.R4 Signature (seal) Hy Gsrm.Expires♦p T.3,2:22 I, Kio Lo,Assistant Secretary of U.S. Specialty Insurance Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of June 2019 ``ttpl111i,,,tl: = Bond No. 100449995 "y �- .},` .moo a Agency No. 3602 Kio Lo, Assis Secretary ��• •:;� HCCSZZ POAUSSIC06/2018 fit visit tmhcc.com/surety forrfmore information ^ ` � � � .....�����... ���������� ����......�......� .............���� ���` ����������������� . . Executed in Two(2)Original ! Counterparts � Bond No. 100448995 | Premium Subject ToAdjustment Premium Included on Based nn Final Contract Price PAYMENT BOND—PUBLIC WORKS Performance Bond KNOW ALL MEN BY THESE PRESENTS, � / WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, 88 Obligee, (hereinafter referred to as the"CUv" , has awarded to the undersigned Contractor, i (hereinafter referred to as the"Contractor"), an agreement for the work described as follows: ' - RA88{)NRCJAD STORM WATER RETENTION BASIN CITY PROJECT NO. 18~15 (hereinafter referred hoao the"Public\8ork")' and VVBEREAS, 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 Projectheneinabove named, (hereinafter referred t000 the''ContxyoC').which Contract is incorporated herein by this reference; and WHEREAS. said Contractor ia required to furnish o bond in connection with said Contract and pursuant to Section 055Dbf the California Civil Code. NOW,THEREFORE,we, the undersigned Contractor, ao Principal, and: U.S.Specialty Insurance Company . a corponaUon organized and existing under the |nvvm of the State of Texas . 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, oomponieo, or corporations entitled to fi|o stop payment notices under Section 8100 of the California Civil Code, in the f 'One Hundred Eighty Two Thousand Fifty Nine and 00/100 Dollars ($ 182,059.00 1 said sum being not less than 100percen o[the total amount payable bv the City under the terms tnthe said Cordnout' for which amount well and truly to be rnade, we bind oursm|veu, our heiro, axeoudora, administrators, aucceaauna` and assigns,jointly and severally, firmly by these presents. THE C{]00XTIQ0 OF THIS OBLIGATION IS SUCH, that. if said Cuntractor, his or Its ho|m, axecutoru, 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 r other necessaryi thereon, r for amounts due under th Unemployment Insurance Code ith 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 0560 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 peroona, companiea, 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. nAmow ROAD STORM WATER RETENTION BASIN PAYMENT BOND CITY PROJECT NO.10-1a AGREEMENT AND BONDS'PAGE 1u DATE:May 2019 _ .................... ................. ..._......... _ ..................................._____.................__ ...............................--- ........................................................... ......... _____ ............. .............._ ___ _ _ 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 tonno of the said Contract or to the work to be performed thereunder or the Specifications accompanying the ooma shall in any way effoot its obligations on this bond. and it does hereby vvm|vo notice of any such change, extension of time, o)texoUon, or addition to the terms of the Contract orto the work u[to the Specifications. No final settlement between the City and the Contractor hereunder ahoU abridge the right of Any beneficiary hereunder,whose claim may bounsatisfied. Contractor and Gunaty, an admitted surety inuurer, further ogvao that if the City or any entity or person entitled tofi|e stop payment notices 1m required to engage the services ofan attorney in connection with the enforcement of this bond, each shall be liable for the vaaoonmb|$ attorney'o haeo |ncurnad, with or xv|th0Ut.GUit. ln addition to the above sum. SIGNED AND SEALED, this 18th day of Juno . 2019. CONTRACTOR: George Arlen MarontzdbaG&MConstruction �� Check one: individual,___pa�nermhip.�L�corponaUon Payment Bond must besigned by napnaaardotivmn and/or officers having appropriate authority to bind the Contractor and Surety ho the terms of the Payment Bond.) EkCUTED FOR THE CONTRACTOR: EXECUTED FOR THE SURETY: George Arlen MorantcdbaG&MConstruction U.G.Specialty Insurance Company ` ' By: By .~— - 4~ ^ +^mgnamm signam (NOTARIZED) (NOTAR12E[). ` Pri me and Title: PhnName and T�e � ^~_' T 'Ted ���� By: ` signature (NOTARIZED) Print Name and Title: - RUMON ROAD STORM WATER RETENTION BASIN PAYMENT BOND CITY PROJECT NO.18-1a AGREEMENT AND BONDS'PAGE 1u _ DATE:May on10 � ___________________�______--^----_ ' . ' ' PAYMENT BOND—PUBLIC WORKS (CONTINUED) The rate of premiumon this bond ia NA parthouomnd. Premium IncludedonPohbnnanooBond Thato�oamourdufpnam\umooharged� (The above must be filled inbv corporate surety). IMPORTANT: Surety companies executing bonds must possessa 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 p'r6ject is financed, in whole or in part,with Federal, grant, or loan funds,it must also appear on the Treasury Department's most cunentoso(Circular o'uu* moe/m""/. THIS ."" REQUIRED FORM. ' Any claims under this bond may ba addressed to: ' (Name and Address ofSurety) U.S.Specialty Insurance Company 625 The City Drive S.,Suite 205 Orange, CA 92868 ' - ' ofAgent or HUB International In surance Representative Services Inc. ' of process inCalifornia if 77564 Country Cluborivo different from above) Palm` D—er ' �0O�713 (Telephone NuD�berofGuret and Agent or Representative for Gurety:714J4O70OU mem4tecf process |nC�a�urnia) � ` ' RAMOw ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.1u10 PAYMENT BOND DATE:Mavoom AGREEMENT AND BONDS'PAGE w 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 IDr County of, nn On "1 before me, CG 5• .fel Date I Name,Title of Offer' personally appeared . NAMES)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 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. Witness y and and offica eat. i RENEE S.BREILING Commission P 2123982 z Si nature of Notary Notary Pub IN-Calowma Riverside.County M Comm.E res goo 16,2019 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 RAMON ROAD STORM WATER RETENTION BASIN WARRANTY BOND CITY PROJECT NO.18-15 AGREEMENT AND BONDS-PAGE 15 DATE:May 2019 CALIFORNIA ALL-PURPOSE ACKNo.WLEDGMENT CIVIL c.ODE§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,&validity of that document:. State of California ) County of / Orange_ ) On D6 l J L/ Zed I before me, K. Ho, Notary Public , Date Here InsertWame and Title of the Officer, personally'appeared Ted Lee Nairie(s) of Signers) who proved to-me: on the. basis of .satisfadtory evidence to be .the person(X),:whose name is/aw subscribed to the within. instrumenf and-acknowledged to me that he/sbe/try executed the.same:in his/W/t authorized.capacity(tA);and that byhis/t?WR**signature(lo on-the instrument the:person('; :or the entity upon-behalf of which.the.person(s)acted;:executed the instrument.. I certify urider,PENALTY OF PERJ.URY:under the laws, of the State of California that the foregoing;paragraph istrue and- correct: WITNESS my hand and fficial seal. K.Ho . .. ... _ Notary Public-California — Orange County Commission#2262101 Signature My Comm.Expires Hoy 7.2022,11 Signat re of Notary Public: Place;Notary-Seal.Above: - OPTIONAL Tliough'this.tocttoh is optional,.cgrimpleting this_information:cari,deter,alteration of the document or fraudulent reattachment:of this form' `tb an unintended document. Description of Attached Document Title or Type of Document: Bond# l 0 0 9 clf Document Date: Numberof Pages: . Signer(s) Other Than .Named Above: -Capacity(ies)Claimed by Signers) Signer'_s l\lame:_Ted Lee Signer's.Name: 0 Corporate Officer'—,=T.itle(s):. .. 0 Corporate Officer — Title(s): _ El Partner_ O Limited: ,0 General ❑Partner p Limited 0 General :D.Individual 11:Attorney`in.Fact [:1 Individual ❑Attorney.in Fact D.Trustee El Guardian.or Conservator 0 Trustee ❑Guardian.or"Conservator b Other: 0 Other: Signer IsRepresenting, Signer is:.Representing: ©20.14 National`Notary-Association :w.ww.NationalNotarporg -1-M0-US NOTARY(1-800=876=6827) Item#5907 TOKIOMAR[NE H C C POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That, U.S. SPECIALTY INSURANCE COMPANY(the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County,Texas,does by these presents make, constitute and appoint, TED LEE its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name, place and stead,to execute, acknowledge and deliver bond number 100449995 , issued in the course of its business and to bind the Company thereby, in an amount not to exceed Two hundred thousand and 00/100 ( $200,000.00 ). Said appointment is made under and by authority of the following resolutions of the Board of Directors of U.S. Specialty Insurance Company: "Be it Resolved, that the President,any Vice-President, any Assistant Vice-President,any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved,that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached."Adopted by unanimous written consent in lieu of meeting on September 1st,2011. The Attorney-in-Fact named above may be an agent or a broker of the Company.The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF,U.S.Specialty Insurance Company has caused its seal to be affixed hereto and executed by its Senior Vice President on this 181h day of December 2017. 'o�ns Will, "o .`2.w.......a U.S.SPECIALTY INSURANCE COMPANY State of California County of Los Angeles r s By: Adam S. Pes in, Senior Vice President A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document. On this 1st day of June, 2018, before me, Sonia 0. Carrejo, a notary public, personally appeared Adam S. Pessin, Senior Vice President of U.S.Specialty Insurance Company,who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS my hand and official seal.. �s...... 1 l {{ � Na.ary F.Gilc•Caatxn-a 1 :v,Aq,!a C.✓,,ty t Cvxunhxlvnd 12i5a7p Signature (seal) My Ceram.Eapkei Apr H,Y'22 I, Kio Lo, Assistant Secretary of U.S. Specialty Insurance Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of June 2019 \1\\\ii 11111111/f/ Bond No. 100449995 `` � lnsura,��P Agency No. 3602 Kio Lo, Assis Secretary HCCSZZ POAUS&C06/2018 visit tmhcc.com/surety for more information WORKER'S COMPENSATION CERTIFICATE (AS REQUIRED BY SECTION 1861 OF THE CALIFORNIA LABOR CODE) am aware of the provisions of Section 3700 of the California Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self-insurance in accordance with the provisions of said Code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Contractor ��[u-TIC1L� By Title RAMON ROAD STORM WATER RETENTION BASIN WORKER'S COMPENSATION CERTIFICATE CITY PROJECT NO.18-15 AGREEMENT AND BONDS-PAGE 7 DATE:May 2019 BID PROPO�S'.4 s } 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: RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO. 18-15 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 .Notk.°e 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 insuran-�e %ertificates, Payment Bond, Performance Bond, and all Permits required by the Contract Doclurne its. Bidder has examined copies of all the Contract Documents, including the following Addenda (receipt of which is hereby acknowledged): Number Da.e } Number DatF• Number Date: Number Date Number Cute 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. RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BID PROPOSAL DATE:May 2019 BID FORMS-PAGE 2 a 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: Bidder: r Cc ` By: (Signature) Title: FQ 2� RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BID PROPOSAL DATE:May 2019 BID FORMS-PAGE 3 BID SCHEDULE A Schedule of Prices for Construction of the: RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO. 18-15 Item Description Estimated Unit Unit Amount No. Quantity Price 1. Mobilization 1 LS $ noo.C) 2. Project information sign 1 LS $ 3. Water pollution control. 1 LS $ 4. Temporary Traffic Control 1 LS $ d. O�c5I' Unclassified excavation (Cut) and 5' Grading - Final Pay Item 2,640 CY $ p $ 6 Abandon existing 10"VCP pipe, plug, 110 LF �-1— nn^^ and backfill with sand cement slurry $ _ $ co 7. Remove Existing PCC Sidewalk 440 SF Remove Existing Local Depression CP 8. (includes AC Slot patch removal) 138 SF $ G $ U, Remove Existing Curb and Gutter 34 LF ^� do 9 (includes AC Slot patch removal) $ 5 $ I l� Remove.Existing Catch Basin 10' (includes AC Slot patch removal) 2 EA $ ' Construct Curb and Gutter Type A4 11. per COPS Std Dwg 200 (includes AC 18 LF U" Slot patch replacement) $ $ ou' Construct PCC 4"Thick PCC 12. Sidewalk per COPS Std Dwg 210 193 SF $ Q $ y C,�,� Construct 6"Thick PCC Driveway —L�— 13. Apron per COPS Std Dwg 201 220 SF Q 0 (includes AC Slot patch replacement) $ _ $ ' 14.' Construct 6"Thick PCC Access Road 890 SF + 50 C)G per Detail on Plans $1�• $ 15. Standard Pipe Gate (Single Gate) per 1 EA 7 00 SPPWC Std Plan 602-3 (L=16') $ z iITaee of Bidder or Firm RAMON ROAD NUISANCE WATER RETENTION BASIN CITY PROJECT NO. 18-15 BID SCHEDULE FEBRUARY 2019 BID FORMS-PAGE 4 WD SOHEDULE A (Continued) Schedule of Prices for Construction of the: RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO. 18-15 Item Description Estimated Unit Unit Amount No. Quantity Price Construct Modified Curb Outlet per 16. COPS STD Dwg 705 and Spillways per 1 LS Details on Plans (includes AC Slot GO C, patch replacement and rip rap) 17. Field Orders 1 AL $15,000 *An allowance has been provided for Field®rders in accordance with Section 9-3.5 of the Special Provisions. The Contractor shall be limited to payment for Field Orders authorized by the Engineer up to and not exceeding the allowance specified. TOTAL OF ALL iTEMS OF THE BID SCHEDULE: @ C) 0 (Price in Figures) CAP H( k) (Puce in words) &C1 VVV 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 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 ".:11 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 iterns of work, and no additional payment will be allowed therefore. Name of Bidder or Firm RAMON ROAD NUISANCE WATER RETENTION BA.S)N CITY PROJECT NO.18-15 BID SCHEDULE FEBRUARY 2019 BID FORMS-PAGE 5 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*%York identified in this Bid. In the event a Bidder lists subcontractors who will perform Work under this Bid in excess of 50%of the Work identified in this Bid, the Bid shall be considered non-responsive. A. BIDDER'S PORTION OF WORK Page 1 of 1. Nalne of Prime ontractor: 1 T� 2. Bid Items/Portion of Work to be Self-Performed (if less than 100%of the contract): sucoor 3. Dollar Amount of Work Self- 4. Percentage of Work Self- 5. Date: I� Performed: C Performed: By signing the Bid Form, Contractor hereby certifies that it will perform not less than 50% of the Contract Work with its oven forces. E. LIST OF SUBCONTRACTORS 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. �Ad �e�ss�: �j �') R �Aaejp, 09 96 14. Bld ' s/Portion of Work: II ,( e t� Phone No.: _ 6. CoAactor's License No.: 7. Annual Gross Receipts: lIU <$10M enL ❑ <$1 M <$5M ❑ 8. Amount of C 6 led Work: 9. DIR Public Works Contractor Registration No: ❑ <$15M ❑ >$15M d 10. Percentage of Contracted Work: 11. DBE Firm? [] Yes No 12. DBE Certification No.: .� Q BIDDER'S LIST OF SUBCONTRACTORS— (Continued) RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 LIST OF SUBCONRACTORS DATE:May 2019 BID FORMS-PAGE 6 N�Pr Copy this page as needed to provide a complete listing. Page Of 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ <$1 M ❑ <$5M ❑ < $10KA 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ <$15M ❑ > $15M Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes [] No 12. DBE Certification No.: 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. �Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: I ❑ <$1 M - ❑ <$5M ❑ < $10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor El <$15M ❑ > $15M Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type,of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ <$lM ❑ <$51VI ❑ <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ <$15M ❑ >$15M Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 LIST OF SUBCONRACTORS DATE:May 2019 BID FORMS-PAGE 7 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS City Proiect No. 18-15 Bid Opening Date: June 13, 2019 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) "Lr:)cal 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 Subcontr ctors not listed on the List of Subcontractors: PT Local fir that` 'll furnish materials or supplies to the Bidder for this project: I RAMON ROAD STORM WATER RETENTION BASIN LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO.18-15 GOOD FAITH EFFORTS DATE:May 2019 BID FORMS-PAGE 8 LOCAL BUSINESS PREFERENCE PROGRAM s 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 _ L) 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 ti I f� RAMON ROAD STORM WATER RETENTION BASIN LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO.18-15 GOOD FAITH EFFORTS DATE:May 2019 BID FORMS-PAGE 9 C. The items of work which the bidder made available to local firms, including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate participation by local firms. Items of Work Bidder Breakdown of Items Amount Percentage Normally ($) Of Performs Item Contract (Y/N) NI 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 frrn if the selected firm is not a local firm: Dames, addresses and phone numbers of rejected local firms and the reasons for the bidder's rejection of the local firms: Names, addresses and phone numbers of firms selected for the work above: O il a EMOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. RAMON ROAD STORM WATER RETENTION BASIN LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO.18-15 GOOD FAITH EFFORTS DATE:May 2019 BID FORMS-PAGE 10 NON-COLLUSION DECLARATION The undersigned declares: ��++ I at n the �� P 1� of lD the (Title.of Officer) (Firm/Company) party making the foregoing bid. The Enid 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, submited 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 or, behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the for gOin is true and cop�3'ct and that this declaration is executed on (Date) (City) (State) Signature RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 NON-COLLUSION DECLARATION DATE:May 2019 BID FORMS-PAGE 11 CERTIFICATION OF NON-DISCRIMINATiON BY CONTRACTORS As suppliers of goods in connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to their race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Such actions shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. We agree specifically: 1. To establish or Observe employment policies, which affirmatively promote opportunities for minority persons at all job levels. 2. To communicate this policy to all persons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large. 3. To take affirmative steps to hire minority employees within the company. FIRM NAME OF PERSON SIGNING rn TITLE OF PERSON SIGNING I l�f(1P DATE_ a — 13"Iq Please include any additional information available regarding equal opportunity employment programs now in effect within your company. RAMON ROAD STORM WATER RETENTION BASIN NON-DISCRIMINATION CERTIFICATION CITY PROJECT NO.18-15 BID FORMS-PAGE 12 DATE:May 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. BID R/CONT ACTOR'S ame and Street Address: CD ri Telephone Number: Gci I Facsimile Number: T 1 U0 ) 6109 E-Mail: Tax Identification Num er: (o I C103 115 2. . TYPE OF FIRM _ Individual Partnership k*loGorporation (State ) 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 Ac V Q C State License Number(s) 01 Via to- Supplemental License Classifications I •Ir'T 4. BUSINESS LICENSE: Yes No License No.:Mr,01L(C) 5. Surety Company and Agent who will provide the required Bonds: Name of Surety u^t Add ss -S(.LA r Surety Company . Telephone Numbers: Age Surety ) ��� Uo RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BIDDER'S GENERAL INFORMATION DATE:May 2019 BID FORMS-PAGE 14 BIDDER'S GENERAL INFORMATION (Continued) 6. List the names and addresses of the principal members of the firm or names and titles of the principal officers of the corporation or firm; also include those who has gr ter than $2,000 interest in the corporation or firm. l Je c iV1 7. Number of years experience as a contractor in this specific type of construction work: 8. List at least three related projects completed to date: a. Owner. Address S. �cLSprinSS Contac Class of Work I(Jy (I ML Phone-LUO,_ V q-,A Contract Amount 1 �1� CQ-15 •00 Project Date Completed _10,[m aalsi Contact Person Telephone number SQM2� b. Owner L Address Pri I�SS Contac Class of Work Phone W- to Contract Amount 11r`tA r:U Project. u Date Completed xa bL.6 Conta Perso Telephone numberYr.2� C. Own r Address, e � Li 2 0 t(�_ j Contact 1WClass of Work m ovr .,L,I , Y 5_. Phony (�'� -$3� Contract Amount eg,to Project I"C�2aate�Completed Contact Person Telephone number 9. Name of Project Manager/Superintendent: 1''I�L�� 10. Name(s) of person(s) who inspected job site: r(L 13y'aA.)rt_ RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BIDDER'S GENERAL INFORMATION DATE:May 2019 BID FORMS-PAGE 15 -! (' + Surety Group t TOKIONiARINE 625 The City Drive South,Suite 205,Orange,CA 92868 HCC T;714-740-7000;F:714-740-9058 Bond Number: BB2008271 BID BOND Bid Date: 06/13/2019 KNOW ALL PERSONS BY THESE PRESENTS: That we, George Arlen Marantz dba G&M Construction (hereinafter called Principal), as Principal, and U.S.Specialty Insurance Company a corporation organized and existing under the laws of Texas (hereinafter called Surety) as Surety, are held and firmly bound unto City of Palm Springs (hereinafter called Obligee) as Obligee, in the penal sum of Ten percent L to %) of amount bid not to exceed Twenty Seven.Thousand Five Hundred and 00/100 Dollars ($_ 27,500.00 )for the payment of which the Principal and the Surety bind themselves, their heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS.SUCH,That,whereas the Principal has submitted or is about to submit a proposal to the Obligee on.a contract for Abandon exiting 10"PVC pipe-sidewalk,curb&gutter Ramon Road in Palm Springs CA NOW,THEREFORE, if the said contract be awarded to the Principal and the Principal shall,within such time as may be specified, enter into the contract in writing, then this obligation shall be void. If the Principal shall fail to do so, then the undersigned shall pay the obligee the damages which the obligee may suffer by reason of such failure up to and not exceeding the penal sum of the bond. Signed and sealed this 30th day of May 2019 Principal: -Wge Arlen arantz dba G&M Construction 10 By: Surety: U.S.Specialty Insurance Company By: Ted Lee Attorney-In-Fact HCCSZZA_BIDBOND 1/2017 Page 1 of 1 copy CALIFORNIA ALL-PURPOSE ACKOW'' . 9f :§ . A notary Public or other:officer completing this certificate verifies.only the identity of,the individ.u.al.who signed the document to which this certificate is attached,and:not the truthfulness,accuracy;.or validity_ofihat document.: State of California ) County f. Orange } On before me,. Angela K.Kim,Notary Public Da e Here Insert Name and Title of the Officer persohail.y. appeared Ted Lee Nofine(s) of Slgner(s) Who proved to me on the basis :of satisfactory:evidence to be. the persono .whose,nanie(o. is/ subscribed to the within:instrument and acknowledged to, me that he/st / executed;the:same in. hlsr/ authori.zed capaclty(#e�),.and that by hisffk/f signature( on the:instrumenf theperson( j, or th:e entity upon behalf of which the.person(9) 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. ANGELA K.KIM WITNESS.my hand and official seal.. Notary Public-California Orange County n Commission#2190918 My Comm.Expires Apr 11,2021 Signature Signa re o otaV 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 docuirient. Description of Attached Document: Title or Type of Docur7lent::Bond#3`nj` �x. a`-1 S Document;Rate: Number of Pages: Signer(s) Other Than.Named Above: Capacity(ies) Claimed by Signer(s) Signer'-s Name: Ted Lee Signer's Name:. D Corporate Officer— Title(s): Q Corporate Officer — Titie(s): n Partner — i`-I Limited [1 General O Partner 0 Limited General u individual 91 Attorney in Fact E 1 Individual 0 Attorney in Fact L1Trustee D Guardian or Conservator D.Trusteez ❑Guardian or Conservator. EF--1 Other: L1 Other: Signrier Is Representin : . c��) — Signer Is Representing: . t'l�'':G4.`�'C'>�•!V.Ldvt'''fd3%Gi`z';G..�-ti' .. �C:-t?Cx r'. �d�{}�ti� .`�i"�_Flu` , 'k,.-"�`L-�i`rh��r0._'.. _ i, r =.`??3s2e(9'(`.z�C>,_`t�'`Z. 02014 National Notary Association•www.NationalNotary:o.rg • 1-600=US NOTARY'(1-800-87.6-6827) Item#5907 1 copy TOKIOMARINE H C C POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That, U.S. SPECIALTY INSURANCE COMPANY (the"Company"), a corporation duly organized and existing under the laws of the State of Texas,and having its principal office in Houston, Harris County,Texas, does by these presents make,constitute and appoint, TED LEE its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver bond number BB2008271 , issued in the course of its business and to bind the Company thereby, in an amount not to exceed Three hundred thousand and 00/100 ( $300,000.00 ). Said appointment is made under and by authority of the following resolutions of the Board of Directors of U. S.Specialty Insurance Company: "Be it Resolved,that the President,any Vice-President,any Assistant Vice-President,any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver,any and all bonds, recognizances, contracts,agreements or indemnity and other conditional or obligatory undertakings,including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved,that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached."Adopted by unanimous written consent in lieu of meeting on September 151,2011. The Attorney-in-Fact named above may be an agent or a broker of the Company.The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF,U.S.Specialty Insurance Company has caused its seal to be affixed hereto and executed by its Senior Vice President on this 18th day of December 2017. 5;5;,�"'"•,,, 'X...... anc State of California '� 3�= U.S.SPECIAL. NSURANCE COMPANY County of Los Angeles 7i•,Y s By: ' Adam S.Pes in, Senior Vice President A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy,or validity of-that document. On this 151 day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, Senior Vice President of U.S.Specialty Insurance Company,who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person,or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS my hand and official seal., wwao:urtxrm NOWry Po�U • LOS ANOes CoOnly- l Commzilion/2239479- Signature (seal) 1.:My COMM•?YOR+s APr23,ia22. I, Kio Lo,Assistant Secretary of U.S. Specialty Insurance Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of May 2019 wpuuun„�,J Bond No. BB2008271 ````a��i....su..... zVe o� Agency No. 3602 = Kio Lo, Assis Secretary a •'..•........... �� HCCSZZ POAUSSIC06/2018 visit tmhcc.corri/surety'for,more information copy 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 C nia ) County of I ) On iD ' I ' before me, rei Of LnAC, Date Here Insert Name and tle of the Offi r personally appeared nAz 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. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph RENEE S.BREILING t is true and correct. Commission#t 2123982 9 WITNESS 7hajn-"-d official s L. z Notary Public'-California Riverside County My Comm.Expires Sep 16,2019 Signature Signature of Notary Pubic 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 Dofen Title or Type of Document: T 1 � ) C'�M;� Document Date: q Number of Pages: Signer(s) Other Than Named Above: L Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): ❑Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02014.National Notary Association -www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 ` HAPPTRA-09 DNIELSEN AC.ORO®`� CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY) 6/18/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0757776 CONTACT Diane Nielsen HUB International Insurance Services Inc. AX 77564 Country Club Drive,Suite 401 (AH/cc;No,Et):(760)360-4700 4742 (A/C,No):(760)200-9706 Palm Desert,CA 92211 AD RIEs :diane.nielsen@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:JameS River Insurance Company 12203 INSURED INSURER B:Ohio Security Insurance Company 24082 GNM Construction Inc. INSURER C:State Compensation Insurance Fund of California 35076 DBA:G&M Construction 1055 S Palm Canyon Dr. INSURER D:Greenwich Insurance Company 22322 Palm Springs,CA 92264 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LT INSD WVD MM/DD MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1 3/6/2019 3/6/2020 DAMAGE RENTED 50,000 X X 00081902- DA A ES(Ea occurrence) $ X Owner's&Contractor MED EXP(Any oneperson) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT POLICY X PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ ED B AUTOMOBILE LIABILITY Ea arB.clidenfSINGLE LIMIT $ 1,000,000 X ANY AUTO X X BAW66397600 3/6/2019 3/6/2020 BODILY INJURY(Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE 00030062-12 3/6/2019 3/6/2020 AGGREGATE $ 1,000,000 DEC RETENTION$ $ C WORKERS COMPENSATION X PER - AND EMPLOYERS'LIABILITY 9113409-18 10/1/2018 10/1/2019 STATUTE ER Y 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ X E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Equipment Floater 2869041 6/23/2019 5/23/2020 Leased/Rented. 300,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Ramon Road Storm Water Retention Basin-City Project No.18-15 The City of Palm Springs,its officials,employees and agents are named as an additional insured per attached CG2010 0704,CG2037 0704 and CA7110 0307. This insurance is primary and non-contributory. Waiver of subrogation applies to general liability&automobile liability and workers compensation per attached endorsement. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date.10 days notice applies for non payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tYACCORDANCE WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs,CA 92263 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy, #BAQ56397600 COMMERCIAL AUTO - CA 8810 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage,afforded by thls:endorsement, the provisions of the policy-apply unless modified by the endorsement. COVERAGEINDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT;AGREEMENT OR PERMIT 3 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR:LOSS 19 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 22 EMPLOYEES AS INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 23 EXTRA EXPENSE - BROADENED COVERAGE 10 GLASS REPAIR- WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) -. 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN/LEAS E.GAP 14 PARKED AUTO.COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) -16 PERSONAL EFFECTS COVERAGE 11 . PHYSICAL DAMAGE-ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT . 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR- 7 TWO OR MORE DEDUCTIBLES 17 UNINTENTIONAL FAILURE TO,DISCLOSE HAZARDS 18 . ,.WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 20 SECTION II-LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, '.'insured" does not include any organization that: (1) is a partnership or joint venture; or (2).. Is-an insured under any other automobile policy; or- (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d.. (2) of this provision does not apply, to a.policy written to apply specifically in - excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture,of which you own more than 50 percent of the voting stock.This automatic coverage is afforded only for .180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) if there is similar insurance or a self-insured retention plan available to that organization; © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1.of 7 (2) If the Limits of Insurance of.any other insurance policy have been exhausted; or. (3) To "bodily injury" or "property damage".that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION Il - LIABILITY COVERAGE, paragraph A.1. - WHO 1S AN INSURED is amended to include the following as an insured: f. Any "employee".of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee".. g. An "employee of yours while operating an "auto hired or borrowed under a written contract or agreement In_that "employee's" name;with your permission, while performing duties re lated to the-conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the"employee". 3. DDITIONAL INSURED BY CONTRACT,AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.I. WHO iS AN INSURED is amended to include the following as an insured: h. Any person or organization with.respect to the operation, maintenance or use of a covered "auto", provided that you and such person.or organization have agreed in a written contract, agreement,or permit issued to you by governmental or public authority,to add such person, or organization,or governmental or public authority to this policy as an "insured". However,such person or organization is an"insured": (1) Only with respect to the operation,maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage''caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract,agreement or permit 4. SUPPLEMENTARY PAYMENTS , SECTION 11 - LIABILITY COVERAGE, Coverage-Extensions, 2.a. Supplementary Payments, para- graphs(2)and(4)are.Teplaced by the following: (2) Up to $3,000 for cost of bail-.bonds (including bonds for related traffic violations) required because.of an "accident"we cover.We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn ings up to$500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by taw;fellow employees are not entitled to the protection afforded to the employer by the workers compensation.exclusivity rule, or similar protection, the following . provision is added: SECTION II - LIABILITY, exclusion B.5. FELLOW.EMPLOYEE does not apply if the "bodily injury" results from the use of a covered"auto"you own or hire. SECTION Ill.-PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION fll -PHYSICAL DAMAGE COVERAGE, is amended byadding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive; Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto"you own,then the Physical Damage coverages provided are extended to"autos": a. You hire, rent or borrow; or. 2013.Liberty Mutual Insurance CA 88 10 01-13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 7 b. Your "employee" hires or rents under a written contract or agreement in that"employee's". name, but only if the damage occurs while the vehicle is being used in the conduct of,your business, subject to the following limit and deductible:. A. The most we will pay for"loss'- in any one"accident" or"loss" is the smallest of: (1) $50,000;or (2) The actual cash value of the damaged.or stolen property as of the time of the "loss"; or. (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible., B. The deductible will be equal to the largest deductible.applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described-in this provision, we will provide coverage equal to the broadest coverage applicable to any.covered "auto" you own. D. .Subject to a maximum of$1,000 per"accident",.we will also cover the actual loss of use of the hired."auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage-extension does not apply to; (1) Any"auto" that is hired,rented or borrowed with a driver; or (2) Any"auto" that is hired, rented or borrowed from your"employee Forthe purposes of this provision,SECTION V-DEFINITIONS is amended by adding the following. "Total loss" means a "loss" in'Which the cost of repairs plus the salvage value exceeds the actual cash value. 7. _ TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE; paragraph Al Towing, is amended by the addition of the following; We will-pay towing and laborr costs incurred, up to the limits shown below, each time a covered "auto" classified and rate_ d as a private passenger type, "light truck" or "medium truck" is dis- abled: a. For.private passenger type vehicles,we will pay up to$50 per disablement. b. For "light trucks", we will pay up to$50 per disablement. "Light trucks" are trucks that have a gross vehicle weight(GVW).of 10,000 pounds or less. c. For .'medium trucks" , we will..pay up to.$150 per disablement. "Medium trucks"are trucks that have a gross vehicle weight(GVW)of 10,001 -20,000 pounds. However,the labor must be performed at the place.of disablement. 8. PHYSICAL DAMAGE ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION III PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of$50 per day and a.maximum limit of$1,500 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page.3 of 7 9. RENTAL REIMBURSEMENT SECTION III-PHYSICAL DAMAGE COVERAGE,A.COVERAGE,is amended by adding the following: a. We will pay up to$75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss to an "auto" for which we also.pay a 'loss" under Comprehensive; Specified Causes of Loss or Collision Coverages. We will,pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered"auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75_per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality,up to a maximum of 30 days. c. We will also pay up to$500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you-have a business necessity that other "autos" avail- .able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4.Coverage Extension. f. No deductible applies to this coverage: For the purposes of this endorsement provision,materials and equipment do not include "personal effects" as defined in provision 11.- 10. EXTRA EXPENSE-BROADENED COVERAGE - Under SECTION III-PHYSICAL DAMAGE COVERAGE,A.COVERAGE,we will pay for the expense of returning a stolen covered "auto"to you.The maximum amount we will pay.is$1,000. 11. PERSONAL EFFECTS COVERAGE & SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If-you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects"stolen with the"auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V-DEFINITIONS-is amended by adding the following. For-the purposes of this provision, "personal effects". mean tangible property that is worn or carried by an insured." "Personal effects" does not include tools, equipment,jewelry,money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to-the accidental.discharge of an airbag.. Any insurance we provide shall-be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree.to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO,VISUAL AND DATA ELECTRONIC EaUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a.to exclu- sions 4.c.and 4.d.is deleted and replaced with the following: 2073 Liberty Mutual Insurance CA 88.10 01 13 Includes copyrighted material of Insurance Services Office,Inc,with its permission. Page 4 of 7 f Exclusion 4.c.and 4.d.do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction,of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use Of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered"auto"; or If the "loss" occurs solely to,audio,visual or data electronic equipment or accessories used with this'equipment,then our obligation to pay for, repair, return.or replace damaged or stolen property will be reduced by a$100 deductible, -14. LOAN/LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one"accident" is the greater of the: 1. Balance due under the terms of the.loan or lease to which the damaged covered "auto" is subject at the time of the"loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the"loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab-. normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or.rollover balances.from previous loans or leases, e. Final payment due under a ",Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by p lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", L Any amount representing taxes, , j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the"loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the"loss"..This.adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral,or lease written on the covered"auto" that incurred the loss. C. SECTION V- DEFINTIONS is changed by adding the following: As.used in this endorsement provision,the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A"balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan,thereby requiring a large final payment. . © 2013 Liberty Mutual Insurance . CA 88 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 7 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced: 16. PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply.to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs,or less as defined by the manufacturer as maximum loaded weight the"auto" is designed to carry while it is: a. in the charge of an"insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police-authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any"loss".if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 17. TWO OR MORE-DEDUCTIBLES Under SECTION 111 PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same accident,the following applies to paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived;or b. If the applicable Business Auto deductible is not the smaller(or smallest)deductible it will be reduced by the amount of the smaller(or smallest)deductible; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller, (or smallest)deductible,will be waived.For the purpose of this endorsernent company means any.company that is part of.the Liberty Mutual Group. - SECTION IV-BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION.iIV-BUSINESS AUTO CONDITIONS, Paragraph.B.2,is amended by adding the following: If you unintentionally fail to disclose any hazards;.exposures or material facts existing as of the inception date or renewal date of the Business Auto.Coverage Form,the coverage afforded by this policy will not be prejudiced. However, you must report the.undisclosed hazard of exposure as soon.as practicable after its discovery,and we have the right-to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT,CLAIM,SUIT,OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2-a. is replaced in its entirety by the following: a. in the event of "accident", 'claim, "suit" or "loss", you must promptly notify us when It is known to: 1. You,if you are an individual; 2. A partner, if you area partnership; 3... Member,if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice,if you are a corporation. ® 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of insurance Services Office,Inc.,with its permission. Page 6 Of 7 To the extent possible, notice`to us should include: , (1) How,when and where the"accident" or"loss'.' took.place; (2) The "insureds" name and address;.and (3) The names and addresses.of any injured persons and witnesses.. 12 )AIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.5.,, Transfer of Rights of Recovery -Against Others to Us, is amended by the addition of the following: If the person or org;aniaation has waived those rights before an "accident" or "loss", our rights are waived also. 21: HIRED AUTO COVERAGE TERRITORY SECTION IV- BUSINESS AUTO CONDITIONS, paragraph.B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or.less,the coverage territory is anywhere in the world,provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V-DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V=DEFINTIONS,definition C.'is replaced by the following: _ "Bodily injury" means physical.injury, sickness or disease sustained by a person, including mental anguish,.mental injury,shock,fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS,.paragraph A. - CANCELLATION condition applies except as fol- lows- If we cancel for any reason other than nonpayment of premium,.we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation.This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 7 of 7 ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION REP 02 BLANKET EMIS 9113409-.. FUND RENEWAL SP HOME OFFICE 4-07-81-44.18 SAN FRANCISCO EFFECTIVE OCTOBER 1, 2 018AT 12.01 A.M. PAGE 1 OF 1 AND EXPIRING OCTOBER 1, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12.01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HAPPY TRAVELER RV PARK 211 W Mesquite Ave Palm Springs, CA 92264 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS' FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED- IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO .THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM. US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 3.oD% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION -BLANKET WAIVER OF FOR WHOM. THE NAMED INSURED SUBROGATION HAS AGREED BY .WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL HE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS. OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO- SEPTEMBER 28 $ 2018 AUTHORIZED REPRESENT VE PRESIDENT AND CEO 2572 SCIF FORM 10217 IREV:7.20143 OLD OP 217 Policy#00081902-1 COMMERCIAL GENERAL LIABILITY - CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifes1nsurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Locations Of Covered Operations Where required by written contract or written agreement - All operations of the Named Insureds Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to. B,.With respect to the insurance afforded to these include as an additional insured the person(s) or additional,insureds, the following additional exclu- organization(§) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does-not apply to '.'bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused,In whole or in part, by: 1: Your acts or omissions;or -1. All work, including materials, parts or equip- merit furnished in connection with such work, 2. The.acts or omissions of those acting on your on the project(other than service, maintenance behalf,. or repairs) to be performed by or on behalf of in the-performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the locations) desig- covered operations has been completed;or nated above. 2. That portion of "your .work" out of which the injury or damage arises has been put to its in- tended use by any person or organization oth- er 'than another contractor or subcontractor engaged in performing operations for a.princk pal as a part of the same project. CG 2010 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 O Policy#00081902-1 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ,IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Or anization s : tions Where required by written contract or written agree- All operations of the Named Insureds ment Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II"Who Is An.Insured is amended to include as an additional insured the person(s) or organiza- tion(s) shown in the Schedule, but only with respect to liability for"bodily.injury"or"property damage" caused, In whole or in part, by"your work"at the location desig- nated and-described in the schedule of this endorse- ment performed for that additional insured and included in the"products-completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 E Policy#/00081902-1 COMMERCIAL GENERAL LIABILITY CG24040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Where required by written contract or written agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of We waive any right of recovery we may have against Rights Of Recovery Against Others To -Us of the person or organization shown in the Schedule Section IV—Conditions: above because of payments we make for injury or damage arising out of your ongoing operations or your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies . only to the person or organization shown in -the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 13 Policy#00081902-1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL.COVERAGE PARTS Name Of Additional Insured Person(s) Or Or anization s : When required by written contract !f no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under-this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written,agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, AP5031US O4-10 Page 1 of 1 PUBLIC INTEGRITY CISCLOSUSZE APPLICANT CISCLOSURE FORM 1. Name of Entity 2. Address of Entity (Principle Place of Business) fy\ t1 G 3. Local or California Address (if diflc'ere t than # ) 4. State where Entity is Registered with Secretary of State C � If other than California, is the Entity also registered in California? ❑Yes ❑ No 5. Type of Entity Corporation ❑ Limited Liability Company ❑ Partnership ❑ Trust ❑ Other(please specify) 6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify) Note: If any response is not a natural person, please identify all officers, directors, members,managers and otherfiduciaries for the member,manager, trust orotherentily ('Oo Ej Officer ❑ Director ❑ Member ❑ Manager [name] ❑ General Partner 11 Limited Partner l (Other _ —)jV�0—� ❑ Officer ❑ Director ❑ Member ❑ Manager[name] ❑ General Partner ❑ Limited Partner ❑ Other ❑ Officer ❑ Director ❑ Member ❑ Manager[name] ❑ General Partner ❑ Limited Partner Other CITY OF PALM SPRINGS—PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 1 of 2 RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BIDDER'S GENERAL INFORMATION DATE: May 2019 BID FORMS-PAGE 16 7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity A. [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP A, EXPLANATTON OF THE RELATIONSHIP: B. [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP B, EXPLANATION OF THE RELATIONSHIP: C. [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP C, EXPLANATION OF THE RELATIONSHIP: I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Discl in arty, Pi- ted Name,Title Date CI OF PALM SPRINGS—PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 2 of 2 RAMON ROAD STORM WATER RETENTION BASIN CITY PROJECT NO.18-15 BIDDER'S GENERAL INFORMATION DATE:May 2019 BID FORMS-PAGE 17 CITY OF PALM SPRINGS,CALIFORNIA PROCUREMENT CONTRACTING DIVISION BID ABSTRACT BID# ;Bidder: Bidder: Bidder: Bidder: Bidder: Bidder: 7ENAME:1 b' l�[ ►-<'' � _ r Cz�_ ryi DUE DATE: �, 1J 'C. °.erL� ('.9 -/ lI Description: $ ova Total of all Bid Schedule Items: $ Witnessed by: -P6 Date: r ,/ 1 CITY OF PALM SPRINGS,CALIFORNIA PROCUREMENT CONTRACTING DIVISION BID ABSTRACT BID# [ ;Bidder: Bidder: Bidder: Bidder: Bidder: Bidder: P QM Kj r4 DUE DATE: Description: $ I Total of all Bid Schedule Items: $ Witnessed by: Le-Ink Date: Business • • GEORGE ARLEN MARANTZ DBA G & M CONSTRUCTION 1055 S'PALM CANYON DR PALM SPRINGS, CA 92264 Business Phone Number:(760) 322-6918 Entity Sole Ownership Issue Date 12/01/1971 Expire Date 03/31/2020 Licenso'St, tus This license is current and active. All information below should be reviewed. ClassiRc4ons • A-GENERAL ENGINEERING CONTRACTOR • B -GENERAL BUILDING CONTRACTOR • C21 - BUILDING MOVING. DEMOLITION s _ Cert�fi ations • ASB-ASBESTOS (For Bidding Purposes Only) • HAZ-HAZARDOUS SUBSTANCES REMOVAL C • • • • 77- 7 7 _ f5 _. Co "do Bond ,..� ... _ This license filed a Contractor's Bond with SURETEC INDEMNITY COMPANY. Bond..Number: 132990 Bond Amount: $15,000 Effective Date: 03/02/2016 Contractor's Bond History WorkusCompensation This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND Policy Number:9113409 Effective Date: 10/01/2014 Expire Date: 10/01/2019 Workers' Compensation History