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Home My WebLink AboutA6948 - TRI-STAR CONTRACTING II, INC. ADA ACCESS IMP AT DEMUTH PARK CP 15-15TRISCON-02 ACOKO CERTIFICATE OF LIABILITY INSURANCE IDNIELSEN DAM(MMmDIYYYY) 6/1712024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # 0767776 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 Palm Desert, CA 92211 CDN ACT Diane Nielsen (VTNE., Eat): (760) 360-4700 4742 1 W, No:(760) 200-9706 MSS, diane.nielsen@hubintemational.com INSURERISI AFFORDING COVERAGE RAID INSURER A: United Specialty Insurance Company 12537 INSURED Tri-Star contracting e, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER B: Securtty National Insurance Company (Am T 19879 INSURER C: Everest Premier Insurance Company 16046 INsuRER o: Travelers Property Casualty Company of America 26674 INSURER E: INSURER F : Cr1V1=0A[SPS CFRTIFIr:ATF NI ISSRFR• RFVISION NIIMRFR- 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 TYPE OF INSURANCE ADDL SUB pOLJCY NUMBER POLICY EFF POLICY UP LIMITS _LMA X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR $5,000 Deductible X TN2488856 6/2612024 6/26/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES lEa occurrence) $ 50,000 X NED EXP (Any we 5,000 PERSONALS ADV INJURY 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑X JECT OLOC OTHER', GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOP AGG 2,000.000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLV X RUTOS OIJIY Deductible JXX SPP181817800 1112312023 11/23/2024 COMBINED SINGLE LIMIT $ 1,0001000 BODILY INJURY Per BODILY BOODILY INJURY Pere $ 40a� l AMAGENo A UMBRELLA UAB EXCESs me X OCCUR CLAIMS -MADE BTN2481652 6/2612024 6/2612025 EACH OCCURRENCE S 2,000,000 X AGGREGATE 21000,000 X DELI I I RETENTIONS O C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIET01a)PARTNEWEXECUTNE Y❑ FILE ory In NHR EXCLUDED? ( I If yes. describe untie, DESCRIPTION OF OPERATIONS below N I A 600005937231 101112023 10/1/2024 X PER I STATUTE OTH- EL. EACH ACCIDENT 1,000,000 E.L. DISEASE -EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY UMn 1,000,000 p Leased/Rented TI 6606072C693 1MI12024 IM112025 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD IN, Additional Remarks Schedule, may be attached if more space is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA RECEIVED City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium JUN 'L y 2024 OFFICE OF THE CITY CLER CFRTIFICATF HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Palm Springs CityACCORDANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORED REPRESENTATIVE s4� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -.SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART &101:1#11111114 Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered O erations s equire By ritten Contract, Fully As Require By ritten Contract, Ful y Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With.respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2. 1. The Insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the Insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s). at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its Intended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project. CG 2010 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of Insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 TRISCON-02 CERTIFICATE OF LIABILITY INSURANCE I DATE I(MMID^ IYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # 0757776 rigA T Diane Nielsen Palm Desert, CA 92211 INSURED Services Inc. Tri-Star Contracting 11, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 360-4700 4742 COVFRAr;FS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSUMNCE ADDL INMM SUB POLICY NUMBER POLICY EFF POLICY EXP DMnS A I X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR $5,000 Deductible X X TN2488856 6/2612024 6/26/2025 EACH OCCURRENCE E 1,000,000 DAMAGE TO RENTED (Ea commence) 50,00PREMISES X MED EXP (Any one Noom 5,000 PERSONAL B ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC 11 OTHER: GENERAL AGGREGATE E 2,OOQ000 PRODUCTS - COMPIOP AGG E 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AIUIppT��O��S ONLY AUTOS X AUTOS ONLY X 00S ONLY X No Deductible X X SPPIS1817800 1112312023 11123/2024 COMBINED SINGLE LIMIT IEa accident) E 1,000,000 BODILY INJURY Per E BODILY INJURY Peraccident BODILY S OPaEwR�t AMAGE E A UMBRELLA LIAR EXCESS LAB X OCCUR CLAIMS -MADE STN2481662 6/2612024 6/26/2025 EACH OCCURRENCE S 2,000,000 X AGGREGATE 2,000,000 X I DEO RETENTIONS D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AoNY PROPREIETgO�Rq/PARTNERMXECUTNE YIN 'MFa[CE in NH)EXCLUDED? IM 1 NN) If yes, clesaibe under DESCRIPTION OF OPERATIONS bekn NIA X 7600005937231 101112023 10/1/2024 X I PER STATUTE OTM- E L. EACH ACCIDENT E 1,000,000 E.L. DISEASE - EA EMPLOYE f 110001000 E.L. DISEASE -POLICY LIMIT 1,000,000 D Leased/Rented 6606072C693 1111/2024 111112025 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may he attached R more space is mqulred) The City of Palm Springs, its officials, employees and agents are named as additional Insured per attached CG2010 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice Will be given to the certificate holder should any of the above policies be cancelled before the expiration^tCi` ay notice applies for non payment of premium REC Y E AN Z 4 2024 CFRTIFICATF WEII nFR CANCFI I ATiON OFFICE OF THE CITY CLERK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Palm Springs CityACCORDANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORIZEDREPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:, SPP181817800 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement. A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and Blanket Additional Insured Status for Certain Entities. Item 1. Who is an Insured of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 1800' day after you acquire or form the organization or the end of the policy period, whichever is earlier, (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or If similar insurance would have been available but for its termination or the exhaustion of its limits of Insurance. This insurance does not apply 9 coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. f. Any person or organization you are required by written contract or agreement to name as an additional "insured°, but only with respect to liability created in whole or part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 — COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply If the "bodily injury' results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CAS90187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limlted Automatic Towing Coverage Item 2. T&dng, of Paragraph A. Coverage, under SECTION III — POY51CAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and, labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per "loss', for that covered 'auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss' expenses you sustain as a result of a covered physical damage "loss" to a covered "auto up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: - a. We will provide "downtime loss" beginning on the 5' day after we have given you our agreement to pay for repairs to a covered "auto and you have given the repair facility your authorization to make repairs; b. Coverage far "downtime loss" expenses will end when any of the following occur. (1) You have a spare or reserve 'auto" available to you to continue your operations. (2) You purchase a replacement 'auto'. (3) Repairs to your covered "auto have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of d. Contraband or property in the course Paragraph A. Coverage, under SECTION of illegal transportation or trade. III. PHYSICAL DAMAGE COVERAGE, is e. "Loss" caused, by theft, unless there is amended to add:. evidence of forced entry into the We will pay any resulting -rental covered 'auto' and a police report is reimbursement expenses incurred by you for filed. a rental of an °auto' because of 'loss' to a K. Accidental Alrbag Discharge Coverage covered "auto" up to a maximum of $100 per Item 3.a, of Paragraph B. Exclusions under day, fora maximum of 30 days for the same SECTION III — PHYSICAL DAMAGE physical damage"loss', subject to the COVERAGE is amended to read: following conditions: a. We will provide rental reimbursement a. Wear and tear, freezing, mechanical or electrical breakdown. The incurred during the policy period beginning 24 hours after the'loss' and exclusion relating to mechanical ending, regardless of the policy break -down does not apply to the expiration, with the number of days accidental discharge of an air bag. reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered °auto°. If the'loss is Paragraph C. Limit Of Insurance under caused by theft, this number of days is SECTION III — PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add: covered 'auto" and return it to you or the number of days It takes for the claim to If a covered 'auto' is owned or leased and be settled, whichever comes first. if we provide Physical Damage Coverage on it, we will pay, in the event of a covered b. Our payment is limited to necessary and total °loss°, any unpaid amount due on the actual expenses incurred. lease or loan for a covered "auto°, less: c. This coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos" Damage Coverage Section of the available to you for your operations. policy; and d. If a'loss' results from the total theft of a b. Any: covered 'auto' of the private passenger 1 Overdue lease or loan type, we will pay under this coverage only that amount of your rental payments including penalties, reimbursement expenses which is not interest or other charges resulting from overdue already provided for under the Physical payments at the time of the Damage Coverage Extension. loss°; J. "Personal Effects" Exclusion (2) Financial penalties imposed Paragraph B. Exclusions under SECTION under a lease for excessive use, III — PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss' to "personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or evidence of debt, money, notes, lease; securities or commercial paper or (4) Security deposits not refunded other documents of value. by the lessor; and b. Bullion, gold, silver, platinum, or other (5) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III —PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same "loss", only one deductible will apply to that "loss'. If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss'. N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductlble will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the flrst"loss" t oi" _2 25°% 3 50% A 75% 5 100% If we pay a Physical Damage 'loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM Wit not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident', claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, 'suit' or "loss" Is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; (3) An "executive officer' or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (5) Your insurance manager; or (6) Your legal representative. P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an 'accident" or "loss' to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. insurance is Primary and Noncontributory Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item S..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV —BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the Inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured. "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income° means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or Incurred; and 2. Continuing normal operating expenses Incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NvC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/01/2023 Policy No. 7600005937231 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: i r = -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered Operations As Require y ntten Contract, Fully s equlre By ritten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With.respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s). at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of Insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown In Declarations. Of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION —PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Or Governmental Agency Or Subdivision Or Political Subdivision: Required By Written Contract, Fully Executed Prior To The Named Insured's Work I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section H — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1: This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the products - completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section HI —Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement; the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2012 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER• ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by .,your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However. 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured Is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Organization: :n Contract, Fully Executed Prior To The Named Insured's Work to The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: — —We waive any -right -of recovery we may have.against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ Policy # ATN2488856 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 05100 (02120) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: The Additionailhsured"is a Named -insured undersuch-otherinsurance and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the speciflcproject that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other Insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Or anization s As Required By Written Contract, Fully Executed Prior To The Named Insured's Work. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02120) Page 1 of 1 Recording Requested By: 201 ■ -0379212 09/13/2017 10:31 AM Fee: $ 0.00 City of Palm Springs Page 1 of 2 Recorded in Official Records County of Riverside When Recorded Mail To: Peter Aldana Assessor-County Clerk-Recorder I Name Kathleen D.Hart,Interim City Clerk 'lll 'ItJ1.lIJllV[tFM �I III Street R Exam: IIh Address 3200 E.Tahquitz Canyon Way I A Page DA PCOR Misc Long RFD 15t Pg Adtl Pg Cert CC Ciry&State Palm Springs,CA 92262 ) SIZE NCOR SMF NCHG ��;,n, NOTICE OF COMPLETION (CA Civil Code§§8180-8190,8100-8118,9200-9208) NOTICE IS HEREBY GIVEN THAT: 1. The undersigned is an owner of an interest of estate in the hereinafter described real property,the nature of which interest or estate is: fee (e.g.fee,leasehold,joint tenancy,etc.) 2. The full name and address of the undersigned owner or reputed owner and of all co-owners or reputed co-owners are: Name Street and No. City State City of Palm Springs 3200 E.Tahquitz Canyon Way Palm Springs CA 3. The name and address of the direct contractor for the work of improvement as a whole is: Tri Star Contracting II Inc. 15-501 Little Morongo Road, Desert Hot Springs,CA 92240 4. This notice is given for(check one): l 0 Completion of the work of improvement as a whole. ❑ Completion of a contract for a particular portion of the work of improvement(per CA Civ.Code§ 8186). 5. If this notice is given only of completion of a contract for a particular portion of the work of improvement(as provided in CA Civ.Code §8186),the name and address of the direct contractor under that contract is: Not Applicable. 6. The name and address of the construction lender,if any,is: Not Applicable. 7. On the 16th day of June 2017 ,there was completed upon the herein described property a work of improvement as a whole(or a particular portion of the work of improvement as provided in CA Civ.Code §8186)a general description of the work provided: City Project 15-15,Demuth Park ADA Access Improvements 8. The real property herein referred to is situated in the City of Palm Springs County of Riverside State of California,and is described as follows: APN's: 680-120-031;680-020-043;680-020-051;680-020-052;680-020-053 9. The street address of said property is: 4365 Mesquite Avenue,Palm Springs CA 92264 10. If this Notice of Completion is signed by the owner's successor in interest,the name and address of the successor's transferor is: Not applicable I certify(or declare;)under penalty of perjury under the laws of the St of Cal ifor that the foregoing is true and correct. Date: L By: Signatu a of Owner or Owner's Authorized Agent-City Engineer for City of Palm Springs Thomas Garcia, City Engineer ©Porter Law Group,Inc.2013 Print Name,and Title Page 1 of 2 r , VERIFICATION I, Thomas Garcia state: I am the City Engineer _("Owner","President", "Authorized Agent","Partner',etc.)of the Owner identified in the foregoing Notice of Completion.I have read said Notice of Completion and know the contents thereof;the same is true of my own knowledge. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on �eP � � 1� 20t1 (dale),at Palm Springs I (City), CA (state). Signature of Owner or Owner's Authorized Agent Thomas Garcia,City Engineer 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 CAL" RNIA COUNTY OF On 6L,1�,, (date), before TEARI HINTZ me, / ! - i Net3;y Public(name and title of Notary Public-California 2 officer) personally appeared ,a a✓4/ who proved 5 Riverside county to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are Commissionr2202861 subscribed to the within instrument and acknowledged to me that he/she/they executed the My Comm.Expires Jun 26,2021 ,w,�w.rwwl same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s),or the entity upon behalf of which the person(s)acted,executed the instrument. I certify under PENALTY OF PURJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and officials Page 2 of 2 Signature Y�LM �AIFOA�' CITY OF PALM SPRINGS CONTRACT CHANGE ORDER To: Tri Star Contracting II Inc. Date: August 10, 2017 15501 Little Morongo Rd. Desert Hot Springs, CA 92240 Project: 15-15 Demuth Park ADA Access (760) 251-5454 Improvements Fax: (760) 251-5458 Change Order No: 2 Purchase Order 17-0974 Attn: Brian Willis Account Nos. 260-4500-59488 261-1395-59488 CHANGES TO CONTRACT This Contract Change Order No. 2 (two) makes construction quantity adjustments to both the original bid schedule and Contract Change Order No. One(1). In addition this change order adds one new item pertaining to concrete delivery charges. Changes to Original Bid Schedule Quantities: Bid Item Description Quantity Unit Cost Per Unit Total Cost 4 Clearing and Grubbing .0419638 LS $65,392.00 $2,744.10 5 Earthwork 34 CY $31.00 $1,054.00 6 Remove Existing Curb 225 LF $6.10 $1,372.50 7 Remove Existing Sidewalk -16 SF $1.20 $19.20 10 Cold Milling 2.5 inches deep) -350 SY $25.90 $9,065.00 11 Hot Mix Asphalt -50 TON $224.00 $11,200.00 12 Construct Concrete Pavement 48.53 CY $279.10 $13,544.72 13 Construct A-1 Curb 232 LF $36.40 $8,444.80 16 Construct Type "B" Curb Ramp 1 EA $2,182.00 $2,182.00 20 Inst. Detectable Warning Surface 6 SF $49.80 $298.80 26 Ready Mix Concrete Delivery -1 LS $971.25 $971.25 Subtotal $8,385.47 Changes to Change Order One (1) Quantities: CCO1 # Item "A" Construct 4" PCC Sidewalk 232 1 SF 1 $4.93 $1,143.76 New Item: New Item "B" Ready Mix Concrete Delivery 15 LOAD 1 $215.50 1 $3,232.50 Total Change Order Amount $12,761.73 CP 15-15 Demuth Park ADA Access Improvements Contract Change Order No.2 August 8,2017 Page 2 REASONS FOR CHANGES Items 4,5,6,7,10,11,12,13,16,20, 26, and CCO #1 Item A: Following the completion of Construction all quantities of completed work were measured and found to be more or less than the originals estimates in the quantities indicated. Note that Bid Items 10 (Cold Milling) and 11 (Hot Mix Asphalt), are being deleted entirely. It was determined that a concrete parking surface would require less maintenance and provide increased ADA accessibility. Increases to bid items 4, 5, and 12 are inclusive of all additional quantities of these items necessary to construct the parking area in concrete rather than asphalt concrete paving. New Item "B": California Assembly Bill 219 which requires payment of prevailing wages for the delivery of ready mixed concrete was determined to be applicable to this project after bidding. This required that the City make payment for delivery fees incurred by the Contractor. These additional costs are being paid without additional mark up. The majority of these costs were paid as part of Bid Item 26, Field Orders but the total cost exceeded the funds available in that bid item. This New Item B, compensates the Contractor for delivery of 15 additional loads of Portland Cement Concrete at a cost of $215.50/1-oad for a total additional cost of$3,232.50. CHANGES TO CONTRACT TIME No additional working days are being added to the project. SUMMARY OF COSTS Council Approved Amount: $521,098.30 Original Completion Date: 30 Working Days Previous Change Order $29,091.30 Previous Days Added 15 This Change Order: $12,761.73 Days Added 0 Revised Contract Amount: $562,951.33 Revised Completion 45 Working Days SOURCE OF FUNDS Funds are available in account No.: 261-1395-59488 ****SIGNATURES ON NEXT PAGE CP 15-15 Demuth Park ADA Access Improvements Contract Change Order No.2 August 8,2017 Page 3 1 have received a copy of this Change Order and the above AG ED P ES are acceptable to Contractor Tri Star Contractina II Inc. �� I �(� Si nature Date lam' Printed Name and Title Citv of Palm SDrinas d� f d Recomm nd d By: ^1a r $ �� Thomas Garcia, City Engineer Date Approved By: David . eady, City Manager Date Attest By: Y—��e v .` � Kathleen D. Hart, Interim City Clerk Da e Distribution: Original Conformed Copy: Conformed - File Copv: Contractor (1) Engineering Pay File (1) Citv Clerk (1) City Proiect File (1) Purchasinq (1) Finance (1) APPROVED By CITY MANAGER CITY OF PALM SPRINGS CONTRACT CHANGE ORDER To: Tri Star Contracting II Inc. Date: April 5, 2017 15501 Little Morongo Rd. Desert Hot Springs, CA 92240 Project: 15-15 Demuth Park ADA Access (760) 251-5454 Improvements Fax: (760) 251-5458 Change Order No: 1 (one) Purchase Order 17-0974 Attn: Brian Willis Account Nos. 260-4500-59488 261-1395-59488 This CCO No. 1 identifies a change in construction materials used to create the ADA path throughout the park. Bid Item No. Description Quantity Cost Per Unit Total Cost Bid Item 14 Construct 4" PCC Sidewalk -14,930 SF $5.78 Per SF $86,295.40 Bid Item 22 Decomposed Granite 4"Thick -31,410 SF $2.20 Per SF $69,102.00 Bid Item 23 Install 1"X 6' Plastic Header -10,225 LF $4.30 Per LF ($43,967.50) Total Cost: ($199,364.90) New Item Description Quantity Cost Per Unit Total Cost New Item "A" Construct 4" PCC Sidewalk 46,340 SF $4.93 $228,456.20 Total Cost: $228,456.20 Total Amount of this Change Order $29,091.30 Reasons for Change in Work: Original construction of the ADA walkways throughout the park was to be performed using Decomposed Granite to help accommodate possible relocation of ball fields in the future. However, with extensive review DG would not be cost efficient in regards to maintenance and longevity. The materials would eventually degrade and deteriorate in the future requiring costly repairs and replacements. The decision was made to use Portland Cement Concrete to construct the sidewalks within the park. Bid Item 14 indicates the estimated quantity of concrete needed for the project at $5.78 a square foot. However in consideration of the substantially large amount of concrete that will be used replacing the use of Decomposed Granite, the Contractor and Engineering Staff negotiated a lower cost of$4.93 a square foot. Therefore Bid Item 14 is to be removed from the contract. Bid Items 22 and 23 will be deleted due to the revised construction. New Items: New item "A" indicates the estimated quantity of Portland Cement Concrete that will be needed to construct the ADA sidewalks throughout Demuth Park. CP 15-15 Demuth Park ADA Access Improvements Contract Change Order No. 1 April 03,2017 Page 2 Changes to Contract Time: The above described work performed on the project warrants an additional 15 working days is added to the contract. SOURCE OF FUNDS: Funds are available in Account No. 261-1395-59488 SUMMARY OF COSTS: Council Approved Amount: $521,098.30 Original Completion Date: 30 Working Days Previous Change Order 0 Previous Days Added 0 This Change Order: $29,091.30 Days Added 15 Revised Contract Amount: $550,189.60 Revised Completion 45 Working Days **** SIGNATURES ON NEXT PAGE **** CP 15-15 Demuth Park ADA Access Improvements Contract Change Order No. 1 April 03,2017 Page 3 1 have received a copy of this Change Order and the above AGREED PRICES are acceptable to Contractor Tri Star Contracting II Inc. 5'/�-,Z' ;�, / Signature Date /Za - Printed Na e a d Title City of Palm Springs Recommended By: ' 'Y�(7 11 Assistant City anager/City Engineer fDate Approved By: David H. Ready, anager Dafe Attest By: D ' KctAltf-n D, Kxr--tjlnterim City Clerk Date Distribution: Original Conformed CoDy: Conformed - File Copy: Contractor (1) Engineering Pay File (1) City Clerk (1) City Proiect File (1) Purchasinq (1) Finance (1) CLAPPROVED BY CITY COUNCIL S�Cw, 5,c- ajf i7 A�9u� a AGREEMENT (CONSTRUCTION CONTRACT) THIS AGREEMENT made this �(. V+ lay of , 2017, by and between the City of Palm Springs, a charter city, organized and existing fin the County of Riverside, under and by virtue of the laws of the State of California, hereinafter designated as the City, and Tri-Star Contracting II, 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: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 The Work comprises the removal of existing surface materials (earthwork) necessary to construct accessible walkways throughout Demuth Park located at 4365 Mesquite Avenue. The scope of work shall include constructing new asphalt concrete pavement, portland cement concrete pavement, cold milling, curb, sidewalk, curb ramps, detectable warning surfaces, decomposed granite, signing and striping and modifying existing irrigation. 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. DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 AGREEMENT FORM OCTOBER 27,2016 ORIGINAL BID AGREEMENT AND BONDS-PAGE 1 AND/OR AGREEMENT 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 Five Hundred Twenty One Thousand Ninety Eight Dollars and Thirty Cents ($521,098.30). Contractor agrees to receive and accept the prices set forth herein, as full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Said compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of the Work during its progress or prior to its acceptance including those for well and faithfully completing the Work and the whole thereof in the manner and time specified in the Contract Documents; and, also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the Work, suspension of discontinuance of the Work, and all other unknowns or risks of any description connected with the Work. ARTICLE 4 --THE CONTRACT DOCUMENTS The Contract Documents consist of the Notice Inviting Bids, Instructions to Bidders, the prevailing rate of per diem wages as determined by the Director of the California Department of Industrial Relations, the accepted Bid and Bid Schedule(s), List of Subcontractors, Local Business Preference Program — Good Faith Efforts, Non- Discrimination Certification, Non-Collusion Declaration, Bidder's General Information, Bid Security or Bid Bond, this Agreement, Worker's Compensation Certificate, Performance Bond, Payment Bond, Standard Specifications, Special Provisions, the Drawings, Addenda numbers 1 to 1 , inclusive, and all Construction Contract Change Orders and Work Change Directives which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto. ARTICLE 5 -- MUTUAL OBLIGATIONS For and in consideration of the payments and agreements to be made and performed by the City, the Contractor agrees to fumish 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. DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 AGREEMENT FORM OCTOBER 27,2016 AGREEMENT AND BONDS-PAGE 2 Contractor specifically acknowledges and agrees to be bound by the Wage Rates and Labor Code requirements specified in the Contract Documents, including the requirement to furnish electronic certified payroll records directly to the Labor Commissioner (via the Division of Labor Standards Enforcement), and shall pay the general prevailing rate of per diem wages as determined by the Director of the Department of Industrial Relations of the State of California. ARTICLE 6 -- PAYMENT PROCEDURES The Contractor shall submit Applications for Payment in accordance with the Standard Specifications as amended by the Special Provisions. Applications for Payment will be processed by the City Engineer as provided in the Contract Documents. ARTICLE 7 -- NOTICES Whenever any provision of the Contract Documents requires the giving of a written Notice between the parties, it shall be deemed to have been validly given if delivered in person to the individual or to a member of the firm or to an officer of the corporation for whom it is intended, or if delivered at or sent by registered or certified mail, postage prepaid, to the last business address known to the giver of the Notice. ARTICLE 8 -- INDEMNIFICATION The Contractor agrees to indemnify and hold harmless the City, and all of its officers and agents from any claims, demands, or causes of action, including related expenses, attorney's fees, and costs, based on, arising out of, or in any way related to the Work undertaken by the Contractor hereunder. This Article 8 incorporates the provisions of Section 7-15 "Indemnification," of the Special Provisions, which are hereby referenced and made a part hereof. Prevailing Wages. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq. ("Prevailing Wage Laws"). Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, its officials, officers, employees, agents and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. ARTICLE 9 -- NON-DISCRIMINATION In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to their race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Such actions shall include, but not DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 AGREEMENT FORM OCTOBER 27,2016 AGREEMENT AND BONDS-PAGE 3 be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. ARTICLE 10 -- MISCELLANEOUS Terms used in this Agreement which are defined in the Standard Specifications and the Special Provisions will have the meanings indicated in said Standard Specifications and the Special Provisions. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and specifically, but without limitation, monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. The City and the Contractor each binds itself, its partners, successors, assigns, and legal representatives, to the other party hereto, its partners, successors, assigns, and legal representatives, in respect of all covenants, agreements, and obligations contained in the Contract Documents. SIGNATURES ON NEXT PAGE DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 AGREEMENT FORM OCTOBER 27,2016 AGREEMENT AND BONDS-PAGE 4 IN WITNESS WHEREOF, the City and the Contractor have caused this Agreement to be executed the day and year first above written. CITY OF PALM SPRINGS, APPROVED BY THE CITY COUNCIL: CALIFORNIA Date By David H. Ready City Manager Agreement No. ATTEST: APPROVED BY CITY COUNCIL By i&A damesT+ierepsen lha+lAltie-ri D. t'Eu-r �I �Y1 C Twee�tm City Clerk APPROVED FORM: By /ff/ �ZZ�J glas Holland City Attorney RECOMMENDED: Marcus L'F!ullek, PE, PLS Assistant City Manager/City Engineer DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 AGREEMENT FORM OCTOBER 27,2016 AGREEMENT AND BONDS-PAGE 5 CONTRACTOR By: Tri-Star Contracting II. Inc.. a California Corporation Firm/Company Name By: By: � \\Signs re (nlottarized()) ignature``(not``arized) Name: F�d 9 7 e hb� 4 Name: ✓�� LW Title Tr t� Title: �-eyyT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. (This Agreement must be signed in the above (This Agreement must be signed in the above space by one having authority to bind the space by one having authority to bind the Contractor to the terms of the Agreement.) Contractor to the terms of the Agreement.) State of C w 0. State of LQ\\-tOV V�3 CG County of ss County of wS1 . t )ss On Ve ( 1�p On V- _ v k4O`1 before met r A_ [before me,LGVGR��:v ,Arg �-k- t4oAuL.�I�)C�Wc personally appeared 1 ey\ V� personally appeared —it-'VA v\ �O\ who proved to me on the basis of satisfactory who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and is/are subscribed to the within instrument and acknowledged to me that he/she/they executed acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), the same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s) on the and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the of which the person(s) acted, executed the instrument. instrument. I certify under PENALTY OF PERJURY under the I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing laws of the State of California that the foregoing paragraph is true and correct. paragraph is true and correct. NA WITNESS my hand and official seal. WITNESS my hand and official seal. �glary Signature: yotary Signature:�� yC,GLrwA �� Notary Seal: Notary Seal: LAURA A. DAVENPORT „ s ' - Notary Public - California ,_ LAURA A. DAVENPORT « $ s --i Y Riverside County = Ff l Notary PubNa -Catilorniz : e :_ z -y,(s.- n i-;M. Riverside County a 3 9 Commission M 2163715 ti My Comm.Expires Se 24,2020 ' �� Commissidn#216- a �" M Comm.Expires Sa u 0 DEMUTH PARK ADA ACCESS IMPROVEMENTS t4r CITY PROJECT NO. 15-15 AGREEMENT FORM OCTOBER 27,2016 AGREEMENT AND BONDS-PAGE 6 BID DOCUMENTS Only the following listed documents, identified in the lower right corner as "Bid Forms" shall be fully executed and submitted with the Bid at the time of opening of Bids. Bid (Proposal) Bid Schedules List of Subcontractors Local Business Preference Program Good Faith Efforts Non-Collusion Declaration Non-Discrimination Certification Bid Bond (Bid Security Form) Bidder's General Information Failure of a Bidder to fully execute and submit all of the listed documents with the Bid will render a Bid as non-responsive and subject to rejection. DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 OCTOBER 27,2016 COVER SHEET BID FORMS-PAGE 1 BID PROPOSAL BID TO: CITY OF PALM SPRINGS, CALIFORNIA The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with the City in the form included in the Contract Documents (as defined in Article 4 of the Agreement) to perform the Work as specified or indicated in said Contract Documents entitled: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 Bidder accepts all of the terms and conditions of the Contract Documents, including without limitation those in the Notice Inviting Bids and the Instructions to Bidders dealing with the disposition of the Bid Security. This Bid will remain open for the period stated in the 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): �1 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. DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 OCTOBER 27,2016 LUMP SUM BID SCHEDULE 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: \� 1 Bidder:\ '\ C QV-\'�Y U By: (Signature) Title: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 OCTOBER 27,2016 LUMP SUM BID SCHEDULE BID FORMS-PAGE 3 BID SCHEDULE Schedule of Prices for Construction of the: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 Item Description Estimated Unit Unit Amount No. Quantity Price 1. Mobilization --- LS $53,983.00 2. Temporary Traffic Control LS $8,916.00 3. Water Pollution Control LS $5,116.00 4. Clearing, Grubbing and Removals --- LS $65,392.00 5.(F) Earthwork 575 CY $31 .00 $ 17,825.00 6. Remove Existing Curb 160 LF $6.10 $976.00 7. Remove Existing Sidewalk 2,720 SF $ 1 .20 $3,264.00 8. Remove Existing Curb Ramp 5 EA $672.00 ,t3,360.00 9. Remove Existing Wheel Stop 1 EA $30.00 $30.00 10. Cold Miling (2.5" deep) 350 SY $25.90 $91065.00 11. Hot Mix Asphalt 50 TON $224.00 $ 11 ,200.00 12. Construct Concrete Pavement 160 CY $279.10 $44,656.00 13. Construct Al Curb 160 LF $36.40 $5,824.00 14. Construct 4" PCC Sidewalk 14,930 SF $5.78 $86,295.40 15. Construct Type A Curb Ramp 2 EA $2,171.00 $4,342.00 16. Construct Type B Curb Ramp 4 EA $2,182.00 $8,728.00 17 Construct Curb Ramp 5 EA 2,100.00 10,500.00 (Case A, Type 2) $ $ Note: "(F)" identifies a "Final Pay' item, and shall be paid in accordance with Section 9-1.4 of the Special Provisions. Tri-Star Contracting II, Inc. DEMUTH PARK ADA ACCESS IMPROVEMENTS Name of Bidder or Firm CITY PROJECT NO. 15-15 OCTOBER 27,2016 BID SCHEDULE BID FORMS-PAGE 4 BID SCHEDULE (Continued) Schedule of Prices for Construction of the: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 Item Description Estimated Unit Unit Amount No. Quantity Price 18 Construct Curb Ramp 1 EA 1,656.00 1 656.00 (Case D, Type 1 Modified) $ $ ' Construct Curb Ramp 19. 1 EA 1,710.00 1710.00 (Case D, Type 2 Modified) $ $ ' 20 Install Detectable warning Surface 423 SF 49.80 21 ,065.40 (surface mounted) $ $ 21. Install Parking Stall Bollard 12 EA $341 .00 $4,092.00 22. Decomposed Granite (4" thick) 31,410 SF $2.20 $69,102.00 23. Install 1"x6" Plastic Header 10,225 LF $4.30 $43,967.50 24. Irrigation System --- LS $4,161 .00 25. Traffic Striping, Signing & Markings --- LS $17,122.00 26. Field Orders AL $ 18,750 "An allowance has been 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. Tri-Star Contracting II, Inc. Name of Bidder or Firm DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 OCTOBER 27,2016 BID SCHEDULE BID FORMS-PAGE 5 BID SCHEDULE (Continued) Schedule of Prices for Construction of the: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 TOTAL OF ALL ITEMS OF THE BID SCHEDULE: $ 521,098.30 (Price in figures) Five Hundred Twenty-one Thousand Ninety-eight Dollars & Thirty Cents (Price in words) 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. Tri-Star Contracting II, Inc. Name of Bidder or Firm DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 OCTOBER 27,2016 BID SCHEDULE BID FORMS-PAGE 6 BIDDER'S LIST OF SUBCONTRACTORS — PART I The bidder shall list all subcontractors (both DBE and non-DBE), includina 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 2 1. Name of Prime Contractor: Tri-Star Contracting ll, Inc. 2. Bid Items/Portion of Work to be Self-Performed(if less than 100%of the contract): 2-9, #6: Water truck & labor, 10-11, 12-19: Fine Grade, 21 - 24 3. Dollar Amount of Work Self- 4. Percentage of Work Self- 5. Date: Performed: Performed: $368,002.19 70% 12/01/16 By signing the Bid Form,Contractor hereby certifies that it will perform not less than 50%of the Contract Work with its own forces. B. LIST OF SUBCONTRACTORS 1. Type of Subcontractor(Check One) P First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: Archuleta Concrete 3. Address: 79-607 Country Club Drive Ste. 1 , Bermuda Dunes CA 92201 4. Bid Items/Portion of Work: PCC Construction 12-20 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 760-345-8722 672066 ❑ < $1M d <$5M ❑ <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ < $15M ❑ >$15M $133,853.11 Registration No: 1000010213 10. Percentage of Contracted Work: 11 DBE Firm? 4 Yes ❑ No 12. DBE Certification No.: 26% 27172 DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LIST OF SUBCONRACTORS-PART I OCTOBER 27,2016 BID FORMS-PAGE 7 i BIDDER'S LIST OF SUBCONTRACTORS - PART I (Continued) Copy this page as needed to provide a complete listing. Page 2 Of 2 1. Type of Subcontractor(Check One) IN First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: LSAP Consultants 3. Address: PO Box 1060, Desert Hot Springs, CA 92240 4. Bid Items/Portion of Work: 1 - Survey 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 760-288-2232 LS8880 a < $1M ❑ <$5M ❑ <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ <$15M ❑ > $15M $4,840.00 Registration No: 1000028602 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes 4 No 12. DBE Certification No.: 1% N/A 1. Type of Subcontractor(Check One) P First Tier; Cl Second Tier; ❑ Supplier, ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: Superior Pavement Markings 3. Address: PO Box 278, Beaumont CA 92223 4, Bid Items/Portion of Work: #25 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 951-845-2799 776306 ❑ < $1 M ❑ <$5M 8 <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ < $15M 6 >$15M $14,403.00 Registration No: 1000001476 10. Percentage of Contracted Work: 11. DBE Firm? El Yes IN No 12. DBE Certification No.: 3% N/A 1. Type of Subcontractor(Check One) 4 First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 0 <$1M 0 <$5M 0 < $10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ <$15M ❑ >$15M Registration No: 10. Percentage of Contracted Work: 11 DBE Finn? ❑ Yes I No 12. DBE Certification No.: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LIST OF SUBCONRACTORS-PART I OCTOBER 27,2016 BID FORMS-PAGE 8 • 0 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) 6 First Tier; ❑ Second Tier; ❑ Supplier, ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: Chrisp Company 3. Address: 2280 South Lilac Ave 4. Bid Items/Portion of Work: 21 & 25 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 909-746-0356 374600 ❑ < $1 M ❑ <$5M ❑ <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ < $15M ❑ >$15M $29,464.00 Registration No: 1000000306 10. Percentage of Contracted Work: 11 DBE Firm? ❑ Yes I No 12. DBE Certification No.: 6% NIA 1. Type of Subcontractor(Check One) ❑ First Tier; Il Second Tier; [] Supplier; ❑ Service Contractor(e.g. Truckin 2. Subcontractor Name: Statewide Traffic Safety & Signs 3. Address: 2225 Kansas Ave, Riverside CA 92507 4. Bid Items/Portion of Work: Signs only 21&25 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 951-213-3708 975518 ❑ < $1 M ❑ <$5M ❑ <$10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor ❑ < $15M ❑ >$15M $7,420.00 Registration No: 776306 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes 4 No 12. DBE Certification No.: 1.5% N/A DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LIST OF SUBCONTRACTORS-PART II OCTOBER 27,2016 BID FORMS-PAGE 9 BIDDER'S LIST OF SUBCONTRACTORS - PART II (Continued) Copy this page as needed to provide a complete listing. Page_of 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ <$lM 0 <$5M ❑ < $10M 8. Amount of Contracted Work: 9. DIR Public Works Contractor [I <$15M ❑ >$15M Registration No: 10. Percentage of Contracted Work: 11 DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 0 < $1M ❑ <$5M 0 <$10M 8. Amount of Contracted Work: 9. OR Public Works Contractor ❑ < $15M ❑ >$15M Registration No: 10. Percentage of Contracted Work: 11 DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type of Subcontractor(Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor(e.g. Trucking) 2. Subcontractor Name: 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 0 <$1M ❑ <$5M ❑ <$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.: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LIST OF SUBCONTRACTORS-PART II OCTOBER 27,2016 BID FORMS-PAGE 10 • ! LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS City Project No. 15-15 Bid Opening Date 12/01/16 The contract for this project is subject to the provisions of Palm Springs Ordinance No. 1756, and Section 7.09.030 of the Palm Springs Municipal Code, "Local Business Preference Program", subsection (5) "Local Preference in Public Works Contracts (Sub-Contracting)", which states: The prime contractor shall use good faith efforts to sub-contract the supply of materials and equipment to local business enterprises and to sub-contract services to businesses whose work force resides within the Coachella Valley. The prime contractor shall submit evidence of such good faith efforts at the time of submission of bids. Good faith efforts may be evaluated by placing advertisements inviting proposals in local newspapers, sending request for proposals to local sub-contractors, or by demonstrating that no local sub-contracts are qualified to perform the work or supply the materials or equipment. Any notice inviting bids which may require the use of sub-contractors shall include notification of this subsection. The City Council or Director may reject as non-responsive the bid of any contractor proposing to use sub-contractors that fail to comply with the requirements of this subsection. FAILURE TO IDENTIFY GOOD FAITH EFFORTS ON THESE FORMS MAY BE SUFFICIENT CAUSE TO FIND THE BID NON-RESPONSIVE. BIDDERS SHALL ENSURE ALL APPROPRIATE GOOD FAITH EFFORTS ARE IDENTIFIED. Bidders shall provide sufficient information to demonstrate that they have made good faith efforts to comply with Palm Springs Ordinance No. 1756. In the event no local firm (as defined in Ordinance No. 1756) is listed as a subcontractor on the "List of Subcontractors" submitted with its Bid, Bidders shall identify local subcontractors not required to be identified on the List of Subcontractors, and/or shall identify local firms with whom the Bidder has solicited to furnish materials and supplies for incorporation into the work of this project. Local Subcontractors not listed on the List of Subcontractors: N/A Local firms that will furnish materials or supplies to the Bidder for this project: Matich West Coast Sand And Gravel Imperial Sprinkler Supply DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LIST OF SUBCONTRACTORS-PART II OCTOBER 27,2016 BID FORMS-PAGE 11 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS (CONTINUED) In the event no local firms (as defined in Ordinance No. 1756) will provide services, or furnish materials and supplies to the Bidder for this project, the Bidder shall provide information sufficient to demonstrate good faith efforts to do so. Examples of information accepted by the City to demonstrate good faith efforts shall be included below: A. The names and dates of each publication in which a request for participation by local firms for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement ov�`lrv� 11 � IS5 -I (0 B. The names and dates of written notices sent to local firms soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the local firms were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of Date of Follow Up Methods firms Initial and Dates Solicited Solicitation 0 I ►�, DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LOCAL BUSINESS PREFERENCE PROGRAM OCTOBER 27,2016 GOOD FAITH EFFORTS BID FORMS-PAGE 12 C. The items of work which the bidder made available to local firms, including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate participation by local firms. Items of Work Bidder Breakdown of Items Amount Percentage Normally ($) Of Performs Item Contract (Y/N) #1: Survey N Survey $4,840.00 1% #12-20 PCC N Concrete Improvements $133,853.11 26% #25 Striping N Signing & Striping $14,403.00 3% D. The names, addresses and phone numbers of rejected local firms, the reasons for the bidder's rejection of the local firms, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each firm if the selected firm is not a local firm: Names, addresses and phone numbers of rejected local firms and the reasons for the bidder's rejection of the local firms: None Received Names, addresses and phone numbers of firms selected for the work above: LSAP Consultants:PO Box 1060,Desert Hot Springs CA 92240,760-288-2232 Archuleta Concrete:79-607 Country Club Drive, Ste. 1,Bermuda Dunes CA 92201,760-345-8722 Superior Pavement Markings, PO Box 278, Beaumont CA 92223, 951-845-2799 NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 LOCAL BUSINESS PREFERENCE PROGRAM OCTOBER 27,2016 GOOD FAITH EFFORTS BID FORMS-PAGE 13 NON-COLLUSION DECLARATION The undersigned declares: l am the C rrb of 1�n��C� c��v�, C �,�� 1 \1nC the (Title of Officer) (Firm/Company party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on 1 u-1 u7 C A (Date) (City) (State) r Signature DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 OCTOBER 27,2016 NON-COLLUSION DECLARATION BID FORMS-PAGE 14 BID BOND KNOW ALL MEN BY THESE PRESENTS, That TRI-STAR CONTRACTING II, INC., 15-501 Little Morongo Road, Desert Hot Springs, California 92240 as Principal, and NATIONWIDE MUTUAL 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(10%)of the Total Amount of the Bid dollars (not less than 10 percent of the total amount of the bid) for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns,jointly and severally,firmly by these presents. WHEREAS, said Principal has submitted a Bid to said City to perform the Work required under the Bid Schedule(s)of the City's Contract Documents entitled: DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 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 1st day of December 2016. EXECUTED FOR THE PRINCI AL: EXECUTED FOR THE SURETY: TRI-STAR CONTRALTI G II, INC ft NATIONWIDE MUTUA INSURANCE COMPANY BY B7 Signature Signaturk (NOTARIZED) C, ( OTARIZ ) Print Name and Title: Print Name and Title: C Douglas J. Rothey,Attomey-in-Fact ey Signature (NOTARIZED) Print Narril and Title: bL �i.� "Vks DEMM PARK.ADA ACCESS IMPROVEMENTS BID BOND(BID SECURITY FORM) CITY PROJECT NO.15-15 BID FORMS-PAGE 16 OCTOBER 27,2016 State of COLORADO ) )SS. County of ARAPAHOE ) On December 1, 2016, before me, a Notary Public in and for said County and State, residing therein, duly commissioned and swom, personally appeared Douglas J. Rothey known to me to be Attorney-in-Fact of NATIONWIDE MUTUAL INSURANCE COMPANY the corporation described in and that executed the within and foregoing instrument, and known to me to be the person who executed the said instrument on behalf of the said corporation, and he duly acknowledged to me that such corporation executed the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal, the day and year stated in this certificate above. My Commission Expires: December 8, 2018 Cy hthlla M. Burnett, Notary Public CYNTHIAM BURNETT NOTARY PUBLIC STATE OF COLORADO NOTARY ID 19944019211 COMMISSION EXPIRES DEC.8,2018 • Power of Attorney KNOW ALL MEN BY THESE PRESENTS THAT: Nationwide Mutual Insurance Company,an Ohio corporation AMCO Insurance Company,an Iowa corporation Farmland Mutual Insurance Company,an Iowa corporation Allied Property and Casualty Insurance Company,an Iowa corporation Nationwide Agribusiness Insurance Company,an Iowa corporation Depositors Insurance Company,an Iowa corporation hereinafter referred to severally as the"Company'and collectively as the"Companies,"each does hereby make,constitute and appoint: DOUGLAS J.ROTHEY CYNTHIA M.BURNETT LITTLETON CO each in their individual capacity,its true and lawful attorney-in-fact,with full power and authorityto sign,seal,and execute on its behalf any and allbonds and undertakings, and other obligatory Instruments of similar nature,in penalties not exceeding the sum of ONE MILLION AND NO1100 DOLLARS $ 1,000,000.00 and to bind the Company thereby,as fully and to the same extent as If such Instruments were signed by the duly authorized officers of the Company;and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed. This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company: 'RESOLVED,that the president,or any vice president be,and each hereby is,authorized and empowered to appoint attorneys-in-fact of the Company,and to authorize them to execute and deliver on behalf of the Company any and all bonds,forms,applications,memorandums,undertakings,recognizances,transfers,contracts of indemnity,policies,contracts guaranteeing the fidelity of persons holding positions of public or private trust,and other writings obligatory in nature thatthe business of the Company may require;and to modify or revoke,with or without cause,any such appointment or authority;provided,however,that tie authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company.' -RESOLVED FURTHER,that such attorneys-in-fact shall have full power and authorityto execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them,and to affix the seal of the Company thereto;provided,however,that said seal shall not be necessaryfor the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company. Execution of Instruments. Any vice president,any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents,Instruments,contracts,cr other papers in connection with the operation of the business of the company in addition to the chairman of the board,the chief executive officer,president,treasurer or secretary;provided,however,the signature of any of them may be printed,engraved,or stamped on any approved document, contract,Instrument,or other papers of the Company. IN WITNESS WHEREOF,the Company has caused this instrument to be sealed and duly attested by the signature of its officer the I day of February 2014. ♦ ♦ \ /♦ \R Iy9!4- / Terrance Williams,President and Chief Operating Officer of Nationwide Agribusiness Insurance Company / � and Farmland Mutual Insurance Company;and Vice President of Nationwide Mutual Insurance Company, R ; 1..!/ SEAL,',A AMCO Insurance Company, Allied Property and Casualty Insurance Company,and Depositors Insurance / I Company f�= I ACKNOWLEDGMENT Imo.... , ♦♦\ / 'O.' "' STATE OF IOWA,COUNTY OF POLK: as Al �.. 6, OnthlstidaycfFebruary 2014,before me came the above-named officer for the Companies aforesaid,to SF U me personally known to be the officer described in and who executed the preceding instrument, and he :•/ �SEAL: / ,�„ :;;� acknowledged the execution of the same,and being by me duly sworn,deposes and says,that he Is the officer ��,=,r/ �,4+... of the Companies aforesaid,that the seals affixed hereto are the corporate seals of said Companies,and the said corporate seals and his signature were duly affixed and subscribed to said instrument by the authority and .♦♦\, .♦ v,� direction of said Companies. ��c�r!"/ C/Jn ,mac. S®dy Abu • Q / Notarial Scel—Iowa I. i7� I 'MAT'';/ Commisdoo N®bcr 152785 '/ / `.... •/ My Com --..E:pirca Marcly 24,2017 Notary Public `�\��/ 'a\�to ♦ CERTIFICATE My CommMarch i24o20 Expires 17 I,Robert W Horner III,Secretary of the Companies,do hereby certify that the foregoing is a full,true and correct copy of the original power of attorney Issued by the Company;that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner;thatsaid Terrance Williams was on the date of the execution of the foregoing power of attorneythe duly elected officer of the Companies,and the corporate seals and his signature as officer were duly affixed and subscribed to the said Instrument by the authority of said board of directors;and the foregoing power of attorney is still In full force and effect IN WITNESS WHEREOF, I have hereunto subscribed my name as Secretary,and affixed the corporate seals of said Companies this 1st day of December 20 16 _ " Secretary ... This Power of Attorney Expires 03/20/19 BD7 1(03-14)00 24615 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of `l0 � On Q I C�k before me,\ ua A.VTt Date .Here Inse Name and Title of the O icer personally appeared i2 6 \v r Q_y\x 7 D I 6V\_Aa1_\Uj\f f)S 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 77 hand and official seal. LAURA A. DAVENPORT Notary Public-California Signature z Riverside County i Signature of Notary Public Commission #2163715 0My Comm Expires Sep 24,2020 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 nn Title or Type of Document: I Document. A Document Date: 1 oL 1 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Cie d. Signe Q. Signer's Name: A ❑Corporate Officer — Title(s): ❑ Corporate Officer — Ti e(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: �Signe ReP sen tng: Rep�r�e�ntig: 02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS As suppliers of goods In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to their race, religion, color, sex, age, marital status, ancestry, national origin, sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition. Such actions shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. We agree specifically: 1. To establish or observe employment policies, which affirmatively promote opportunities for minority persons at all job levels. 2. To communicate this policy to all persons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large. 3. To take affirmative steps to hire minority employees within the company. FIRM NAME OF PERSON SIGNING TITLE OF PERSON SIGNING � I C Hal DATE r I I . 6 Please include any additional information available regarding equal opportunity employment programs now in effect within your company. DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 NON-DISCRIMINATION CERTIFICATION OCTOBER 27,2016 BID FORMS-PAGE 15 �"1 • ORISCON-01 DNIELSEN AG ORO' DATE IMMIDDmyY) •tom. CERTIFICATE OF LIABILITY INSURANCE 1 112 312 01 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,Certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#OF09643 CO NM E:TACT Diane Nielsen Desert Empire Ins Services,Inc. PHONE Desert Eal 760 360d700 FAX, 760 200-9706 77664 Country Club Drive 1 )_(__-).. _ _ (AICNo):( _ ) Suite 401 ADDRESS:diane.nielsen@desertempireins.com Palm Desert,CA 92211 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Ironshore Specialty Insurance Co 25445 INSURED INSURER B:Ohio Casualty Insurance Company 24074- TriStar Contracting e,Inc. INSURERC-American Fire&Casualty Company 24066 Telar,Inc. 15501 Little Morongo Road INSURER D:Everest National Insurance Company 10120 Desert Hot Springs,CA 92240 INSURER E:Travelers Casualty and Surety Company of America 03609 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPEOFINSURANCE /1DDL SINSID UER POLICYNUMBER POLICY EFF POLICY EXP LIMITS WVDA X COMMERCIAL GENERAL LIABILITY 1,000000 EACH OCCURRENCE $ , CLAIMS-MADE X OCCUR AGS0003005 06/26/2016 06/26/2017 DAMAGE TO RENTED 1$ 50,000 MED EXP(Any one emw $ 5,000 _PERSONAL S ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY l X�jra1:1 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY EOMaBINEDcenISINGLE LIMIT $ 1,000,000 X ANY AUTO BA055813694 1112312016 11/2312017 BODILY INJURY Per arson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accidem $ HIM NON-py�}IED PROPERTY DAMAGE x_ AUTOS ONLY X AUTOS ONLY Per.I iER Q _. $ $ C UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB (CLAIMS-MADE ESA55813694 11/23/2016 11123/2017 AGGREGATE $ 1,000,000 DED RETENTION$ EXCESSAUTO $ D WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X ER �I 7600006937161 10/01/2016 10/01/2017 1,000,000 AppFFICER/MEM ER/EXCLUDED?ECUTIVE u.N/A E L.EACH ACCIDENT $ `Meneelory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS be. E.L.DISEASE-POLICY LIMIT $ E Equipment Floater 6606072C693 0111112016 01/11/2017 Leased/Rented 260,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached K man apace 4 mqulmd) Job-15-15,Demuth Park ADA Access Improvements CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CityOf Palm s THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3200 E Tahquitz Canyon Way Springs ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs,CA 92262 AUTHORIZED REPRESENTATIVE ✓v(4bv/- Coei�t" ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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/CONTRA TOR'S Name and Street Address: r 4 \� Telephone Number: (1 too )1r, Facsimile Number: E-Mail: �bl�eV�S(Cy \- G f. IV\�ll Tax Identification Number: 0 L ILDS306 2. TYPE OF FIRM Individual Partnership `� Corporation (State c ) 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) C s Supplemental License Classifications 4. BUSINESS LICENSE: Yes No License No.: h00021a 11 5. Surety Company and Agent who will provide the required Bonds: Name of Surety _�)2Sg v'V 2v�� \1n�1�\(fJ.V�CS� Address (` C_ L uti Surety Company NAck \(nnW\C\Q Telephone Numbers: Agent 7( UO ). D Surety (3u3)QaE_� DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 BIDDER'S GENERAL INFORMATION OCTOBER 27,2016 BID FORMS-PAGE 17 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: �lvS�C, v,Q a V-\W��as �C \ rA \Cye y,\"1 7. Number of years experience as a contractor in this specific type of construction work: -Q o4)� 8. List at least three related projects completed to date: a. Owner CA t—A � Address UySLN\ Contact vAVQ r v-Y(K1 Class of Work �Wtxmv\(A'li� kUlq Phoned IPO 62SULl 11, Contract Amount 6 so(pIcezy Project tr3 VuVP YOW�ate Completed j`J Contact Person Telephone number b. Ownei„ �- �Z Address l i l,6 aA ContactYy�4k. LaM(aS Class of Work R Stctk��c>QK Phone d-t02)Q #(41) Contract Amount ProjectC0.bC7ASNkl"vD toe Completed L Contact Person Telephone number C. OwnerC F 1 ) Iddress Contact Class of Work CuJ *f Y�At Phone�� "� 1 Con(�tract Amount _ 01�A a t\U�' q �v1�/�0.`\VG. G ProjectVlxx4111 VVy(Xy Date Completed Contact Person Telephone number 1 , 9. Name of Project Manager/Superintendent:� 6Y\4ICA-Vw�� 1� 10. Name(s) of person(s) who inspected job siteECX�`nQ.0 OWRVV.S DEMUTH PARK ADA ACCESS IMPROVEMENTS CITY PROJECT NO. 15-15 BIDDER'S GENERAL INFORMATION OCTOBER 27,2016 BID FORMS-PAGE 18 The Desert Sun 750 N Gene Autry Trail Certificate of Publication Palm Springs, CA 92262 760-778-4578/Fax 760-778-4731 State Of California ss: County of Riverside Advertiser: TRI-STAR CONTRACTING 15501 LITTLE MORONGO RD DESERT HOT SPR , CA 92240 Order# 0001740202 1 am over the age of 18 years old, a citizen of the United States and not a party to, or have interest in this matter. 1 hereby certify that the attached advertisement appeared in said newspaper(set in type not smaller than non panel) in each and entire issue of said newspaper and not in any supplement thereof on the following dates,to wit: Newspaper: The Desert Sun 11/18/2016 1 acknowledge that I am a principal clerk of the printer of The Desert Sun, printed and published weekly in the City of Palm Springs, County of Riverside, State of California.The tslx.Y a yea�ssa�o-1 Desert Sun was adjudicated a Newspaper of qor m6�oarlsaROra ' rat- general circulation on March 24, 1988 by the ce 1756ror'MPalm sodn Da,mnn Superior Court of the County of Riverside, TMaPerk o 'A Arxeu75-1 of Pa%rr`�memems p of State of Califomia Case No. 191236. '%OW PfO . ,G"abydffw- Daumbar 19t at 1'Aq�amber at 3 10 PM of l MI bidr are to be .I to Rodney M_ �S .ster.lnb or are -Wars and'gs.1 pcPgo" httav-Jt ww ailable declare under penalty of perjury that the from malty a;pakrfsg's 3uvA M bmr.wM MXdceMse�d foregoing is true and correct. Executed on 09 a pu proled this 18th day of NOVEMBER, 2016 in Palm ao Pprevaninq V. wa mug gek1e_ Springs, Califo `\ sug{0p '7. o�"nP vot�aw16 U an ,nto5mat Bid Farm P�7. Dec arant City of Calm Springs, CA Ij Pro MMn1 cmkwU g UM" ` Bid Abstract BID ABSTRACT Vendors,& Bid Amounts BID # 0/0 /s-/s �� % �`� Q��" �y PROJECT /f--X� NAME:D�2UT/4 PGgpr- A110/a DICE DATE:_ /.-�-/�/�, s 97 7 93 7y9 S9 DESCRIPTION: Total of all Bid Schedule Items Witnessed By. u Date: City of Palm springs, CA BID ABSTRACT Bid Abstract Vendors& Bid Amounts # CP /sy� UPRIOJF � w NAIWE: DUE DATE: D -J-Q- ,16 DESCRIPTION: Total of all.Bid Schedule Items vvitne"ssed B . „� u /2 t- C" City of halm Springs, CA 3 Procurement Contracting DlNafen BID ABSTF ACT Bid Abstract Vendors & Bid Amounts BID PROJECT vi NA�inE�f, /0 DUE DATE: ) -1- �.I 7 9Yl DESCRIPTION: Total of all Bid Schedule Items Witness n Date: 'heck A License- License Detail • • Page I of Contractor's License Detail for License # 909195 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. C51-8 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. Business Information TRI-STAR CONTRACTING II INC 15-501 LITTLE MORONGO ROAD DESERT HOT SPRINGS,CA 92240 Business Phone Number:(760)251-5454 Entity Corporation Issue Date 01/16/2008 Expire Date 0 1131/2 01 8 License Status hi _ -- ---- _.. -. -- — -- -- s license is current and active.---- ---- All information below should be reviewed. Classifications A-GENERAL ENGINEERING CONTRACTOR Bonding Information Contractor's Bond his license filed a Contractors Bond with SURETEC INDEMNITY COMPANY. P3ond Number: 119948 bond Amount: $15,000 ffective Date: 01/61/2016 ontractor's Bond History I Bond of Qualifying Individual nff rest o Des company;01 therefore, the Bond of Qualifying Individual is not required. p he uali in indiv u1 BRYAN DANIEL WILLIS certified that he/she owns 10 percent or more of the votingstocklmembershi 08 Workers'Compensation his license has workers compensation insurance with the EVEREST NATIONAL INSURANCE COMPANY olicy Number:7600005937 ffective Date: 10/01/2012 xpire Date: 10/01/2017 hNorkers'Compensation History Other Personnel listed on this license(current or disassociated)are listed on other licenses. ups://www2.cslb.ca.gov/OnlineServices/CheekLicenseII/LicenseDetail.aspx?LicNum=909195 2/16/201 k�C�q� TRISCnN-09 DNIELSEN '4� EY CERTIFICATE OF LIABILITY INSURANCE DATE(MMmDIYYYY) 12/27/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER License # 0757776 C REACT Diane Nielsen (O No, EM): (760) 360-4700 4742 FAX No :(760) 200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 Palm Desert, CA 92211 . diane.nielsen@hubintemational.com INSURE S AFFORDING COVERAGE NAIC If INSURER A: United Specialty Insurance Company 12637 INSURED Tri-Star Contracting II, Inc. INSURER 911111e1140 Insurance Company 25011 INSURER c: Everest Premier Insurance Company 16045 INSURER 0: Travelers Pro Casua Com an of America 25674 Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER E: NSURER F: r, ruor:o. RFV1RIrlhl NI IMRFR- YVvs MV`s vr,",,-- 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 MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A SUBR POLICY NUMBER POLICY EFF POLICY UP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f 1,000,000 CLAIMS#ADE [X] occuR X X ATN2262138 6126/2022 6/26I2023 DAMAGETORENTED I f 50,000 MED UP (Any one vessom S 5,000 PERSONAL B ADV INJURY s 1,000,000 L AGGREGATE LgIIMpIIT. APPLIES PER: - POLICY IX-1 LOC GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPA)PAGG S 2,000,000 S OTHER IS AUTOMOBILE AUTOMOBILE LIABILITY SINGLE LIMIT Me acddwti 1,000,000 f BODILY INJURY Per S X ANY AUTO X X P1987680.00 11/2312022 11123/2023 BODILY INJURY Porac6denl f OWNED ONLY SCHEDULED P�qT�O� AUTOS X AUTOS ONLY X 0(21 NLV �1, aE�RdY AMAGE S A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE STN2268997 612612022 6/2612023 EACH OCCURRENCE 2,000,000 X AGGREGATE 21000,000 DED RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER,FJIECUTIVE ��FFFIOFF�gp.��EMa�q EXCLUDED? (MarMatoryln NH) NIA X 7600005937221 10/1/2022 10/1/2023 X( ER POTf4 E.L. EACH ACCIDENT 1,000,000 f E.L DISEASE -EA EMPLOYE f 1,000,000 E.L. DISEASE- POLICY LIMIT 1,000,000 It yes, deecribe under DESCRIPTION OF OPERATIONS below D Equipment Floater 6606072C593 1/11/2023 1111/2024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATONSI VEHICLES (ACORD 101, Adtlttional Remarks Schedule, may he attached n more space Is mqulmd The City Palm Springs, its officials, employees and agents are named as additional insured per attached CG2010 0413 and CG2037 0413 (GL) and of Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium City of Palm Springs DEC 2 9 2022 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 City Hall Reception Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) U 1988-ZU15 ACUKIJCUKPUKA I IUP1. AU ngms resenreu. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anizat10n s Locations Of Covered Operations s Required 13y rltten Contract, Fu y s equlre y ntten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured Is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 0413 m Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of Insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. of the the Page 2 of 2 ©insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER• ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, In whole or in part, by "your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and Included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following Is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured Is the amount of Insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy #ATN2262138 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02/20) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART,and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured Is a Named Insured under such other Insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specific project that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Organization(s) As Required By Written Contract, Fully Executed Prior To The Named Insured's All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 POLICY NUMBER- WPP1987680-00 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply 0s modified by the endorsement. Newly Acquired or Formed e. An "employee" of yours is an "insured" Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement in that Status for Certain Entitles. "employee's" name, with your Item 1. Who is an Insured of Paragraph A. permission, while performing duties Coverage under SECTION II — COVERED related to the conduct of your business. AUTOS LIABILITY COVERAGE Is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180" day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury', "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply If coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. f. Any person or organization you are required by written contract or agreement to name as an additional "insured", but only with respect to liability created in whole or in part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION II —COVERED AUTOS LIABILITY COVERAGE is amended to read: (4) We will pay reasonable expenses incurred by the `insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 6. Fellow Employee of Paragraph B. Exclusions under SECTION 11— COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE Is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your'auto . F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" Is returned to use or we pay for Its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto' subject to a maximum limit of $2,500 per'loss", for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide 'downtime loss" beginning on the 5" day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto" available to you to continue your operations. (2) You purchase a replacement "auto'. (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, Is amended to add: We will pay any resulting rental reimbursement expenses incurred by you for a rental of an "auto" because of "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide rental reimbursement incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy expiration, with the number of days reasonably required to repair or replace the covered "auto". If the "loss" is caused by theft, this number of days is the number of days it takes to locate the covered "auto" and return it to you or the number of days It takes for the claim to be settled, whichever comes first. b. Our payment is limited to necessary and actual expenses incurred. c. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. d. If a "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. J. "Personal Effects" Exclusion Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Exclusion We will not pay for "loss" to "personal effects" of any of the following: a. Accounts, bills, currency, deeds, evidence of debt, money, notes, securities or commercial paper or other documents of value. b. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. d. Contraband or property in the course of illegal transportation or trade. e. "Loss" caused by theft, unless there is evidence of forced entry into the covered 'auto" and a police report is filed. K. Accidental Airbag Discharge Coverage Item 3.a. of Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Wear and tear, freezing, mechanical or electrical breakdown. The exclusion relating to mechanical break -down does not apply to the accidental discharge of an air bag. L. Loan or Lease Gap Coverage Paragraph C. Limit Of Insurance under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: If a covered "auto' is owned or leased and if we provide Physical Damage Coverage on it, we will pay, in the event of a covered total "loss", any unpaid amount due on the lease or loan for a covered "auto', less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease or loan payments including penalties, interest or other charges resulting from overdue payments at the time of the "loss" (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (4) Security deposits not refunded by the lessor; and (5) Carry-over balances from previous loans or leases CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same'loss", only one deductible will apply to that 'loss". If the deductible amounts vary by'autos", then only the highest applicable deductible will apply to that "loss'. N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the first "loss" 1 0% 2 25% 3 50% 4 75% 5 100% If we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. 0. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident', claim, "suit' or "loss" to us or our authorized representative only applies after the "accident", claim, "suit" or "loss" is known to: (1) You, if you are an individual, (2) A partner, if you are a partnership; (3) An "executive officer' or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (5) Your insurance manager; or (6) Your legal representative. P. aiver Of Subrogation For Auto Liability osses Assumed Under Insured Contract Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 6. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or "loss" to Impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. surance Is Primary and O.0oncontributory Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 6..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto' you lease, hire, rent or borrow, and CAS90187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income' for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage 'loss" and 2. Is in the custody of a repair facility If not a total "loss". "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are Inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains In effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, N not shown above will be shown in the Declarations. The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 (off Insurance Services Office, Inc , 2008 Page 1 of 1 0 WORIERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective:10/0112022 Insured: Tri-Star Contracting II, Inc. Policy No.7600005937221 Endorsement No.001 Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual- 1999. 41 --2,2-7 - A 6 4>yP TRISCON-02 DNIELSEN CERTIFICATE OF LIABILITY INSURANCE DATEIMMRDYYYY) 12127/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER License # 0757776 HUB International Insurance Services Inc. Suite 201 Gerald Ford Drive Suite Palm Desert, CA 92211 C NTACT Diane Nielsen FAX (McTNo, Evil: (760) 3604700 4742 , xo):(760) 200-6706 .diane.nielsen ubinternational.com INSURERS AFFORDING COVERAGE NAICa INSURER A: United Specialty Insurance Company 12537 _ INSURED Tri-Star Contracting II, Inc. INSURER B:WBSCOInsurance Company 25011 INSURER c:Everest Premier Insurance Com an 16045 INSURER D:Travelers Property Casualty Company of America 25674 Telar, Inc. 16-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER E: INSURER F: ...-.arm'n<�c all uaoco. REVISIr1NNUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE iibm SUER POLICY NUMBER POLICY EFF MWDDrinr POLICY EXP umrrs A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEFAI OCCUR X TN2262138 6/26/2022 6126/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 50,00 MEDEXP A one rsor S 6,000 PERSONALS ADV INJURY s 1,000,000 GEN'L AGGREGATE LIRMpIT. APPLIES PER: POLICY � JECTEl LOC GENERAL AGGREGATE 2,OOD,000 PRODUCTS-COMPIOP AGG 2,000,000 COMBINED SINGLE LIMIT S S 1,000,000 B OTHER: AUTOMOBILE LIABILITY BODILY INJURY Per X ANr AUTO P1987680-00 11/2312022 11123/2023 BODILY INJURY Par ecadent S AUTOSDONLV ANUpT�EOSWVAL.�EDp X AUTOS ONLY X A O S'a Pei dent AMAGE S S A UMBRELLA DAB EXCESS LIAB X I OCCUR CLAIMS -MADE 13TN2268997 6/2612022 W2612023 EACH OCCURRENCE AGGREGATE DED RETENTIONSC WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN AOoFFICEOPRIIEMT9OERR/PARTNERIE ECUTIVE ❑ (ManAstory In NH)E.L NIA 7600006937221 10f112022 101112023 jt RTUT, AK EM E.L. EACH ACCIDENT DISEASE -EA EMPLOYII E.L. DISEASE - PODCV DMnD Leased/Rented yea, describe under DESCRIPTION OF OPERATIONS below Equipment Floater 8606072CS93 1/11/2023 1MI12024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1ACORD 101, Additional Remarks Schedule, my be atUched if more space is requiretl) RE: T75 W Chino Canyon Drive, Palm Springs, A The City of Palm Springs, its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice Will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEC 2 9 2022 ATHE EXPIRATION DATE THEREOF, NO CCORDANCE WITH THE POLICY PROVISIONSCE WILL BE DELIVERED IN City Hall AUTHORIZED REPRESENTATIVE Reception Desk a ACORD 25 (2016103) I000-<v r n�.�n'. ..a...�..'...'.......... ..n--- ---- The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or onizetion s Location s Of Covered Operations s Requiredy rltten Contract, Fu y As equlre y ritten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its Intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional Insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 @ insurance Services Office, Inc., 2012 CG 20 10 0413 TRISCON-02DNIELSEN A�iRO CERTIFICATE OF LIABILITY INSURANCE �`� DATE(MMDDYVYV) 9/22/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # 0757776 co TACT Diane Nielsen Pn/c°Nly , Est; (760) 360-4700 4742 Fes, No:(760) 200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 E L . diane.nielsen@hubintemational.com Palm Desert, CA 92211 INSURE S AFFORDING COVERAGE NAICi INSURER A: United Specialty Insurance Company 12537 INSURED INSURER B:WescoInsurance Company 25011 INSURERC : Everest Premier Insurance Company16045 Tri-Star Contracting 11, Inc. Telar, Inc. 15-501 Little Morongo Road Travelers Pro Casua Company of America INSURER D: Property W 25674 Desert Hot Springs, CA 92240 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE seen w POLICY NUMBER POLICY EFF PODGY EXPyn LIMITS A X COMMERCIAL GENERALLUIBILTFY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE [X] OCCUR $6,000 Ded BI & PD X ATN2376531 6/26/2023 6/26/2024 DAMAGE TO RENTED 50,000 X MED EXP AD one f 5,000 PERSONAL&ADV INJURY $ 1'000'000 Gfibn AGGREGATE L�IIMpIT. APPLIES PER: POLICY jECT LOC GENERAL AGGREGATE 2,000,000 PRODUCTS -COMPIOP ADD Z,000,OOO OTHER: B AUTOMOBILE UABIDTY COMBINED SINGLE LIMIT 1,000,000 S BODILY INJURY PeOWNED MY AUTO WPP1987680-00 11/23/2022 11/23/2023 BODILY IINNYJURY Per acckMRAUTOS SCHEDULED AURTEO�S ONLY AUUIT.�OSwN�p ONLY AUTO1 ONLY No Deal QbM 1xx PaiaOPER" AMAGE A ukasuaLAUAB EXCESS UAB X OCCUR CLAIMS -MADE BTN2370408 6/26/2023 6/26/2024 EACH OCCURRENCE 21000,000 X AGGREGATE 2,000,000 X I DED RETENTIONS 0 Following Form C WORKERS COMPENSATION ANDEMPLOYERS'UASILTY YIN ANY PROPRIETOMPARTNERIEXECUTIVE OFe�CdEaef�Pln� Exauoeoa IM If Yes, describe urMer DESCRIPTION OF OPERATIONS p low NIA 7600005937221 10/1/2022 10M/2023 ER OTH- X PSTA E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYE 1,000,00B E.L. DISEASE -POLICY LIMIT 1,000,000 f D Equipment Floater 6606072C693 1/11/2023 1/11/2024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may M attached K more apace Is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA City of Palm Springs Its officials, employees and agents are named as additional Insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium r`Al I AT1nhl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs S E P 2 7 2023 THE TION DATE THEREOF, ACCORDANCE WITH THEPOLICY P OVISIO SCE WILL BE DELIVERED IN 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 City Hall Receo 111, on Desk AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD