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HomeMy WebLinkAboutAGMT - Excel Paving (Arbor Park Resurfacing) Recorded in Official Records, Orange County RECORDING REQUESTED BY Tom Daly, Clerk-Recorder AND WHEN RECORDED MAIL TO I 01010 II0 II0 II0 III IIIIIIII IIII IIII IIII IIII III III NO FEE * $ R 0 0 0 4 9 6 S 9 7 4 $ 2012000397821 9:58 am 07/13/12 CITY OF SEAL BEACH 90 414 N12 1 Attn: City Clerk 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 211 - 8th Street Seal Beach, CA 90740 Space of above this line for Recorder's use. *** No Recording Fee Pursuant to Government Code Section 6103, 27383 **** NOTICE OF COMPLETION Notice pursuant to Civil Code Section 3093, must be filed within 10 days after completion. Notice is hereby given that: ,f • 1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the property hereinafter described: 2. The full name of the owner is: City of Seal Beach. 3. The address of the owner is: 211 —8th Street, Seal Beach, CA 90740. 4. The nature of the interest or estate of the owner is: In Fee. The City of Seal Beach. 5. A work of improvement on the property hereinafter is described as substantially completed on April 20, 2012. The work was Arbor Park Resurfacing Project. No. PR1102. 6. The name of the contractor(s), if any, for such improvement was: Excel Paving Company. The date of the Contract Award was February 27, 2012. 7. The property on which said work of improvement was completed in the City of Seal Beach, County of Orange, State of California, and is described as follows: Arbor Park on Lamson Avenue between Heather Street and Rose Street. Date: 7/ 12- i s Director of Public Yorks, City of Seal Beach Signature of owner or corporat:'officer of owner named in paragraph 2 or agent. VERIFICATION I, the undersigned, say: the Director of Public Works declarant of the foregoing notice of completion; 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 the foregoing is true and correct. Executed on 7/9//2-- , 2012, at Seal Beach, California. (Date of Signature) �� %/ / Director of Public Works, City .(Seal Beach PUBLIC WORKS AGREEMENT FOR ARBOR PARK RESURFACING CIP NO. PR1102 between City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 & Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 (562) 599 -5841 (562) 591 -7485 - FAX THIS AGREEMENT is made as of February 27, 2012, by and between the City of Seal Beach, a California charter city ( "City "), and Excel Paving Company, a General Contractor ( "Contractor "). 1 of 9 RECITALS A. WHEREAS, the City Council has approved the plans and specifications for the Arbor Park Resurfacing Project No. PR1102 ( "Project ") with respect to design criteria; and B. WHEREAS, Contractor has submitted a bid to City for the Project dated February 9, 2012 in the amount of $57,736.00 ( "Accepted Proposal" hereinafter). The Accepted Proposal is attached hereto as Exhibit G and contains, among other things, provisions defining the Project scope. NOW, THEREFORE, in consideration of performance by the parties of the mutual promises, covenants, and conditions herein contained, the parties hereto agree as follows: AGREEMENT 1. Contractor's Services. 1.1 Scope and Level of Services. For and in consideration of the mutual promises set forth herein, and subject to the terms and conditions set forth in this Agreement, Contractor shall perform and complete in good and workmanlike manner all work ( "Work ") required by this Agreement and the documents listed in Subsection 1.2 for the Project. 1.2 Contract Documents. The "Contract Documents" that comprise the agreement between the City and the Contractor are the: Notice Inviting Bids, Instructions to Bidders, Accepted Proposal, Non - Collusion Affidavit, Bid Schedule(s), List of Subcontractors, Contractor's Industrial Safety Record, Contractor's Qualification Statement, Bid Security Forms for Check or Bond, Specifications, General and Special Provisions and documents referenced therein, all addenda as prepared prior to the date of bid opening setting forth any modifications or interpretations of any of said documents, this Agreement, Exhibits attached to this Agreement, including but not limited to the Performance Bond (Exhibit A), Payment Bond (Exhibit B), Workers' Compensation Insurance Certificate (Exhibit C), Insurance Endorsements (Exhibit D), Acknowledgment of Penal and Civil Penalties Concerning Contractor Licensing Laws (Exhibit E), Labor Law Requirements (Exhibit F), Accepted Proposal (Exhibit G) and any and all supplemental agreements executed amending or extending the Work contemplated and that may be required to complete the Work in a substantial and acceptable manner. These Contract Documents are hereby incorporated into this Agreement. 1.3 The Work shall be performed in accordance with the Plans, Specifications and other Contract Documents. Contractor shall furnish at its own expense all labor, materials, equipment and services necessary therefor, except such labor, materials, equipment and services as are specified in the Contract Documents to be furnished by City. 2 of 9 1.4 In the event of any material discrepancy between the express provisions of this Agreement and the provisions of the other Contract Documents, the provisions of this Agreement shall prevail. 2. Effective Date. This Agreement is effective as of February 27, 2012 (the "Effective Date "), and shall remain in full force and effect until Contractor has rendered the services required by this Agreement. 3. Payment. For performing and completing the Work in accordance with the Contract Documents, City shall pay Contractor, in full compensation therefor, the amount of $57,736.00, subject to any additions and deletions pursuant to the terms of the Contract Documents. Said sum shall constitute payment in full for all work performed hereunder, including, without limitation, all labor, materials, equipment, tools and services used or incorporated in the Work, supervision, administration, overhead, expenses and any and all other things required, furnished or incurred for completion of the Work as specified in the Contract Documents. City shall make payments to Contractor on account of the contract sum at the time, in the manner, and upon the conditions specified in the Contract Documents. 4. Contractor's Personnel. 4.1 All Work shall be performed by Contractor or under Contractor's direct supervision, and all personnel shall possess the qualifications, permits, and licenses required by state and local law and by the Notice Inviting Bids /Instructions to Bidders to perform such Services, including, without limitation, a City of Seal Beach business license as required by the Seal Beach Municipal Code. 4.2 Contractor shall be responsible for payment of all employees' wages and benefits, and shall comply with all requirements pertaining to employer's liability, workers' compensation, unemployment insurance, and Social Security. Contractor shall fully comply with the workers' compensation law regarding Contractor and Contractor's employees. 4.3 Contractor shall indemnify and hold harmless City and its elected officials, officers, employees, servants, designated volunteers, and agents serving as independent contractors in the role of city officials, from any and all liabilities, damages, claims, costs and expenses of any nature to the extent arising from Contractor's alleged violations of personnel practices. 4.4 Contractor is, and shall at all times remain as to City, a wholly independent contractor. Contractor shall have no power to incur any debt, obligation, or liability on behalf of City or otherwise act as an agent of City. Neither City nor any of its agents shall have control over the conduct of Contractor or any of Contractor's employees, except as set forth in this Agreement. Contractor shall not, at any time, or in any manner, represent that it or any of its officers, agents, or employees are in any manner employees of City. Contractor shall pay all required taxes on amounts paid to Contractor under this Agreement, and indemnify and hold City harmless from any and 3 of 9 all taxes, assessments, penalties, and interest asserted against City by reason of the work performed pursuant to this Agreement. 4.5 City shall have the right to offset against the amount of any fees due to Contractor under this Agreement any amount due to City from Contractor as a result of Contractor's failure to promptly pay to City any reimbursement or indemnification arising under this Section 4. 5. Indemnification. 5.1 Contractor's Duty. Contractor shall defend, indemnify, and hold the City, its elected officials, officers, employees, volunteers, agents, and those City agents serving as independent contractors in the role of City officials (collectively "Indemnitees ") free and harmless from and against any and all claims (including, without limitation, claims for bodily injury, death or damage to property), demands, obligations, damages, actions, causes of action, suits, losses, bid protests, stop notices, judgments, fines, penalties, liabilities, costs and expenses (including, without limitation, attorney's fees, disbursements and court costs) of every kind and nature whatsoever (individually, a "Claim," collectively, "Claims "), in any manner arising out of or incident to the performance of the Agreement, including without limitation, the payment of all consequential damages and attorneys' fees and other related costs and expenses. Further, Contractor shall appoint competent defense counsel, at Contractor's own cost, expense and risk, to defend any and all such suits, actions or other legal proceedings of _every._kind_arising_out _of or incident to the performance .. of the Agreement that may. be brought or instituted against Indemnitees. Contractor shall pay and satisfy any judgment, award or decree that may be rendered against City or the other Indemnitees in any such suit, action, or other legal proceeding arising out of or incident to the performance of the Agreement. Contractor shall reimburse the City and the other Indemnitees, for any and all legal expenses and costs incurred by each of them in connection therewith or in enforcing the indemnity herein provided. Contractor's obligation to indemnify shall not be restricted to insurance proceeds, if any, received by Contractor or Indemnitees. This indemnity shall apply to all Claims and liability regardless of whether any insurance policies are applicable. 5.2 Bid Protests. In addition to its obligations pursuant to Section 5.1, Contractor shall reimburse the City for all attorneys' fees and costs incurred by City in connection with, arising out of or incident to any bid protest. 5.3 City's Sole Negligence. Nothing in Section 5.1 shall be construed to require Contractor to indemnify lndemnitees for that portion of any Claim to the extent arising from the sole negligence or willful misconduct of the lndemnitees. 5.4 Nonwaiver of Rights. lndemnitees do not, and shall not, waive any rights that they may possess against Contractor because of the acceptance by City, or the deposit with City, of any insurance policy or certificate required pursuant to this Agreement. 4 of 9 J 5.5 Waiver of Right of Subrogation. Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation against the Indemnitees, while acting within the scope of their duties, from all claims, losses, and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor. 5.6 Survival. The provisions of this Section 5 shall survive the termination of the Agreement and are in addition to any other rights or remedies that Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against a Contractor shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. 6. Insurance. 6.1 Liability Insurance. Contractor shall procure and maintain in full force and effect for the duration of this Agreement insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the services hereunder by Contractor, and its agents, representatives, employees and subcontractors. The policy limits set forth below do not act as a limitation upon the amount of indemnification to be provided by Contractor. Contractor shall complete and execute the following documents attached as Exhibits hereto and incorporated herein by this reference: 6.1.1 Exhibit Commercial General Liability. Automobile Liability. 6.1.2 Exhibit D -1: Additional Insured Endorsement - D -2: Additional Insured Endorsement - 6.1.3 Exhibit D -3: Additional Insured Endorsement. 6.2 Minimum Scope of Insurance. Unless otherwise approved by City, coverage shall be at least as broad as: 6.2.1 Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001). 6.2.2 Insurance Services Office form number CA 0001 (Ed. 1/87) covering Automobile Liability, code 1 (any auto). 6.2.3 Insurance Services Office form number CG 20 10 11 85 (Ed. 11/85) covering Additional Insured — Owners, Lessees or Contactors (Form B). 6.2.4 Workers' Compensation insurance as required by the State of California and Employer's Liability Insurance. 5 of 9 • I' 6.3 Minimum Limits of Insurance. Contractor shall maintain limits no less than: 6.3.1 General Liability: $2,000,000 per occurrence and in the aggregate for bodily injury, personal injury and property damage. Commercial General Liability Insurance or other form with a general aggregate limit shall apply separately to this Agreement or the general limit shall be twice the required occurrence limit. 6.3.2 Automobile Liability: $2,000,000 per occurrence for bodily injury and property damage. 6.3.3 Employer's Liability: $1,000,000 per occurrence and in the aggregate for bodily injury or disease and Workers' Compensation Insurance in the amount required by law. 6.4 Deductibles and Self- Insured Retentions. Contractor shall inform City of any deductibles or self- insured retentions except with respect to any professional liability insurance. 6.5 Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 6.5.1 City, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of City officials, are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of Contractor; products and completed operations of Contractor; premises owned, occupied or used by Contractor; or automobiles owned, leased, hired or borrowed by Contractor. The coverage shall contain no limitations on the scope of protection afforded to City, its officers, officials, employees, designated volunteers or agents serving as independent contractors in the role of City officials which are not also limitations applicable to the named insured. 6.5.2 For any claims related to this Agreement, Contractor's insurance coverage shall be primary insurance as respects City, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of City officials. Any insurance or self- insurance maintained by City, their officers, officials, employees, designated volunteers or agents serving as independent contractors in the role of City officials shall be excess of Contractor's insurance and shall not contribute with it. 6.5.3 Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 6.5.4 Each insurance policy required by this Section 6 shall be endorsed to state that coverage shall not be canceled or materially modified except after 30 days prior written notice by first class mail has been given to City. 6 of 9 6.5.5 Each insurance policy, except for any professional liability policy, required by this Section 6 shall expressly waive the insurer's right of subrogation against City and its elected officials, officers, employees, servants, attorneys, designated volunteers, and agents serving as independent contractors in the role of city or agency officials. 6.6 Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best's rating of no less than A:VIII unless waived in writing by City's Risk Manager. 6.7 Verification of Coverage. All insurance coverages shall be confirmed by execution of endorsements on forms approved by the City. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. All endorsements are to be received and approved by City before services commence. As an alternative to City forms, Contractor's insurer may provide complete, certified copies of all required insurance policies, including endorsements effecting the coverage required by these specifications. 7. Liquidated Damages. Should the Contractor fail to complete the project, or any part thereof, in the time agreed upon in the Contract, the Contractor shall reimburse the City for the additional expense and damage for each calendar day that the Contract remains uncompleted after the Contract completion date. It is agreed that the amount of such additional expense and damage incurred by reason of failure to complete the. Contract is the per diem rate of $750.00per calendar day. Such amount is hereby agreed upon as liquidated damages for the Toss to the City resulting from the failure of the Contractor to complete the project within the allotted time and to the value of the operation of the works dependent thereon. It is expressly understood and agreed that this amount is a reasonable amount and is established in lieu of damages that are incapable of calculation at the inception hereof; and this amount is not to be considered in the nature of a penalty. The City shall have the right to deduct such damages from any amount due, or that may become due to the Contractor, or the amount of such damages shall be due and collectible from the Contractor or the Contractor's Surety. Progress payments made after the scheduled completion date shall not constitute a waiver of liquidated damages. 8. Suspension. City may, in writing, order Contractor to suspend all or any part of the Contractor's Services for the convenience of City or for work stoppages beyond the control of City or Contractor. A suspension of the Services does not void this Agreement. 9. Notices. Any notices, bills, invoices, or reports authorized or required by this Agreement shall be in writing and shall be deemed received on (a) the day of delivery if delivered by hand or overnight courier service during Contractor's and City's regular business hours or by facsimile before or during Contractor's regular business hours; or (b) on the third business day following deposit in the United States mail, postage prepaid, to the addresses heretofore set forth in the Agreement, or to such 7 of 9 other addresses as the parties may, from time to time, designate in writing pursuant to the provisions of this Section. All notices shall be addressed as follows: If to City: If to Contractor: City Clerk City of Seal Beach 211 -8th Street Seal Beach, California 90740 Telephone: (562) 431 -2527 Fax: (562) 493 -9857 With a copy to: Public Works Director City of Seal Beach 211 -8th Street Seal Beach, California 90740 Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 Telephone: (562) 599 -5841 Fax: (562) 591 -7485 Attn: Curtis P. Brown 10. Non - Assignability; Subcontracting. Contractor shall not assign, transfer, or subcontract any interest in this Agreement or the performance of any of Contractor's obligations hereunder. Any attempt by Contractor to so assign, transfer, or subcontract any rights, duties, or obligations arising hereunder shall be null, void and of no effect. 11. Compliance with Laws. Contractor shall comply with all applicable federal, state and local laws, ordinances, codes and regulations in force at the time Contractor performs the Services. 12. Non - Waiver of Terms, Rights and Remedies. Waiver by either party of any one or more of the conditions of performance under this Agreement shall not be a waiver of any other condition of performance under this Agreement. In no event shall the making by City of any payment to Contractor constitute or be construed as a waiver by City of any breach of covenant, or any default which may then exist on the part of Contractor, and the making of any such payment by City shall in no way impair or prejudice any right or remedy available to City with regard to such breach or default. 13. Attorneys' Fees. In the event that either party to this Agreement shall commence any legal action or proceeding to enforce or interpret the provisions of this Agreement, the prevailing party in such action or proceeding shall be entitled to recover its costs of suit, including all attorneys' fees incurred in connection therewith. 14. Construction. The validity, interpretation, and performance of this Agreement shall be controlled by and construed under the laws of the State of 8 of 9 California. In the event of any asserted ambiguity in, or dispute regarding the interpretation of any matter herein, the interpretation of this Agreement shall not be resolved by any rules of interpretation providing for interpretation against the party who causes the uncertainty to exist or against the party who drafted the Agreement or who drafted that portion of the Agreement. 15. Entire Agreement. This Agreement, including any other documents incorporated herein by specific reference, represents the entire and integrated agreement between Contractor and City. This Agreement supersedes all prior oral or written negotiations, representations, or agreements. This Agreement may not be amended, nor any provision or breach hereof waived, except in a writing signed by the parties which expressly refers to this Agreement. 16. Severability. The invalidity in whole or in part of any provisions of this Agreement shall not void or affect the validity of the other provisions of this Agreement. IN WITNESS WHEREOF, the parties, through their respective authorized representatives, have executed this Agreement as of the date first written above. CITY OF SEAL BEACH CONTRACTOR: By: . Ingram, City meager Attest: By: k Lin a Devine, City Clerk Approved as to Form: umn M. Barrow, City Attorney 9 of 9 BY e Name: Curtis P. Brown Title: President By P1( „k„li f . l4l clIf cA) Name: Michele E. Drakulich Title: Assistant Secretary EXHIBIT A FAITHFUL PERFORMANCE BOND EXHIBIT B PAYMENT BOND EXHIBIT C WORKERS' COMPENSATION INSURANCE CERTIFICATE EXHIBIT D -1 ADDITIONAL INSURED ENDORSEMENT (COMMERCIAL GENERAL LIABILITY) EXHIBIT D -2 ADDITIONAL INSURED ENDORSEMENT (AUTOMOBILE LIABILITY) EXHIBIT D -3 ADDITIONAL INSURED ENDORSEMENT EXHIBIT E ACKNOWLEDGMENT OF PENAL AND CIVIL PENALTIES CONCERNING CONTRACTOR LICENSING LAWS EXHIBIT F LABOR LAW REQUIREMENTS EXHIBIT G ACCEPTED PROPOSAL (NOTE: Exhibits will not be included with the contract at the time of award. The Contractor shall have 10 working days to submit all exhibits to the City after the award of contract. Failure to do so will result in voiding of the contract. The City will then have the right to cash the bid bond for the project and re- advertise for construction or award to the next lowest responsive bidder.) 10 of 9 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of LOS ANGELES On — a before me, MONA COVINGTON, NOTARY PUBLIC (Here insert name and title of the officer) personally appeared C . P . BROWN who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /arm subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/he,r/thcir authorized capacity(ies), and that by his/144- /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. Bv: • WITNESS my hand and official seal. • Signature of Notary Public (Notary Seal) MONA COVINGTON COMM. #1798405 3 c! 4''' NOTARY PUBLIC 0CALIFORNIA 'n ORANGE COUNTY mr, Comm. Exp. MAY 27, 2012 ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (Le. certying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required • 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 signers) personally appeared which 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 commission followed by a comma and then your title (notary public). • Print the names) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. hatshe/ihey is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • 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 sufficient area permits, otherwise complete a different acknowledgment form • Signature of the notary public must match the signature on file with the office of the county clerk. 4 Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document Indicate title or type of attached document, number of pages and date. •S Indicate the capacity claimed by the signer If the claimed capacity is a corporate officer, indicate the title (i.e CEO, CFO, Secretary). • Securely attach this document to the signed document DESCRIPTION OF THE ATTACHED DOCUMENT (Title or descnption of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other • 2008 Version CAPA v12 10 07 800- 873 -9865 www.NotaryClasses com CALIFORNIA ALL - PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of LOS ANGELES On a- - before me, MONA COVINGTON, NOTARY PUBLIC (Here insert name and title of the officer) personally appeared MICHELE E. DRAKULICH who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /aie subscribed to the within instrument and acknowledged to me that he/she/they_ executed the same in 414s/her/their authorized capacity(ies), and that by 4iis/her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. y: :, /`IT W V.1K) Signature of Notary Public (Notary Seal) MONA COVINGTON COMM. 01798405 NOTARY PUBUC • CALIFORNIA (� ORANGE COUNTY a Comm. Exp. MAY 27, 2012 ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other • 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 signers) personally appeared which 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 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. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they- is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • 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 sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. • Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. ❖ 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) • Securely attach this document to the signed document 2008 Version CA PA vI2 1007 800 -873 -9865 www NotaryClasses.com • • • Bond No. 8229 -12 -67 Bond Premium $318.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that WHEREAS the City of Seal Beach, has awarded PALP Inc. dba Excel Paving Company 2230 Lemon Ave. Long Beach, CA 90806 (Name and address of Contractor) ( "Principal "), a contract (the "Contract ") for the work described as follows: Arbor Park Resurfacing, CIP# PR1102 WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful performance of the Contract. NOW, THEREFORE, we, the undersigned Principal, and Federal Insurance Company 15 Mountain View Rd. Warren, NJ 07059 (Name and address of Surety) ( "Surety ") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Fifty seven thousand seven hundred thirty six and no /100 Dollars ($ 57, 736.00 ), this amount being not less than the total contract price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal, his, her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions and agreements in the Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and performed, all within the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers, agents, and others as therein provided, then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FUR'1liER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to be performed there under, or the specifications for. the same, shall in any way affect its obligations under this bond, and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications there under. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. The City is the principal beneficiary of this bond and has all rights of a party hereto. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s) pursuant to authority of its governing body. Dated: "Principal" "Surety" PALP Inc. dba Excel Paving Company Federal Insurance Company Page D-43 • • • By: (2 - By Its Its Timothy D. Rapp, Attorney in Fac By: C. P, BROW, PRESIDENT By: Its Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. Page D-44 CALIFORNIA ALL - PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of LOS ANGELES On oZ- R, — (� before me, MONA COVINGTON, NOTARY PUBLIC (Here insert name and title of the officer) personally appeared C.P. BROWN who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /ace subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and,official seal. By: Signature of Notary Public (Notary Seal) MONA COVINGTON �f. COMM. #1798405 a O �A NOTARY PUBLIC 0 CALIFORNIA n ORANGE COUNTY omm. Exp. MAY 27, 2012 ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certing the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other • 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 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 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. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. ha/she/theyr is /ere ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or Imes. If seal impression smudges, re -seal if a sufficient area permits, otherwisc complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. {r Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. 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) • Securely attach this document to the signed document 2008 Version CA PA v12 1007 800 -873 -9865 www NotaryClasses com • • • State of California County of Orange On 02/16/2012 ACKNOWLEDGMENT before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Timothy D. Rapp who proved to me on the basis of satisfactory evidence to be the person() whose name() is/er• subscribed to the within instrument and acknowledged to me that he/3he%thcy executed the same in his /hor/thcir authorized capacity(iesj, and that by hisfilier4heir signature(') on the instrument the person(), or the entity upon behalf of which the person(0) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature �7� . (Seal) DEBRA SWANSON COMM.* 1822117 sX NOTARY PUBIJC.CALIFORNIA X ORANGE COUNTY N My Comm, Expires NOV 10, 2012 IIC Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY pacific Indemnity Company Warren, NJ 07059 CHUIB6 •Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Douglas A. Rapp and Timothy D. Rapp of Aliso Viejo, California-------_ ----- ---------------- ----- --------- each as their true and lawful Attomey- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 16th day of December, 2011. Kenneth C. Wende , Assistant Secretary STATE OF NEW JERSEY. ss. County of Somerset Norris, Jr., Vice President On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attomey, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attomey are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attomey as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attomey is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By- Laws and in deponent's presence. Notarial Seal • KATHERINE 1. ADELAAR NOTARY PUBLIC OF NEW JERSFl No. 2316685 Commission Expires July 16. 2014 CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: "All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attomey or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.' I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the 'Companies") do hereby certify that (i) the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (iii) the foregoing Power of Attomey is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 16th day of February, 2012 Kenneth C. We el, Assistant Secretary • IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 - 3493 Fax (908) 903- 3656 e -mail: surety@chubb.com Form 15 -10- 0225B- U (Ed. 5- 03) CONSENT • Bond No, 8229 -12-67 Bond Premium Included PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach, has awarded to PALP Inc. dba Excel Paving Company 2230 Lemon Ave. Long Beach, CA 90806 (Name and address of Contractor) ( "Principal "), a contract (the "Contract ") for the work described as follows: Arbor Park Resurfacing, CIP# PR1102. WHEREAS, Principal is required under the terms of the Contract and the Califomia Civil Code to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law. NOW, THEREFORE, we, the undersigned Principal, and Federal Insurance Company 15 Mountain View Rd. Warren, NJ 07059 (Name and address of Surety) • ( "Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Twenty eight thousand eight hundred sixty eight and no /100 • Dollars ($ 28, 868.00 this amount being not less th n fifty percent (50 %) of the total contract price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal, his, her or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the California Civil Code, or any amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the .wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the Contract, the Surety will pay for the same in an amount not exceeding the penal sum specified in this bond; otherwise, this obligation shall become null and void. This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to be performed thereunder, or the specifications for the same, shall in any way affect its obligations under this bond, and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the Page D-46 • • • name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s) pursuant to authority of its governing body. Dated: "Principal" PALP Inc. dba Excel Paving Company By: By: Its Its . P. BROWN, PRP IDET "Surety" Federal Insurance Company By — Its Timothy D. Rapp, Attorney in Fact By: Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. Page D-47 ■ CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of LOS ANGELES On (1^4C -la before me, MONA COVINGTON, NOTARY PUBLIC (Here insert name and title of the officer) personally appeared C.P. BROWN 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/hey executed the same in his/hor/their authorized capacity(ies), and that by his/her/the..ir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature of Notary Public (Notary Seal) MONA COVINGTON COMM. #1798405 3 ,.^�.' NOTARY PUBLIC 0 CALIFORNIA n 2 ' I ORANGE COUNTY m,.,.,�- Comm. Exp. MAY 27, 2012 ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California In such instances, any alternative attached document) acknowledgment verbiage as may be punted on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. cenfying the authorized capacity of the signer). Please check the document continued) document carefully for proper notarial wording and attach this form if required • 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 signers) personally appeared which 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 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. SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they- is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible Impression must not cover text or Imes. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document 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) • Securely attach this document to the signed document • DESCRIPTION OF THE ATTACHED (Title or description of attach (Title or description of attached doe Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other 2008 Version CA PA v12.1007 800 -873 -9865 www NotaryClasses com c • • • State of California County of Orange ACKNOWLEDGMENT On 02/16/2012 before me, Debra Swanson, Notary Public (insert name and title of the officer) personally appeared Timothy D. Rapp who proved to me on the basis of satisfactory evidence to be the person(A) whose name(0) isfefe subscribed to the within instrument and acknowledged to me that he/slheithey executed the same in his /hor/titeir authorized capacity(ies$, and that by hiskliefAtheic signature(0) on the instrument the person(I), or the entity upon behalf of which the person(0) acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. DEBRA SWANSON ^' 1; comm.* 1822117 e� NOTARY F'UBUGCAUFORNIA X '`' " ORANGE COUNTY �auFa` My Comm Fxpires NOV 10, 2012 Signature (Seal) • 111C POWER Federal Insurance Company Attn: Surety Department OF Vigilant insurance Company 15 Mountain View Road Pacific Indemnity Company Warren, NJ 07059 cNUes S Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Douglas A. Rapp and Timothy D. Rapp of Aliso Viejo, California each as their true and lawful Attomey- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on This 16th day of December, 2011. Kenneth C. Wende , Assistant Secretary STATE OF NEW JERSEY County of Somerset On this 16th day of December, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attomey, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attomey are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attomey is in the genuine handwriting of David B. Noms, Jr., and was thereto subscribed by authority of said By- Laws and in deponent's presence. ss. . Norris, Jr., Vice President Notarial Seal • KATHERINE J. ADELAAR NOTARY PUBUC OF NEW JFRSFI Nt. 2316685 Commission Expires July 16, 2014 CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: "All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and 'certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.' I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the 'Companies ") do hereby certify that (i) the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in Amencan Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (iii) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 16th day of February, 2012 Notary Public Kenneth C. We el, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903 - 3493 Fax (908) 903- 3656 e -mail: surety ©chubb.com Form 15-10- 0225B- U (Ed. 5- 03) CONSENT i lib AMENDMENT TO PUBLIC WORKS AGREEMENT FOR ARBOR PARK RESURFACING PROJECT CIP NO. PR1102 between SE i4 AS B't,� =��GpRPORq j6O,q�� i o %a, • • ,1 City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 (562) 599-5841 (562) 591-7485 FAX THIS AMENDMENT is made as of July 09, 2012, by and between the City of Seal Beach, a California charter city ("City"), and Excel Paving Company, a General Contractor ("Contractor"). 1 of 3 RECITALS A. WHEREAS, the City Council approved the plans and specifications for the Arbor Park Resurfacing Project, CIP No. PR1102 ("Project") with respect to design criteria; B. WHEREAS, Contractor has submitted a bid to City for the Project dated February 9, 2012 in the amount of $57,736.00 for Arbor Park Resurfacing Project, CIP No. PR1102; AGREEMENT, NOW, THEREFORE, in consideration of performance by the parties of the mutual promises, covenants, and conditions herein contained, the parties hereto agree as follows: 1. Section 3 (Payment) of the February 27, 2012 Agreement is hereby amended to read as follows: 3. Payment. For performing and completing the Work in accordance with the Contract Documents, City shall pay Contractor, in full compensation therefor, the amount of $72,674.05, subject to any additions and deletions pursuant to the terms of the Contract Documents. Said sum shall constitute payment in full for all work performed hereunder, including, without limitation, all labor, materials, equipment, tools and services used or incorporated in the Work, supervision, administration, overhead, expenses and any and all other things required, furnished or incurred for completion of the Work as specified in the Contract Documents. City shall make payments to Contractor on account of the contract sum at the time, in the manner, and upon the conditions specified in the Contract Documents. IN WITNESS WHEREOF, the parties, through their respective authorized representatives, have executed this Amendment as of the date first written above. 2 of 3 . ! CITY OF SEAL BEACH CONTRACTOR: Palp Inc. dba Excel Paving Co. ,,'I 2 t. . By: ,, By: a_ri-,...„.. J I -. Ingram, City M." •er Name: C.P. Brown Attest: • 4a 11:4 6 Title: President By: U r �Devine, ity Clerk A f ' C i�,� I�1 �J Name: c.-4 C 0" `GPI Approved as to Form: Title: Michele E. Drakulich Asst. Secretary By: / i 0 uinn M. Barrow, City Attorney 3 of 3 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of _Los Angeles _ On —.2.25r ( q, , before me, C. Phill ps. N•t. y P • , (Here=err name and title of the officer) personally appeared _C.P.Brown and M chele F. n akrjli h r who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)itsgare subscribed to the within instrument and acknowledged to me that 3neItheithey executed the same in hiether/their authorized capacity(ies), and that by r/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. C.PHILLIP "F COMM.#1s.cLoi n • WITNESS my hand and official seal. ", Notary Public�alifornla q - ,I LOS ANGELES COUNTY n C i f / My Comm,ErplraaAug.1e,24121 . (Notary Seal) ,t,• Si.. .11 f Notary Public . ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM i1 . Any acknowledgment completed in California must contain verbiage exactly as I' DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document The only exception is if a i! docwnent is to be recorded outside of California.In such.instances,arty alternative �: (Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in ;j California(i.e. cerr{rying the authorised capacity of the signer). Please check the i (rifle or description of attached document continual) carefully far proper notarial wording and attach this form if required 1 • • State and County information must be the State and County where the document it Number of Pages Document Date signers)personally appeared before the notary public for acknowledgment. • II • Date of notarization must be the date that the signers)personally appeared which ii must also be the same date the acknowledgment is completed. I+ • (Additional information) • The notary public must print his or her name as it appears within his or her '! commission followed by a comma and then your title(notary public). • • Print the names) of document signer(s) who personally appear at the time of notarization. j CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e it :1 El Individual(S) he/shelthey;is/are)or circling the correct forms Failure to correctly indicate this information may lead to rejection of document recording !i ❑ 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 II ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of j II the county clerk. j ❑ Attorney-in-Fact <• Additional information is not required but could help to ensure this 1 I ❑ Trustee(s) acknowledgment is not misused or attached to a different document. I. <• 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). • Securely attach this document to the signed document i 2008 Version CAPA v12 10 07 800-873-9865 www NotaryClasses corn 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 LTR TYPE OF INSURANCE I1 •7•2uu"1 .� R 7I�I1 POLICY NUMBER P • LICY EFF MMIDDIYYYY POLICY EXP MM/DDIYYYY LIMITS PRODUCER EXCELP1 CUSTOMER ID #: A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X X •1CG50211108 11/01/11 11/01/12 EACH OCCURRENCE $ 1,000,001 X EREMEMEIII $ 100,001 ■■ CLAIMS -MADE X MED EXP (Any one person) $ 5,001 X DED: $25,000 PERSONAL & ADV INJURY $ 1,000,001 ■ GEN'L GENERAL AGGREGATE $ 2,000,001 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,001 POLICY X PRO ■ LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS SEE NOTES X X • 1CA50211108 11/01/11 11/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,001 X BODILY INJURY (Per person) $ ■ ■ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ B ■ UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE ISCCCL01607011 11/01/11 11/01/12 EACH OCCURRENCE $ 1,000,000 X ■ AGGREGATE $ 1,000,001 ■ DEDUCTIBLE RETENTION $ $ ■ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS Y N / A • 1CW50211108 11/01/11 11/01/12 X WWI IN E.L EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 below E L DISEASE - POLICY LIMIT $ 1,000,000 .. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES *Except 10 Days Notice of Cancellation RE: Excel Job #4912 - City of Seal Beach; PR1102. Waiver of Subrogation for General Compensation: See Attached Endorsements. *SEE NOTES* • Iai • wv (Attach for Non- Arbor and /auaiwc/wcwv/wet ACORD 101, Additional Remarks Schedule, if more space Is required) Payment of Premium. Park Resurfacing; Spec. No. Auto Liability and Workers' - forms r UP ID: JFR '"' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/14/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED -EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s . PRODUCER 949 -553 -9800 The Wooditch Company Insurance 949 -553 -0670 Services, Inc. 1 Park Plaza, Suite 400 Irvine, CA 92614 NAME: CT PHONE FAX A/C No Ext : A/C No : E -MAIL ADDRESS: PRODUCER EXCELP1 CUSTOMER ID #: INSURER S) AFFORDING COVERAGE NAIC # INSURED Palp, Inc., dba: Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 INSURERA:OId Re•ublic General Ins. Corp 24139 INSURERB:Starr Indemni & Liabili Co 38318 INSURER C : INSURER D : - INSURER E : INSURER F : REVISION NUMBER: • • SEALBEA City of Seal Beach City Hall 211 Eighth Street, 2nd Floor 211 Eighth Sr Seal Beach CA 90740 -6379 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ! 1 C 'v ♦ ." '' {,V✓1 (}� J ,J�'" © 1988 -2009 ACORD The ACORD name and logo are registered marks of ACORD •--•- • rig s reserve • . ACORD 25 (2009/09) • • • NOTEPAD INSURED'SNAME Palp, Inc., dba: EXCELPI OP ID: JR PAGE 2 DATE 02/14/12 *Auto Deductible: $1000 COMP /$1000 COLL except $5000 COMP /$5000 COLL for vehicles valued over $75,000 Cost New* *Should this policy be cancelled before the expiration date The Wooditch Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* • • • NOTEPAD: HOLDER CODE SEALBEA INSURED'S NAME Palp, Inc., dba: EXCELP1 OP ID: JR PAGE 3 DATE 02/14/12 City of Seal Beach, its officers, elected officials, attorneys employees, designated volunteers and agents serving as independent contractors in the role of City officials are named as Additional Insureds as respects General and Auto Liability per attached endorsements. This Insurance shall apply as Primary and Non - Contributory per attached endorsement. *Contractual coverage applies to the General Liability policy.* • • • 02/14/2012 07:40 FAX 562 591 7485 EXCEL PAVING CO. &J 008/010 WORKER'S COMPENSATION CERTIFICATE OF INSURANCE WHEREAS, the CITY (W SRA .. REACH has required certain insurance to be provided by Old Republic General Ins. Corp. c/o The Wooditch Company NOW THEREFORE, the ttndersigaed insurance company does hereby certify that it liar isstiel the policy or policies described below to the following named insureds and that the same are in force at this time. I. This certificate is issued to: CITY OF SEAL BEACH. City Hall, 211 EIGHTH STREET. SEAL BEACH, CA 90740 -6379. 2. The insureds under such policy or p lkira arc- Palp, Inc. dba Excel Paving Company 3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of C:xlifnrnia rnvr.ring all operations of the named in.aireds, as follows: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A1CW50211108 11/01/11 11/01/12 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, uuja' aad omit aibty days• aavantc written nonce meteor nos peen servers upon the City Clerk of the CITY OF� SEAL BEACH. By: Y' S; (A-- Its Authorized Representative Page D-49 • • • 02/14/2012 07:40 FAX 582 591 7485 EXCEL PAVING CO. ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY Palp, Inc. dba Excel Paving Company 2230 Lemon Ave., Long Beach, CA 90806 Nana and address of named insured ("Named insured "): Old Republic General Ins. Corp. Go The Wooditch Company 1 Park Plaza, Suite 400, Irvine, CA 92614 Naive and address of Insurance Company ( "Company"): OFFICIAL TITLE OP PROJECT. A813oi. PARK KF.3ulth.ACING CIF' No. PR 1102 Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the °Policy ") or in any endorsement now or hereafter attached th u tv, it is armed as tbtlows: 1. "tile City of Seal Reach, its elected officials, officers, attorneys. agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the " Additional Insureds") under the Policy in relation to those activities described genrrntty above with regard so operations pertortned by nr on behalf of oho muted Insured_ The Additional Insureds nave no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained. by the Additional insureds _hall be called upon to wuuibute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with reopcct to the limits oft!. u C puay's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one inured under the policy against another insured under the policy. All such claims shall covered as third -party claims, i.e., in the same manner as if separate policies had been issued tin narb inai,rrd aaa,uuucu in toss provision shall operate to increase or replicate the Cornpaoy's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance ( subiect to the terms. conditions and excluslona applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named lamed and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to tetlation, change in coverage, reduction of limits (except as the result of the payment of claims), or non - renewal except after written notice to Public Agency, by certified mail. return receipt rerinected, n t lets than thirty (30) days prior to the effective date therestf In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until. compliance; with this notice requirement_ •Except 10 days notice of cancellation for non - payment of premium. 7_ Company hceby waives all rights of subrogation and contribution against the Additional Insureds, white acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils 'insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of say prim, concurrent, er subsequent active or passive n ligercrice by the Additimnal Insureds. 8. I1 is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation, and enforcement of this contract of insurance 9. This endorsement and all notices given hereunder shall be sent to Public Agency at Page D-51 I j 007/010 \, 02/14/2012 07:41 FAX 562 591 7485 • • EXCEL PAVING CO. @x008/010 City hogmear City of Scal Beach 211 8th Street, 2'1 Floor Seal Beach CA 90740 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, aher or extend any of the limits, agreements, or exclusions of the policy to which this ondorsomcnt is aitachcd. TYPE OF COVERAGES TO WHICH Tins FNEX Rea is iI, TTACHES POLICY PERIOD FROM/TO 11/01/11 - 11/01/12 LIMITS OF $2,000,000 general agg LIABILITY $1,000,000 occur. 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: fl Contractual Liability O Ownerst1,andlords/Teaants p Maaufacturentractors U preducts/Comptctcd Operations ❑ Broad Form Property Damage U Extended Bodily Injury O Broad Fame Comprehensive t? C:eneral 1.ishtlity 1'ndnraement D Bxplwriuu 13aaard ❑ Collapse Hazard () Underground Property Damage I7 Pollution Liability ❑ Liquor Liability 0 12. Ala deductible or ❑ self - insured retention (check one of $ 25,000 applies to all coverage(s) except Auto Liability, Excess Liability and Workers ompansation (if uvu4, au a.aw). Tim, .I..lu. Gill/.. is ayplivaLi4 0 fru ..Laiva v. &1 pw vwu+sw.w (4tu . k one). 13. This is au Id occurrence or 0 claims made policy (check onc). 14. This endorsement is effective on 11/01/11 at 12:01 A.M. and forms a part of Policy Number Al CG50211108 William S. Wooditch (prier name), hereby declare under penalty of perjury under the laws of the State of California, that I.have the authority to bind the Company to this endorsement and that by my execution hereof, I do so bind the Company_ Executed iPtt ► of 1 (941% .20 7 Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) Plume NO.: ( 949 ) 553 -9800 Page D-52 02/14/2012 07:41 FAX 562 591 7485 EXCEL PAVING CO. • • ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY Pelp, Inc. dba Excel Paving Company 2230 Lemon Ave., Long Beach, CA 90800 Name autl atltlrms of named insured (Named insured"): Old Republic General Ins. Corp. c/o The Wooditch Company 1 Park Plaza. Suite 400. Irvine. Ca 92614 Name and address of Insurance Company ("Company"): OPFJCLAL 77TLk'OFP.PO,7ECT,A 884. 14PA RA" ACSCTRFACX NGC.tMNu,,R.rxO2Notwithstanding any inconsirtcnt.renigma( in due pufiry w winch this endorsement it attached (the "Policy") or in any endorsement now or hereafter attached thereto, it is. agreed as follows: The City of Seal Beach, its elected officials, officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds -) under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 1. 2. 3. 4. 5. 6. 009/010 The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the nolicv against anther inCiwM nnrinr rho. rent: 1. AIL LLiudl Yuty the crane manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) include.; liability assumed by the Natued Insured under the indemnification and/or hold bananas provisien(s) contained or executed in conjunction with the written agreement(s) or permits) designated above, between the Named Insured and the Additional Insureds. The policy to which this endorsement is attached shall not be subject to cancellation. change in novorage, redoetwo of imvtte (except an the result of the payment of allure), Ir ma- renewal except after written nOfCe LO Public Agency,. by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this notice provision, ale policy as initially drafted will continue in hill Rare and esffrrt tmtil eompbinaen with this ootioe requirement. "Except 10 days notice of cancellation Company hereby waiveo all rights of subrogatiou nal contribution against the Additional Insureds, while acting for non - payment within the scope of their'duties, from all claims, losses and liabilities arising otlt of or incident to the perils of premium. insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Nesned armed Legaldlnss of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. It is hereby agreed that the laws of the State of California shall apply to and govern the validity. construction, interpretatloo, and enforcement of this contract of insurance. This endorsement and all nori�ees given hereunder shall be sent to Public Agency at: City Engineer City of Seal Beach 211 9th Street, 2'° Floor Seal Beach CA 90740 7. Except as stated above and not in conflict with this endorsement, nothing containedhezeia shall be held to waive, alter or extend any ankle limits, agreements, or exchlsions of the policy to which this endorsement is attached. Page D-54 • • 02/14/2012 07:42 FAX 562 591 7485 TYPE OF COVERAGES TO WHICH LIMITS OF THIS I:NDORSEMENTATTACHES LIAEOL11Y Auto Liability EXCEL PAVING CO. jj010/010 POLICY PERIOD FROM/ TO 11/01/11 - 11/01/12 Schodukd ilcurs or locations are to be identified on an attached sheet. The following inclusions relate to the ahnvok coverages. includes: t Any Automobiles f) A!1 Omred Automobiles 0 T' � Coverage fi m d Nun -owned Automobiles 0 Motor �T Act r cl 0 aired Automobiles Rcgttlatory Reform Act I 7 Scheduled Automobiles 0 Public Livery Coverage 0 Oarage Coverage U $1,000 comp /colt except $5,000 comp /colt 1L A 0 deductible or 0 self -Les ted re for vehicles valued over $75,000 Cost New coverage(s except: General is i Excess �= of S p y Excess i and Workers' eompeneation applies to a1I of none, so state). The deductible is applicable U per claim or is per occurrence (check one). 12. This is 81[13 occurrence or D claims made policy (check one). l3• This endorsement is effective on 11/0!1111 Nttmbcr A1CA50211108 at 12:01 A.M. and forms a part of Policy 1, William S. Wooditch declare under penalty of perjury under the laws of the State of, California, that r have the (print to bind the Company to this endorsement and that by my execution hereof, 1 do so bind the Company, Executed el form! & ,, y l 1 Signature ofAuthorized Representative (Original signature only; no facsimile signature or initialed signature accepted) Phone No.: ( 949 ) 553 -9800 Page D-$5 • • • POLICY NUMBER: A1CG50211108 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Opera- tions 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. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or In part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". CG 20 37 07 04 ® ISO Properties, Inc., 2004 Page 1 of 1 0 • • POLICY NUMBER: Al CG50211108 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Thls endorsement modifios Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT. Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising Injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, mainten- ance or repairs) to be performed by or on be- half of the additional insured(s) at the location of the covered operations has been completed: or 2. That portion of your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. • CG 2010 07 04 ® ISO Properties, Inc.. 2004 Page 1 of 1 • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION 'CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Palp, Inc. dba Excel Paving Company Policy Number A1CG50211108 I Endorsement No. Policy Period 11101/2011- 11/01/2012to Endorsement Effective Date: 11/01/2011 Producer's Name: Old Republic Construction Insurance Agency Inc. Producer Number: 11/01/2011 AUTHORIZED REPRESENTATIVE DATE CG EN GN 0029 09 06 • • • POLICY NUMBER: AiCG50211108 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Where Required by Written Contract. Information required to complete this Schedule, if not shown above. will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ • OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURED WHERE REQUIRED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING. BUSINESS AUTO COVERAGE FORM The following is added to Section II — Liability Coverage, A. — Coverage. 1. Who Is An Insured d Any person or organization to whom you become obligated to include as an additional insured under this policy. as a result of any contract or agreement you enter into which required you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lessor of: 1. The coverage or limits of this policy, or 2. The coverage or limits required by said contract or agreement. • Named Insured Palp. Inc. dba Excel Paving Company Policy Number A1CA50211108 Endorsement No Policy Period 11/01/2011 - 11/01/2012 to Endorsement Effective Date 11/01/2011 Producer's Name II, Old Republic Construction Insurance Agency Inc. F'; nrlllr:ei Nl1'rber OA AUTHORIZED REPRESENTATIVE •.,A, EN GN 0020 03 07 • 11/01/2011 DATE • • • • POLICY NUMBER: A1CA50211108 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Palp, Inc. dba Excel Paving Company Endorsement Effective Date: 11/01/2011 SCHEDULE Name(s) Of Person(s) Or Organization(s): Where Required by Written Contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1 D • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION • WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 Named Insured Paip, Inc. dba Excel Paving Company Policy Number A1CW50211108 Endorsement No. - Policy Period 1110112011- 1110112012 Endorsement Effective Date: 11/01/2011 Producer's Name: OLD REPUBLIC CONSTRUCTION INSURANCE AGENCY, INC. Producer Number. AUTHORIZED REPRESENTATIVE WC 99 03 15 (01/07) 11/01/2011 DATE