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HomeMy WebLinkAbout9/5/2018 - AGREEMENTS AGREEMENT (CONSTRUCTION CONTRACT) 33d D THIS AGREEMENT made this day of 5spt , 2018, 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 LC Paving and Sealing, Inc., a California corporation hereinafter designated as the Contractor. The City and the Contractor, in consideration of the mutual covenants hereinafter set forth, agree as follows: ARTICLE 1 -- THE WORK For and in consideration of the payments and agreements to be made and performed by City, Contractor agrees to furnish all materials and perform all work required to complete the Work as specified in the Contract Documents, and as generally indicated under the Bid Schedule(s) for the Project entitled: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CMLN 5282 (045) The Work comprises the addition of a turn lane on the south side of the intersection of Gene Autry Trail and Vista Chino/111. The work includes removing existing improvements within the limits of work and replacing them with new pavement and median improvements, adding new overlay on the west side of the intersection, new striping and traffic signal improvements related to the new lane. ARTICLE 2 -- COMMENCEMENT AND COMPLETION The Work to be performed under this Contract shall commence on the date specified in the Notice to Proceed by the City, and the Work shall be fully completed within the time specified in the Notice to Proceed. The City and the Contractor recognize that time is of the essence of this Agreement, and that the City will suffer financial loss if the Work is not completed within the time specified in Article 2, herein, plus any extensions thereof allowed in accordance with applicable provisions of the Standard Specifications, as modified herein. They also recognize the delays, expense, and difficulties involved in proving in a legal proceeding the actual loss suffered by the City if the Work is not completed on time. Accordingly, instead of requiring any such proof, the City and the Contractor agree that as liquidated damages or delay (but not as a penalty), the Contractor shall pay the City the sum specified in Section 6-9 of the Special Provisions for each calendar day that expires after the time specified in Article 2, herein. In executing the Agreement, the Contractor acknowledges it has reviewed the provisions of the Standard Specifications, as modified herein, related to liquidated damages, and has made itself aware of the actual loss incurred by the City due to the inability to complete the Work within the time specified in the Notice to Proceed. Termination Prior to Expiration of Term. City may terminate this Agreement for its convenience at any time, without cause, in whole or in part, upon giving Contractor thirty GENE AUTRY AND VISTA CHINO DUAL LEFT TURN 14,1 41 r i CITY PROJECT NO. 14-13 ° ` ' •^• � AGREEMENT AND BONDS N PAGE M11 SEPTEMBER 5, 2018 (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 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 Three Hundred Ninety Nine Thousand Four Hundred Thirty Seven Dollars ($399.437.00). 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, Federal Labor Standards Provisions, Federal Rates of Prevailing Wages, the accepted Bid and Bid Schedule(s), List of Subcontractors, Non-collusion Declaration, Equal Employment Opportunity Certification, Debarment and Suspension Certification, Non-Lobbying Certification for Federal-Aid Contracts, Disclosure of Lobbying Activities, Bid Security or Bid Bond, Bidder's General Information, Exhibit 15G Local Agency Bidder DBE Commitment, Exhibit 15H DBE Information —Good Faith Efforts, Public Contract Code Section 10285.1 Statement, Public Contract Code Section 10162 Questionnaire, Public Contract Code Section 10232 Statement, this Agreement, Worker's Compensation Certificate, Performance Bond, Payment Bond, Standard Specifications, Special Provisions, the Drawings, Addenda numbers 0 to 0, inclusive, and all Change Orders and Work Change Directives which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES AGREEMENT FORM SEPTEMBER 5,2018 CITY PROJECT 14-13 AGREEMENT AND BONDS-PAGE 2 201 The Contract Documents shall also incorporate those certain required federal contract provisions and the Federal Requirements for Federal-Aid Construction Projects (Form FHWA 1273), included in Exhibit "A" attached hereto and made a part hereof. 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. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES AGREEMENT FORM 201 SEPTEMBER 5, 2018 CITY PROJECT 14-13 AGREEMENT AND BONDS-PAGE 3 Prevailing Wages. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000. et seq. ("Prevailing Wage Laws"). Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, its officials, officers, employees, agents and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. ARTICLE 9 -- CONFLICT OF INTEREST Conflict of Interest. Contractor acknowledges that no officer or employee of the City has or shall have any direct or indirect financial interest in this Agreement nor shall Contractor enter into any agreement of any kind with any such officer or employee during the term of this Agreement and for one year thereafter. Contractor warrants that Contractor has not paid or given, and will not pay or give, any third party any money or other consideration in exchange for obtaining this Agreement. ARTICLE 10 -- NON-DISCRIMINATION Covenant Against Discrimination. In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin (i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Contractor certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship; and further, that Contractor is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. ARTICLE 11 -- MISCELLANEOUS Terms used in this Agreement which are defined in the Standard Specifications and the Special Provisions will have the meanings indicated in said Standard Specifications and the Special Provisions. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and specifically, but without limitation, monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES AGREEMENT FORM CITY PROJECT NO. 14-13 AGREEMENT AND BONDS-PAGE 2 SEPTEMBER 5,2018 The City and the Contractor each binds itself, its partners, successors, assigns, and legal representatives, to the other party hereto, its partners, successors, assigns, and legal representatives, in respect of all covenants, agreements, and obligations contained in the Contract Documents. SIGNATURES ON NEXT PAGE GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES AGREEMENT FORM 201 SEPTEMBER 5, 2018 CITY PROJECT 14-13 AGREEMENT AND BONDS-PAGE 3 IN WITNESS WHEREOF, the City and the Contractor have caused this Agreement to be executed the day and year first above written. CITY OF PALM SPRINGS, CALIFORNIA B David H. Re City Manager ATTE : By Anthony q. Mejia, JUAe Ci APPROVED AS TO FORM: B '' Edward Z. Kotl in City Attorney RECOMMENDED: Marcus Fuller, Assistant City Manager/City Engineer APPROVED BY THE CITY COUNCIL: Date °I 5 a 1 Agreement No. ArR03 GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES AGREEMENT FORM SEPTEMBER 5,2018 CITY PROJECT 14-13 AGREEMENT AND BONDS-PAGE 4 201 CONTRACTOR By: LC Paving and Sealing, Inc., a California Corporation Firm/Company Name B?J'na-t�udre-(notarized) _ By: Signature (notarized) Name: JOSEA.SALINAS Name: Title: PRESIDENT, SEC,TREASURER, VP Title: 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 th above (This Agreement must be signed in the above space space by one having authority to ind the by one having authority to bind the Contractor to the Contractor to the terms of the Agreem t.) terms of the Agreement.) State of ) State of ) County of 1 County of )ss On On before me, before me, personally appeared personally appeared who proved to me on t basis of satisfactory who proved to me on the basis of satisfactory evidence to be the perso (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 at he/she/they executed the acknowledged to me that he/she/they executed the same in his/her/th authorized capacity(ies), and same in his/her/their authorized capacity(ies), and that by his/her/th r signatures(s)on the instrument that by his/her/their signatures(s)on the instrument the person(s), o the entity upon behalf of which the the person(s), or the entity upon behalf of which the person(s) act , executed the instrument. person(s) acted, executed the instrument. I certify un er PENALTY OF PERJURY under the I certify under PENALTY OF PERJURY under the laws of t e State of California that the foregoing laws of the State of California that the foregoing paragr h is true and correct. paragraph is true and correct. WIT ESS my hand and official seal. WITNESS my hand and official seal. N ary Signature: Notary Signature: otary Seal: Notary Seal: ' ye 6�m-erg I I GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES AGREEMENT FORM SEPTEMBER 5,2018 CITY PROJECT 14-13 AGREEMENT AND BONDS-PAGE 2 201 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On 0a • I � �j before me, Marisa Haas, Notary Public (insert name and title of the officer) personally appeared Jose A. Salinas who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. A ANN HAAS WITNESS my hand and official seal. Commission on N 2122991 Notary Public-California San Diapo County Comm. gg 15 2010 Signature (Seal) BID PROPOSAL BID TO: CITY OF PALM SPRINGS, CALIFORNIA The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with the City in the form included in the Contract Documents (as defined in Article 4 of the Agreement) to perform the Work as specified or indicated in said Contract Documents entitled: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CML 5282 (045) Bidder accepts all of the terms and conditions of the Contract Documents, including without limitation those in the Notice Inviting Bids and the Instructions to Bidders dealing with the disposition of the Bid Security. This Bid will remain open for the period stated in the Notice Inviting Bids, unless otherwise required by law. Bidder will enter into an Agreement within the time and in the manner required in the Instructions to Bidders, and will furnish the insurance certificates, Payment Bond, Performance Bond, and all Permits required by the Contract Documents. Bidder has examined copies of all the Contract Documents, including the following Addenda (receipt of which is hereby acknowledged): pc>,v& Number Date Number Date Number Date Number Date Number Date Number Date Number Date Bidder has familiarized itself with the nature and extent of the Contract Documents, the Work, the site, the locality where the Work is to be performed, the legal requirements (federal, state, -and local laws, ordinances, rules, and regulations), and the conditions affecting cost, progress, or performance of the Work, and has made such independent investigations as Bidder deems necessary. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 BID PROPOSAL BID FORMS-PAGE 2 In conformance with the current statutory requirements of California Labor Code Section 1860, et seq., the undersigned confirms the following as its certification: I am aware of the provisions of Section 3700 of the Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self- insurance in accordance with the provisions, before commencing the performance of the Work of this Contract. To all the foregoing, and including all Bid Schedule(s), List of Subcontractors, Non-Collusion Declaration, Bidder's General Information, and Bid Bond contained in these Bid Forms, said Bidder further agrees to complete the Work required under the Contract Documents within the Contract Time stipulated in said Contract Documents, and to accept in full payment therefor the Contract Price based on the Lump Sum or Unit Bid Price(s) named in the aforementioned Bidding Schedule(s). Dated: Bidder: (-� ��✓ I r L. By: (Signature) Title: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 BID PROPOSAL BID FORMS-PAGE 3 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 full credit in the amount shown in the Bid Schedule for the deleted item of Work. SPECIAL NOTE: In the event of any "missing" bid items or scope of work not otherwise included or identified in the Bid Schedule, but indicated or required by the Plans and Specifications, the Contractor shall prosecute the work as required by the Plans and Specifications, and payment for any "missing" bid items or scope of work shall be included in the various bid items of work, and no additional payment will be allowed therefore. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 LIST OF SUBCONRACTORS-PART I BID FORMS-PAGE 6 BID SCHEDULE Schedule of Prices for Construction of the: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CML 5282 (046) Item Description Estimated Unit Unit Amount No. Quantity Price 1. MOBILIZATION 1 LS $ o 2. TEMPORARY TRAFFIC CONTROL 1 LS $ .3.) _ CX) 3. WATER POLLUTION CONTROL 1 LS $ 3SDx3' CLEARING, GRUBBING AND 4. REMOVALS 1 LS $ IdU'cxn= Ja 5. SAWCUT EXISTING PAVEMENT 1,160 LF $ $ . 9_ a0 COLD PLANE EXISTING _ 6' PAVEMENT 1,080 SF S$ , 7S- $ go;Z1(3,00 7. INSTALL 5 ASPHALT CONCRETE 320 TON $ i Z-7 60 $ 0 3Z.ao CONSTRUCT 4" CLASS 2 8' AGGREGATE BASE 125 CY $ .3 W $ I 6L� cxJ CONSTRUCT TYPE Al-6 CURB 9' CALTRANS PLAN RSP A87 1,120 LF $ -92. Ib $ z2z452. a7 10. CONSTRUCT ASPHALT OVERLAY 14,050 SF $ Z,53 $3S 06 SJ ADJUST SEWER MANHOLE TO 11. GRADE 2 EA $ SD.0� $ w 00 CONSTRUCT 4" CLASS 3 12. CONCRETE 1075 SF, $ 01,50 $ .7 v 13. SURVEY MONUMENT TIE-IN 1 EA INSTALL SIGNS, STRIPING, 14. THERMOPLASTIC MARKING, AND 1 LS RAISED MARKERS INSTALL STANDARD SIZE SIGN 15. ON SIGNAL MAST ARM 3 EA $ 3e�e, $ Z'•740 00 INSTALL HYBRID VIDEO/RADAR 16. DETECTION CAMERA ON 1 LS LUMINAIRE OR MAST ARM I I $S�,'Xt7 " $ �*' 70o-QJ L . .UMAG Name of idder or Fir GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 BID SCHEDULE BID FORMS-PAGE 4 BID SCHEDULE (Continued) Schedule of Prices for Construction of the: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CML 5282 (045) Item Description Estimated Unit Unit Amount No. Quantity Price REMOVE EXISTING TRAFFIC 17. SIGNAL CONDUCTORS. INSTALL 1 LS ALL NEW CONDUCTORS. $ !2.,Z $3641 V6 W REMOVE AND SALVAGE EXISTING BICYCLE PUSH 18. BUTTON. SEAL POLE IN 2 EA WATERPROOF MANNER INSTALL SIGNS PER CITY 19' STANDARD DWG. 621 1 EA $550,cXJ $ -- x� REMOVE AND SALVAGE EXISTING PEDESTRIAN SIGNAL 20. HEADS. INSTALL COUNTDOWN 8 EA PEDESTRIAN SIGNAL HEADS. $ $ REMOVE AND SALVAGE EXISTING PEDESTRIAN PUSH 21. BUTTONS. INSTALL APS PUSH 8 EA BUTTON $ +1740.;�, $_Ialiw, CONSTRUCTION PROJECT 22. IDENTIFICATION SIGN 1 LS $ CALTRANS ENCROACHMENT 23. PERMIT 1 AL $1,640 24. FIELD ORDERS* --- AL $28,000 TOTAL OF ALL ITEMS OF THE BID SCHEDULE: $ 3q � 1 �31 . oa (Price eiin_figures) T )A 'I 1 l h �fe-(, 4v,Ax- A � m,n> I( yve, (Vl(1LfV 'Hf yiA(,,(( �/ rice in words) —TIf Al 0(( civil Lz 6 Ce .An allowance s een provided for Field Orders 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. mtV,\ w� - Name of Bid r or Firm GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 BID SCHEDULE BID FORMS-PAGE 5 BIDDER'S LIST OF SUBCONTRACTORS — PART I The bidder shall list all subcontractors (both DBE and non-DBE), including those who will perform Work under this Bid for less than one-half of one percent of the Contractor's Total Bid Price. This required Bidder's List shall be provided in accordance with Section 2-3.1 of these Special Provisions and in accordance with Title 49, Section 26.11 of the Code of Federal Regulations. After the opening of Bids, no changes or substitutions will be allowed except as otherwise provided by law. The listing of more than one subcontractor for each item of Work to be performed with the words "and/or" will not be permitted. Failure to comply with this requirement will render the Bid as non-responsive and may cause its rejection. Special Note: The Prime Contractor shall perform not less than 50% of the Work identified in this Bid. In the event a Bidder lists subcontractors who will perform Work under this Bid in excess of 50% of the Work identified in this Bid, the Bid shall be considered non-responsive. A. BIDDER'S PORTION OF WORK Page 1 of Z 1. Name of Prime Contractor: 2. Bid Items/Portion of Work to be Self-Performed (if less than 100%of the contract): j - i2- 5 ZI - 7-H 3. Dollar Amount of Work Self-Performed: 4. Percentage of Work Self-Performed: 5. Date: By signing the Bid Form,Contractor hereby certifies that it will perform not less than 60%of the Contract Work with its own forces. B. LIST OF SUBCONTRACTORS 1. Type of Subcontractor(Check One) S First Tier, ❑ Second Tier, ❑ Supplier. ❑ Service Contractor(e.g.Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: tt ' 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: y 1) (v$'1,- 1091 5-6935z 11 <$1M ❑ < $5M 0 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor �1<$15M *'*$-15M el rO . (O Registration No: IOlXOOS363 10. Percentage of Contracted Work: 12. DB Certification No.: 11. DBE Firm? ❑ Yes ® No 25 ` t� GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12.2018 LIST OF SUBCONRACTORS-PART I BID FORMS-PAGE 7 BIDDER'S LIST OF SUBCONTRACTORS - PART I (Continued) Copy this page as needed to provide a complete listing. Page of 2 1. Type of Subcontractor(Check One) X First Tier, ❑ Second Tier; ❑ Supplier, ❑ Service Contractor(e.g.Trucking) 2. Subcontractor Name: 3. A dress: Z--�2, 3ca T zz� 3 4. Bid Items/Portion of Work: # iy /5 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: GS/ Sqs-- Z75e 776306 1] <$1M X < $5M 1-1 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ <$15M ❑ > $15M 00 Registration No:i0000Vly�4 10. Percentage of Co acted Work: 11. DBE Firm? ❑Yes R No 12. DBE erttiflcation No.: 2, -1 1. Type of Subcontractor(Check One) 3I 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: QSI' �� ' IUID 7AJ LA DLl 11 <$1M < $5M 0 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor El <$15M ❑ > $15M '1 plj Registration Na , 10. Percentage of Contracted Work.- ork 111. DBE Firm? ❑Yes &�No 12. DBE C 'fication No.: Z1 - h�6 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: ❑ <$1M ❑ < $5M ❑ <$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.: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 LIST OF SUBCONRACTORS-PART I BID FORMS-PAGE 8 BIDDER'S LIST OF SUBCONTRACTORS — PART II (Subcontractors not selected nor listed in the bid.) The bidder shall list all subcontractors (both DBE and non-DBE) who provided a quote or bid but were not selected to participate as a subcontractor on this project, including quotes or bids to perform Work under this Bid for less than one-half of one percent of the Contractor's Total Bid Price. This required Bidder's List shall be provided in accordance with Section 2-3.1 of these Special Provisions and Title 49, Section 26 of the Code of Federal Regulations. Page 1 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: 71 <$1M 0 <$5M 0 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ <$15M El > $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: ❑ <$1M ❑ <$5M 0 < $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.: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 LIST OF SUBCONRACTORS-PART I BID FORMS-PAGE 9 BIDDER'S LIST OF SUBCONTRACTORS - PART II (Continued) Copy this page as needed to provide a complete listing. Page Of 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier, ❑ Supplier; ❑ Service Contractor(e.g.Tr cking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: /AnnI Gross Receipts: ❑ <$5M ❑ <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ > $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. Contr or's License No.: 7. Annual Gross Receipts: 0 <$1M 11 <$5M 11 <$10M 8. Amount of Contracted Work: 9. Public Works Contractor El < $15M ❑ >$15M Re tration No: 10. Percentage of Contracted Work: 1. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 11 1. Type of Subcontractor(Check ne) ❑ First Tier; ❑ Second Tier, ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion o ork: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ <$1M ❑ < $5M ❑ <$10M 8. Amount o ontracted Work: 9. DIR Public Works Contractor ❑ <$15M El >$15M Registration No: 10. Percetflage of Contracted Work: 11 DBE Firm? ❑ Yes ❑ No 12, DBE Certification No.: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 LIST OF SUBCONRACTORS-PART II BID FORMS-PAGE 10 NON-COLLUSION DECLARATION TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the City of Palm Springs ENGINEERING SERVICES DEPARTMENT In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true, and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non-collusion Declaration is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non- collusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Bidder 1,1, By _ G s Title , Organization Address 350 5TG Z00 'S a /H.asz..c_. C.,4 9 2c1E 9 GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12.2018 NON-COLLUSION DECLARATION BID FORMS-PAGE 11 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS As suppliers of goods or services to the City of Palm Springs, the firm listed below certifies that it does 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, that it is in compliance with all federal, state, and local directives and executive orders regarding non-discrimination in employment; and that it agrees to demonstrate positively and aggressively the principle of equal employment opportunity in employment. 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 Jos �I �s TITLE OF PERSON SIGNING 51 pcs T DATE Please include any additional information available regarding equal opportunity employment programs now in effect within your company. of hgVC on _ � � �Ia �:� nAA A0AI`i hlL cla I) Itu�• GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 JULY 12,2018 NON-DISCRIMINATION CERTIFICATION BID FORMS-PAGE 12 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder Ce_ SI, , =,. and its proposed subcontractors (as listed on the bidder's list of subcontractors), hereby certify that they have _*_, have not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, the prime bidder has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 EEO CERTIFICATION FORM JULY 12,2018 BID FORMS-PAGE 13 DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • Has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years, • Does not have a proposed debarment pending; and • Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. 1 N\c'\-- Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 DEBARMENT AND SUSPENSION CERTIFICATION JULY 12,2018 BID FORMS-PAGE 14 NONLOBBYING CERTIFICATION FOR FEDERAL-AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and discloge accordingly. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 MARCH 8,2018 NON-LOBBYING CERTIFICATION BID FORMS-PAGE 15 DISCLOSL;RE OF Lit IN(; ACTIVITIES COMPLL fL 11IIS I'0R%I TU DIS(LOST 1013111-ING.A('HA I I II S PI RS114N 1 7U 31 1 .S.C. 13�' 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: F1a_ cuntMCI El 1,10 If applicabkin a. imITitI IS. gr;wt b. 'oettal imard IT. mamial chat C. c'olpelnll\'e a'neelIIcIIt C. P011-hard d. Item Fur Material ange Only: C. loan guaranl.e year y Ili]acr I. loan I xuuucc Jut If tact report _ 4. Same and Address of Reporting Entity 5. If Reporting FIT in a.4 is Suhmvardar. Enter Same and Ad ess of Prime: - Plimc ❑ Subawardc. I Cr ,it known Congressional District.ifknmsn Congr 'sional District.it known li. Federal DcpartmenV.%genes: 7, Fc( ral Program\mne'Description: CFDA\umber,it applicable 8. Federal Action Number,if kuovn: .board Amount ifknuran: la. a. Same and Address of Lab hy Euth"s h. Indkiduals Performing Senices (includinc Ilfindhiehml.last nanw. flxl name,M1) iddre,,it difforaa from\o. l0a) I lahl nalnc_first name,SI I) tau t Cunlinualiun Shntlsl if nrccssa rsl 11. Amount of Payment(check alit tapplyj 13. Type of Payment(check all Thal apple) S actual planneil a. rciai ner h. one-nmc ec 12. Farm of Payment(check I that apply): C. cnnmtissinn u. cash d. contingent fee b, lu-kind: vp city: nature e Jefu'rad v:duc I: eWcr,spes'ifs IJ. Brief Descriptio of Se n ices Performed or to he performed and Date(sl of Scrsice,including offcens),em tscc{s),nr memher(s)cnnlacleN,for Pasmcnl Indicated in nem I1: (anadi('(altlnnalltln Shee(ts)ifnece>sar)') 15, Conti ation Shect(s)anachcd: No ❑ No Ih. lulom ion rcy ucat,l Ihmuyh Ihis lon,in aulhorwd he Tide 'I C C.5eaion 1312. This Jixlnsnm of lnhM ine rd i:wec Stenaturc: un placJ by the lice M1 when his Ir m.-rtion w;i mark��r e bred inm. I ITS di Selo.Llre is rcynired pUr4nar1t ui;I L e.I'. Print\ame: l id_. I his inlbnn;niun mll he mlunc l l.(:mhress _------ mia - J will h ail i le Or puhli i xi action :\nv prison 111,fits lu file th r' Imred disl ..tallh thleet m a.irit penally ofnnt lesn Ihulr 51 gouu alai uol more Ihan Slo)plo kW.ch"tdi lailurc. Telephone No.. Uatc: Atnhorizcd for Lrxal It 7truduclinn Federal Use Only: Snlndaid roan-LLL l mndvN F.tLL IT,, 011-1 S-97 GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 DISCLOSURE OF LOBBYING ACTIVITIES JULY 12,2018 BID FORMS-PAGE 16 INSTRUCTIONS FOR CO W PLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES Thi, disclosure form shall be completed by the reporting entity.whether SUbawardee or prime federal recipient,at the initiation or receipt of covered federal action or it material change to pre%iouS filing pursuant to title 31 U.S.C. Section 1332. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency,a Member of toneless an officer or employee of Congress or an employee of a Member of Congress in connection N ith a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial tiling and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered federal action for which lobbying activity is and or has been secured to influence. the outcome of it covered federal action. 2. Identifv the status of the covered federal action. 3. Identifv the appropriate classification of this report. If this is a follow-up report caused by a material change to the information prex iously reported. enter the year and quarter in which the change occurred. Enter the date of the last. previously submitted report by this reporting entity for this covered federal action. 4. Enter the full name, address, city. State and zip code of the reporting entity. Include Congressional District if known. ('heck the appropriate classification of the reporting entity that designates if it is or expects to he it prime or subaward recipient. Identify the tier of the subawardee,e.g.,the first subawardee of the prime is the first tier. Suhatvards include but are not limited to subcontracts.subgrants and contract awards under grants. �. If the organization filing the report in Item 4 checks "Subawardee" then enter time full name. address, city. State and zip code of the prime federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation.. United States Coast Guard. 7. Enter the federal program name or description for the coveted federal action (itenm I). If known,enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements. loans and loan commitments. S. Enter the most appropriate federal identitying number available for the federal action identification in item I (e.g.. Request for Proposal (RFP) number, Imitation for Bid(IFB) number, grant announcement number,the contract grant. or loan award number, the application.proposal control nunmber assigned by the federal agency). Include prefixes,c.g.,"RFP-DC-90-00 L" 9. For a covered federal action where there has been an award or loan commitment by the Federal agency. enter the federal amount of the award,loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name. address. city. State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered federal action. (b) Enter the full names of the individuahs) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (%IF. 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is it material change report,enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). ('heck all boxes that apply. If payment is made through an in-kind contribution, specif}' the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 DISCLOSURE OF LOBBYING ACTIVITIES JULY 12,2018 BID FORMS-PAGE 17 14. Provide a specific and detailed description of the serN ices that the lobbyist has pertonned or will be expected to perform and the date(s) of any set ices rendered. Include all preparatory and related activ ity not just time spent in actual contact with federal officials. Identif} the federal officer(s) of employee(s) contacted or the officer(s) employce(s) or Member(s)ofCon,_ress that �kere contacted. 15. Check wliether or not a continuation sheet(s) is attached. 16. The certifying official shall sign and date the form. print his her name title and telephone number. Public reporting burden for this collection of information is estimated to axerage 30 minutes per response, includm,,; time for reciewin,, inslnrction. searching existing data sources,gathering and maintainim,, the data needed,and completing and rex iewing the collection ofinfomlation. Send comments regarding the burden estimate or any other aspect of this collection of information, including xt__estions for reducing this burden. to the Office of%lanagement and Budget. Paperwork Reduction Project(0348-0046). Washin2t0n, D.C. 20503. S1-1-1-1--lusrructiun, Rcr.06-III90-ENDII>� GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 DISCLOSURE OF LOBBYING ACTIVITIES JULY 12,2018 BID FORMS-PAGE 18 BIDDER'S GENERAL INFORMATION The Bidder shall furnish the following information. Failure to complete all Items will cause the Bid to be non-responsive and may cause its rejection. 1. BIDDER/CONTRACTOR'S Name and Street Address: C l_� Telephone Number: (-7c v ) 75 Z - i7er3 Facsimile Number: (7c,o ) )S Z — 1&7N E-Mail: a- rd_r�_ Tax Identification Number: 2'7-237765 2. TYPE OF FIRM Individual Partnership Corporation (State 4 ) 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 State License Number(s) e,Z 1 610 Supplemental License Classifications e-I?_ 3 4. BUSINESS LICENSE. Yes No License No.: 5. Surety Company and Agent who will provide the required Bonds: Name of Surety ah" T ,� \ 101 A UW\. Address _I�SD 1R) SJQB S*p�'Zlloj2 lAi\ 1-(�) opt �ti1D1 Surety Company Telephone Numbers: Agent (U)q ) U- Y 91 Surety (LAJ ) AZD 0 GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 BIDDER'S GENERAL INFORMATION JULY 12,2018 BID FORMS-PAGE 20 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 have greater than $2,000 interest in the corporation or firm: 7. Number of years experience as a contractor in this specific type of construction work: 27 8. List at least three related projects completed to date: tom- aa5o 5eBa�r ,�J 5hwT a. Owner Address Contact Class of Work Phone Contract Amount Project Date Completed Contact Person Telephone number b. Owner Address Contact Class of Work Phone Contract Amount Project Date Completed Contact Person Telephone number c. Owner Address Contact Class of Work Phone Contract Amount Project Date Completed Contact Person Telephone number 9. Name of Project Manager/Superintendent: Al,i l /ass /51w4,,0 lc2ll -,,,l 10. Name(s) of person(s) who inspected job site: .5/w �.a GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 BIDDER'S GENERAL INFORMATION JULY 12.2018 BID FORMS-PAGE 21 REFERENCES BUREAU OF LAND MANAGEMENT SAI SYHAPHOM 22835 CALLE SAN JUAN DE LOS LAGOS ssyhapho@blm.gov MORENO VALLEY, CA 92553 951-697-5367 *OSBORNE OVERLOOK - $500,000.00 - JAN 2017 CITY OF RIVERSIDE KEVIN GOODWIN 3900 MAIN STREET kgoodwin@riversideca.gov RIVERSIDE, CA 92522 951-826-5990 *BRUCE AVENUE - $320,000.00 -JULY 2017 TEMECULA VALLEY UNIFIED SCHOOL DISTRICT STEVE BRIZENO 31350 RANCHO VISTA ROAD sbrizeno@tvusd.kl2.ca.us TEMECULA, CA 92592 951-506-7971 *ASPHALT &CONCRETE REPAIRS - $750,000.008 CITY OF MENEFEE ALLEN YUN 29714 HAUN ROAD ayun@cityofinenifee.us M} NIFEE, CA 92586 951-672-6777 X3720 MENIFEE RD/NEWPORT ROAD $170,000.00 EXHIBIT 15G -LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTION CONTRACTS) ! NOTE: /^PLEASE ,�REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM LOCALAGENCY: 64IN�d yR�AIYY\ IAAI,I,NGl��`1 LO7C�ATION�-�y.'rQpm M PROJECT DESCRIPTION: (A U 4t.VlAyW VL1rY Le i±14ya lA � TOTAL CONTRACT AMOUNT2$ BID DATE: S )w4 ' 14� BIDDER'S NAME: L .C . T Iq jvl J Y1 C� CONTRACT DBE GOAL: CONTRACT ITEM ON WORK AND DBE CERT NO. NAME OF EACH DBE DOLLAR AMOUNT ITEM NO. DESCRIPTION OR SERVICES TO AND EXPIRATION (Must be certified on the date DBE BE SUBCONTRACTED OR DATE bids are opened-include DBE MATERIALS TO BE PROVIDED address and phone number) (or contracted if the bidder is a DBE) For Local Agency to Complete: Total Claimed DBE Local Agency Contract Number: Participation .--1 Federal-aid Project Number: 1 D ! Federal Share: �— Contract Award Date: Local Agency certifies that all DBE certifications have been verified and S&atur f Bidder information is complete and accurate. QW to (Area Code)Tel.No. Print Name Signature Dale 't 1a / , Local Agency Representative 1� ImoN Q Person to Contact (Please Type or Print) (Area Code)Telephone Number: Local Agency Bidder DBE Commitment(Construction Contracts) (Rev 6/26109) Distribution (1) Copy — Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 30 days of contract execution. Failure to send a copy to the DLAE within 30 days of contract execution may result in de- obligation of funds for this project. (2)Copy—Include in award package to Caltrans District Local Assistance (3)Original—Local agency files GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 LOCAL AGENCY BIDDER-DBE COMMITMENT JULY 12,2018 BID FORMS-PAGE 22 Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penal y of perjury under the laws of the State of California that the bidder has _, has not been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder' is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT JULY 12,2018 BID FORMS-PAGE 28 Public Contract Code Section 10162 Questionnaire In conformance with Public Contract Code Section 10162, the Bidder shall complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE JULY 12,2018 BID FORMS-PAGE 29 Bond No.: CMGP0001753 Premium: $6,992.00 PERFORMANCE BOND—PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CML 5282 (045) (hereinafter referred to as the"Public Work"); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract"), which Contract is incorporated herein by this reference; and WHEREAS, the Contractor is requifed by said Contract to perform the terms thereof, and to provide a bond both for the performance and guaranty thereof. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: Argonaut Insurance Company a corporation organized and existing under the laws of the State of Illinois and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City In the sum of Three Hundred Ninety Nine Thousand Four Hundred Thirty Seven and 00/100 Dollars ($ 399,437.00 ), said sum being not less than 100 percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if the bounden Contractor, his or its heirs, executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the said Contract and any alteration thereof made as therein provided, on his or its parts, to be kept and performed at the time and in the manner therein specified, and in all respects according to their intent and meaning; and shall faithfully fulfill the one year guarantee of all materials and workmanship; and indemnify and save harmless the City, its officers and agents, as stipulated in said Contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. The said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the Contract or to the work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration of addition to the terms of the Contract, or to the Public Work or to the Specifications. No final settlement between the City and the Contractor shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PERFORMANCE BOND JULY 12,2018 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 October 2018. CONTRACTOR: LC Paving & Sealing, Inc. Check one: _individual, partnership, g 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: LC Paving & Sealing, Inc. SURETY: Argonaut Insurance Company By: By signature si to (NOTARIZED) (NO ARIZED) Print Name and Title: Print Name a d T le: L%� l ittGSl-�r�,S!L (ffGS Gabriella G Attorne -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 64 "Default by the Contractor", as further amended by the Special Provisions. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PERFORMANCE BOND JULY 12,2018 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On t�r . ZS I ZOl before me, Marisa Haas, Notary Public (insert name and title of the officer) personally appeared Jose A. Salinas who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. MARISA ANN HAAS WITNESS my hand and official seal. z . Commission M 2122991Notary Public-California San Diego County Comm.Ex Ires Aug15,2019 r Signature (Seal) PERFORMANCE BOND—PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ 17.50 per thousand. The total amount of premium charged: $ 6,992.00 (The above must be filled in by corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part, with Federal, grant, or loan funds, it must also appear on the Treasury Department's most current list(Circular 570 as amended). THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: (Name and Address of Surety) Argonaut Insurance Company C/O CNIGIA 20335 Ventura Blvd,Suite 426 Woodland Hills, CA 91364 (Name and Address of Agent or BB&T -John Burnham Insurance Services Representative for service of process in California if 750 B. Suite 2400 different from above) San Diego, CA 92101 (Telephone Number of Surety and Surety: (866)363-2642 Agent or Representative for service of process in California) Agent: (620)920-3089 GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PERFORMANCE BOND JULY 12,2018 CMGP0001763 Argonaut Insurance Company $6,992.00 Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company,a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook,Illinois does hereby nominate,constitute and appoint: Gabriella Grady,Shilo Lee Losino,Stephanie Hope Shear Their true and lawful agent(s)and attorney(s)-in-fact,each in their separate capacity if more than one is named above,to make,execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all bonds,contracts..agreements of indemnity and other undertakings in suretyship provided,however,that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: $10,000,000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED,That the President,Senior Vice President,Vice President,Assistant Vice President,Secretary,Treasurer and each of them hereby is authorized to execute power of attorney,and such authority can be executed by use of facsimile signature,which may be attested or acknowledged by any officer or attorney,of the Company,qualifying the attorney or attorneys named in the given power of attorney,to execute in behalf of,and acknowledge as the act and deed of the Argonaut Insurance Company,all bond undertakings and contracts of suretyship,and to affix the corporate seal thereto." IN WITNESS WHEREOF,Argonaut Insurance Company has caused its official seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 8th day of May,2017. Argonaut Insurance Company 0. =:SEAL t 9? .:• ; .g: b di'., ,cos tr y: ••*• ,+ Joshua C.Betz, Senior Vice President STATE OF TEXAS .. ....����„ COUNTY OF HARRIS SS: On this 8th day of May,2017 A.D.,before me,a Notary Public of the State of Texas,in and for the County of Harris,duly commissioned and qualified,came THE ABOVE OFFICER OF THE COMPANY,to me personally known to be the individual and officer described in,and who executed the preceding instrument, and he acknowledged the execution of same,and being by me duly sworn,deposed and said that he is the officer of the said Company aforesaid,and that the seal affixed to the preceding instrument is the Corporate Seal of said Company,and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation,and that Resolution adopted by the Board of Directors of said Company,referred to in the preceding instrument is now in force. 1N TESTIMONY WHEREOF,I have hereunto set my hand,and affixed my Official Seal at the County of Harris,the day and year first above written. KATHLEEN' M. MEEKS "U 1wn rn. `%uU N°,a,y Public,State of Texa. -ui�:y= co..,R,.Expires oz,5-z02r (Notary Public) %.�'°i�.:•��� N°ta:y ID 5579U2.8 1,the undersigned Officer of the Argonaut Insurance Company.Illinois Corporation,do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full,true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF,I have hereunto set my hand,and affixed the Seal of said Company,on the 18th day of October 12018 r, sr'��FO�,? - zee!.• g= d,�prtab:' Sarah Heineman, VP-Underwriting Surety t.\. THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF.ATTORNEYARE IN BLUE.IF YOU HAVE QUESTIONS ON .AUTHENTICITY OF THIS DOCUMENT CALL(210)321-8400. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 -srrm.,-� �c�e,,�c �r,�rm�r�-rs�c,�c�r,�r.�e�ct:evmsrTr,:c.�.rcreycaurec,�.c�,.e�,rstxc�s,�.; A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of LOS ANGELES ) On TT 1 8 ?013 before me, SHIRLEY GIGGLES, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared GABRIELLA GRADY Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand %d7offlcial seal. Signature ign of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — L Limited ❑ General ❑ Individual ❑Attomey 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) Rem#5907 Bond No.: CMGP0001753 Premium: Included in Performance Bond PAYMENT BOND— PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CML 5282 (045) (hereinafter referred to as the"Public Work"); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract)for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract"), which Contract is incorporated herein by this reference; and WHEREAS, said Contractor is required to furnish a bond in connection with said Contract and pursuant to Section 9550 of the California Civil Code. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: Argonaut Insurance Company a corporation organized and existing under the laws of the State of Illinois and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City, and to any and all persons, companies, or corporations entitled to file stop payment notices under Section 9100 of the California Civil Code, in the sum of Three Hundred Ninety Nine Thousand Four Hundred Thirty Seven and 00l100 Dollars ($ 399,437.00 ), said sum being not less than 100 percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that, if said Contractor, his or its heirs, executors, administrators, successors, or assigns, or Subcontractors, shall fail to pay for any materials, provisions or other supplies, implements, machinery, or power used in, upon, for, or about the performance of the Public Work contracted to be done, or to pay any person for any work or labor of any kind, or for bestowing skills or other necessary services thereon, or for amounts due under the Unemployment Insurance Code with respect to such work or labor, or for any amounts required to be deducted, withheld, and paid over to the Employment: Development Department from the wages of employees of paid Contractor and his Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to such work and labor as required by the provisions of Sections 9550 through 9560 of the Civil Code, the Surety or Sureties hereon will pay for the same in an amount not exceeding the sum specified in this bond, otherwise the above obligation shall be void. In addition to the provisions herein above, it is agreed that this bond will inure to the benefit of any and all persons, companies, and corporations entitled to serve stop payment notices under Section 9100 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO, 14-13 PAYMENT BOND JULY 12,2018 PAYMENT BOND- PUBLIC WORKS (CONTINUED) The Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or additions to the terms of the said Contract or to the work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration, or addition to the terms of the Contract or to the work or to the Specifications. No final settlement between the City and the Contractor hereunder shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. Contractor and Surety, an admitted surety insurer, further agree that if the City or any entity or person entitled to file stop payment notices is required to engage the services of an attorney in connection with the enforcement of this bond, each shall be liable for the reasonable attorney's fees incurred, with or without suit, in addition to the above sum. SIGNED AND SEALED, this 18th day of October , 2018. CONTRACTOR: LC Paving & Sealing, Inc. Check one:—individual, _partnership, X corporation (This Payment Bond must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Payment Bond.) EXECUTED FOR THE CONTRACTOR: EXECUTED FOR THE SURETY: LC Paving & Sealing, Inc. Argonaut I suranc pany By: � By / r signature nature (NOTARIZED) qGr TARIZED) Print Narne and Title: Print nAS- �C4 r 54C6aTr�� Gabttorne -in-Fact By: h signature (NOTARIZED) Print Name and Title: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PAYMENT BOND JULY 12.2018 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On a . 7i15 r Zn� before me, Marisa Haas, Notary Public (insert name and title of the officer) personally appeared Jose A. Salinas who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. MARISA ANN HAAS WITNESS my hand and official seal. Commission#2122991 Notary Public-Callforne Z San Diego County Comm.E Ires Au 15,2019 r Signature (Seal) PAYMENT BOND— PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ 17.50 per thousand. The total amount of premium charged: $ 6,992.00 (The above must be filled in by corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part, with Federal, grant, or loan funds, it must also appear on the Treasury Department's most current list (Circular 570 as amended). THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: (Name and Address of Surety) Areonaut Insurance Comnanv C/O CNIGIA 20335 Ventura Blvd, Suite 426 Woodland Hills, CA 91364 (Name and Address of Agent or BB&T -John Burnham Insurance Services Representative for service of process in California if 750 B. Suite 2400 different from above) San Dieao, CA 92101 (Telephone Number of Surety and Surety: (866)363-2642 Agent or Representative for service of process in California) Agent: (620)920-3089 GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 PAYMENT BOND JULY 12,2018 AGREEMENT AND BONDS-PAGE 28 CMGP0001753 Argonaut Insurance Company $6,992.00 Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company,a Corporation duly organized and existing under the laws of the State of Illinois and having its principal office in the County of Cook,Illinois does hereby nominate,constitute and appoint: Gabriella Grady.Shilo Lee Losino.Stenhanie Hope Shear Their true and lawful agent(s)and attomey(s)-in-fact,each in their separate capacity if more than one is named above,to make,execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all bonds,contracts,agreements of indemnity and other undertakings in suretyship provided,however,that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: $10,000,000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of Argonaut Insurance Company: "RESOLVED,That the President,Senior Vice President,Vice President,Assistant Vice President,Secretary,Treasurer and each of them hereby is authorized to execute powers of attorney,and such authority can be executed by use of facsimile signature,which may be attested or acknowledged by any officer or attorney,of the Company,qualifying the attorney or attorneys named in the given power of attorney,to execute in behalf of,and acknowledge as the act and deed of the Argonaut Insurance Company,all bond undertakings and contracts of suretyship,and to affix the corporate seal thereto." IN WITNESS WHEREOF,Argonaut Insurance Company has caused its official seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 8th day of May,2017. .................. Argonaut Insurance Company = SEAL 0 „ io: ,ws F by: Joshua C.Betz, Senior Vice President STATE OF TEXAS �.....�����• COUNTY OF HARRIS SS: On this 8th day of May,2017 A.D.,before me,a Notary Public of the State of Texas,in and for the County of Hams,duly commissioned and qualified,came 171E ABOVE OFFICER OF THE COMPANY,tome personally known to be the individual and officer described in,and who executed the preceding instrument, and he acknowledged the execution of same,and being by me duly sworn,deposed and said that he is the officer of the said Company aforesaid,and that the seal affixed to the preceding instrument is the Corporate Seal of said Company,and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation,and that Resolution adopted by the Board of Directors of said Company,referred to in the preceding instrument is now in force. IN TESTIMONY WHEREOF,1 have hereunto set my hand,and affixed my Official Seal at the County of Harris,the day and year first above written. a........•,, KAQHLEEN M. MEEKS p.- >F;' �is No[ury PUUIh;,State°t Texas -- ---_--_-- -%`+ .�= Comm-E.,i,ea 0? 15-2021 (NOtary Public) N.1w, 10 557902-8 I,the undersigned Officer of the Argonaut Insurance Company,Illinois Corporation,do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full,true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF,I have hereunto set my hand,and affixed the Seal of said Company,on the 18th day of October 12018 .. f•SEAL•;;; wr��- •`k3!R9:6'• °• Sarah Heineman , VP-Underwriting Surety THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF ATTORNEYARE IN BLUE.IF YOU HAVE QUESTIONS ON AUTHENTICITY OF THIS DOCUMENT CALL(210)321-8400. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189 :r�Q.r�cEvarrrr,,-.ar=P�c�.sr�E,.c,:ccy.crcrr,e�a�srcc�,c�^,arccr.�r.�r.�`,c�'.ccCrS;�;.c�rs�.zr.�,c<>�c;:�x A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of LOS ANGELES ) On r . !3 _ "! before me, SH(RLEY GIGGLES, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared GABRIELLA GRADY Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph SHIRLEY GIGGLES is true and correct. NotaryPublic•Celitorale Los Angeles Coenty WITNESS my han and official seal. t Los commission•210817 Comm.E fes 7,21t�0 Signature Si re of Notary Public Place Notary Seal Above OP77ONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): L Corporate Officer — Title(s): ❑ Partner — ❑ Limited Li General ❑ Partner — ❑ Limited F'General LJ Individual 7 Attorney in Fact I I Individual Gi Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee I7 Guardian or Conservator ❑Other: LJ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association•www.NationaiNotary.org• 1-800-US NOTARY(1-800-876-6827) Item#5907 COPYBond No.CMGB0003334 BID BOND KNOW ALL MEN BY THESE PRESENTS, That LC Paving & Sealing Inc. as Principal, and Argonaut Insurance Company as Surety, are held and firmly bound unto the City of Palm Springs, California, hereinafter called the"City" in the sum of: Ten Percent of Their Greatest Amount Bid (10% G.A.B.) dollars (not less than 10 percent of the total amount of the bid) for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns,jointly and severally, firmly by these presents. WHEREAS, said Principal has submitted a Bid to said City to perform the Work required under the Bid Schedule(s) of the City's Contract Documents entitled: GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 FEDERAL AID PROJECT NO. CML 5282 (045) NOW THEREFORE, if said Principal is awarded a Contract by said City, and within the time and in the manner required in the "Notice Inviting Bids" and the "Instructions to Bidders" enters into a written Agreement on the Form of Agreement included with said Contract Documents, furnishes the required Certificates of Insurance, and furnishes the required Performance Bond and Payment Bond, then this obligation shall be null and void, otherwise it shall remain in full force and effect. In the event suit is brought upon this Bond by said City, and City prevails, said Surety shall pay all costs incurred by said City in such suit, including a reasonable attorney's fee to be fixed by the court. SIGNED AND SEALED, this 13th day of August 201$ EXECUTED FOR THE PRINCIPAL: EXECUTED FOR THE SURETY: By Pavin & al' g, Inc_ By Argonau insura a pany Signature e (NOTARIZED) 7(N ED) Print Name and Title: Print Na a and Titl -V,se SA IAYVAt -&AkjitA Gabriella Grady, Attorney-in-Fact By Argonaut Insurance COnlpe V c/o CMGUI,INC Signature 20336 Ventura BW.,809426 (NOTARIZED) Woodland Hills,CA91984 Print Name and Title: 0 COPY GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES BID BOND(BID SECURITY FORM) CITY PROJECT NO, 14-13 BID FORMS-PAGE 19 JULY 12,2018 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On (P Z01 before me, Marisa Haas, Notary Public (insert name and title of the officer) personally appeared Jose A. Salinas who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. MARISA ANN HAAS WITNESS my han eat. Commission 8 2122991 Z%Womm. Notary Public•calllornia s San Diego County Ex IreS Au 15,2019+ Signature - (Seal) Argonaut Insurance Company Deliveries Only: 225 W. Washington, 24th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, San Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company,a Corporation duly organized and existing under the laws of the State of ro. Illinois and having its principal office in the County of Cook,Illinois does hereby nominate,constitute and appoint: -•+74 Gabriella Grady,Shilc Lee Losino,Stephanie Hope She - r a Their true and lawful agent(s)and attomey(s)-in-fact,each in their separate capacity if more than one is named 46y tomake,execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all bonds,contracts,agreements of indemnity and other undertakmgs in suretyship provided,however,that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: '`r✓„x"` This Power of Attorney is granted and is signed and sealed under and by the authority of the foll6wii)g Resolution adopted by the Board of Directors of Argonaut Insurance Company': "RESOLVED,Ihat the President,Senior Vice President,Vice President,Assistant .ice P dent,Secretary,Treasurer and each of them hereby is authorized to execute powers of attorney,and such authority can be executed by use of facsimile s re, hich maybe attested or acknowledged by any officer or attorney,of the Company,qualifying the attorney or attorneys named in the given power of alto xecute in behalf of,and acknowledge as the act and deed of the Argonaut Insurance Company,all bond undertakings and contracts of suretyship,and affix the corporate seal thereto." IN WITNESS WHEREOF,Argonaut Insurance Company has caused!s`o"' icial seal to be hereunto affixed and these presents to be signed by its duly authnri7xd officer on the 8[h day of May,2017. it T, ........ Argonaut Insurance Company O.SEALilia . _ rrLL rase Joshua C.Betz, Senior Vice President STATE OF TEXAS - COUNTY OF HARRIS SS; On this 8th day of May,2017 A DD.t b4ore me,a ?Notary Public of the State of Texas,in and for[he County of Harris,duly commissioned and qualified,came THE ABOVE OFFICER OF Tqr C�(*Wly,to me personally known to be the individual and officer described in,and who executed the preceding instrument, and he acknowledged the execs it "of same,and being by me duly sworn,deposed and said that he is the officer of the said Company aforesaid,and that the seal affixed to the precedinginFrstrume is[he Corporate Seal of said Company,and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by uteuthon and direction of the said corporation,and that Resolution adopted by the Board of Directors of said Company,referred to in the preceding instrum t is n in force. IN TESTIMONY WFIBRFOF,I have hereunto set my hand,and affixed my Official Seal at the County of Harris,the day and year first above written. V# .y LEEN M. MEEKS t'Itkllt.ut`rfl.`1l'L"kQ _ .3� °Notary public,Stele of Texas e]-t 62pYr (Notary Public) ' oi tt N otary l0 557902.8 I,the undersigned Officer of the Argonaut Insurance Company,Illinois Corporation,do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full,true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF,I have hereunto set my hand,and affixed the Seal of said Company,on the 13th day of August , 2018 SEALI% c. �a K«45; TZ . _ Sarah Heineman, VP-Underwriting Surety THIS DOCUMENT IS NOT VALID UNLESS THE WORDS ARGO POWER OF ATTORNEYARE IN BLUE.IF YOU HAVE QUESTIONS ON AUTHENTICITY OF THIS DOCUMENT CALL(210)321-8400. y 1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 :r�;rocr,<.r.�r�,orsr,�.�rcru:sumrr,�c�erccr..nmress�.e.�es:r.,�.�:e.�csr,�ar e, r,:mrr.�.rrrzrnsm.<:r.�e..�c<,rmn A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of LOS ANGELES ) On AUG 13 2018 before me, SHIRLEY GIGGLES, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared GABRIELLA GRADY 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 is true and correct. SHIRLEY GIGGLES WITNES _y hand a official seal. Notary Public - California < `m Los Angeles County = Commission a 2163817 = Signature M Comm. Expires Sep 7,2020 Sig of otary Public Place Notary Sea/Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: 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 WORKER'S COMPENSATION CERTIFICATE (AS REQUIRED BY SECTION 1861 OF THE CALIFORNIA LABOR CODE) I am aware of the provisions of Section 3700 of the California Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self-insurance in accordance with the provisions of said Code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Contractprj c PAVING&SEALING, INC. By /�1t Title,/ PRESIDENT GENE AUTRY AND VISTA CHINO DUAL LEFT TURN LANES CITY PROJECT NO. 14-13 WORKER'S COMPENSATION CERTIFICATE JULY 12, 2018 I � � 1 b I � son ���.�®MONOM OW -��� MAN Mon -���� wr. ��•..: �-��� ���= 11h, CONTRACTORS STATE LICENSE BOARD Contractor's License Detail for License # 621610 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. CSLB complaint disclosure is restricted by law(B&P 7124.6)If this entity is subject to public complaint disclosure,a link for complaint disclosure will appear below.Click on the link or button to obtain complaint and/or legal action information. Per B&P 7071.17,only construction related civil judgments reported to the CSLB are disclosed. Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. Due to workload,there may be relevant information that has not yet been entered onto the Board's license database. Data current as of 10/30/2018 9:27:01 AM Business Information L C PAVING&SEALING INC 996 BORDEN ROAD SAN MARCOS, CA 92069 Business Phone Number:(760)752-1743 Entity Corporation Issue Date 0 6/0811 9 91 Reissue Date 08/12/2010 Expire Date 08/31/2020 License Status This license is current and active. All information below should be reviewed. Classifications C12-EARTHWORK AND PAVING A-GENERAL ENGINEERING CONTRACTOR B-GENERAL BUILDING CONTRACTOR Bonding Information Contractor's Bond This license filed a Contractor's Bond with BUSINESS ALLIANCE INSURANCE COMPANY. '.. Bond Number: G80621463222 Bond Amount:$15,000 Effective Date: 0 8/0812 01 8 Contractor's Bond History ._. _.. _.... __. _. .............. ......... _. __. Bond of Qualifying Individual The qualifying individual JOSE ANDRIS SALINAS certified that he/she owns 10 percent or more of the voting stock/membership interest of this company;therefore,the Bond of Qualifying Individual is not required. Effective Date:03/09/2011 BQI's Bond History '.. The qualifying individual LOUIE JOHN CABRERA certified that he/she owns 10 percent or more of the voting stockimembership interest of this company;therefore,the Bond of Qualifying Individual is not required. '.. Effective Date:04/29/2011 Workers'Compensation ACC CERTIFICATE OF LIABILITY INSURANCE GATE(MMIODM YYI 11/7/2018 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 IN SURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: TANA CLARK HARTLEY CYLKE PACIFIC-M0574253 (NO,N (619)295-5155 AID No: (sia)=ai-oavz INSURANCE SERVICES, INC. E-MAIL jana@hcpacinsurance.com ADDRESS: 2747 UNIVERSITY AVENUE INSURER(S)AFFORDING COVERAGE NAIC M SAN DIEGO CA 92104-4068 INSURERA:UNITED SPECIALTY INSURANCE CO. INSURED INSURER B:Nationwide Insurance Co. 23787 L.C. Paving 6 Sealing, Inc. INSURERC:TOPA INSURANCE COMPANY 330 Rancheros Drive b208 INSURERD:STARNET INSURANCE COMPANY INSURERS San Marcos CA 92069 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1S 91154707 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF ADDL BUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMMDIVYYY NMIDDrfIYY X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ X Y NTNSY1811545 2/18/2018 2/18/2019 MED EXP(Any one person) S 5,000 PERSONAL SADV INJURY $ 1,000,000 GENLAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X PNO PRODUCTS AGO $ 2,000,000 POLICY JECT LOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ $ ALL OWNED F I SCHEDULED AUTOS AUTOS X Y ACPT893enS94 2/18/2019 2/18/2019 BODILY INJURY(Per accident) $ NON-OWNED COMP DED: $250 PROPERTY DAMAGE $ HIREDAUTI AUTOS Per accident COLL DED: $500 Medical Payments $ 5,000 UMBRELLALIAB X OCCUR EACH OCCURRENCE S 4,000,000 C XX EXCESS LIAB CLAIMS-MACE AGGREGATE S 4,000 000 DEC RETENTION$ IXL0020024201 2/18/2018 2/18/2019 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYCER,MEETOREXCLUDED' CUTIVE El EACH ACCIDENT $ 1,000,000 OFFICER ry In N )EXCLUDED' El D (Mandatory In NH) y eMINc013803e 9/12/2018 9/12/2019 E.L.DISEASE-EA EMPLOYEE 8 1,000,000 Ryes under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B COMMERCIAL PROPERTY MP7893877894 2/18/2018 2/18/2019 BPP.$15700 DED: $500 INLANO HARINE LEASED,RENTED EQUIP $500,000 DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES(ACORD 101,Addieonal Remarks Schedule,may be attached if more space is required) The City of Palm Springs, its officials, employees, and agents are named as additional insured as respects City of Palm Springs Project No. 14-13, Gene Autry and Vista Chino Dual LeTt Turn Lanes. General liability insurance is primary and non-contributory. Wail i of subro ation apply to general liability, auto liability, and workers compensat__coverages. *Should any of the above described policies be canceled before expiration date thereof, the issuing company will mail 30 days written notice to the Certificate Holder named. 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 3200 E Tahcluitz Canyon Way ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs, CA 92260 AUTHORIZED REPRESENTATIVE f MICHAEL HARTLEY/KAKI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro',lded under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) _ Or Organization{sZ� Location(sl Of Covered Operations Where Required By Written Contract Where Required By Written Contract Infoanation re uired to,complete this Schedule. if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to S. With respect to the insurance afforded to these include as an additional insured the oerson(s) or additional nsureds the following addtlional organ!zanon(sl s�town h. the Sched�.ile. but only exclusions apply. with respect to liabi;ay for "bod.lI �.ulurI "property This insurance does not apply to "bodily injury' or damage" or "personal an(: advertising injury" ^property damage" eccurnng after. caused, in whole or in pars, by' 1. A!I work, including materials- parts Or 1. Your acts or omissions. or equipment furnished in connection with such 2. The acts or omissions of those acting on your work_ on the project iother than service. behalf: maintenance or repairs) !o be performed by or in, the perfonnance of your angoin.g operations for on behalf of the additional insured(sl at the the additional inaured(s) at the locations) location of the covered operations has been designated above romp'.eted. cr However: 2. That portion of "your work' out of which the injury or damage arises has been out to Its 1- The insurance afforded to such additional intended use by any person or organ,Zation Insured only applies to the extent permitted by other ,han another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project, required by a contract or agreement, the utsurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to Grovide for such additional rs:.f ec CG 20 10 04 13 D Insurance Services Office, Inc., 2012 Page 1 of 2 addar.-Jral ,nsureds, the toilcwing is added to Insurance shown.In the Declarations Section III— Limits Of Insurance: wh!cheve: :s tess. If coverage provided to the additional insured is l his endorsement snail not increase tine regwred by a contract or agreement. the most we apoficable L!ptits of Insurance shown rn the sell pay on behalf of the addrtiona'. insured is the Dec'araGens. amount of insurance. 1. Required by the contract or agreement. or Page 2 of 2 ,=:`Inso'ance Se^ices Office. Inc.. 2612 CG 20 10 04 13 POLICY NUMBER ATN-SF1 811545 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 Personis) i Or Organizations ___ - I Location And Description Of Completed Operations Where Required By Written Contract Where Required By Written Contract ........... Information rear cared to com ete this Schedule, if not shown above, will be shown m the Declarations Section 11 — Who Is An Insured is amended to include as an adchlional nswed the persons} or arganizitior)(s) shown in the Scl,edule but only with respect to liability for "bodily jrjLsry" or "property dam- age caused, in whole or in part.. by "YOW work' at the location designated and described in the sche. oule of this endorsement performed for that addi- tional insured and included in the "products- com.oleted operations hazard' CG 20 37 07 04 CP ISO Properties. Inc , 2004 Page 1 of 1 ❑ United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 05100 (01t15) / PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT ✓ This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Any coverage provided to an Additional Insured 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. 1) a written contract or written agreement specifically requires that this insurance apply on a primary and non-contributory basis: or 2) prior to a loss, you request in writing and we agree that this insurance shall apply on a primary and non-contributory basis. Name Of Person(s) Or O(ganizationUs As Per Written Contract J i All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VriN 061 00(0.1151 Page I of 1 POLIO) VMlILR;AIN-SI1811545 COMM ER(C[Al.GENERAVI.JARILIIA' CG 2404 III 93 THIS ENDORSEMENT C111ANCES THE POLICY. PLEASE HEAD IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US "this endursemem rnodrhes insurance provided under tire hrllowing. I OMMI,R("IA1 (it,NF.RAI 1.1AIIII I Y ( 0% I(RAt d. PAR I SC IE'DI LF Name or Person or Organization: Pcr'A nttcn Contract (Ilno entrn appears above, inli rmation;r4uired III complete this endorwrncnt "ill he shorn in the Dcolaralions as applies-Me to duff cndorscmenr.l 1 he l RANSr1=R UP 1<1(;f tIS ()F RI I, f A I_R', At%INSI I II IiL12S I O t's,( onditiim (suction IA' (OMMI R('IAl, t t.NLRAI_ LLAIIII 1"rY ( ()N )I I kiNS) I,amendod bs the 'additi- ,r ill, toll"k,mc- 1bc .veive am r obi of reoovcr) we m o h rvc against the permm or'rgwwn itiim showi in the Schcdolc above hacuosc III payments "c makc for;oiu,n or dam ag,ar isine um 'sour onpr ing operations or"tour vNork"duns under a contract with tlup person or �rg.miiatioll and inclndcd in the "p raduC[s-coatplctrd r,perations hannd 1 hi,vvwi cr applic,only to the person or organization shown in the Schedule above. ((; 24 04 11)93 Copyright, htsacutcc Services 0113ce,Inc,. 1992 Page I or 1 0 POLICY NUMBER: ENUVVC0138038 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA(Blanket) We have the right to recover our payments from anyone liable for an triJary covered cy this policy. We wit+not enforce our right against the person or organization named In the Schedule.,This agreement app:ies only to the extent that you perform work under a written Contract that requires you to obtain this agreement from us ; You must roam aln payroll records accurately segregating the remuneration of your employees while engaged in the work described ir.the Schedule. The additional premium for this endorsement shai!be-C.0200W i10 of the Califomrna workers'compensation premium otherwise due on such remuneration. Schedule State Description CA Hey party with whom the Insured agrees to waive subrogation in a written contract. T ,S enduisemeut CrlangeS the yOLry to wtbo>'.it i5 dt!a Cheri and iS etvOvu OP".he date issued unless otherwise slated (The information below is required only when this endorsement is issuod subsequent to preparation of the policy.) Erndorveinem Effective Date. Pubcy Numbef BNU WC0138038 Endw$emenr No.: .nsured Name. L C PAVING&SEALING lW; Insurance company Midwest Ernpioyers Casualty Company ;:,nr=lersigne� ..y COMMERCIAL AUTO AC 70 05 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO PROTECTION - GOLD This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGES A Effect of This Endorsement B Newly Acquired or Formed Entities C Employees as Insureds-Nonowned Autos D. Additional Insured by Contract, Permit or Agreement E Supplementary Payments- Bail Bonds F Supplementary Payments- Loss cf Earnings G. Personal Effects and Property of Others Extension H. Prejudgment Interest Coverage I Fellow Employee-Officer_ Managers and Supervisors J. Hired Auto Physical Damage K Temporary Substitute Autos - Physical Damage Coverage L Expanded Towing Coverage M Auto Loan or Lease Coverage N Original Equipment Manufacturer Parts- Leased Private Passenger Types 0 Deductible Amendments P. Rental Reimbursement Coverage 0 Expanded Transportation Expense R. Extra Expense- Stolen Autos S Physical Damage Limit of Insurance T. New Vehicle Replacement Cost U Physical Damage Coverage Extension V Transfer of Rights of Recovery Against Others To Us W Section IV- Business Auto Condbons- Notice of and Knowledge of Occurrence X. Hired Car Coverage Territory Y. Emergency Lock Out Z. Cancellation Condition AC 70 05 03 16 Includes copyrighted material of Insurance Services Office.. Inc. Page 1 of 7 with its permission COMMERCIAL AUTO AC 70 05 03 16 A. EFFECT OF THIS ENDORSEMENT If specifically required by trine .vntten contract or Coverage provided under this policy is modified agreement referenced in he paragraph above, by the provisions of this endorsement. If there any coverage provided by this endorsement to is any conflict between the provisions of this an other valid insured shall be primary and endorsement and the previsenfs) of any state- any other valid and collectible insurance avail- endorsement endorsement also attached to this poll- able to the )tin additional insured shall be non- cy, then the provisioo{sj of the state-specific contributory with this insurance. If the written endorsement shall apply instead of the prow- contras, does riot require this coverage to be primary and the additional insureds coverage to sions of this endorsement that are in conflict. be non-conhlbuton then this insurance will be but only to the extent of the conflict, and only to excess over any a Ter valid and ooKectible insur the extent necessary to bring such provisions once available to the additional insured. into conformance with the state requirement{s) contained in the provisions) of the state-specific endorsement E. SUPPLEMENTARY PAYMENTS - BAIL B. NEWLY ACQUIRED OR FORMED ENTITIES BONDS The Named Insured sho.vn in the Dec at wions Is Suppiernentary Payments of SECTION II - amended to include any organization you newly COVERED AUTOS LIABILITY COVERAGE is acquire nr form- other than a pai triersiIip. joint revised as follows. venture, or hmlted liability company. and over Olt Up to 52,500 for cost of ball bonds(including which you maintain ownership or majority fmcre bonds for related traffic law violations) than 50 F) interest, if there is no other similar in- required because of an 'accident we cover srrance available to that organization Coverage We do !)at !)eye to furnish these bonds Under this provision is afforded unfil the 180"' F. SUPPLEMENTARY PAYMENTS - LOSS OF day after you acquire e: farm file organ¢at'ion or EARNINGS vine Fund of the poi cy period whichever is later C. EMPLOYEES AS INSUREDS - NONOWNED Supplementary Payments of the SECTION II - AUTOS COVERED AUTOS LIABILITY COVERAGE is revised as follows: The following is added to paragraph A.1. Who is ,,4; Ali reasonable expenses incurred by the "n,- An Insured of SECTION II LIAHIL.i I COVERAGE. -COVERED AUTOS sured" at our request, including actua loss of earnings up to $500 a day because of d. Any "employee" of yours is an "insured" time off from work_ white using a covered "auto" you don't own, G. PERSONAL EFFECTS AND PROPERTY OF hire or borrow in your business or your per- OTHERS EXTENSION so•?al affairs. 0. ADDITIONAL INSURED BY CONTRACT, 1- The Care, Custody or Control Exclusion of PERMIT OR AGREEMENT SECTION II - COVERED AUTOS LIABILi'fY COVERAGE, does not apply to The following is added to A . Who Is An In- "property damage" to property, other than sured of SECTION II - COVERED AUTOS your property_ up to an amount not exceed- LIABII.iTY COVERAGE. ing 5250 in any one "accident Coverage Any person or organization that you are re- is excess over any other valid and collectible quired to name as an addtional insured in a insurance wctten contract or agreement that is executed 2. The following paragraph is added to A.4. or signed by you pnor to a "badly nmlury or Coverage Extensions of SECTION III - 'prcpertv damage` occurrence is an ";nsured" PHYSICAL DAMAGE COVERAGE for Covered Auto L ability coverage. How- c tha will pay up age for your property ever, with respect to covered -autos', such that is last or damaged as a result of a person or organization is an insured only to covered "toss'. without applying a de- the extent that person or organization qualifies ductible. Coverage is excess over any as an `insured" under A . Who is an Insured of other valid and collectible insurance. SECTION II -- COVERED AUTOS LIABILITY COVERAGE. Page 2 of 7 Includes copyrighted material of Insurance Services Office. Inc AC 70 05 03 16 'dvrn ifs permission COMMERCIAL AUTO AC 70 05 03 16 H. PREJUDGMENT INTEREST COVERAGE substitute for a covered "auto' you own that The fallowing paragraph is added to SECTION 11 is out of service because of its. - COVERED AUTOS LIABILITY COVERAGE, a. Breakdown: 2 Coverage Extensions, a Supplementary b Repair; Payments c Servicing. 17) Prejudgment interest awarded against the d, "Loss", or 'insured" on that part of the judgment we pay. If we make an offer to pay the appli- e Destruction cable limit of insurance, we will not pay The coverage that applies is the same as any prejudgment interest based on that the coverage provided for the vehicle being period of time after the offer. replaced. I FELLOW EMPLOYEE - OFFICERS, MANAGERS, AND SUPERVISORS L. EXPANDED TOWING COVERAGE The Fellow Employee Exclusion in SECTION II 1. We will pay up to - COVERED AUTOS LIABILITY COVERAGE is a S100 for a covered "auto" you Own of replaced as follows; the private passenger type. or A "Bodily injury" to any fellow 'employee" of the "insured" arising out of and in the course b. $500 for a covered "auto" you own that of the fellow "employee's" employment or is not of the private passenger type, while performing duties related to the con- for towing and labor costs incurred each duct of your business. This exclusion does time the covered "auto" is disabled. Howev- not apply to an "insured" who occupies a er, the labor must be performed at the Glace position as an officer manager or supervi- of disablement sor 2 This coverage applies only for an 'auto" J. HIRED AUTO PHYSICAL DAMAGE covered on this policy for Comprehensive or If covered "auto" designation symbols 1 or 8 ap- Specified Causes of Loss Coverage and ply to Liability Coverage and if at least one "au- Collision Coverages. to' you own is covered by this policy for Com- 3 Payment applies in addition to the otherwise prehensive. Specified Causes of Loss. or Colli- app'icable amount of each coverage you sion coverages, then the Pnysica! Damage have on a covered auto . coverages provided are extended to "autos' you M. AUTO LOAN OR LEASE COVERAGE lease hire rent or borrow without a driver, and 1. In the event of a total "loss' to a covered provisions in the Business Auto Coverage Form "auto'. we will pay any unpaid amount due applicable to Hired Auto Physical Damage apply on the !oan or lease, including up to a max- up to a limit of $100.000. The deductible will be imum of $500 for early termination fees or equal to the largest deductible appL:cable to any penalties, for your covered"auto" less. owned "auto' for that coverage- Any Compre• hens+ve deductible does not apply to fire or a The amount paid under SECTION III - lightning. PHYSICAL DAMAGE COVERAGE of K. TEMPORARY SUBSTITUTE AUTOS - this policy: and PHYSICAL DAMAGE COVERAGE b. Any; The following is added to paragraph C- Certain 1? Overdue leaselloan payments at the Trailers. Mobile Equipment And Temporary time cf the "loss". Substitute Autos of SECTION I - COVERED 2) Financial penalties imposed under a AUTOS lease for excessive use, abnormal If Physical Damage Coverage is provided by wear and tear or high mileage: this Coverage Form, the following types of 3) Security deposits not refunded by a vehicles are also covered "autos" for Physi- lessor; cal Damage Coverage: A) Costs of extended warranties, Credit Any "auto" you do not own while used with Life insurance. Health, Accident, or the permission of its owner as a temporary Disability insurance purchased with thelease. and AC 70 05 0316 Includes copyrighted material of Insurance Services Office, loc, Page 3 of 7 with its permission COMMERCIAL AUTO AC 70 05 03 16 5i Carry-over balances from previous No deductible applies to glass if the glass is re- leases paired, in a manner acceptable to us, rather than 2 This coverage only applies to a "loss" which replaced. is also covered under this policy for Com- P. RENTAL REIMBURSEMENT COVERAGE prehensive, Specified Causes of Loss, or 1. This coverage applies only to a covered "au- Collision coverage to" for which Physical Damage Coverage is Coverage does no-. apply to any unpaid provided on this policy. amount due on a loan for which the covered 2. We w.li pay for rental reimbursement ex- 'auto'is not the sole collatera;_ penses ir.a.ured by you for the rental of an N- ORIGINAL EQUIPMENT MANUFACTURER 1.auto" because of"loss" to a covered "auto'. PARTS - LEASED PRIVATE PASSENGER Payrvent applies In addition to the otherwise TYPES applicable amount of each coverage you Under Paragraph C. Limit of Insurance of have on a covered "auto." No deductibles SECTION III - PHYSICAL DAMAGE apply to this coverage. COVERAGE. Section 4 is added as fellows: 3. We will pay only for those expenses incurred 4. We will use new original equipment vehicle during the policy period beginning 24 hours manufacturer parts for any private passen- after the 'loss" and ending, regardless of the ger type covered "auto- where required by policy's expiration, with the lesser of the the lease agreement which has a term of at following number of days. least six rnonths. If a new original equip- a. The number of days reasonably ment vehicle manufacturer part is not In pro- required to repair or replace the covered duction or distribution we may use a like, "auto' If 'loss" is caused by theft, this kind and quality replacement part number of days Is added to the riumber O. DEDUCTIBLE AMENDMENTS of days it takes to locate the covered The following are added to me Deductible prov:- .auto"and rerun it to you. sibn of SECTION IT - PHYSICAL DAMAGE b. The number of days shown in the COVERAGE Schedule If another policy or cure age `.urn,. that is not an 4 Ow payment is Limed to the lesser of the automobile policy or coverage form issued by follceving ambunt$. this company applies to the same "accident the a. Necessary and actual expenses following applies: incurred. IH lire deductble under this coverage is the h $75 for any one day or for a maximum smaller or smalles;j deductible, It will be of 30 days. %valved 5. This coverage does not apply while there 2 If the deductible under this coverage s not are spare or reserve "autos" available to you the smaller (or smallest) deductible, it will be for your operations reduced by the amount of the smaller (or G. If "loss' results from the total theft of a cov- smallestl deductible ered "auto" of the private passenger type. If a Comprehensive or Specified Causes of Loss we will pay under this coverage only that Coverage 'loss' from one 'accident` involves amount of your rental reimbursement ex• two or more covered "autos', only the highest penses which to cot already provided for ur- deductible applicable to those coverages will be der SECTION III - PHYSICAL. DAMAGE applied to the "accident." if the cause of the loss COVERAGE Coverage Extension is covered for those vehicles This provision only Q_ EXPANDED TRANSPORTATION EXPENSE applies if you carry Cbmprehensve or Specified paragraph A.4.a. of SECTION III - PHYSICAL Causes of Loss Coverage for those vehicles, DAMAGE COVERAGE Is replaced by the follow and does not extend coverage to any covered "autos' for which you an not carry such 'nq coverage- We will pay up to $5C per day to a maxirnurn of $1500 for temporary transportation expense in- curred by you because of the total theft of a Page 4 of 7 Includes copyrighted material of Insurance Services Office, Inc AC 70 05 03 16 with its permission. COMMERCIAL AUTO AC 70 05 03 16 covered "auto" of the private passenger type ment manufacturer or other sources in- We will only pay for those covered "autos" for cludiro non-original equipment manu- which you carry Comprehensive or Specified facturers and Causes of Loss Coverage We will pay for teir- b If a repair or replacement results in bet- porary transportation expenses inccrred d.eing ter than like kind or quality.. we will not the period beginning 24 hou-s after the theft and pay for the amount of the net improve- ending. regardless of the policy's expiration, ment_ when the covered"auto"is returned to use or we 5. If we offer to pay the actual cash value of pay for its"loss the damaged or stolen property we will R. EXTRA EXPENSE-STOLEN AUTOS value auto advertising wraps, paint customi- The following paragraph is added to Coverage zatlon, and similar business related advertis- Extensions of SECTION III - PHYSICAL irig modifications, in addition to the actual DAMAGE COVERAGE. cash value of the property. Auto advertising c. We will pay for up to $5,000 for the expense wraps, paint Customization, and similar of returning a stolen covered "auto" to you, business related advertising modifications We will pay only for those covered autos" will be valued at the cost to replace them for which you carry Comprehensive or Spec- with an adjustment made for depreciation ified Causes of Loss Coverage and physical condition. S. PHYSICAL DAMAGE LIMIT OF INSURANCE T. NEW VEHICLE REPLACEMENT COST Under SECTION III - PHYSICAL DAMAGE The following is added to the Limit of Insurance COVERAGE, Paragraph C.. Limit of Insurance provision of SECTION III - PHYSICAL is replaced by the following. DAMAGE COVERAGE: C Limit Of Insurance 5 The provisions of paragraphs ", and 3 do 1 The most we will pay for 'loss n ar.y one not apply to a covered "auto of the private "accident' is the lesser of passenger type or a vehicle with a gross vehicle weight rating of 20,000 pounds or a The actual cash value of the darnaged less which is a "new vehicle." or stolen property as of the time of the In the event of a total "loss to your new ve- loss or hide to which this coverage applies, we will b. The cost of repairing or replacing the pay at your option: damaged or stolen property. a. The verifiable `new vehicle' purchase 2 51500 is the most we will pay for doss" in price you paid for your damaged vehi- any one -accident' to all electronic equip- cle, not including any insurance or war- ment that reproduces. receives or transmits ranties purchased: audio, visual or data signals which, at the b If ,t is available, the purchase price as time of"loss', is negotiated by us, of a "new vehicle' of a Permanently installed in or upon the the same make, model, and equipment covered 'auto- in a housing, opening or or the most similar model available, not other location that is not normaty used including any furnishings, parts, or by the "auto" manufacturer for the in- equipment not installed by the manufac- stallation of such equipment turer or manufacturers' dealership, or . b. Removable from a permanently installed c The market value of your damaged ve- housing and as described in Paragraph hicle. not including any furnishings: 2.a. above or is an integral part of that parts, or equipment not installed by the equipment or manufacturer or manufacturer's dealer- s. An integral part of such equipment. ship. 3. An adjustment for depreciation and physical We will not pay for initiation or set up costs condition will be made in determining actual associated with loans or leases cash value in the event of a total -loss' As used in this endorsement, a 'new 4. The cost of repairing or replacing may: vehicle' means an "auto' of which you are a. Be based on an estimate which includes the original owner that has not been previ- parts furnished by the original equip- AC 70 05 03 16 Includes copyrighted material of Insurance Services Office, Inc.. Page 5 of 7 with its Perm'.ssion COMMERCIAL AUTO AC 70 05 03 16 cusly titled and which you purchased less a. Your obligation in the Duties in the Event than 365 days before the date of the `lass of Accident Claim. Suit or Loss Condi- lion relative to notification requirements U. PHYSICAL DAMAGE COVERAGE applies only when the "accident or EXTENSIONS 'loss' is known to. Under SECTION III — PHYSICAL DAMAGE (1) You,it you are an individual, COVERAGE, A. Coverage. Coverage Exten- (2) A partner. if you are a partnership, sons, b. Loss of Use Expenses is replaced by ;3j A ,hemmer, if you are a limited liability the fol;awmg company, or b. Loss of Use Expenses iti An executive officer or insurance For Hired Auto Physical Damage.. we will manager, if you are a corporation. pay expenses for which an "insured" be- b. Your obligation in the, Duties in the Event comes legally responsible to pay for loss of of Accident, Claim. Suit or Loss Condition use of a vehicle rented or hired without a relative to providing us with documents driver, under a written rental coritraot or concerning a Gairn or "suit" will not be agreement. We will pay for loss of use ex- considered breached unless the breach penses if caused by: occurs after such claim or "suit' !s known it Other than collision if the Declarations to. indicate that Comprehensive Coverage (1) You, if you are an individual is provided for any covered 'auto'. (2) A partner, if you are a partnetship; (2) Specified Causes of Loss only if the �- A member, if you are a limited Declarations indicate that Specified i liabi',ity company. or Causes of Loss Coverage is provided for any covered aeto'. of (4) An executive officer or insurance manager, if you are a corporation t3i Collision only if the Declaratons indicate that Col sion Coverage is provided for any covered "auto.` X. HIRED CAR —COVERAGE TERRITORY However, the most we will pay for any Item i5) of the Policy Period. Coverage Territory expenses for loss of use is $50 per day, to a General Col?citions is replaced by the following: rnaxvmum Of$1.500. The insurance provided (51 Anywhefe in the word d a covered 'auto" is by this provision is excess over any other leased, hired. rented or borrowed without a co]ecuble insurance drive.,for a period of 30 days or less, and V- TRANSFER OF RIGHTS OF RECOVERY Y. EMERGENCYLOCKOUT AGAINST OTHERS TO US We will reimburse YOU up to $100 for reasonable The following is added to the Transfer Of Rights expense incurred for the services of a locksmith Of Recovery Against Others To Us Condition- to gain entry into your covered `auto" subject to We waive any right of recovery we may these provisions have against any person or organization to 1. Your door key, electronic key or key entry the extent required of you by a wntten con- pad has been lost., stolen or locked in your tract executed prior to any 'accident' be. covered "auto" and you are unable to enter cause of payments we make to, damages such 'at;to or under this coverage form. 2 Your keyless enry device battery dies and W. NOTICE OF AND KNOWLEDGE OF you are unable to enter such "auto" as a re- OCCURRENCE suit, SECTION IV— BUSINESS AUTO 3. Your key, electronic key or key entry pad CONDITIONS, Paragraph A is amended as has been lost or stolen and YOU have follows changed the lock to prevent an unauthorized 6. NOTICE OF AND KNOWLEDGE OF entry, and OCCURRENCE Page 6 of 7 Includes copynghted material of Insurance Services Office, Inc AC 70 05 03 16 With its permission. COMMERCIAL AUTO AC 70 05 03 15 a Original copies of receipts for services of a if we cancel for any reason other than non- locksmith must be provided before reim- payment of premium, we will mail or deliver bursement is payable to the First Named Insured written notice of Z. CANCELLATION CONDITION cancellation at least 60 days before the ef- fective date of cancellation. This provision Paragraph A.2. of the COMMON POLICY does not apply in those states that require CONDITION — CANCELLATION applies more than 60 days prior notice of cancella- except as follows: tion AC 70 05 03 16 Ir cludes copyrighted material of Insurance Services Office. Inc, Page 7 of 7 with its permission