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HomeMy WebLinkAboutA8409 - MATICH COMPANYRecording Requested By: City of Palm Springs When Recorded Mail To: Name Anthony J. Mejia, City Clerk Street Address 3200 E. Tahquitz Canyon Way Ctat & State Palm Springs, CA 92262 NOTICE IS HEREBY GIVEN THAT: RECEIVED CITY OF PALM PRINGS 3= 26 OFFICE OF THE CIITY CLE�: 06/22/2020 02:04 PM Fee: $ 0.00 Page 1 of 6 Recorded in Official Records County of Riverside Peter Aldana Assessor -County Clerk -Recorder Ni ;_ 4 11 is 1U.1A vll*fflk� wKY11 11 SPACE ABOVE THIS LINE FOR RECORDERS USE NOTICE OF COMPLETION (CA Civil Code § § 8180-8190, 8100-8118, 9200-9208) 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 92262 3. The name and address of the direct contractor for the work of improvement as a whole is: Matich Corporation, 1596 Harry Sheppard Blvd., San Bernardino, CA 92408 4. This notice is given for (check one): 0 Completion of the work of improvement as a whole. ❑ Completion of a contract for a particular portion of the work of improvement (per CA Civ. Code § 8186). 5. If this notice is given only of completion of a contract for a particular portion of the work of improvement (as provided in CA Civ. Code § 8186), the name and address of the direct contractor under that contract is: Not Applicable 6. The name and address of the construction lender, if any, is: Not Applicable 7. On the 11th day of June 20 20 , there was completed upon the herein described property a work of improvement as a whole (or a particular portion of the work of improvement as provided in CA Civ. Code § 8186) a general description of the work provided: 2019 Pavement Rehabilitation, City Project No. 19-01 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: Within City right-of-way, limits per attached list of streets on Exhibit A 9. The street address of said property is: Not Applicable 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 ate of California that regoin is true and correct. Date: Signature of Own& or Owner's Authorized Agent Marcus Fuller, Assistant City Manager/City Engineer City of Palm Springs Page 1 of 2 VERIFICATION 1, Marcus Fuller , state: I am the _Assistant City Manager/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 5 (date), at Palm Springs (City), CA (State). Signature of Owner or Owner's Authorized Agent Marcus Fuller, Assistant City Manager/City Engineer City of Palm Springs a. b. PROOF OF SERVICE DECLARATION (Signature of Person Making Service) A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. TERRI HINTZ Notary Public - Cali'ornia Riverside County Commission x 2202861 My Comm. Expires Jun 26, 2021 STATE OF CALPORNIA COUNTY OF A 4 � (date), before me, t°/—/ i Notary Public (name and title of officer) personally appeared Zls/ lr who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PURJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official I. Page 2 of 2 Signature AGREEMENT (CONSTRUCTION CONTRACT) THIS AGREEMENT made this 2nd day of October, 2019, by and between the City of Palm Springs, a charter city, organized and existing in the County of Riverside, under and by virtue of the laws of the State of California, hereinafter designated as the City, and Matich Corporation, 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: 2019 PAVEMENT REHABILITATION CITY PROJECT NO. 19-01 The Work comprises reconstruction and overlay of approximately 3,000,000 square feet inclusive of 112 street segments in various locations throughout the City of Palm Springs, ADA and parking lot improvements at the Palm Springs Train Station, parking lot rehabilitation at the Palm Springs Boxing Club, and the construction of a retaining wall on Belardo Road. The work includes but is not limited to recording, preservation and resetting of existing and new survey monuments; pulverization of existing asphalt concrete pavement; full depth milling of existing asphalt concrete pavement; unclassified excavation (export); preparation of subgrade; asphalt concrete paving; adjustment of sewer manholes and water valves to grade; removal and replacement or installation of concrete curb ramps, curb and gutter, sidewalks, and parking areas; construction of new cross gutters; concrete pavement; traffic striping, and markings; construction of a new masonry retaining wall and stucco; and all other appurtenant work. ARTICLE 2 -- COMMENCEMENT AND COMPLETION The Work to be performed under this Contract shall commence on the date specified in the Notice to Proceed by the City, and the Work shall be fully completed within the time specified in the Notice to Proceed. The City and the Contractor recognize that time is of the essence of this Agreement, and that the City will suffer financial loss if the Work is not completed within the time specified in Article 2, herein, plus any extensions thereof allowed in accordance with applicable provisions of the Standard Specifications, as modified herein. They also recognize the delays, expense, and difficulties involved in proving in a legal proceeding the actual loss suffered by the City if the Work is not completed on time. Accordingly, instead of requiring any such proof, the City and the Contractor agree that as liquidated damages or delay(but 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 AGREEMENT FORM August 2019 AGREEMENT AND BONDS—PAGE 1 not as a penalty), the Contractor shall pay the City the sum specified in Section 6-9 of the Special Provisions for each calendar day that expires after the time specified in Article 2, herein. In executing the Agreement, the Contractor acknowledges it has reviewed the provisions of the Standard Specifications, as modified herein, related to liquidated damages, and has made itself aware of the actual loss incurred by the City due to the inability to complete the Work within the time specified in the Notice to Proceed. Termination Prior to Expiration of Term. City may terminate this Agreement for its convenience at any time, without cause, in whole or in part, upon giving Contractor written notice, pursuant to Section 6-8 of the Special Provisions. Where termination is due to the fault of Contractor and constitutes an immediate danger to health, safety, and general welfare, the period of notice shall be such shorter time as may be determined by the City. Upon such notice, City shall pay Contractor for Services performed through the date of termination in accordance with the Contract Documents. Upon receipt of such notice, Contractor shall immediately cease all work under this Agreement, unless stated otherwise in the notice or by written authorization of the Contract Officer. After such notice, Contractor shall have no further claims against the City under this Agreement. Upon termination of the Agreement under this section, Contractor shall submit to the City an invoice for work and services performed prior to the date of termination. ARTICLE 3 -- CONTRACT PRICE (BID SCHEDULES A, B AND C) 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 Eight Million Five Hundred Eighty Six Thousand Dollars ($ 8,586,000). 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 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 AGREEMENT FORM August 2019 AGREEMENT AND BONDS—PAGE 2 issued during bidding (if any), and all Construction Contract Change Orders and Work Change Directives which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto. ARTICLE 5 -- MUTUAL OBLIGATIONS For and in consideration of the payments and agreements to be made and performed by the City, the Contractor agrees to furnish all materials and perform all work required for the above stated project, and to fulfill all other obligations as set forth in the aforesaid Contract Documents. City hereby agrees to employ, and does hereby employ, Contractor to provide the materials, complete the Work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the Contract Price herein identified, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Contract Documents. Contractor specifically acknowledges and agrees to be bound by the Wage Rates and Labor Code requirements specified in the Contract Documents, including the requirement to furnish electronic certified payroll records directly to the Labor Commissioner (via the Division of Labor Standards Enforcement), and shall pay the general prevailing rate of per diem wages as determined by the Director of the Department of Industrial Relations of the State of California. ARTICLE 6 -- PAYMENT PROCEDURES The Contractor shall submit Applications for Payment in accordance with the Standard Specifications as amended by the Special Provisions. Applications for Payment will be processed by the City Engineer as provided in the Contract Documents. ARTICLE 7 -- NOTICES Whenever any provision of the Contract Documents requires the giving of a written Notice between the parties, it shall be deemed to have been validly given if delivered in person to the individual or to a member of the firm or to an officer of the corporation for whom it is intended, or if delivered at or sent by registered or certified mail, postage prepaid, to the last business address known to the giver of the Notice. ARTICLE 8 -- INDEMNIFICATION The Contractor agrees to indemnify and hold harmless the City, and all of its officers and agents from any claims, demands, or causes of action, including related expenses, attorney's fees, and,costs, based on, arising out of, or in any way related to the Work undertaken by the Contractor hereunder. This Article 8 incorporates the provisions of Section 7-15 "Indemnification," of the Special Provisions, which are hereby referenced and made a part hereof. 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 AGREEMENT FORM August 2019 AGREEMENT AND BONDS—PAGE 3 Prevailing Wages. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq. ("Prevailing Wage Laws"). Contractor.shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, its officials, officers, employees, agents and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. ARTICLE 9 -- NON-DISCRIMINATION In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin (i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent'to City's lawful capacity to enter this Agreement, and in executing this Agreement, Contractor certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; and further, that Contractor is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. ARTICLE 10 -- MISCELLANEOUS Terms used in this Agreement which are defined in the Standard Specifications and the Special Provisions will have the meanings indicated in said Standard Specifications and the Special Provisions. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and specifically, but without limitation, monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. The City and the Contractor each binds itself, its partners, successors, assigns, and legal representatives, to the other party hereto, its partners, successors, assigns, and legal representatives, in respect of all covenants, agreements, and obligations contained in the Contract Documents. SIGNATURES ON NEXT PAGE 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 AGREEMENT FORM August 2019 AGREEMENT AND BONDS—PAGE 4 IN WITNESS WHEREOF, the City and the Contractor have caused this Agreement to be executed the day and year first above written. CITY OF PALM SPRINGS, APPROVED BY THE CITY COUNCIL: CALIFORNIA Date By David H. Ready City Manager Agreement No. ATTES APPROVED BY CITY COUNCIL AK*� S C By Anthony ejia, C City APPROVED AS TO FORM: By A rey S. Balinger, City Attorney RECOMMEND D: By Marcus L. r6iler, P.E., P.L.S. Assistant City Manager/City Engineer 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 AGREEMENT FORM August 2019 AGREEMENT AND BONDS—PAGE 5 CONTRACTOR By: Matich Corporation Firm/Company Name By: �/LL..�.�� 2-� By: Signature(notarized) Signature(notari Name: Mark T. Hickman Name: Randall S.Valadez Title: Vice President Title: Secretary/Treasurer A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. (This Agreement must be signed in the above (This Agreement must be signed in the above space space by one having authority to bind the by one having authority to bind the Contractor to the Contractor to the terms of the Agreement.) terms of the Agreement.) State of ) State of ) County of )ss County of )ss On See Attached On See Attached before me, before me, personally appeared personally appeared 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)is/are evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and subscribed to the within instrument and acknowledged to me that he/she/they executed the acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s)on the instrument that by his/her/their signatures(s) on the instrument the person(s),or the entity upon behalf of which the the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing laws of the State of California that the foregoing paragraph is true and correct. paragraph is true and correct. WITNESS my hand and official seal. WITNESS my hand and official seal. Notary Signature: Notary Signature: Notary Seal: Notary Seal: 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 AGREEMENT FORM August 2019 AGREEMENT AND BONDS—PAGE 6 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On Octoberlt , 2019 before me, Sammi Jo Shubin, Notary Public , (Here insert name and Due of me otuceQ personally appeared Mark T. Hickman who proved to me on the basis of satisfactory evidence to be the person(s) whose name($) Is re subscribed to the within instrument and acknowledged to me that ( he/they executed the same in Is er/their authorized capacity(ies), and that by (fflyher/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. SAMMI JO SHUBIN Notary Public-California WITNESS m hand and official seal. i00V�' ' ' San Bernardino County y Commission k 2279094 My Comm.Expires Feb 28,2023 No ary Public S W nature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/the}--is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www.NotaryClasses.com 800-873-9865 Securely attach this document to the signed document with a staple. CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On October 1b, 2019 before me, Sammi Jo Shubin, Notary Public , (Here insert name and title of the officer) personally appeared Randall S. Valadez who proved to me on the basis of satisfactory evidence to be the person(s) whose name(-&-) Is re subscribed to the within instrument and acknowledged to me that (e he/they executed the same in is er/their authorized capacity(ies), and that by Is er/their signature(e) on the instrument the person(), 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. SAMMI JO SHUBIN WITNESS m hand and official seal. - ' "°tars Public California = y _, y - San Bernardino County s Commission#2279094 My Comm.Expires Feb 28,2023 ry Publi ignature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT tfneeded,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/tliey,is/ere)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple. WORKER'S COMPENSATION CERTIFICATE (AS REQUIRED BY SECTION 1861 OF THE CALIFORNIA LABOR CODE) I am aware of the provisions of Section 3700 of the California Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self-insurance in accordance with the provisions of said Code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Contractor Matich Corporation By /f-Z -7- Title Mark T.Hickman,Vice President 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 WORKER'S COMPENSATION CERTIFICATE August 2019 AGREEMENT AND BONDS-PAGE 7 Bond Number: 24241861 Premium: Included in Performance Bond PAYMENT BOND—PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the"City"), has awarded to the undersigned Contractor, (hereinafter referred to as the"Contractor"), an agreement for the work described as follows: 2019 PAVEMENT REHABILITATION CITY PROJECT NO. 19-01 (hereinafter referred to as the"Public Work"); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract"), which Contract is incorporated herein by this reference; and WHEREAS, said Contractor is required to furnish a bond in connection with said Contract and pursuant to Section 9550 of the California Civil Code. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: Matich Corporation, a corporation organized and existing under the laws of the State of California, and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City, and to any and all persons, companies, or corporations entitled to file stop payment notices under Section 9100 of the California Civil Code, in the sum of Eight Million Five Hundred Eighty-Six Thousand Dollars ($8,586,000), said sum being not less than 100 percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns,jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that, if said Contractor, his or its heirs, executors, administrators, successors, or assigns, or Subcontractors, shall fail to pay for any materials, provisions or other supplies, implements, machinery, or power used in, upon,for, or about the performance of the Public Work contracted to be done, or to pay any person for any work or labor of any kind, or for bestowing skills or other necessary services thereon, or for amounts due under the Unemployment Insurance Code with respect to such work or labor, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of paid Contractor and his Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to such work and labor as required by the provisions of Sections 9550 through 9560 of the Civil Code, the Surety or Sureties hereon will pay for the same in an amount not exceeding the sum specified in this bond, otherwise the above obligation shall be void. In addition to the provisions herein above, it is agreed that this bond will inure to the benefit of any and all persons, companies, and corporations entitled to serve stop payment notices under Section 9100 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 PAYMENT BOND August 2019 AGREEMENT AND BONDS-PAGE 5 PAYMENT BOND—PUBLIC WORKS (CONTINUED) The Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or additions to the terms of the said Contract or to the work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration, or addition to the terms of the Contract or to the work or to the Specifications. No final settlement between the City and the Contractor hereunder shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. Contractor and Surety, an admitted surety insurer, further agree that if the City or any entity or person entitled to file stop payment notices is required to engage the services of an attorney in connection with the enforcement of this bond, each shall be liable for the reasonable attorney's fees incurred, with or without suit, in addition to the above sum. SIGNED AND SEALED, this 8th day of October , 2019. CONTRACTOR: Matich Corporation Check one: individual, _partnership, X corporation (This Payment Bond must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Payment Bond.) EXECUTED FOR THE CONTRACTOR: EXECUTED FOR THE SURETY: By: Matich Corporation By Liberty Mutual Insurance Company signature signature (NOTARIZED) (NOTARIZED) Print Name and Title: Print Name and Title: Nlairk'a. Hickman t VIM PresidenI Heather Saltarelli, Attorney-in-Fact By: 01 signature (NOTARIZE Print Name and Title: Rendall S.Valadez } Treasurer•Sacranry 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 PAYMENT BOND August 2019 AGREEMENT AND BONDS-PAGE 6 PAYMENT BOND—PUBLIC WORKS (CONTINUED) Included in Performance Bond The rate of premium on this bond is $ A per thousand. The total amount of premium charged: $Included in Performance Bond (The above must be filled in by corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part, with Federal, grant, or loan funds, it must also appear on the Treasury Department's most current list (Circular 570 as amended). THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: (Name and Address of Surety) Liberty Mutual Insurance Company 790 The City Drive South, #200 Orange, CA 92868 (Name and Address of Agent or Same as Above Representative for service of process in California if different from above) (Telephone Number of Surety and (714) 634-5719 Surety Agent or Representative for service of process in California) (949) 756-0271 Agent 2019 PAVEMENT REHABILITATION CITY PROJECT NO. 19-01 PAYMENT BOND August 2019 AGREEMENT AND BONDS-PAGE 7 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On October 10, 2019 before me, Sammi Jo Shubin, Notary Public , ere insen name and ti e or the a ceo personally appeared Mark T. Hickman , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(-) is re subscribed to the within instrument and acknowledged to me that lEe he/they executed the same in Is er/their authorized capacity(ies), and that by is er/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. SAMMI JO SHUBIN air Notary Public-California WITNESS my hand and official seal. j S San Bernardino County s= = it Commission N 2279094 My Comm.Expires Feb 28,2023 Notary ublic Sign re (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) a State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. lie/she/they is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual(s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-in-Fact . Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www.NotaryClasses.com 800-873-9865 o Securely attach this document to the signed document with a staple. CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San-Bemardino } On October 10, 2019 before me, Sammi Jo Shubin, Notary Public , (Here insert nameh e Or e cer personally appeared Randall S. Valadez , who proved,to me on the basis of satisfactory evidence to be the person(s) whose name(--) Is re subscribed to the within instrument and acknowledged to me that <ie�'>she/they executed the same in Is er/their authorized capacity(ies), and that by Is er/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. SAMMI JO SHUBIN Notary Public-California WITNESS my hand and official seal. y - San Bernardino County Commission a 2279094 My Comm.Expires Feb 28,2023 Nota Iic Signa a (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING.THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. He/shet1hey,-is/ere)or circling the correct forms,Failure to correctly indicate this ❑ Individual(s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (.Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(-) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attomey-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer.If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple. 11L See Attached Notary Acknowledgment for Surety PAYMENT BOND—PUBLIC WORKS (CONTINUED) ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of County of On before me, Date Name, Title of Officer personally appeared NAME(S) OF SIGNER(S) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State identified herein,that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature of Notary ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could prevent fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s) Other Than Named Above 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 WARRANTY BOND August 2019 AGREEMENT AND BONDS-PAGE 8 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 j County of Orange j On OCT 0 8 2019 before me, Lekim H. Luu,Notary Public Date Here Insert Name and Trtle of the Officer personally appeared Heather Saltarelli Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the perso(% whose name(W is/axa subscribed to the within instrument and acknowledged to me that he/she/t% executed the same in his/her/their authorized capacity('bj,and that by hWher/tlmir signature(s)on the instrument the persons), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and icial seal. LElCIM H. UJU ' > Commission # 2135634 Signature NotaryPublic-California z v Orange County D Signature of Notary Public My Comrn. Expires Dec 3,20'19 Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies)Claimed by Signer(s) Signer's Name: Signer's Name: I Corporate Officer — Title(s): ']Corporate Officer — Title(s): 1 Partner — C Limited D General i:l Partner — ❑Limited '_i General i Individual x!Attorney in Fact Tl Individual a Attorney in Fact -1 Trustee ❑Guardian or Conservator ❑Trustee D Guardian or Conservator D Other: i_1 Other: Signer Is Representing. Signer Is Representing: ©2014 National Notary Association-www.NationalNotary.org- 1-800-US NOTARY(1-800-876-6827) Item#5907 This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No:8201964-977460 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Rhonda C. Abel;Jeri Apodaca;Reece Joel Diaz;Maria Guise;Kim Luu;Michael D.Parizino;Rachelle Rheault;Heather Saltarelli;James A.Schaller all of the city of Newport Beach state of Califomia each individually if there be more than one named,its true and lawful attorney-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 23rd day of August , 2019 Liberty Mutual Insurance Company INSU,p 0,( INSVq� %NsUR The Ohio Casualty Insurance Company ilJp'p°NPOR4rgyC� yJP°oaPORar`9y \GP°oNP OR4���, West American Insurance Company >+ 3 Fo m �Q $ Fo m w 3 Fo cn co 19 0 0 1919 2 1991 0 u, 3 Cl� S4 CHUSF.daNA MPsa a 'l �NOIANP' a I C aoi 0/7 r >� ''i1 * >Na s�'M * 1�a By: w David M.Carey,Assistant Secretary - State of PENNSYLVANIA > County of MONTGOMERY ss L) a) On this 23rd day of August 2019 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 0 o tfa Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes l'— > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. rJ Lu Cal IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. c a C:) Ca U) P PAS �C �N �5�or+w. r COMMONWEALTH OF PENNSYLVANIA '�4�4� Q �4rQ�o`rt ��;y Notarial Seal /(��Q��c i 0 OF Teresa Pastella,Notary Public O IC p Upper MerionTwp.,Montgomery County By: N My Commission Expires March 28,2021 � E �nsrvP� eresa Pastella,Notary Public 0 m aj OT �� Member,Pennsylvania Association of Notaries d In q/? P�3 O rn O -tc))a) This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual o.E- Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: 0 a)a) i ARTICLE IV-OFFICERS:Section 12.Power of Attorney. �2 o Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the a >, Pfesident may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety >o m c any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall�N > have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such ""°O Z � instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. o 0 ARTICLE XIII-Execution of Contracts:Section 5.Surety Bonds and Undertakings. 0 cD Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,F-- shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 8th day of October 2019 . P�1NSU� POSY INS& � 1NSU,4 AJ 4°aPOR°T yC+ yJ G°RPo+ar qy GP °RPoP,r Lc+ L) � m ur 2G Fo to 1912 o Zm 1919 o Q 1991 0 dJl9'IT ACHUs .da yO ryNA MPsa�a ! �N°IANP a By• 8j7 * r� �yl ��, s�M * ��d Renee C.Llewellyn,Assistant Secretary ,r LMS-12873 LMIC OCIC WAIC Multi Co 062018 Bond Number: 24241861 PERFORMANCE BOND—PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: 2019 PAVEMENT REHABILITATION CITY PROJECT NO. 19-01 (hereinafter referred to as the"Public Work"); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the"Contract"), which Contract is incorporated herein by this reference; and WHEREAS,the Contractor is required by said Contract to perform the terms thereof, and to provide a bond both for the performance and guaranty thereof. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: Matich Corporation, a corporation organized and existing under the laws of the State of California, and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City in the sum of Eight Million Five Hundred Eighty-Six Thousand Dollars($ 8,586,000), said sum being not less than 100 percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators,successors, and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if the bounden Contractor, his or its heirs, executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the said Contract and any alteration thereof made as therein provided, on his or its parts,to be kept and performed at the time and in the manner therein specified, and in all respects according to their intent and meaning; and shall faithfully fulfill the one year guarantee of all materials and workmanship; and indemnify and save harmless the City, its officers and agents, as stipulated in said Contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. The said Surety,for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the Contract or to the work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration of addition to the terms of the Contract, or to the Public Work or to the Specifications. No final settlement between the City and the Contractor shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 PERFORMANCE BOND August 2019 AGREEMENT AND BONDS-PAGE 1 PERFORMANCE BOND—PUBLIC WORKS (CONTINUED) Contractor and Surety agree that if the City is required to engage the services of an attorney in connection with enforcement of the bond, each shall pay City's reasonable attorney's fees incurred, with or without suit, in addition to the above sum. SIGNED AND SEALED,this 8th day of October , 2019. CONTRACTOR: Matich Corporation Check one: individual, _partnership, X corporation (This Performance Bond must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Performance Bond.) CONTRACTOR: Matich Corporation SURETY: Liberty Mutual Insurance Company By: By signature signa ure (NOTARIZED) (NOTARIZED) Print-Name and Title: Print Name and Title: Mark T. Hickni-on yVicePIesIdeM Heather Saltarelli, Attorney-in-Fact By: signatur (NOTARI ED Print Name and Title: Randall S.V.aladez , Treasurer.8=re4.0/ By submitting this Performance Bond, the Contractor and Surety acknowledge the provisions of the Contract Documents with regard to Section 6-4 "Default by the Contractor", as further amended by the Special Provisions. 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 PERFORMANCE BOND August 2019 AGREEMENT AND BONDS-PAGE 2 PERFORMANCE BOND—PUBLIC WORKS (CONTINUED) * First$500,000 $7.42 The rate of premium on this bond is $ per thousand. Next$2,000,000 $6.18 Next $2,500,000 $5.07 The total amount of premium charged: $ 44,601.00 Next$2,500,000 $4.57 Over$7,500,000 $4.08 (The above must be filled in by corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part, with Federal, grant, or loan funds, it must also appear on the Treasury Department's most current list (Circular 570 as amended). THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: (Name and Address of Surety) Liberty Mutual Insurance Company 790 The City Drive South, #200 Orange, CA 92868 (Name and Address of Agent or Same as Above Representative for service of process in California if different from above) (Telephone Number of Surety and (714) 634-5719 Surety Agent or Representative for service of process in California) (949) 756-0271 Agent 2019 PAVEMENT REHABILITATION CITY PROJECT NO.19-01 PERFORMANCE BOND August 2019 AGREEMENT AND BONDS-PAGE 3 See Attached Notary Acknowledgment for Surety PERFORMANCE BOND— PUBLIC WORKS (CONTINUED) ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. State of County of On before me, Date Name, Title of Officer personally appeared NAME(S) OF SIGNER(S) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State identified herein,that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature of Notary ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could prevent fraudulent attachment of this certificate to unauthorized document. THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s) Other Than Named Above 2019 PAVEMENT REHABILITATION CITY PROJECT NO. 19-01 PERFORMANCE BOND August 2019 AGREEMENT AND BONDS-PAGE 4 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On October 10, 2019 before me, Sammi Jo Shubin, Notary Public , (Here insert name end e of t e o cer personally appeared Mark T. Hickman , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is re subscribed to the within instrument and acknowledged to me that < he/they executed the same in is er/their authorized capacity(ies), and that by Is er/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. SAMMI JO SHUBIN Notary Public-California WITNESS my hand and official seal. San Bernardino County Commission#2279094 " My Comm.Expires Feb 28,2023 "Wk CbQ M - otary Public igna ure (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/ihe)-is/ere)or circling the correct forms.Failure to correctly indicate this ❑ Individual(s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-in-Fact . Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple. CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On October 10, 2019 before me, Sammi Jo Shubin, Notary Public , ere insert name and tue or the officer) personally appeared Randall S. Valadez who proved to me on the basis of satisfactory evidence to be the person(s) whose name(&) IS re subscribed to the within instrument and acknowledged to me that Ise he/they executed the same in is er/their authorized capacity(ies), and that by Is er/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. o., SAMMI X SHUBIN s ""r Notary Public Californla t WITNESS my hand and official seal. _ y San Bernardino County ' = Commission#2279094 My Comm.Expires Feb 28,2023 Nddry Public US gnature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Titre or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/dwy is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual(S) .information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attomey-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Indicate title or type of attached document,number of pages and date. Other ❑ Indicate the capacity claimed by the signer.If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1188 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of Orange ) On OCT 0 8 2019 before me, Lekim H. Luu,Notary Public Date Here Insert Name and Title of the Officer personally appeared Heather Saltarelli Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(O whose name( is/are subscribed to the within instrument and acknowledged to me that be/she/t?* executed the same in Ns/her/their authorized capacity(},and that by hWher/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. LEKIM H. LUU Commission 2135634 I' WITNESS my hand and o icial seal. Nofary Public-California �o. t <; wv Orange County r My Comm, Expires Dec 3 2019I� Signature Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies)Claimed by Signer(s) Signer's Name: Signer's Name: ;-I Corporate Officer — Title(s): )Corporate Officer — Title(s): Partner — ❑ Limited 17 General i:i Partner — Ci Limited ' i General i Individual xi Attorney in Fact L]Individual a Attorney in Fact C_'Trustee O Guardian or Conservator ❑Trustee ❑Guardian or Conservator Ej Other: Other: Signer Is Representing: Signer Is Representing: ©2014 National Notary Association -www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No:8201964-977460 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Rhonda C. Abel;Jeri Apodaca;Reece Joel Diaz;Maria Guise;Kim Luu;Michael D.Parizino;Rachelle Rheault;Heather Saltarelli;James A.Schaller all of the city of Newport Beach state of California each individually if there be more than one named,its true and lawful attomey-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 23rd day of August , 2019 . Liberty Mutual Insurance Company INSUR ASV INS&q� d %NSUR The Ohio Casualty Insurance Company �JpcoaaorAfgy� yJPo0aa `?T 9'L vP4ORPorty qy0 West American Insurance Company T �O m w 3 �O m 1912cu 0 1919 1991 to r v c/q 3 S ym r 6 �° Yn CIS SS4CHU5" .da 0 �"A MPSa\,aa �s �NOIANP da C ei� * 1� By: co David M.Carey,Assistant Secretary :3 - State of PENNSYLVANIA 6 � County of MONTGOMERY ss L) N On this 23rd day of August 2019 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Co o 2, Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes—� a) > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. w IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. n 0 0 Cl) PA M cc a) �yPorav,-STF COMMONWEALTH OFPENNSYLVANIA Q �Q O`ytt GtTr Notarial Seal 0 do U OF Teresa Pastella,NotaryPublic , 9 O p p upper MerionTvvp.,Montg mery County By: 47 C My Commission Expires March 28,2021 � E ,yam 4yA \G eresa Pastella,Notary Public O to �, Member,Pennsylvania Association of Notaries a M p�2 rn o C a) This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual o Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o (D ARTICLE IV-OFFICERS:Section 12.Power of Attorney. o Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the -0 >1 President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety >o co C any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall cli - m have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such '"0O Z :Ci instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the co provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. o 0 ARTICLE XIII-Execution of Contracts:Section 5.Surety Bands and Undertakings. Uo 0 Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. 1,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attomey executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 8th day of_ October 2019 P�1NSU� P�ZY INS&q� 1NSUR9 tiJ a°aPoyar ti0 5J a°RPO�f qZ \vPooaPOR, yn f 2 me u 2 mo m w 1912 0 0 1919 1991 �,•.d,Gy� g ottuS��dL yo��hgMPSS aa3� `�s '"OtANP as y Renee C.Llewellyn,Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 062018 • '� ® DATE(MM/DDIYYYY) ACC)R o CERTIFICATE OF LIABILITY INSURANCE 10/8/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Diane Weller Alliant Insurance Services, Inc. PHONE FAX 1301 Dove Street, Suite 200 0 •949-756-0271 AIc No):949-756-2713 Newport Beach CA 92660-2436 ADDRESS: dweller@alliant.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Executive Risk Indemnity Inc 35181 INSURED INSURER B:Federal Insurance Company 20281 Matich Corporation INSURER C:Great American Insurance Company 16691 1596 Harry Shepard Blvd. San Bernardino CA 92408 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1682312518 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MMIDD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY 54303169 7/1/2019 7/1/2020 EACH OCCURRENCE S1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) ccurrence $ 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PECOT- LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: S B AUTOMOBILE LIABILITY 54303168 7!1/2019 7/1/2020 COMBIaccNED identSINGLELIMIT S1,000,000 Ea X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S C X UM13RELLALIAB X OCCUR TUE405725713 7/1/2019 7/1/2020 EACH OCCURRENCE S25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 25,000,000 DED RETENTIONS S B WORKERS COMPENSATION 54303170 7/1/2019 7/1/2020 X AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE —N N/A E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Matich Job No.19-053,Project No. 19-01 -City of Palm Springs,2019 Pavement Rehab. The City of Palm Springs,its officials,employees,and agents are named as Additional Insured per attached endorsements on Primary and Non-Contributory basis.Waiver of Subrogation and Per Project Aggregate applies per attached endorsements.Thirty(30)Days Notice of Cancellation/Non-Renewal—Ten(10) Days Notice For Non-Payment of Premium.Umbrella or Excess Liability is a Follow form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Palm Spring 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Policy No. 54303169 COMMERCIAL GENERAL LIABILITY 10-02-2508 (Ed.7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION II—WHO IS AN INSURED is amended c. The insurance provided to the insured does to include any person or organization that you not apply to "bodily injury" or "property agree in a "written contract requiring insurance"to damage" caused by "your work" and included include as an insured on this Coverage Part, but: in the "products-completed operations a. Only with respect to liability for"bodily injury", hazard" unless the "written contract requiring "property damage"or"personal injury"; and insurance" specifically requires you to provide b. If, and only to the extent that, the injury or such coverage for that insured, and then the damage is caused by acts or omissions of insurance provided to the insured applies only you or your subcontractor in the performance to such "bodily injury" or "property damage" of "your work" to which the "written contract that occurs before: requiring insurance" applies. The person or (1) The end of the period of time for which organization does not qualify as an insured the "written contract requiring insurance" with respect to the independent acts or requires you to provide such coverage; or omissions of such person or organization. (2) The end of the policy period; 2. The insurance provided to the insured by this whichever is earlier. endorsement is limited as follows: 3. The insurance provided to the insured by this a. In the event that the Limits of Insurance of endorsement is excess over any valid and this Coverage Part shown in the Declarations collectible other insurance, whether primary, exceed the limits of liability required by the excess, contingent or on any other basis, that is "written contract requiring insurance", the available to the insured for a loss we cover under insurance provided to the insured shall be this endorsement. However, if the "written limited to the limits of liability required by that contract requiring insurance" specifically requires "written contract requiring insurance". This that this insurance apply on a primary basis or a endorsement shall not increase the applicable primary and non-contributory basis, this Limits of Insurance shown in the Declarations. insurance is primary to other insurance available b. The insurance provided to the insured does to the insured which covers that person or not apply to damages, loss, cost or expense organization as a named insured for such loss, arising out of the rendering of, or failure to and we will not share with that other insurance. render, any professional architectural, But the insurance provided to the insured by this engineering or surveying services, including: endorsement still is excess over any other valid (1) The preparing, approving, or failing to and collectible insurance, whether primary, prepare or approve, maps, shop excess, contingent or on any other basis, that is drawings, opinions, reports, surveys, field available to the insured when that person or orders or change orders, or the preparing, organization is an additional insured under such approving, or failing to prepare or other insurance. approve, drawings and specifications; 4. As a condition of coverage provided to the and insured by this endorsement: (2) Supervisory, inspection, architectural or a. The insured must give us written notice as engineering activities. soon as practicable of an "occurrence" or an 10.02-2508 (Ed. 7.15) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. offense which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the`occurrence' or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence' or offense. b. If a claim is made or "suit" is brought against the insured, the insured must: (1) Immediately record the specifics of the claim or"suit"and the date received; and (2) Notify us as soon as practicable. The insured must see to it that we receive written notice of the claim or"suit" as soon as practicable. c. The insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d. The insured must tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover the insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the insured by this endorsement is primary to other insurance available to the insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V —DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury' and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., 10-02-2508 (Ed. 7-15) with its permission. POLICY NUMBER: 54303169 COMMERCIAL GENERAL LIABILITY CG 20 10 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 Organization(s) Locations Of Covered Operations Where required by written contract Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage ,or personal and advertising injury "property damage"occurring after: caused, in whole or in part, by: . 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the 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. CG 20 10 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: 54303169 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 Where required by written contract,but only when coverage for completed operations is specifically required by that contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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. CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 54303169 COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed.7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE FOR SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Additional Insured: Location Of Covered Operations: Where required by written contract. All Locations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at the Location Of Covered Operations shown in the Schedule, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under this policy provided that: (1) The Additional Insured is a named insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. 10-02-2461 (Ed.7-15) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: 54303169 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All of your designated construction project where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by 'occur- damages or under Coverage C for medical rences" under Section I—Coverage A, and for all expenses shall reduce the Designated Con- medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- t. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen- completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by 'occur- "products-completed operations hazard" is pro- rences"under Section I—Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be attrib- the "products-completed operations hazard" will uted only to ongoing operations at a single des- reduce the Products-completed Operations Ag- ignated construction project shown in the Sched- gregate Limit, and not reduce the General Ag- ule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract- Products-completed Operations Aggregate ing parties deviate from plans, blueprints, de- Limit,whichever is applicable; and signs, specifications or timetables, the project will 2. Such payments shall not reduce any Desig- still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. gate Limit. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 0 POLICY NUMBER: 54303169 COMMERCIAL GENERAL LIABILITY Form 10-02-1800 (Rev. 6-09) c. Method Of Sharing To the extent that the insured's rights to recover If all of the other insurance permits contribution all or part of any payment made under this Cover- by equal shares, we will follow this method al- age Part have not been waived, those rights are so. Under this approach each insurer contrib- transferred to us. The insured must do nothing af- utes equal amounts until it has paid its appli- ter loss to impair them. At our request, the insured cable limit of insurance or none of the loss will bring "suit" or transfer those rights to us and remains, whichever comes first. help us enforce them. If any of the other insurance does not permit This condition does not apply to Coverage C. contribution by equal shares, we will contribute 9. When We Do Not Renew by limits. Under this method, each insurer's If we decide not to renew this Coverage Part, we share is based on the ratio of its applicable lim- will mail or deliver to the first Named Insured it of insurance to the total applicable limits of shown in the Declarations written notice of the insurance of all insurers. nonrenewal not less than 30 days before the expi- 5. Premium Audit ration date. a. We will compute all premiums for this Cover- If notice is mailed, proof of mailing will be sufficient age Part in accordance with our rules and proof of notice. rates. SECTION V—DEFINITIONS b. We may audit your books and records as they 1. "Advertisement" means an electronic, oral, written relate to this insurance at any time during the or other notice, about goods, products or services, term of this policy and up to three years after- designed for the specific purpose of attracting the wards. general public or a specific market segment to use c. The first Named Insured must keep records of such goods, products or services. the information we need for premium computa- "Advertisement" does not include any e-mail ad- tion, and send us copies at such times as we dress, Internet domain name or other electronic may request. address or metalanguage. 6. Representations 2. "Advertising injury" means injury, other than"bodi- By accepting this policy, you agree: ly injury", "property damage" or"personal injury", a. The statements in the Declarations are accu- sustained by a person or organization and caused rate and complete; by an offense of infringing, in that particular part of b. Those statements are based upon representa- your"advertisement"about your goods, products tions you made to us; and or services, upon their: c. We have issued this policy in reliance upon a. Copyrighted "advertisement"; or your representations. b. Registered collective mark, registered service 7. Separation Of Insureds mark or other registered trademarked name, Except with respect to the Limits of Insurance, and slogan, symbol or title. any rights or duties specifically assigned in this 3. "Asbestos" means asbestos in any form, including Coverage Part to the first Named Insured, this in- its presence or use in any alloy, by-product, com- surance applies: pound or other material or"waste". a. As if each Named Insured were the only 4. "Auto" means: Named Insured; and a. A land motor vehicle, trailer or semitrailer de- b. Separately to each insured against whom signed for travel on public roads, including any claim is made or"suit" is brought. attached machinery or equipment; or 8. Transfer Or Waiver Of Rights Of Recovery b. Any other land vehicle that is subject to a com- Against Others To Us pulsory or financial responsibility law or other right of recover we would oth- motor vehicle insurance law in the state where We will waive the ri g y it is licensed or principally garaged. erwise have had against another person or organ- ization, for loss to which this insurance applies, However, "auto" does not include "mobile equip- provided the insured has waived their rights of re- ment". covery against such person or organization in a 5."Bodily injury" means physical: contract or agreement that is executed before a. Injury; such loss. b. Sickness; or c. Disease; Page 12 of 16 Includes copyrighted material of ISO Properties, Form 10-02-1800 (Rev. 6-09) Inc., with its permission Policy No. 54303168 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM borrow in your business or your personal This endorsement modifies the Business Auto Coverage Form. affairs. 1. EXTENDED CANCELLATION CONDITION C. Lessors as Insureds Paragraph A.2.b.—CANCELLATION -of the Paragraph A.1.—WHO IS AN INSURED—of COMMON POLICY CONDITIONS form IL 00 17 is SECTION II—LIABILITY COVERAGE is deleted and replaced with the following: amended to add the following: b. 60 days before the effective date of cancellation if e. The lessor of a covered "auto"while the we cancel for any other reason. "auto" is leased to you under a written 2. BROAD FORM INSURED agreement if: A. Subsidiaries and Newly Acquired or Formed (1) The agreement requires you to Organizations As Insureds provide direct primary insurance for The Named Insured shown in the Declarations is the lessor; and amended to include: (2) The"auto" is leased without a driver. 1. Any legally incorporated subsidiary in which Such leased "auto"will be considered a you own more than 50% of the voting stock on covered "auto"you own and not a covered the effective date of the Coverage Form. "auto"you hire. However, the Named Insured does not include However, the lessor is an "insured" only any subsidiary that is an "insured" under any for"bodily injury"or"property damage" other automobile policy or would be an resulting from the acts or omissions by: "insured" under such a policy but for its 1. You; termination or the exhaustion of its Limit of 2. Any of your"employees"or agents; Insurance. or 2. Any organization that is acquired or formed by 3. Any person, except the lessor or you and over which you maintain majority any"employee"or agent of the ownership. However, the Named Insured lessor, operating an "auto"with the does not include any newly formed or acquired permission of any of 1. and/or 2. organization: above. (a)That is an "insured"under any other D. Persons And Organizations As Insureds automobile policy; Under A Written Insured Contract (b)That has exhausted its Limit of Insurance Paragraph A.1 —WHO IS AN INSURED—of under any other policy; or SECTION II—LIABILITY COVERAGE is (c) 180 days or more after its acquisition or amended to add the following: formation by you, unless you have given f. Any person or organization with respect to us written notice of the acquisition or the operation, maintenance or use of a formation. covered "auto", provided that you and Coverage does not apply to"bodily injury" or such person or organization have agreed "property damage"that results from an "accident" under an express provision in a written that occurred before you formed or acquired the "insured contract", written agreement or a organization. written permit issued to you by a B. Employees as Insureds governmental or public authority to add Paragraph A.1.—WHO IS AN INSURED—of such person or organization to this policy SECTION II—LIABILITY COVERAGE is amended to as an"insured". add the following: However, such person or organization is d. Any"employee"of yours while using a an "insured" only: covered"auto'you don't own, hire or Form: 16-02-0292 (Rev. 4-11) Page 1 of 3 "Includes copyrighted material of Insurance Services Office, Inc.with its permission" (1) with respect to the operation, d. Rental Expense maintenance or use of a covered We will pay the following expenses that you or "auto"; and any of your"employees"are legally obligated (2) for"bodily injury"or"property damage" to pay because of a written contract or caused by an "accident"which takes agreement entered into for use of a rental place after: vehicle in the conduct of your business: (a) You executed the"insured MAXIMUM WE WILL PAY FOR ANY ONE contract"or written agreement; or CONTRACT OR AGREEMENT: (b) The permit has been issued to 1. $2,500 for loss of income incurred by the you. rental agency during the period of time that 3. FELLOW EMPLOYEE COVERAGE vehicle is out of use because of actual EXCLUSION B.S. - FELLOW EMPLOYEE—of damage to, or"loss"of, that vehicle, including SECTION II—LIABILITY COVERAGE does not apply. income lost due to absence of that vehicle for 4. PHYSICAL DAMAGE—ADDITIONAL TEMPORARY use as a replacement; TRANSPORTATION EXPENSE COVERAGE 2. $2,500 for decrease in trade-in value of the Paragraph AA.a.—TRANSPORTATION EXPENSES rental vehicle because of actual damage to —of SECTION III—PHYSICAL DAMAGE that vehicle arising out of a covered "loss"; and COVERAGE is amended to provide a limit of$50 per 3. $2,500 for administrative expenses incurred day for temporary transportation expense, subject to a by the rental agency, as stated in the contract maximum limit of$1,000. or agreement. 5. AUTO LOAN/LEASE GAP COVERAGE 4. $7,500 maximum total amount for paragraphs Paragraph A.4.—COVERAGE EXTENSIONS-of 1., 2. and 3. combined. SECTION III—PHYSICAL DAMAGE COVERAGE is 7. EXTRA EXPENSE—BROADENED COVERAGE amended to add the following: Paragraph A.4.—COVERAGE EXTENSIONS—of c. Unpaid Loan or Lease Amounts SECTION III—PHYSICAL DAMAGE COVERAGE In the event of a total"loss"to a covered "auto",we will is amended to add the following: pay any unpaid amount due on the loan or lease for a e. Recovery Expense covered "auto"minus: We will pay for the expense of returning a 1. The amount paid under the Physical Damage stolen covered "auto"to you. Coverage Section of the policy; and 8. AIRBAG COVERAGE 2. Any: Paragraph B.3.a. - EXCLUSIONS—of SECTION a. Overdue loan/lease payments at the time of III—PHYSICAL DAMAGE COVERAGE does not the"loss"; apply to the accidental or unintended discharge of b. Financial penalties imposed under a lease for an airbag. Coverage is excess over any other excessive use, abnormal wear and tear or collectible insurance or warranty specifically high mileage; designed to provide this coverage. c. Security deposits not returned by the lessor: 9. AUDIO,VISUAL AND DATA ELECTRONIC d. Costs for extended warranties, Credit Life EQUIPMENT-BROADENED COVERAGE Insurance, Health,Accident or Disability Paragraph C.2.—LIMIT OF INSURACE-of Insurance purchased with the loan or lease; SECTION III - PHYSICAL DAMAGE is deleted and and replaced with the following: e. Carry-over balances from previous loans or 2. $2,000 is the most we will pay for"loss" in any one"accident"to all electronic equipment that We will pay for any unpaid amount due on the loan or reproduces, receives or transmits audio, visual lease if caused by: or data signals which, at the time of"loss", is: 1. Other than Collision Coverage only if the a. Permanently installed in or upon the Declarations indicate that Comprehensive covered "auto" in a housing, opening or Coverage is provided for any covered`auto"; 2. Specified Causes of Loss Coverage only if the other location that is not normally used by Declarations indicate that Specified Causes of the"auto" manufacturer for the installation Loss Coverage is provided for any covered "auto"; of such equipment; b. Removable from a permanently installed or 3. Collision Coverage only if the Declarations indicate housing unit as described in Paragraph that Collision Coverage is provided for any 2.a. above or is an integral part of that covered "auto. equipment; or 6. RENTAL AGENCY EXPENSE c. An integral part of such equipment. Paragraph A.4.—COVERAGE EXTENSIONS—of SECTION III—PHYSICAL DAMAGE COVERAGE is amended to add the following: Form: 16-02-0292 (Rev. 4-11) Page 2 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" 10. GLASS REPAIR—WAIVER OF DEDUCTIBLE applies, provided the"insured" has waived Under Paragraph D. - DEDUCTIBLE—of their rights of recovery against such person or SECTION III—PHYSICAL DAMAGE COVERAGE organization under a contract or agreement the following is added: that is entered into before such"loss". No deductible applies to glass damage if the glass To the extent that the"insured's" rights to is repaired rather than replaced. recover damages for all or part of any 11.TWO OR MORE DEDUCTIBLES payment made under this insurance has not Paragraph D.- DEDUCTIBLE—of SECTION III— been waived,those rights are transferred to PHYSICAL DAMAGE COVERAGE is amended to us.That person or organization must do add the following: everything necessary to secure our rights and If this Coverage Form and any other Coverage must do nothing after"accident"or"loss"to Form or policy issued to you by us that is not an impair them.At our request, the insured will automobile policy or Coverage Form applies to the bring suit or transfer those rights to us and same"accident", the following applies: help us enforce them. 1. If the deductible under this Business Auto Coverage Form is the smaller(or smallest) 14. UNINTENTIONAL FAILURE TO DISCLOSE deductible, it will be waived; or HAZARDS 2. If the deductible under this Business Auto Paragraph B.2.—CONCEALMENT, Coverage Form is not the smaller(or smallest) MISREPRESENTATION or FRAUD of SECTION deductible, it will be reduced by the amount of IV—BUSINESS AUTO CONDITIONS-is deleted the smaller(or smallest)deductible. and replaced with the following: If you unintentionally fail to disclose any hazards 12.AMENDED DUTIES IN THE EVENT OF existing at the inception date of your policy, we will ACCIDENT, CLAIM, SUIT OR LOSS not void coverage under this Coverage Form Paragraph A.2.a. - DUTIES IN THE EVENT OF because of such failure. AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV-BUSINESS AUTO CONDITIONS is 15. AUTOS RENTED BY EMPLOYEES deleted and replaced with the following: Paragraph B.S. -OTHER INSURANCE of a. In the event of"accident", claim, "suit"or SECTION IV—BUSINESS AUTO CONDITIONS- "loss", you must promptly notify us when the is amended to add the following: "accident" is known to: e. Any"auto" hired or rented by your"employee" (1) You or your authorized representative, if on your behalf and at your direction will be you are an individual; considered an"auto"you hire. If an (2) A partner, or any authorized "employee's"personal insurance also applies representative, if you are a partnership; on an excess basis to a covered "auto" hired (3) A member, if you are a limited liability or rented by your"employee" on your behalf company; or and at your direction,this insurance will be (4) An executive officer, insurance manager, primary to the"employee's" personal or authorized representative, if you are an insurance. organization other than a partnership or 16. HIRED AUTO—COVERAGE TERRITORY limited liability company. Paragraph 13.7.b.(5).(a)- POLICY PERIOD, Knowledge of an "accident", claim, "suit"or COVERAGE TERRITORY of SECTION IV— "loss" by other persons does not imply that the BUSINESS AUTO CONDITIONS is deleted and persons listed above have such knowledge. replaced with the following: Notice to us should include: (a)A covered "auto" of the private passenger (1) How,when and where the"accident"or type is leased, hired, rented or borrowed "loss"occurred; without a driver for a period of 45 days or (2) The"insured's" name and address; and less; and (3) To the extent possible, the names and 17. RESULTANT MENTAL ANGUISH COVERAGE addresses of any injured persons or Paragraph C. of-SECTION V—DEFINITIONS is witnesses. deleted and replaced by the following: 13. WAIVER OF SUBROGATION "Bodily injury" means bodily injury, sickness or Paragraph A.S. -TRANSFER OF RIGHTS OF disease sustained by any person, including RECOVERY AGAINST OTHERS TO US of mental anguish or death as a result of the"bodily SECTION IV—BUSINESS AUTO CONDITIONS is injury"sustained by that person. deleted and replaced with the following: 5. We will waive the right of recovery we would otherwise have against another person or organization for"loss"to which this insurance Form: 16-02-0292 (Rev. 4-11) Page 3 of 3 "Includes copyrighted material of Insurance Services Office, Inc.with its permission" . 1 POLICY NUMBER: #54303168 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement.modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Matich Corporation Endorsement Effective Date: 7/1/2019-2020 SCHEDULE Name Of Person(s) Or Organization(s): Any person or ogranization as where required per written contract prior to loss. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 4810 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: 54303168 COMMERCIAL AUTO 16-02-0316 Ed. 10 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY LIABILITY ; INSURANCE This endorsement modifies insurance provided under 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Matich Corporation Endorsement Effective Date: 7/1/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization as where required by written contract prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Item 5.—"Other Insurance"of Item B.—"General Conditions" under Section IV—"Business Auto Conditions": e. Regardless of the provisions of Paragraph 5.a. through d. above, for any liability arising out of the ownership, maintenance, use, rental, lease, loan, hire or borrowing by an "insured" of a covered "auto" for which an "insured" is contractually obligated to provide primary insurance coverage to a client, this Coverage Form will be primary and non-contributory with respect to the Persons or Organizations in the schedule, regardless of the availability or existence of other collectible insurance under any other Coverage Form or policy that applies on a primary basis. 16-02-0316 Ed. 10 14 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY / 1 WC 99 03 04 (Ed. 7-08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTCALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need to be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 7/1/2019 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. 54303170 of the Federal Insurance Company (NAME OF INSURANCE COMPANY) issued to Matich Corporation Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for the blanket waiver offered by this endorsement shall be 0.00 % of total California premium. Schedule Person or Organization Job Description Where required by written contract. WC 99 03 04(Ed.7-08) df`f U-L- / CALIFORNIA PRELIMINARY 20-DAY NOTICE A" c"4 Q 9 (For use on Private and Public Works) See Civil Code Section 3097 & 3098 CONSTRUCTION LENDER or YOU ARE HEREBY NOTIFIED THAT... Reputed Construction Lender, if any (city) (state) (zip code) OWNER or PUBLIC AGENCY or Reputed Owner (public work) (private work) City of Palm Springs (name) 3200 E Tahquitz Canyon Palm Springs, CA 92262 (city) (state) (zip code) ORIGINAL CONTRACTOR or Reputed Contractor, if any Matich Corporation (Job No.24008-5 1596 Harry Sheppard Blvd (address) San Bernardino, CA 92408 (city) (site) (zip code) If bills are not paid in full for the labor, services, equipment, or materials furnished or to be furnished, a mechanics' lien leading to the loss, through court foreclosure proceedings, of all or part of your property being so improved may be placed against the property even though you have paid your contractor in full. You may wish to protect yourself against this consequence by (1) requiring your contractor to furnish a signed release by the person or firm giving you this notice before making payment to your contractor, or (2) any other method or device that is appropriate under the :R THAN RESIDENTIAL HOMEOWNERS OF DWELLINGS 'AINMG FEWER THAN FIVE UNITS, PRIVATE PROJECT ERS MUST NOTIFY THE ORIGINAL CONTRACTOR AND ANY CLAIMANT WHO HAS PROVIDED THE OWNER WITH A PAI NARY 20•DAY LIEN NOTICE IN ACCORDANCE WITH ION 3097 OF THE CIVIL CODE THAT A NOTICE OF ?LETION OR NOTICE OF CESSATION RAS BEEN RECORDED IN 10 DAYS OF ITS RECORDATION. NOTICE SHALL BE BY STERED MAIL, CERTIFIED MAIL, OR FIRST-CLASS MAIL, ENCED BY A CERTIFICATE OF MAILING. FAILURE TO FY WILL EXTEND THE DEADLINES TO RECORD A LIEN. CAL STRIPE, INC. (name of person or firm furnishing labor, services, equipment or material) 2040 E STEEL ROAD (address of person or firm furnishing labor, services, equipment or material) COLTON, CA 92324 has furnished or will furnish labor, services, equipment or materials of the following general description: Pavement Striping & Markings (general description of the labor, services, equipment or material furnished or to be furnished) for the building, structure or other work of improvement located at: 24-01 (address or description ofjob site sufficient for identification) 2024 Pavement Rehab. Palm Springs, CA The time of the person or firm who contracted for the purchase of such labor, services, equipment or material is: Matich Coporation An estimate of the total price of the labor, services, equipment or materials furnished or to be furnished is: $ aa155,575.50" Trust Funds to which Supplemental Fringe Benefits are Payable or Laborers Due Compensation for the Project. (Material suppliers not required to furnish) Construction Laborers of Southern California (name) (address) (name) (address) (name) Dated: March 26, 2024 Telephone Number (....W 909 884-7170 RECEIVED MAR 2 8 2024 OFFICE OF THE CITY CLERK PROOF OF SERVICE AFFIDAVIT I Lorraine Cale , declare that I served copies of the above Preliminary Notice (check appropriate box): 4 (a) [ ] By personally delivering copies to each of the parties, addresses and dates as follows: Construction Lender: (name) (address) (date) Owner or Public Entity: (name) X (address) (date) Original Contractor: (name) X (address) (date) (b) [ ] By First Class Registered/Certified Mail, postage prepaid, addressed to each of the parties listed on Page 1, on March 26 20 24 I declare under penalty of perjury, that the foregoing is true and correct. Executed on March 26, 2024 at San Bernardino. tfo tia, tgna of person making service) Ces new: 7i Cal Stripe Inc. 2040 E RD $5.04 US POSTAGE FIRST -Cuss m STEEL COLTON CA 92324-4008 Mailed from from ZIP 92324 ap 10Z FIRSTCI SS WIL LETTER �%,W USPS CERTIFIED MAIL Raze 1923275 06250010937442 ` IIIII IIIIIIIIII IIIIIIIIII III IIIIII 94071118 9876 5400 0869 70 City of Palm Springs 3200 E TAHQUITZ CANYON WAY PALM SPRINGS CA 92262-6959' IrllehhhulrlulrlllllllrlllruhllllrlPhhdlllh41lrll B