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HomeMy WebLinkAboutAGMT - Sancon Engineering Inc. (Old Town Sewer Lining) RECORDING REQUESTED BY Recorded in Official R d range County Hu h Nguyen, Clerk-Recorder AND WHEN RECORDED MAIL TO 11111111111111111111111111111 UM NO FEE CITY OF SEAL BEACH 2013000562706 9:19 am 10101113 Attn: City Clerk 47 422 1412 1 211 -8th Street 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Seal Beach,-CA 90740 ' Space of above this line for Recorder's use. • - - - - --;H"-I*_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: • 1. The undersigned is owner or corporate officer of the owner of the interest or estate stated \\1,below in the property hereinafter described: . 2. The full name of the owner is: City of Seal Beach. . C 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 July 31, 2013. The work was Old Town Sewer Lining Proiect. No. SS0901-2. 6. The name of the contractor(s), if any, for such improvement was: Sancon Engineering, Inc. The date of the Contract Award was November 13, 2012. 77-The-property-on which-said-work-of-improvernent-was completed-in-the-City-of-Seal-Beach, County of Orange, State of California, and is described as follows' • - own & Hill Date .1/4-0g ra �� Director of Public Wor s, City of Se/Beach Signature of owner or corporate off er 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 pe alty of perjury the foregoing is true and correct. Executed on z3/ 2013, at Seal Beach, California. (Date of Signature) ,/ de, Direct° of Public Wo s, 'y of Se=I Beach • PUBLIC WORKS AGREEMENT Old Town Sewer Lining (C.I.P.P.) Project City CIP No. SS0901-2 State Project No. C-06-5310-120 between >�F_SEALeF fit,co. y41 • �' of ff 21∎=.:- ��Oi. City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 Sancon Engineering Inc. 5841 Engineer Drive Huntington Beach, CA 92649 (714) 891-2323 (714) 891-2524 - FAX THIS AGREEMENT is made as of November 13, 2012, by and between the City of Seal Beach, a California charter city ("City"), and Sancon Engineering Inc., a General Contractor ("Contractor"). RECITALS A. WHEREAS, the City Council has approved the plans and specifications for the Old Town and Hill Sewer Lining C.I.P.P. Project No. SS0901-2 ("Project") with respect to design criteria; and B. WHEREAS, Contractor has submitted a bid to City for the Project dated October 24, 2012 in the amount of $1,655,111.75 ("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. 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 November 13, 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 $1,655,111.75, 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. The City Manger may authorize extra work to fund unforeseen conditions up to the amount approved at the time of award by the City Council. Payment for additional work in excess of this amount requires prior City Council authorization. 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 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 Indemmitees for that portion of any Claim to the extent arising from the sole negligence or willful misconduct of the Indemnitees. 5.4 Nonwaiver of Rights. Indemnitees 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. 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 D-1: Additional Insured Endorsement - Commercial General Liability. 6.1.2 Exhibit D-2: Additional Insured Endorsement - Automobile Liability. 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. 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. 6.5.5 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 per calendar day. Such amount is hereby agreed upon as liquidated damages for the loss 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 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: 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 If to Contractor: Sancon Engineering Inc. 5841 Engineering Drive Huntington Beach, CA 92649 Telephone: (714) 891-2323 Fax: (714) 891-2524 Attn: Nick DeBeneditto, President 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 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: l By: L 'AM-- R. Ingram, City ' a ager /� Name: 64-75 D,BesieCtie770 Attest: • in ot-di b ruu • Title: S�i'eDiu// By: (Jl � Linda Devine. City Clerk Approved as to Form: • Va.- Q4 M. Ba .ow, City Attorney CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 . .r.,rr rr -r- . rw . r-r- -• rr 7 r.r., r,•.rr, r.,r..-rrrr.o. tState of California 3 3 County of oZR, 3 On to13oj12- before me, c4-sn cS ?m -sa'°s Date Here Insert Name and Title of the Officer S r personally appeared CAA a,.c • c,JE.Wp10 Name(s)of Signer(s) �� ' 91 twho proved to me on the basis of satisfactory A r evidence to be the person,(s) whose name(s) is/We r subscribed to the within instrument and acknowledged 5 r to me that he/stye/they executed the same in 5 t r.,+ CHARLES B. PARSONS his/her/their authorized capacity(ies), and that by i Commission # 1943036 5 r. •ir._r z his/het/tf�eir signature( on the instrument the a.y, a� Notary Public -California z t it i ` *l Orange County - person( , or the entity upon behalf of which the t 11__"`'F_ Co My mm.Expires 01 Jul ul 30, 51 person(s) acted, executed the instrument. i r I certify under PENALTY OF PERJURY under the r laws of the State of California that the foregoing paragraph is true and correct. V,P t WITNESS my hand and o ' seal. 5 r C gSignature: ��5 r, Place Notary Seal Above Signature of Notary Public 91 r OPTIONAL ),.. Though the information below is not required by law, it may prove valuable to persons relying on the document a and could prevent fraudulent removal and reattachment of this form to another document. a Description of Attached Document 5 V, • Title or Type of Document: a Document Date: Number of Pages: s Signer(s) Other Than Named Above: a t • Capacity(ies) Claimed by Signer(s) s r Signer's Name: - Signer's Name: S t� ❑ Corporate Officer — Title(s): ❑Corporate Officer — Title(s): s ❑ Individual RIGHTTHUMBPRINT ❑Individual RIGHT THUMBPRINT OF SIGNER OF SIGNER 6. ❑ Partner —❑Limited ❑General Top of thumb here ❑ Partner — ❑Limited ❑General Top of thumb here q ,,• ❑ Attorney in Fact ❑Attorney in Fact • ❑ Trustee ❑Trustee S ❑ Guardian or Conservator ❑Guardian or Conservator 1 ❑ Other: ❑Other: S r 5 Signer Is Representing: Signer Is Representing: . 9, • ., • O 2. ^�cc��'s�^�'-�'�'•^`h''c•c>'r=f.^c.V •�>c.^�-'�`s�� ro.e=,czw�u:�c,.�..:�....: _ _ ..-.�: mow:. � _._. �..�. _ - 2010 National Notary Association•NationalNotary.org-1-800-US NOTARY(1-800-876-6827) Item#5907 Bond No. 1973815 - Bond Premium $16,386.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded SANCON ENGINEERING, INC. 5841 ENGINEER DRIVE, HUNTINGTON BEACH, CA 714-891-2323 - (Name and address of Contractor) ("Principal"),a contract(the"Contract")for the work described as follows: Old Town Sewer Lining(C.I.P.P.)Project,City CIP No.SS0901-2, State Project No.C-06-5310-120 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 HANOVER INSURANCE COMPANY 2 MacArthur Place, Santa Ana, CA 9270/ 714-415-3808 (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 ONE MILLION, SIX HUNDRED FIFTY FIVE THOUSAND, ONE HUNDRED TWELVE AND 00/100 DOLLARS Dollars($1,655,112.00 ),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. 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 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: NOVEMBER 19,2012 - "Principal" "Surety" SANCON ENGINEERING, INC. HANOVER INSURANCE COMPANY Page D-78 ' r � V y` By: /�/as-/c Digig1�rt/�'t4. By: Michael R. Langan Y� Q itg ( ItS Attorney in Fact = _ • By: 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-79 CA(LDFORMGA ALL-PURPOSE &CKR9OWLE'e GbViiWENT State of California County of Lqs ,Angeles On NOV._ lg , 2012 before me, Kendra Michelle Boots, Notary Public . Date . Here Insert Name and The of the Officer . personally appeared Michael R. Langan Name(s)of Sgne ls) who proved to me on the basis of satisfactory evidence to be the person( whose name(0) isltgl subscribed to the within instrument and acknowledged to me that KENDRA MICHELLE BOOTS ; he/pan executed the same in hi a uthorized r COMM. > 1951463 �y(03) and that by ' fl:,' signature(g) on the w '7__ -,n.oll NOTARY PUBLIC -CALIFORNIA y instrument the person(a), or the entity upon behalf of > , LOS ANGELES COUNTY which the person(§)).acted, executed the instrument i My COMM Expires Oct 7,2415 J 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. Place Notary Seal Above SignatlltEi���°✓� yea Notary Public OPTIONAL Though the information below is not required by law.it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document FAT . • • • . ' _ _ :e, Document Date: Number of Pages: Signer(s)Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signers Name: Michael R. Langan Signers Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Trtle(s): ❑Corporate Officer—Title(s): ❑ Partner—❑Limited ❑ General 0 Partner—❑Limited ❑General sisnattq.',aCsiter LX Attorney in Fact OaSLGNE� ❑Attorney in Pact aro C),2 sl�c�R Ma ❑ Trustee Top of thumb here ❑Trustee Top ❑ Guardian or Conservator 0 Guardian or Conservator n Other: 0 Other: • Signer Is Representing: Signer Is Representing: HANOVER INSURANCE CO +PANY AND OR M A S Y.'-.'_ F =. . ,I...SU- L E 0a LITANY 0200?Me&Onsl Notary Amoaeoun-9350 Dc Solo Ma.PO.Bac 2402.CtialonM.CA 91313-2402•mvmNafmnatNdaryag Item e5907 Reuderca0Ta0.Free 1.80D-876{,927 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY . CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint MICHAEL R.LANGAN Of Pasadena,CA and each is a true and lawful Attomey(s)-in-fad to sign,execute,seal,acknowledge and deliver for,and on its behalf, and as its act and deed any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Ten Million and No1100($10,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: "RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14,1982—Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice President and an Assistant Vice President,this 12th day of July, 2010. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY w .. CITIZEN SURANCE COMPANY OF AMERICA QQ (r r Q 'e, tq 1Ys1� —� Mary Jeanne ••d-i on,Vile Preside t 6Z/ft/ti � /! ✓ Robert K.Grennan,Assistan lice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER )ss. On this 12th day of July, 2010 before me came the above named Vice President and Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. {�.� NSF Pelt ct�sw m+errra NOtBry Public My commission expires on November 3,2011 I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED, That any and all Powers of Attorney and Certified Copies of such Powers of Attomey and certification in respect thereto, granted and executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company,shall be binding on the Company to the same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14, 1982 Massachusetts Bay Insurance Company;Adopted September 7, 2001 - Citizens Insurance Company of America) _ f,, / 7 GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this /9r Day of�()t/ , ,20 I Z THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY C IIII�S INSU'• CE CO PANT OF ERICA .— i. . .d Step/ Brau 7,ssistan Vice Pm'ant CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 S.•rr,rrrrr• 7 rr• . .v:rr•rrrr r• rry-r✓-r rr •r,rr•r•v:•i:r. .••9roa C 7) I. State of California r . County of OaA„x..� 5 S tOn iV f ze/t t before me, QHH#u of /?AL,ti-+S , Date Here Insert Name and Title of the Officer is r personally appeared !J 1Lt --0: ftt4 EDt TT-0 5 Names)of Sigler(s) t. who proved to me on the basis of satisfactory S t evidence to be the person() whose name(s) is/are t subscribed to the within instrument and acknowledged 5 t• to me that he/sMRe/t$ey executed the same in ? his/httr/tFjeir authorized capacity($), and that by s t re CHARLES B. PARSONS his/her/t�feir signature(-5) on the instrument the g Commission # 7943036 person(,), or the entity upon behalf of which the i . Notary Public-California Z s person( acted, executed the instrument. 5 Orange County My Comm. Expires Jul 30,2015+ I certify under PENALTY OF PERJURY under the I t laws of the State of California that the foregoing S t paragraph is true and correct. z S t WITNESS my hand and offi I. 3 P. Y /� C / 1 , Signature: `^ 5 Place Notary Seal Above Signature of Notary Public 9 P OPTIONAL 5 Though the information below is not required by law, it may prove valuable to persons relying on the document rand could prevent fraudulent removal and reattachment of this form to another document P Description of Attached Document S Pk. Title or Type of Document: g Document Date: Number of Pages: s ( Signer(s) Other Than Named Above: s Capacity(ies) Claimed by Signer(s) C. ( Signer's Name: .. Signer's Name: 5 E, ID Corporate Officer — Title(s):_ ❑Corporate Officer — Title(s): 5 ❑ Individual RIGHT THUMBPRINT. ❑ Individual RIGHT THUMBPRINT OF SIGNER' ' . OF SIGNER 2 ❑ Partner — ❑Limited ❑General Top of thumb here ❑ Partner — ❑ Limited ❑ General Top of thumb here t, ❑ Attorney in Fact ❑Attorney in Fact ❑ Trustee ❑Trustee t ❑ Guardian or Conservator ❑Guardian or Conservator • 4 ❑ Other: ❑Other: t 5 9) Signer Is Representing: Signer Is Representing: S - cs� 9 PL2,00 0c. • '&t. , - ^cc,^ ^ . cwr < us0-4' ,— t mot._ ©2010 National Notary Association•NationalNotary.org•1-800-US NOTARY(1-800-876-6827) Item#5907 Band NO. 1973815 Bond Premlmn Included in Performance Bond PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded to SANCON ENGINEERING, INC. 5841 ENGINEER DRIVE, HUNTINGTON BEACH, CA 92649 714-891-2323 (Name and address of Contractor) ("Principal"),a contract(the"Contract")for the work described as follows: Old Town Sewer Lining(C.I.P.P.)Project,City CIP No.SS0901-2, State Project No.C-06-5310-120 WHEREAS, Principal is required under the terms of the Contract and the California 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 HANOVER INSURANCE COMPANY 2 MacArthur Place, 2nd Floor, Santa Ana, CA 92707 714-145-3808 (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 EIGHT HUNDRED TWENTY SEVEN THOUSAND, FIVE HUNDRED FIFTY SIX AND 00/100 DOLLARS Dollars(S 827,556.00 this amount being not less than 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 pi.'funned 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. FUR'HER, 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-81 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT cece eruct=,-"- rcazezczecezet eera-zacrcat-et cacre(,.ect-cl.ercrerececcrc(t te4,rcr-c.`erircreccrereroct-nece< State of California County of LO$ ANGELES On Nov. 19 ,,2.012 before me, - e • _ _ • - - :. . • Date Here Insert Name and Title• t e l cer personally appeared Michae] B, Langan Namels)of Signerls) who proved to me on the basis of satisfactory evidence to be the person whose name(g) is/ge subscribed to the within instrument and acknowledged to me that he/ itheV executed the same in hisktrafilheit authorized KENDRA MICHELLE BOOTS capacity(i�), and that by his/ Y signature(on the 3 ., tia COMM. # 1951463 < instrument the personI4), or the entity upon behalf of rt rn _ ,,,',,-.r which the person(@) acted, executed the instrument. a ;.y� .�r� N9rARx PUBLIC- CALIFORNIA rn =.T. LUu ANGELES COUNTY r" f My Comm.Wires pot I.20tS I certify under PENALTY OF PERJURY under the laws °° s oat of the State of California that the foregoing paragraph is true and correct. WITNESS my ha d and official seal. -��,- Signature e / J.I Place Notary Seal Above • -rae. .. OPTIONAL Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: PAYMENT BOND Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Michael R. Langan- Signer's Name: • Individual ❑ Individual ❑ Corporate Officer—Title(s): U Corporate Officer—Title(s): • Partner—❑ Limited 0 General ❑Partner—❑limited ❑General 'RIGHTTHUMBPRNT ,RIGfi,THUtABP,RRdr — El Attorney in Fact O=SIGNERS ❑Attorney in Fact ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other. Signer Is Representing: Signer Is Representing: 1. -• u,�:c,-w+=cx-e-wax-cwtw ex<exe--c.�c>u^wu: .e^www�=<x-ew<-t:ux-.-u^<<e^w^wwrcx-e*=s�cx,ex-c :u^w+-�'w .tecct a 200]National Notary Association•93500e Soto Ave.,P.O.Bon 2402•Chatslwrth,CA 91313-2402 wvnyNatonalNotaryorg Near 55907 Reorder.Cal TA-Free 1.&O.876. 27 / THE HANOVER INSURANCE COMPANY • MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint MICHAEL R LANGAN Of Pasadena,CA and each is a true and lawful Attomey(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf, and as its act and deed any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Ten Million and No/100($10,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attomey(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: "RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14,1982—Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of Amenca) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice President and an Assistant Vice President,this 12th day of July, 2010. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY .,,,"1"""• k� wW CITIZEN SURANCE COMPANY OF AMERICA ( ,J) ( :• la ® 1Yf{ , F;"r Mary Jeanne'.id— on.Vice Preside k (P � I'� Robert K.Grennan.Assistan ice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER )ss. On this 12th day of July, 2010 before me came the above named Vice President and Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. , ^ 3 was wawa 761:1 a/,4n d.. ,)UaP/->/- ,\ i�++ - ;Votary Public worreerx.a • , . My commission expires on November 3,2011 I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED, That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company,shall be binding on the Company to the same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14, 1982 Massachusetts Bay Insurance Company;Adopted September 7,2001 - Citizens Insurance Company of America) /\ Ay' n GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this day of n V• ,20 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY . CITE S INSU' •' CE CO PANY OF •ERICA • ' . Ste .Brawl, •ssistant Vice Pres•nl r CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 r••• ry v:rr •rrr,V rrr• v-V'S•.-r••rrV r.••r•.i •r•rrr , r'v r•••v:•C r rr.•--•a 91 r State of California v5 r County of oaoar.e 9 rOn ty' t r,I I t. before me, taan.us c {7n�Sore5 S 0 to Here Insert Name and Title of the Officer S personally appeared iJ t7 1 r a- ■GIN aswTO S Name(s)of Signer(s) V ( 9 E who proved to me on the basis of satisfactory r evidence to be the person(%) whose name(t) is/are g subscribed to the within instrument and acknowledged S to me that he/slice/ttrey executed the same in CHARLES B. PARSONS his/I-Pr/their authorized capacity(ias), and that by int@ Commission # 1943036 his/h¢r/tlfeir signature(G) on the instrument the S ' a ('aa Notary Public -California z person(%), or the entity upon behalf of which the 3 • z 41'j Orange County '- person(g) acted, executed the instrument. s.2 r• 3_ _ _ _ _ My Comm Expires Jul 30.201 6.r ry� r I certify under PENALTY OF PERJURY under the r laws of the State of California that the foregoing y r paragraph is true and correct. h r WITNESS my hand and official seal. g S t4 Signature: 0_,76:2- Place Notary Seal Above Signature of Notary Public 9 OPTIONAL 5 ( Though the information below is not required by law, it may prove valuable to persons relying on the document E, and could prevent fraudulent removal and reattachment of this form to another document. P, E Description of Attached Document V, • Title or Type of Document: 5 r Document Date: Number of Pages: l Signer(s) Other Than Named Above: S t 0,Claimed by Signer(s) s ? Signer's Name: Signer's Name: s • ❑ Corporate Officer — Title(s): ❑Corporate Officer — Title(s): S ❑ Individual •RIGHT THUMBPRINT ❑ Individual RIGHT THUMBPRINT 1 OF SIGNER' - OF SIGNER • ❑ Partner — ❑Limited ❑General Top of thumb here ❑ Partner — ❑Limited ❑General Top of thumb ere S r ❑ Attorney in Fact ❑Attorney in Fact r ❑ Trustee ❑Trustee i ❑ Guardian or Conservator ❑Guardian or Conservator S ❑ Other: ❑Other: S rr S t' 9 Signer Is Representing: - Signer Is Representing: 1 t 9 ©2010 National Notary Association•NationalNatary.org•1-800-us NOTARY(1-800-876-6827) Item$5907 ® A . DATE(MM/DDrrvYY) CERTIFICATE OF LIABILITY INSURANCE :11/19/2012 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 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 Mary J. Healy Poms & Associates Insurance Brokers, Inc. PHONE 818-449-9336 I FAX WC.No): 818)449-9321 (A/C No Fxtl• CA License #0814733 E-MAIL s:MHealy @pomsassoc.corn 5700 Canoga Ave. #400 INSURER(S)AFFORDING COVERAGE NAICf Woodland Hills CA 91367 INSURERA:Travelers Indemnity Co of CT 25682 INSURED INSURER 13:Travelers Prop & Cas Co of Amer 25674 INSURERC:Liberty Surplus Ins Corp 10725 Sancon Engineering, Inc. INSURERD: 5841 Engineer Drive INSURER E: Huntington Beach CA 92649 INSURERF: ' COVERAGES CERTIFICATE NUMBER:12-13 ALL LINES 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 SUER POLICY NUMBER (MM/DDY ) IMMIDOY/YYYY) LIMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR X DT22-CO-9181R93A-TCT-12 10/1/2012 10/1/2013 MEDEXP(Any one person) $ 5,000 PERSONAL SADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 'G�EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 A POLICY JECT I I LOC $ COMBINED SINGLE LIMIT 1,000,000 000,000 AUTOMOBILE LIABILITY (Ea accident) $ A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ■ SCHEDULED DT-810-9181R93A-TCT-12 10/1/2012 10/1/2013 BODILY INJURY(Per accident) $ AUTOS ■ NON-OWNED PROPERTY DAMAGE $AUTOS X HIRED AUTOS © AUTOS (Per accident) X Uninsured motorist combined $: UMBRELLA LIAB • _ OCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED X RETENTIONS 10,000 X DTSM-CUP-91B1R93A-TIL-12 10/1/2012 10/1/2013 8 WORKERS COMPENSATION X WC STATU- OTH- $ TORY LIMITS I ER - AND EMPLOYERS'LIABILITY YIN EL.EACH ACCIDENT S 1,000,000 ANY PROPRIETOR/PARTNEWEXECUTIVE Y N I A (Mandatory In NH)EXCLUDED? DTJUB-9818893-A-12 10/1/2012 10/1/2013 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory In If yes.describe and under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Contractor's Pollution TIE5F104833112 10/1/2012 10/1/2013 Each Claim $2,000,000 CLAIMS MADE POLICY Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Re: Old Town Sewer Lining Project, CIP No. SS0901-2, Project # C-06-5310-12 It is agreed that the City of Seal Beach, its officers, officials, employees, designated volunteers and agents are named as Additional Insured per the attached endorsement. It is further agreed that said insurance is Primary and that Waiver of Subrogation apply, per the attached endorsements. *10 Days Notice of Cancellation will apply for non-payment of premium. 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 Seal Beach 211 Eight Street AUTHORIZED REPRESENTATIVE Seal Beach, CA 90740 Mary Healy/MARY '7-7-7Q--t ce-- ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02S',ninnsnt Tha Arnan nama and Inn.,arm raniafarad marl.a of Af]non Travelers Indemnity Company of CT Policy No. DT22-CO-9181R93A-TCT-12 Eff : 10/01/2012 • INSURED: SANCON ENGINEERING, INC. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM(OUTPUT POLICY)COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL.PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART - MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART • PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation Com- date of the policy, of one or more of the mon Policy Condition are replaced by the follow- following: mg: (1) Nonpayment of premium, including 2. All Policies In Effect For 60 Days Or Less payment due on a prior policy we is- If this policy has been in effect for 60 days or sued and due during the current poi- less,and is not a renewal of a policy we have icy tens covering the same risks. previously issued, we may cancel this policy (2) Discovery of fraud or material misrep- by mailing or delivering to the first Named In- resentation by: sured at the mailing address shown in the a( ) Any insured or b his or her re - policy and to the producer of record,advance sentative in obtaining this insur- written notice of cancellation, stating the rea- ance;or son for cancellation,at least a. 10 days before the effective date of can- (b) You or your representative in pursuing if we cancel for. pursuing a claim under this pol- cellation (1) Nonpayment of premium;or (3) A judgment by a court or an adminis- (2) Discovery of fraud by: trative tribunal that you have violated (a) Any insured or his or her repre a California or Federal law, having as sentative in obtaining this insur- one of its necessary elements an act ance; or which materially increases any of the (b) You or your representative in risks insured against. ti pursuing a claim under this poi- (4) Discovery of willful or grossly negli- icy gent acts or omissions, or of any vio- lations of state laws or regulations es- b. 30 days tablishing safety standards, by you or collation if we cancel for any other rea- your representative, which materially son. increase any of the risks insured 3. All Policies In Effect For More Than 60 against. Days (5) Failure by you or your representative a. If this policy has been in effect for more to implement reasonable loss control than 60 days, or Is a renewal of a policy requirements, agreed to by you as a we issued, we may cancel this policy only condition of policy issuance, or which upon the occurrence, after the effective were conditions precedent to our use of a particular rate or rating plan, If • IL 02 70 09 08 ®ISO Properties, Inc., 2007 Page 1 of 3 that failure materially increases any cel this coverage for any reason, except of the risks Insured against. as provided In b.and c.below. (6) A determination by the Commissioner b. We may not cancel this policy solely be- of Insurance that the: cause the first Named Insured has: (a) Loss of, or changes in, our rein- (1) Accepted an offer of earthquake cov- surance covering all or part of the erage;or risk would threaten our financial •integrity or solvency;or (2) Cancelled thor e did not renew t policy issued by the California C Earthquake (b) Continuation of the policy cover- Authority (CEA) that included an age would: earthquake policy premium sur- (I) Place us in violation of Call- charge. fomia law or the laws of the However, we shall cancel this policy if the state where we are domi- first Named Insured has accepted a new cried;or or renewal policy issued by the CEA that (II) Threaten our solvency. includes an earthquake policy premium 7 A change by your P surcharge but fails to pay the earthquake ( ) g y you or our re resenta- policy premium surcharge authorized by five in the activities or property of the the CEA. commercial or industrial enterprise, c. We may not cancel such coverage solely which results in a materially added, because corrosive soil conditions exist on increased or changed risk, unless the the premises.This Restriction (c.)applies added, increased or changed risk is only if coverage is subject to one of the included in the policy. following, which exclude loss or damage b. We will mail or deliver advance written caused by or resulting from corrosive soil notice of cancellation, stating the reason conditions: for cancellation, to the first Named In- (1) Capital Assets Program Coverage sured, at the mailing address shown in Form(Output Policy); the policy, and to the producer of record, at least: (2) Commercial Property Coverage Part (1) 10 days before the effective date of —Causes Of Loss—Special Form;or cancellation if we cancel for nonpay- (3) Farm Coverage Part — Causes Of ment of premium or discovery of Loss Form — Farm Property, Para- fraud;or graph D. Covered Causes Of Loss — (2) 30 days before the effective date of Special. cancellation if we cancel for any other C. The following is added and supersedes any pro- reason listed in Paragraph 3.a. visions to the contrary: B. The following provision is added to the Cannella- NONRENEWAL tion Common Policy Condition: 1. Subject to the provisions of Paragraphs C.2. 7. Residential Property and C.3. below, if we elect not to renew this This provision applies to coverage on real policy, we will mail or deliver written notice stating property which is used predominantly for the reason for nonrenewal to the first residential purposes and consisting of not Named Insured shown in the Declarations more than four dwelling units, and to cover- and to the producer of record, at least 60 age on tenants' household personal property days, but not more than 120 days, before the in a residential unit, if such coverage Is writ- expiration or anniversary date. • ten under one of the following: We will mail or deliver our notice to the first Commercial Property Coverage Part Named Insured, and to the producer of re- cord, at the mailing address shown in the pol- Farm Coverage Part—Farm Property—Farm Icy. Dwellings, Appurtenant Structures And 2. Residential Property Household Personal Property Coverage Form a. If such coverage has been in effect for 60 This provision applies to coverage on real days or less, and Is not a renewal of coy- property used predominantly for residential a erage we previously issued, we may can- purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential Page 2 of 3 ®ISO Properties, Inc.,2007 IL 02 70 09 08 unit, If such coverage is written under one of and equitable, and that Is responsive the following: to the changes in our reinsurance po- Capital Assets Program (Output Policy) Coy- siflon. erage Part c. We will not refuse to renew such cover- Commercial Property Coverage Part age solely because the first Named In- Farm Coverage Part—Farm Property—Farm sued has cancelled or did not renew a Earth- Dwellings, Appurtenant Structures And quake, Issued by the Coded an earth- Household Personal Property Coverage Form quake policy premium that included g . earth- Household policy premium suroharge. a. We may elect not to renew such cover- d. We will not refuse to renew such cover- age for any reason,except as provided In age solely because corrosive soil condi- b.,C.and d.below: Lions exist on the premises. This Restric- b. We will not refuse to renew such cover- tlon (d.) applies only if coverage Is sub- age solely because the first Named In- ject to one of the following,which exclude sured has accepted an offer of earth- loss or damage caused by or resulting quake coverage. from corrosive soil conditions: However, the following applies only to in- (1) Capital Assets Program Coverage surers who are associate participating In- Form(Output Policy); surers as established by Cal. Ins. Code 2 Section 10089.16. We may elect not to 1 1 —CauseciOl Loss—S Coverage Part —Causes Of Loss—Special Form;or renew such coverage after the first (3) Farm Coverage Part — Causes Of Named Insured has accepted an offer of earthquake coverage, if one or more of Loss Form — Farm Property, Para- the following reasons applies: graph D. Covered Causes Of Loss — (1) The nonrenewal is based on sound Special. underwriting principles that relate to 3. We are not required to send notice of nonre- the coverages provided by this policy newel in the following situations: and that are consistent with the ap- a. If the transfer or renewal of a policy, with- proved rating plan and related docu- out any changes in terms, conditions, or ments filed with the Department of rates, is between us and a member of our Insurance as required by existing law; insurance group. (2) The Commissioner of Insurance finds b. If the policy has been extended for 90 that the exposure to potential losses days or less, provided that notice has will threaten our solvency or place us been given in accordance with Paragraph in a hazardous condition. A hazard- C.1. ous condition Includes, but is not Ikn- c. If you have obtained replacement cover- Ited to, a condition in which we make age, or if the first Named Insured has claims payments for losses resulting agreed, in writing, within 60 days of the from an earthquake that occurred termination of the policy, to obtain that within the preceding two years and coverage. that required a reduction In policy- d. If the policy is for a holder surplus of at least 25% for po icy period of no more payment of those claims;or than 60 days and you are notified at the re- (3) We have: time of issuance that it will not be re- newed. (a) Lost or experienced a substantial e. If the first Named Insured requests a reduction in the availability or change in the terms or conditions or risks scope of reinsurance coverage; covered by the policy within 60 days of or the end of the policy period. (b) Experienced a substantial in- f. If we have made a written offer to the first crease in the premium charged Named Insured, in accordance with the for reinsurance coverage of our timeframes shown in Paragraph C.1., to residential property insurance renew the policy under changed terms or policies;and conditions or at an Increased premium the Commissioner has approved a rate,when the increase exceeds 25%. plan for the nonrenewals that Is fair IL 02 70 09 08 ®ISO Properties, Inc.,2007 Page 3 of 3 Sancon Engineering, Inc. Travelers Indemnity Company of CT COMMERCIAL AUTO Policy#DT-810-9181R93A-TCT-12 Eff : 10/01/2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT 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 modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE-This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE-INCREASED LIMIT B. BLANKET ADDITIONAL INSURED I. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES-INCREASED LIMIT C. EMPLOYEE HIRED AUTO J. PERSONAL EFFECTS D. EMPLOYEES AS INSURED K. AIRBAGS E. SUPPLEMENTARY PAYMENTS - INCREASED L. NOTICE AND KNOWLEDGE OF ACCIDENT LIMITS OR LOSS F. HIRED AUTO - LIMITED WORLDWIDE M. BLANKET WAIVER OF SUBROGATION COVERAGE-INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE-GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED executed by you before the "bodily injury" or The following is added to Paragraph A.1., Who Is "property damage" occurs and that is in effect An Insured, of SECTION II - LIABILITY COV- during the policy period, to be named as an addi- ERAGE: tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance Any organization you newly acquire or form dur- applies and only to the extent that person or or- ing the policy period over which you maintain ganization qualifies as an "insured" under the 50% or more ownership interest and that is not Who Is An Insured provision contained in Section separately Insured for Business Auto Coverage. II Coverage under this provision is afforded only un- C EMPLOYEE HIRED AUTO til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- 1. The following is added to Paragraph Al.,. ever is earlier. Who Is An Insured, of SECTION II - LI- B. BLANKET ADDITIONAL INSURED ABILITY COVERAGE: The following is added to Paragraph e. in A.1., An "employee" of yours is an "insured" while Who Is An Insured, of SECTION II- LIABILITY operating an "auto" hired or rented under a COVERAGE: contract or agreement in that "employee's" name, with your permission, while performing Any person or organization who is required under duties related to the conduct of your busi- a written contract or agreement between you and ness. that person or organization, that is signed and CA T3 53 06 09 ©2009 The Travelers Companies,Inc. Page 1 of 4 Includes the copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., United States of America applies to and pro- Other Insurance, of SECTION IV — BUSI- hibits the transaction of business with or NESS AUTO CONDITIONS: within such country or jurisdiction, for Liability b. For Hired Auto Physical Damage Cover- Coverage for any covered "auto" that you age, the following are deemed to be coy- lease, hire, rent or borrow without a driver for • ered "autos"you own: a period of 30 days or less and that is not an (1) Any covered "auto" you lease, hire, "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are rent or borrow;and a partnership), members (if you are a limited (2) Any covered "auto" hired or rented by liability company) or members of their house- your "employee" under a contract in holds. that individual "employee's" name, (1) With respect to any claim made or "suit" with your permission, while perform- brought outside the United States of ing duties related to the conduct of America, the territories and possessions your business. of the United States of America, Puerto However, any "auto" that is leased, hired, Rico and Canada: rented or borrowed with a driver is not a (a) You must arrange to defend the covered"auto". "insured" against, and investigate D. EMPLOYEES AS INSURED or settle any such claim or "suit" -- The following is added to Paragraph A.1., Who Is and keep us advised of all pro- An Insured, of SECTION II — LIABILITY COV- ceedings and actions. ERAGE: (b) Neither you nor any other in- . Any"employee" of yours is an "insured" while us- volved "insured" will make any • ing a covered "auto"you don't own, hire or borrow settlement without our consent. in your business or your personal affairs. (c) We may, at our discretion, par- E. SUPPLEMENTARY PAYMENTS — INCREASED against,in defending the "insured" LIMITS against, or in the settlement of, any claim or"suit". 1. The following replaces Paragraph A.2.a.(2), of SECTION II—LIABILITY COVERAGE: (d) We will reimburse the"insured": (2) Up to $3,000 for cost of bail bonds (in- (I) For sums that the "insured" cluding bonds for related traffic law viola- legally must pay as damages or tions) required because of an "accident" because of "bodily injury" h we cover. We do not have to furnish this insurance damage" to which these bonds. this insurance applies, that the "insured" pays with our 2. The following replaces Paragraph A.2.a.(4), consent, but only up to the of SECTION II—LIABILITY COVERAGE: limit described in Paragraph (4) All reasonable expenses incurred by the C., Limit II — LIABILITY Y of "insured" at our request, including actual SECTION II — LIABILITY loss of earnings up to $500 a day be- cause COVERAGE; of time off from work. (II) For the reasonable expenses incurred with our consent for F. HIRED AUTO — LIMITED WORLDWIDE COV- your investigation of such ERAGE—INDEMNITY BASIS claims and your defense of The following replaces Subparagraph e. in Para- the "insured" against any graph B.7., Policy Term, Coverage Territory, of such"suit", but only up to and SECTION IV—BUSINESS AUTO CONDITIONS: included within the limit de- e. Anywhere in the world, except any country or scribed in Paragraph C., Limit jurisdiction while any trade sanction, em- Of Insurance, of SECTION II bargo, or similar regulation imposed by the — LIABILITY COVERAGE, Page 2 of 4 02009 The Travelers Companies,Inc. CA T3 53 06 09 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO and not in addition to such I. PHYSICAL DAMAGE — TRANSPORTATION limit. Our duty to make such EXPENSES—INCREASED LIMIT payments ends when we The following replaces the first sentence in Para- have used up the applicable graph A.4.a., Transportation Expenses, of SEC- limit of insurance in payments TION III—PHYSICAL DAMAGE COVERAGE: for damages, settlements or defense expenses. We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- (2) This insurance is excess over any valid curred by you because of the total theft of a cov- and collectible other insurance available ered "auto"of the private passenger type. to the "insured" whether primary, excess PERSONAL EFFECTS J.contingent or on any other basis. (3) This insurance is not a substitute for re- The following is added to Paragraph A.4„ Cover- quired or compulsory insurance in any age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: country outside the United States, its ter- ritories and possessions, Puerto Rico and Personal Effects Canada. We will pay up to $400 for "loss" to wearing ap- You agree to maintain all required or parel and other personal effects which are: compulsory insurance in any such coun- (1) Owned by an "insured': and try up to the minimum limits required by (2) In or on your covered "auto". local law. Your failure to comply with • compulsory insurance requirements will This coverage applies only in the event of a total not invalidate the coverage afforded by theft of your covered "auto". this policy, but we will only be liable to the No deductibles apply to this Personal Effects same extent we would have been liable coverage. had you complied with the compulsory in- K. AIRBAGS surance requirements. The following Is added to Paragraph B.3., Exclu- (4) It is understood that we are not an admit- slons, of SECTION III — PHYSICAL DAMAGE ted or authorized insurer outside the COVERAGE: United States of America, its territories Exclusion 3.a. does not apply to "loss" to one or and possessions, Puerto Rico and Can- more airbags in a covered "auto"you own that in- ada.We assume no responsibility for the flate due to a cause other than a cause of"loss" furnishing of certificates of insurance, or set forth in Paragraphs A.1.b. and A.1.c., but for compliance in any way with the laws only: of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE—GLASS a. If that "auto" is a covered "auto"for Compre- hensive Coverage under this policy; The following is added to Paragraph D., Deducts- b. The airbags are not covered under any war- ble, of SECTION Ill — PHYSICAL DAMAGE ranty; and COVERAGE: e. The airbags were not Intentionally inflated. No deductible for a covered "auto" will apply to We will pay up to a maximum of $1,000 for any glass damage if the glass is repaired rather than one "loss". replaced. L. NOTICE AND KNOWLEDGE OF ACCIDENT OR H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF LOSS USE—INCREASED LIMIT The following is added to Paragraph A.2.a., of The following replaces the last sentence of Para- SECTION IV—BUSINESS AUTO CONDITIONS: graph A.4.b., Loss Of Use Expenses, of SEC- TION III—PHYSICAL DAMAGE COVERAGE: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- However, the most we will pay for any expenses plies only when the "accident" or "loss" is known for loss of use is $65 per day, to a maximum of to: $750 for any one "accident". (a) You (if you are an individual); CA T3 53 06 09 02009 The Travelers Companies,Inc. Page 3 of 4 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO (b) A partner(if you are a partnership); tent'required of you by a written contract (c) A member (if you are a limited liability corn- signed and executed prior to any "accident" pany); or"loss", provided that the "accident"or"loss' arises out of operations contemplated by (d) An executive officer, director or insurance manager(if you are a corporation or other or- such contract. The waiver d applies only to the person or organization designated in such ganization); or contract. (e) Any "employee"authorized by you to give no- N. UNINTENTIONAL ERRORS OR OMISSIONS tice of the"accident" or"loss". M. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of The following replaces Paragraph A.5., Transfer SECTION IV—BUSINESS AUTO CONDITIONS: Of Rights Of Recovery Against Others To Us, The unintentional omission of, or unintentional of SECTION IV — BUSINESS AUTO CONDI- error in, any information given by you shall not TIONS: prejudice your rights under this insurance. How- 5. Transfer Of Rights Of Recovery Against ever this provision does not affect our right to col- Others To Us lect additional premium or exercise our right of We waive any right of recovery we may have cancellation or non-renewal. against any person or organization to the ex- Page 4 of 4 ©2009 The Travelers Companies,Inc. CA T3 53 06 09 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. • Sancon Engineering, Inc. Travelers Property Casualty Company of America COMMERCIAL GENERAL LIABILITY Policy# DT22-CO-9181R93A-TCT-12 Eff : 10 Ol 2012 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. WHO IS AN INSURED — (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring Insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and Included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage Is caused by acts or omissions of "bodily injury" or "property damage" that oc- — you or your subcontractor In the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional Insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this Insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- I. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- rence" or an offense which may result in a II. Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 C 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we Ii. The names and addresses of any Injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by III. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. I. Immediately record the specifics of the -DEFINITIONS: claim or"suit" and the date received; and "Written contract requiring insurance" means II. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit"as person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the"personal injury" is caused by an send us copies of all legal papers received in offense committed: - connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to e. Before the end of the policy period. Page 2 of 2 ®2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 Sancon Eggineering,Inc. Travelers Property Casualty Co. of America Policy#DT22-CO-9181R93A-TCT-12 Eff : 10/01/2012 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE-Provisions A.-H. and J.-N.of this endorsement broaden coverage, and provision I. of this endorsement may limit coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the PROVISIONS of this endorsement carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured H. Additional Insured-State or Political Subdivisions B. Extension of Coverage-Damage To Premises I. Other Insurance Condition Rented To You J. Increased Supplementary Payments • Perils of fire, explosion, lightning, smoke, water • Cost of bail bonds increased to$2,500 • Limit increased to $300,000 • Loss of earnings increased to $500 per day - • C. Blanket Waiver of Subrogation K. Knowledge and Notice of Occurrence or Offense D. Blanket Additional Insured-Managers or Lessors L. Unintentional Omission of Premises M. Personal Injury-Assumed by Contract E. Incidental Medical Malpractice N. Blanket Additional Insured-Lessor of Leased F. Extension of Coverage-Bodily Injury Equipment G. Contractual Liability-Railroads PROVISIONS 3. This Provision A. does not apply to any per- A. BROADENED NAMED INSURED son or organization for which coverage is ex- cluded by endorsement. 1. The Named Insured in Item 1. of the Declara- tions is as follows: B. EXTENSION OF COVERAGE - DAMAGE TO PREMISES RENTED TO YOU The person or organization named in Item 1. of the Declarations and any organization, 1. The last paragraph of COVERAGE A. BOD- other than a partnership, joint venture or lim- ILY INJURY AND PROPERTY DAMAGE LI- ited liability company, of which you maintain ABILITY (Section I - Coverages) is deleted ownership or in which you maintain the major- and replaced by the following: ity interest on the effective date of the policy. Exclusions c.through n. do not apply to dam- However, coverage for any such additional age to premises while rented to you, or tern- organization will cease as of the date, if any, porarily occupied by you with permission of during the policy period, that you no longer the owner,caused by: maintain ownership of, or the majority interest a. Fire; in, such organization. b. Explosion; 2. WHO IS AN INSURED (Section II) Item 4.a. is deleted and replaced by the following: c. Lightning; a. Coverage under this provision is afforded d. Smoke resulting from such fire,explosion, only until the 180th day after you acquire or lightning;or or form the organization or the end of the e. Water. • policy period, whichever is earlier. A separate limit of insurance applies to this coverage as described in Section III Limits Of Insurance. CG D3 16 07 04 Copyright,The Travelers Indemnity Company, 2004 Page 1 of 6 COMMERCIAL GENERAL LIABILITY 2. This insurance does not apply to damage to 5. This Provision B. does not apply if coverage premises while rented to you, or temporarily for Damage To Premises Rented To You of occupied by you with permission of the COVERAGE A. BODILY INJURY AND owner,caused by: PROPERTY DAMAGE LIABILITY (Section I- a. Rupture, bursting, or operation of pres- Coverages) is excluded by endorsement. sure relief devices; C. BLANKET WAIVER OF SUBROGATION b. Rupture or bursting due to expansion or We waive any right of recovery we may have swelling of the contents of any building or against any person or organization because of structure, caused by or resulting from wa- payments we make for injury or damage arising ter; out of: premises owned or occupied by or rented c. Explosion of steam boilers, steam pipes, or loaned to you; ongoing operations performed steam engines, or steam turbines. by you or on your behalf, done under a contract with that person or organization; "your work"; or 3. Paragraph 6. of LIMITS OF INSURANCE "your products". We waive this right where you (Section III) is deleted and replaced by the have agreed to do so as part of a written contract, following: executed by you before the "bodily injury" or Subject to 5. above, the Damage To Prem- "property damage" occurs or the "personal injury" ises Rented To You Limit is the most we will or"advertising injury"offense is committed. pay under COVERAGE A. for the sum of all D. BLANKET ADDITIONAL INSURED - MANAG• - damages because of "property damage" to ERS OR LESSORS OF PREMISES any one premises while rented to you, or temporarily occupied by you with permission WHO IS AN INSURED (Section II) is amended to of the owner, caused by:fire; explosion; light- include as an insured any person or organization ning; smoke resulting from such fire, explo- (referred to below as "additional insured") with Sion, or lightning; or water. The Damage To whom you have agreed in a written contract, exe- Premises Rented To You Limit will apply to all cuted before the "bodily injury" or "property dam- "property damage" proximately caused by the age" occurs or the "personal injury" or "advertis- same "occurrence", whether such damage ing injury" offense is committed, to name as an results from: fire; explosion; lightning; smoke additional insured, but only with respect to liability resulting from such fire, explosion, or light- arising out of the ownership, maintenance or use Wing; or water; or any combination of any of of that part of any premises leased to you, subject these causes. to the following provisions: The Damage To Premises Rented To You 1. Limits of Insurance. The limits of insurance Limit will be the higher of: afforded to the additional insured shall be the limits which you agreed to provide in the writ- a. $300,000; or ten contract, or the limits shown on the Decla- b. The amount shown on the Declarations rations,whichever are less. for Damage To Premises Rented To You 2. The insurance afforded to the additional in- Limit. sured does not apply to: 4. Paragraph a. of the definition of"insured con- a. Any "bodily injury" or "property damage" tract" (DEFINITIONS - Section V) is deleted that occurs, or"personal injury"or"adver- and replaced by the following: tising injury" caused by an offense which a. A contract for a lease of premises. How- is committed, after you cease to be a ten- ever, that portion of the contract for a ant in that premises; lease of premises that indemnifies any b. Any premises for which coverage is ex- person or organization for damage to cluded by endorsement;or premises while rented to you, or tempo- c. Structural alterations, new construction or rarily occupied by you with permission of the owner, caused by: fire; explosion; demolition operations performed by or on lightning; smoke resulting from such fire, behalf of such additional insured. explosion, or lightning; or water, is not an 3. The insurance afforded to the additional in- "insured contract"; sured is excess over any valid and collectible Page 2 of 6 Copyright,The Travelers Indemnity Company, 2004 CG D3 16 07 04 COMMERCIAL GENERAL LIABILITY "other insurance" available to such additional together with all related acts or omissions in insured, unless you have agreed in the writ- the furnishing of the services described in ten contract that this insurance must be pri- paragraph 1. above to any one person will be mary to, or non-contributory with, such "other deemed one"occurrence". insurance". 5. This Provision E. does not apply if you are in E. INCIDENTAL MEDICAL MALPRACTICE the business or occupation of providing any of 1. The following is added to paragraph 1. lnsur- the services described in paragraph 1. above. ing Agreement of COVERAGE A. — BODILY 6. The insurance provided by this Provision E. INJURY AND PROPERTY DAMAGE LIABIL- shall be excess over any valid and collectible ITY(Section I—Coverages): "other insurance" available to the insured, "Bodily injury" arising out of the rendering of, whether primary, excess, contingent or on or failure to render, the following will be any other basis, except for insurance that you deemed to be caused by an"occurrence": bought specifically to apply in excess of the Limits of Insurance shown on the Declare- a. Medical, surgical, dental, laboratory, x-ray tions of this Coverage Part. or nursing service, advice or instruction, or the related furnishing of food or Bever- F. EXTENSION OF COVERAGE — BODILY IN. ages; JURY b. The furnishing or dispensing of drugs or The definition of "bodily injury" (DEFINITIONS — medical, dental, or surgical supplies or Section V) is deleted and replaced by the follow- appliances; ing: c. First aid; or "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- d. "Good Samaritan services." As used in miliation, sickness or disease sustained by a per- this Provision E., "Good Samaritan ser- son,including death resulting from any of these at vices" are those medical services ren- any time. dered or provided in an emergency and G. CONTRACTUAL LIABILITY—RAILROADS for which no remuneration is demanded or received. 1. Paragraph c. of the definition of"insured con- 2. Paragraph 2.a.(1)(d) of WHO IS AN IN- tract" (DEFINITIONS — Section V) is deleted SURED (Section II) does not apply to any and replaced by the following: registered nurse, licensed practical nurse, c. Any easement or license agreement; emergency medical technician or paramedic 2. Paragraph f.(1) of the definition of "insured employed by you, but only while performing contract" (DEFINITIONS — Section V) is de- the services described in paragraph 1. above leted. and while acting within the scope of their em- H. ADDITIONAL INSURED — STATE OR POLITI- ployment by you. Any "employees" rendering CAL ADDITIONAL INSURED —PERMITS "Good Samaritan services" will be deemed to be acting within the scope of their employ- WHO IS AN INSURED (Section II)is amended to ment by you. include as an insured any state or political subdi- 3. The following exclusion is added to paragraph vision, subject to the following provisions: 2. Exclusions of COVERAGE A. — BODILY 1. This insurance applies only when required to INJURY AND PROPERTY DAMAGE LIABIL- be provided by you by an ordinance, law or ITY(Section I—Coverages): building code and only with respect to opera- (This insurance does not apply to:) "Bodily in- tions performed by you or on your behalf for jury" or "property damage" arising out of the which the state or political subdivision has is- willful violation of a penal statute or ordinance sued a permit. relating to the sale of pharmaceuticals corn- 2. This insurance does not apply to: miffed by or with the knowledge or consent of a. "Bodily injury," "property damage," "per- the insured. sonal injury" or"advertising injury" arising 4. For the purposes of determining the applica- out of operations performed for the state ble limits of insurance, any act or omission or political subdivision; or CG D3 16 07 04 Copyright, The Travelers Indemnity Company, 2004 Page 3 of 6 COMMERCIAL GENERAL LIABILITY b. "Bodily injury" or "property damage" in- insured under any other policy, cluded in the "products-completed opera- including any umbrella or excess tions hazard". policy. I. OTHER INSURANCE CONDITION When this insurance is excess, we A. COMMERCIAL GENERAL LIABILITY CON- will have no duty under inured Coverages A DITIONS (Section IV), paragraph 4. (Other or B to defend any the insured"other is deleted and replaced by the fol- any "suit" if any duty d defend"dtthe in- Insurance) P Y surance" has a duly to defend the in- lowing: sured against that "suit". If no pro- 4. Other Insurance vider of "other insurance" defends, If valid and collectible "other insurance" is we will undertake to do so, but we will available to the insured for a loss we ae entitled to the insured's rights a against all those providers of "other cover under Coverages A or B of this insurance". Coverage Part, our obligations are limited as follows: When this insurance is excess over "other insurance", we will pay only a. Primary Insurance our share of the amount of the loss, if This insurance is primary except any, that exceeds the sum of: when b. below applies, If this insur- (1) The total amount that all such ance is primary, our obligations are "other insurance" would pay for not affected unless any of the "other the loss in the absence of this in- insurance" is also primary. Then, we surance; and will share with all that "other insur- ance" by the method described in c. (2) The total of all deductible and below. self-insured amounts under that "other insurance". b. Excess Insurance We will share the remaining loss, if This insurance is excess over any of any,with any"other insurance"that is the "other insurance", whether pri- not described in this Excess Insur- mary, excess, contingent or on any ance provision. other basis: c. Method Of Sharing (1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk, If all of the "other insurance" permits or similar coverage for "your contribution by equal shares, we will work"; follow this method also. Under this (2) That is Fire insurance for rem- approach each provider of insurance ( ) P contributes equal amounts until it has ises rented to you or temporarily paid its applicable limit of insurance occupied by you with permission or none of the loss remains, which- of the owner; ever comes first. (3) That is insurance purchased by If any of the "other insurance" does you to cover your liability as a not permit contribution by equal tenant for "property damage" to shares, we will contribute by limits. premises rented to you or tempo- Under this method, the share of each rarily occupied by you with per- provider of insurance is based on the mission of the owner; or ratio of its applicable limit of insur- (4) If the loss arises out of the main- ance to the total applicable limits of tenance or use of aircraft, insurance of all providers of insur- "autos", or watercraft to the ex- ance. tent not subject to Exclusion g. of B. The following definition is added to DEFINITIONS Section I — Coverage A — Bodily (Section V): Injury And Property Damage Li- ability; or "Other insurance": (5) That is available to the insured a. Means insurance, or the funding of losses, when the insured is an additional that is provided by,through or on behalf of: Page 4 of 6 Copyright,The Travelers Indemnity Company, 2004 CG D3 16 07 04 • COMMERCIAL GENERAL LIABILITY (1) Another insurance company; 2. Notice of an "occurrence" or of an offense (2) Us or any of our affiliated insurance corn- which may result in a claim will be deemed to panies, except when the Non cumulation be given as soon as practicable to us if it is of Each Occurrence Limit section of given in good faith as soon as practicable to Paragraph 5 of LIMITS OF INSURANCE your workers' compensation insurer. This ap- (Section III)or the Non cumulation of Per- plies only if you subsequently give notice of sonal and Advertising Injury limit sections the "occurrence" or offense to us as soon as of Paragraph 4 of LIMITS OF INSUR- practicable after you, one of your "executive ANCE (Section III)applies; officers" (if you are a corporation), one of your partners who is an individual (if you are a . (3) Any risk retention group; partnership),one of your managers(if you are (4) Any self-insurance method or program, a limited liability company), or an "employee" other than any funded by you and over (such as an insurance, loss control or risk which this Coverage Part applies; or manager or administrator) designated by you (5) Any similar risk transfer or risk manage- to give such notice discovers that the "occur- merit method. rence"or offense may involve this policy. b. Does not Include umbrella insurance, or ex- 3. This Provision K. does not apply as respects cess insurance, that you bought specifically to the specific number of days within which you apply in excess of the Limits of Insurance are required to notify us in writing of the shown on the Declarations of this Coverage abrupt commencement of a discharge, re- Part. lease or escape of "pollutants" that causes "bodily injury" or "property damage" which J. INCREASED SUPPLEMENTARY PAYMENTS may otherwise be covered under this policy. Paragraphs 1.b. and 1.d. of SUPPLEMENTARY L. UNINTENTIONAL OMISSION PAYMENTS—COVERAGES A AND B (Section I The following is added to COMMERCIAL GEN- -Coverages)are amended as follows: GEN- ERAL LIABILITY CONDITIONS (Section IV), 1. In paragraph 1.b., the amount we will pay for paragraph 6. (Representations): the cost of bail bonds is increased to$2500. The unintentional omission of, or unintentional 2. In paragraph 1.d., the amount we will pay for error in, any information provided by you which loss of earnings is increased to$500 a day. we relied upon in issuing this policy shall not K. KNOWLEDGE AND NOTICE OF OCCUR- prejudice your rights under this insurance. How- RENCE OR OFFENSE ever, this Provision L. does not affect our right to 1. The following is added to COMMERCIAL collect additional premium or to exercise our right GENERAL LIABILITY CONDITIONS (Section of cancellation or nonrenewal in accordance with IV), paragraph 2. (Duties In The Event of Oc- applicable state insurance laws, codes or regula- currence, Offense, Claim or Suit): lions. Notice of an "occurrence" or of an offense M. PERSONAL INJURY — ASSUMED BY CON- which may result in a claim must be given as TRACT soon as practicable after knowledge of the 1. The following is added to Exclusion e. (1) of "occurrence" or offense has been reported to Paragraph 2., Exclusions of Coverage B. you, one of your "executive officers" (if you Personal Injury, Advertising Injury, and. are a corporation), one of your partners who Web Site Injury Liability of the Web XTEND is an individual (if you are a partnership), one Liability endorsement: of your managers (if you are a limited liability Solely for the purposes of liability assumed in company), or an "employee" (such as an in- an "insured contract", reasonable attorney surance, loss control or risk manager or ad- fees and necessary litigation expenses in- ministrator) designated by you to give such curred by or for a party other than an insured notice. are deemed to be damages because of "per- Knowledge by any other "employee" of an sonal injury"provided: "occurrence" or offense does not imply that (a) Liability to such party for, or for,the cost you also have such knowledge. of, that party's defense has also been as- CG D3 16 07 04 Copyright, The Travelers Indemnity Company, 2004 Page 5 of 6 COMMERCIAL GENERAL LIABILITY sumed in the same "insured contract"; N. BLANKET ADDITIONAL INSURED — LESSOR and OF LEASED EQUIPMENT (b) Such attorney fees and litigation ex- WHO IS AN INSURED (Section II) is amended to penses are for defense of that party include as an insured any person or organization against a civil or alternative dispute reso- (referred to below as "additional insured") with lution proceeding in which damages to whom you have agreed in a written contract, exe- which this insurance applies are alleged. cuted before the "bodily injury" or "property dam- 2. Paragraph 2.d. of SUPPLEMENTARY PAY- age" occurs or the "personal injury" or "advertis- MENTS —COVERAGES A AND B (Section I ing injury" offense is committed, to name as an — Coverages) is deleted and replaced by the additional insured, but only with respect to their li- following' ability for "bodily injury", "property damage", "per- sonal injury" or "advertising injury" caused, in d. The allegations in the "suit" and the in- whole or in part, by your acts or omissions in the formation we know about the "occur- maintenance, operation or use of equipment rence"or offense are such that no conflict leased to you by such additional insured, subject appears to exist between the interests of to the following provisions: the insured and the interests of the in- demnitee; 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the 3. The third sentence of Paragraph 2 of SUP- limits which you agreed to provide in the writ-. PLEMENTARY PAYMENTS — COVERAGES ten contract, or the limits shown on the Decla- A AND B (Section I — Coverages) is deleted rations,whichever are less. and replaced by the following: 2. The insurance afforded to the additional in- Notwithstanding the provisions of Paragraph sured does not apply to any "bodily injury" or 2.b.(2)of Section I— Coverage A— Bodily In- "property damage" that occurs, or "personal jury And Property Damage Liability, or the injury" or"advertising injury" caused by an of- provisions of Paragraph 2.01) of Section I — Tense which is committed, after the equipment Coverage B-Personal Injury, Advertising In- lease expires. jury And Web Site Injury Liability, such pay- ments will not be deemed to be damages for 3. The insurance afforded to the additional in- "bodily injury" and "property damage", or sured is excess over any valid and collectible damages for"personal injury", and will not re- "other insurance" available to such additional duce the limits of insurance. insured, unless you have agreed in the writ- ten contract that this insurance must be pri- 4. This provision M. does not apply if coverage mary to, or non-contributory with, such "other for "personal injury" liability is excluded by insurance". endorsement. Page 6 of 6 Copyright,The Travelers Indemnity Company, 2004 CG D3 16 07 04 TRAVELERS" WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA (BLANKET WAIVER) 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 this endorsement shall be 2 %of the California workers'compensation pre- mium. Schedule Person or Organization Job Description Any person for whom the Named Insured Blanket Waiver has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it Is attached end is effective on the date Issued unless otherwise stated. (TAe InTorma on below fs requl►ed only when this endorsement is Issued subsequent to preparation of the poky.] Endorsement Effective 10/1/12-13 Policy No. DTJUB-9818R-93—A-12 .Endorsement No. Insured Sancon Engineering, Inc. Premium INCL. insurance Company Travelers Indemnity Countersigned by Company of CT DATE OF ISSUE: 10/1/12 ST ASSIGN: CA Page 1 of 1 STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS [Business&Professions Code § 7028.15] [Public Contract Code §20103.5] 1, the undersigned, certify that I am aware of the following provisions of California law and that I, or the entity on whose behalf this certification is given,hold a currently valid California contractor's license as set forth below(required at time of award): Business&Professions Code § 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefore, except in any of the following cases: (I) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104 [now § 20103.5] of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section, the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months,or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract" for the purposes of this subdivision means the ) aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect, land surveyor, or registered professional engineer to form joint ventures with licensed contractors to render services within the scope of their respective practices. (e) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non-responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order, verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13, inclusive. Any contract awarded to, or any purchase order issued to,a contractor who is not licensed pursuant to this chapter is void. (f)- Any compliance or noncompliance with subdivision (e) of this section, as added by Chapter 863 of the Statutes of 1989, shall not invalidate any contract or bid awarded by a public agency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if �l the public employee, officer, or employing agency made an inquiry to the board for the purposes of Page D-93 AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS [Labor Code§§ 1720, 1773.8, 1775, 1776, 1777.5, 1813, 1860, 1861,37001 The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the Following provisions of California law and the Davis-Bacon and Related Acts (DBRA): • 1. Contractor acknowledges that this contract is subject to the provisions of Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code relating to public works and the awarding public agency("Agency")and agrees to be bound by all the provisions thereof as though set forth in full herein. 2. Contractor agrees to comply with the provisions of California Labor Code Section 1773.8 which requires the payment of travel and subsistence payments to each worker needed to execute the work to the extent required by law. • 3. Contractor agrees to comply with the provisions of California Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall,as a penalty to the Agency, forfeit not more than fifty dollars ($50) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the Director of Industrial Relations for the work or craft in which the worker is employed for any public work done under the contract by Contractor or by any subcontractor. 4. Contractor agrees to comply with the provisions of California Labor Code Section 1776 which require Contractor and each subcontractor to (I) keep accurate payroll records, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the Agency of the location of the records. The Contractor is responsible for compliance with Section 1776 by itself and all of its subcontractors. 5. Contractor agrees to comply with the provisions of California Labor Code Section 1777.5 concerning the employment of apprentices on public works projects, and further agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of Califomia Labor Code Section 1813 • concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the Agency, forfeit twenty-five dollars ($25) for each worker employed in the execution of the contract by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than 8 hours in any one calendar day and 40 hours in any one calendar week in violation of the provisions of Division 2, Part 7, Chapter I,Article 3 of the California Labor Code. 7. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861,Contractor hereby certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract" Date 1k•A el/2— Signature • • • Page D-96 Section C PROPOSAL Bidders Name S l9Nf ay- E,✓a,(Acre&r.va riv(, • TO THE HONORABLE MAYOR AND CITY COUNCIL OF THE CITY OF SEAL BEACH: The undersigned, as bidder, declares that: (1)-this proposal is made without collusion with any other person, firm or corporation, and that the only persons or parties interested as principals are those named herein as sworn in the attached Non-Collusion Affidavit; (2)-bidder has carefully examined the project Plans, Specifications, Instructions To Bidders, Proposal, Notice Inviting Sealed Bids and all other contract documents and information furnished therefore and the site of the proposed work; and (3)-bidder has investigated and is satisfied as to the conditions to be encountered, the character, quality and quantities of work to be performed and materials to be furnished. Furthermore, bidder agrees that submission of this proposal shall be conclusive evidence that such examination and investigation have been made and agrees, in the event this contract be awarded to bidder, to enter into a contract with the City Council of the CITY OF SEAL BEACH, to perform said proposed work in accordance with the Plans, if any, and the terms of the Specifications, in the time and manner therein prescribed, and to furnish or provide all materials, labor, tools, equipment, apparatus and other means necessary so to do, except such thereof as may otherwise be furnished or provided under the terms of said Specifications, for the following stated unit prices or lump sum price as submitted on the Bid Sheet herein. The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial Safety Record. This Safety Record must include all construction work undertaken in the State of California by the bidder and any partnership,joint venture or corporation that any principal of the bidder participated in as a principal or owner for the last five calendar years and the current calendar year prior to the date of bid submittal. Separate information shall be submitted for each such partnership,joint venture, or corporate or individual bidder. The bidder may attach any additional information or explanation of data which he would like to be taken into consideration in evaluating the safety record. An explanation of the circumstances surrounding any and all fatalities must be attached. Accompanying this proposal is (Circle one "cash", "a Cashier's Check", "a certified check", or ". idder en the form furnished by the City", as the case may be) in the amount of S/o 'C.F 0'4 an amount equal to at least ten percent (10%).of the total aggregate bid price based on the quantities shown and the unit prices quoted. The undersigned bidder agrees that should bidder be awarded the Contract on the basis hereof and thereafter fail or refuse to enter into a Contract and provide the required evidence of insurance and bonds within 15 calendar days after written notice of the award, the cash, check or bond shall be forfeited to the city in accordance with Public Contract Code section -20172, except as otherwise provided in Public Contract Code section-20174. The undersigned agrees that in the event of such failure,the actual amount of damages to the City would be impractical and extremely difficult to determine. In compliance with the Notice Inviting Sealed Bids,the undersigned hereby agrees to enter into a contract to furnish all labor,materials and supplies for OLD TOWN SEWER LINING(C.I.P.P.)PROJECT,CIP# SS0901-2, STATE PROJECT NO.C-06-5310-120 in accordance with the Specifications,Plans other Contract Documents which are on file in the office of the City Engineer of the CITY OF SEAL BEACH,to the satisfaction and under the direction of the City Engineer,at the following price. Completion by the undersigned is fixed at 100 working days starting from the day after the issuance of the Notice to Proceed. • Page C-I City of Seal Beach �' California PROPOSAL FOR Old Town Sewer Lining (C.I.P.P.) Project City CIF No. SS0901-2 State Project No. C-06-5310-120 Bid Opening Date: October 24, 2012 Wednesday, 10:00 AM BID SHEET Item No. Quantity Unit Description 1. 1 LS Mobilization and Demobilization, complete and in place, in the sum of ,, i s" 1t,,. ,1;, $ 2`190.1,02 Words,per LS 42,5 Wo....g4igures per LS Total (Figures) $ -2// ,,do 2._ (11 nLS Traffic Control, complette and in place, the sum of: Cite 71w45CGnJX 1-(-6 b LW&rtA de 4(5 $ 57 too- O° Words,per LS ca 1/4,45 Figures per LS Total (Figures) $ S>, UO 3. 663 EA Reinstate and repair lateral connections using Top Hats, coynplete anoi Vlace,the sum of: I !A"nQ frmC(la bor,u31/, 'frer os/ $ Q 17G/DO Words, per EA 72p 16:4 Figures per EA Total (Figures) $ G! 167 G6 2-•ctr) 4. 422 LF Furnish and install 12"Cured-In-Place-Pipe (C.I.P.P.) liner, S / L ® / complete and in place,the sum of: T7 7-(64414 G/9G/� 4 li. 3 of,.j 4w J7 ✓2 $ >, [ C ords, per LF egArk3 Figures per LF TO Total (Figures) $ 127 /3 Z. • Page C-2 • I Item No. Quantity Unit Description 5. 151 LF Furnish and install 10" Cured-In-Place-Pipe (C.I.P.P.) liner, complete and in place,the sum of: 76.:- 1- e94104 4S ' a—1 '-7-ero cej, $ 38- coo Wofds, per LF Figures per LF Total (Figures) $ S 733 co i 6. 12,981 LF Furnish and install 8"Cured-In-Place-Pipe(C.I.P.P.) liner,/ complete and in place, the sum of: $ �j 7 C,/ itse.hty �0 "no A'r,( 1 -Le- GQN{� $ _7-.2 ✓ /Words, per LF /// Figures per LF Total (Figures) $ '2---04;3 a z_.)-7. 2 S 7. 5,231 LF Furnish and install 6"Cured-In-Place-Pipe(C.I.P.P.) liner, complete and in place, the sum of: 7-4,-441 5 1c d��a 0i,,,4 22iO r $ 24.'co Wods,per LF Figures per LF Total (Figures) $ /740O6 CYO • 8. 22 LF Remove and Replace 6"VCP Sewer Main Complete in place, the sum of: .4/0(..-7.0- k42 J 44y obfre-a-.I U:r/ -- rn $ 96-2)-be, Words, per LF C.uvis Figures per LF Total (Figures) $ � 9(0 orn 9. 6 EA Construct Manhole and Replace concrete alley panels as required, complete and in place,the sum of: m;7 isy .-fisafrf,anri 6i Y- hnA.J 4 f a,--( o $ 13. 6 5-0-&I, Words, per EA 4-11 74 Figures per EA Total (Figures) $ (3 II 900 00 10. 119 EA Manhole lining and frame and grate replacement,complete /� and in place,th ,sum of: i 1a/ee, `�4arie J in. 4,-4,4721 `i'.r<l-.fr ,,,,„.Q $ 3, 4169. co Words, per EAO /Geyfa Figures per EA Total (Figures) $ C7(O C60 c,o • Page C-3 • Item No. Quantity Unit Description 1 1. 8 EA Construct CIPP Spot Repair, complete and in place,the sum of: O - 44,6e-a .P P 1 "MI o $ 1, 2 Ste. at Words, per EA €6-496 Figures per EA Total (Figures) $ (63 tY vo 12.c 3,859��.)J LF / Remove hard deposits from sewer �y�cy.� N i-Yp., tJ�ll>WI a.).7 GGvto $ /.K/ Words, per LF Figures per LF Total (Figures) $ • t'/ 73 h ®d TOTAL BID PRICE (ITEMS#1 through #12) of w., IC o„, 5 X- 1k,nketQ -11; "14- r— -�1� - tile- ien.fi-r i-47rIy 5,x ,p roa 1 67T t/ 5 36. 7 6— / WORDS 5 pa,c, ,i , / FIGURES ce. • IN CASE OF DISCREPANCY BETWEEN WORDS AND FIGURES,THE WORDS SHALL PREVAIL. • Page C-4 NOTE: The City reserves the right to award a contract to the lowest responsible bidder in parts or in its entirety and reserves the right to reject all bids and re-advertise, as appears to be in the best interests of the • City. A bid is required for this entire work,the estimated quantities set forth in this Bid Sheet being solely for the purpose of comparing bids, and final compensation under the Contract will be based upon the actual quantities of work satisfactorily completed. The unit and/or lump sum prices bid shall include all appurtenant expenses, taxes, royalties, and fees. In the case of discrepancies in the amount bid, unit prices shall govern over extended amounts, and words shall govern over figures. The City reserves the right to increase or decrease the amount of any quantity shown and to delete any item from the Contract. The undersigned bidder agrees that, if awarded the Contract,bidder will complete all work according to the contract documents. The undersigned bidder is licensed in accordance with the requirements of the Business and Professions Code, California Contractor's License No.- 73/777 '/f Class A or Paving/Earthwork(REQUIRED AT TIME OF AWARD). Legal Business Name of Bidder SANG O/✓ tAl///et-4 t/vf r.ve_ Business Address / trey-pa-nit OR. ////NT/A'ItDr /?L99-eN en 924#9 Business Tel.No. JJ J 7/N • F1/y/-2 31 3 Signature Date Title /,` _ / -- C I /"tn."- tn. gnat re - Date Title • • ( 4?S AP—/6 -/2 SAY/78-7;3 Signature Date Title If bidder is an individual, name and signature of individual must be provided, and, if he is doing business - under a fictitious name, the fictitious name must be set forth. If bidder is a partnership or joint venture, legal name of partnership/joint venture must be provided, followed by signatures of all of the partners/joint venturers or of fewer than all of the partners/joint venturers if submitted with evidence of authority to act on behalf of the partnership/joint venture. If bidder is a corporation, legal name of corporation must be provided, followed by signatures of the corporation President or Vice President and Secretary or Assistant Secretary, and the corporate seal. Signatures of partners,joint venturers, or corporation officers must be acknowledged before a Notary Public, who must certify that such partners,joint venturers, or officers are known to him or her to be such, and, in the case of a corporation, that such corporation executed the instrument pursuant to its bylaws or a resolution of its Board of Directors, • Page C-5 • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 • Sr• ..rr• •�'• rr•r v—rrr,r,ry—v'"r r r�;d—r,r•r'r rCC.�ry—y—r'r,Cv v—rr.�-�•a tState of California S t / t 2 f� County of 0a.+re On to I IS i it before me, GMnn per iS awn s owls rvorw r p e..c , s C. Date Here Insert Name and Title of the Officer kk 'l i personally appeared G1+rt,s 1): 0,a...1 a cI'r° r r4.c-r— -D‘‘i%c4.4 ssn.11-221 t Name(s)of Signer(s) Vc V, twho proved to me on the basis of satisfactory y t evidence to be the person(s) whose name(s) mare t subscribed to the within instrument and acknowledged 3 to me that he/${'le/they executed the same in • CHARLES B.PARSONS h$/her/their authorized capacity(ies), and that by e t Commission# 194303. Z y t a i�.� Notary Public-California > fy6/¢�r/their signatures) on the instrument the z ,. orange County person(s), or the entity upon behalf of which the t � � My Comm.Expires Jul 30.2015+ person(s) acted, executed the instrument. r I certify under PENALTY OF PERJURY under the e t laws of the State of California that the foregoing S t paragraph is true and correct. V, t WITNESS my hannd and offi al. t Signature: '— ', fQt t Place Notary Seal Above Signature of Notary Public V t OPTIONAL t Though the information below is not required by law, it may prove valuable to persons relying on the document V and could prevent fraudulent removal and reattachment of this form to another document V t Description of Attached Document t Title or Type of Document: 5 • Document Date: Number of Pages: r Signer(s) Other Than Named Above: S tCapacity(ies) Claimed by Signer(s) s tSigner's Name: __ Signer's Name: V ❑ Corporate Officer — Title(s): ❑Corporate Officer — Title(s): ❑ Individual RIGHT.THUMBPRINT 0 Individual RIGHT THUMBPRINT ' OF SIGNER.. - OF SIGNER ❑ Partner — ❑Limited O General Top of thumb here ❑Partner — ❑Limited ❑General Top of thumb here I t ❑ Attorney in Fact ❑Attorney in Fact ❑ Trustee ❑Trustee 3 • ❑ Guardian or Conservator ❑Guardian or Conservator s ❑ Other: ❑Other: V '. S 3 I Signer Is Representing: Signer Is Representing: V.i. 9 ©2010 National Notary Association•NationalNotary org•1-800-US NOTARY(1-800-816-6821) Item#5907 INFORMATION REQUIRED OF BIDDER • Bidder certifies under penalty of perjury under the laws of the State of California that the following information is true and correct: Name of individual Contractor, Company or Corporation: S R no-co s r /i✓t--ert 11,7 /,✓c Business Address: scg-H/ r v3/,mac e2 0n. Nun 7 fro✓ .l3I C/f fee 726 N I Telephone and Fax Number: 7/t/ - / -,? 3 2 3 F,9 X 7/y- f/ 2 4.-.4 California State Contractor's License No.and Class: 73/ 7 77 /-7 (REQUIRED AT TIME OF AWARD) Original Date Issued: /0 /7 Expiration Date: /- 3/ /? List the name and title/position of the person(s) who inspected for your firm the site of the work proposed in these contract documents: n4,Ta,✓t"'2 / 708 Fot,„„„ V/ld��i 4n4rvpfo'/✓ The following are the names, titles, addresses, and phone numbers of all individuals, firm members, partners,joint ventures, and company or corporate officers having a principal interest in this proposal: Name,Title Address and Telephone /v,c/S D,1.7r.r.vrV7-0 Pat's. /a32 coa,a? C.=zt on. NdA-i�✓r,ev /3mccM ca- 92cw9 5-62- S4z ooCx • _CHR,-c /9;B t rver/7o cc. /G S-6Z CO Mr t S..-r O/!, Hf�MI/t'Y Jane# na 9A6w1 957' 3SH-7o40/ Corporation organized under the laws of the State of ry/,'i The dates of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal are as follows: • Page C-6 All current and prior D.B.A.'s, aliases, and fictitious business names for any principal having interest in • this proposal are as follows: —/A For all arbitrations, lawsuits, settlements or the like (in or out of court) you have been involved in with project owners (public agencies, private companies, etc...) in the past five years (Attach additional Sheets if necessary)provide: Provide the names, addresses and telephone numbers of the parties; Briefly summarize the parties' claims and defenses; • State the tribunal (i.e., Superior Court, American Arbitration Association, etc.) the matter number and outcome. N�I Have you ever had a contract terminated by the owner/agency?If so,explain. „–o • Have you ever failed to complete a project?If so,explain. r0 Have you ever been terminated for cause and then had it converted to a"termination of convenience"? If so,explain. NO For any projects you have been involved with in the last 5 years did you have any claims or actions: Circle One 1. By you against the owner? Yes/® 2. By the owner against you? • Yes/® Page C-7 3. By any outside agency or individual for labor compliance (i.e. failure to pay prevailing wage, • falsifying certified payrolls, etc..) Yes 4. By Subcontractors(Stop Notices, etc.) Yes 5. Are an(�y'�claims or actions unresolved or outstanding? Yes/0J If yes to any of the above,explain. (Attach additional sheets, if necessary) Failure of the bidder to provide ALL requested information in a complete and accurate manner may be considered non-responsive. Subscribed and sworn to before me By This /(e r'` day of O c%•• ,20 /2 (print name of Owner or President of Corporation/Company) C4 //✓,/�/1�.,(licedic//rC(— N 01 Ochs--orort 0 (Signature of Notary Republic) (Signature) Sc68cr6 (Title) / (SEAL) /O- /6- /2, • (Date) CHARLES B. PARSONS (Signature of Secretary of Corporation) Commission M 1943036 _' % E Notary,Public •California 99, Orange County Comm.Exeires Jul 30,20151 • • Page C-8 • REFERENCES: Contractor must use this form!!! Please print or type. Bidders Name SMr✓Coni CMa/N�t/L N� vo FAILURE OF THE BIDDER TO PROVIDE ALL REQUIRED INFORMATION IN A COMPLETE AND ACCURATE MANNER MAY BE CONSIDERED NON-RESPONSIVE. For all public agency projects you have worked on (or are currently working on) in the past 2 years in excess of$15,000,provide the following information: Project Name/Number Port l Alte . betuier 1 r„ 4L 1v 501-157 Project Description L,(PP 7-0•t pc 2-14°C) Approximate Construction Dates From to 91/2/ iv 1) /l ( Agency Name GI y 0-t 9 ma UG key Contact Person Aireirip 1 U' 1/11mnn-.1 Telephone(L3er 563-(0767 Original Contract Amount$ 4233, COD_c Final Contract Amount 422; 4Cb.o0 If final amount is different from original,please explain(change orders,extra work, etc.) • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. 2 Project Name/Number 6;tit AJ ; 6 96B 9:1Pi /-•ft-a' Ref ir6 @ (/or%oub 1a44" inn 6 Project Description CAPP 6' 4 x 3 Ciao, r Approximate Construction Dates From 1 l /I ( to 3,/Z Agency Name G' OS- RtVent.4 Contact Person (n2.Otnv,r4L Albs->g Telephone Olt 02/— 67/2. Original Contract Amount$ t 6 Lir 5-61-1 co Final Contract Amount$ l SNP C5-I. oe If final amount is different from original,please explain(change orders, extra work, etc.) • Page C-9 • Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. 3 Project Name/Number fgita„,i— Project Description (Ape 6," 4 i L 079�K I� Lac- Approximate Construction Dates From t /1 2.. to(� /� 4 /12-. Agency Name Gr .-t7 6. R�-t-w P_(k Contact Person tooth Lyle- Telephone(710 c 2- - 3&67 Original Contract Amount$ Li g 6, 4.3C cx, Final Contract Amount$ LO-16 ‘3 57:et If final amount is different from original, please explain(change orders,extra work,etc.) • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. VO-tY& 4 ,tt '� Project Name Number �yyt� ) +we yam. r� o;} eat. `tZ2u. - A-4 4.-. Project Description GA P �c`s4 (, orj a Z-F Approximate Construction Dates From 2-0e2_I to 6/Z Agency Name I.■ � o F� / L.a- HA,L -4 +7 Contact Person (...1101.-C,(C (ts+O:cel Telephone S62) S6 c Ct Original Contract Amount$ (/00 I, 2_.g6. Final Contract Amount$ L °est., Z.96 If final amount is different from original,please explain(change orders, extra work, etc.) • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. Page C-10 5 L ProjectName/Number 3 01,144-�/JIz joofLa aLQ u+(bi! tk-ko 7.60444.- L'✓+�a Project Description C- Qr 6�"�' /0�r ate/ is° t y,'or 3,yGb GF Approximate Construction Dates From p//y, to 7/7— Agency Name G/ L0; wlai_ 'O Contact Person Iza /Uayr 2— Telephone(cacr 413 I— r71 q I Original Contract Amount$ 28 SUd, Final Contract Amount$ a'O. ro If final amount is different from original,please explain(change orders, extra work,etc.) Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. • 6 p Project Name/Number C..t„ 4 y:h CX-,:o 42 ,5-144.42,-- Al i.1,y4 U' Y- I.I;Nrteez, t- 4("a-✓j Project Description C t epv 6 `, ( (0 " fir( /6 nic- 6- watt, y(;7 LF Approximate Construction Dates { From I O /12. to GV/re�.s- Agency Name G 14'. 0 {- 13ou,#; P)r L Contact Person ROt2 Coati Cs Telephone(?11.1) S(oZ- 3(Q-$7 Original Contract Amount$ gag 293•("O Final Contract Amount$ Y{ZS/ 2-03 3.!30 If final amount is different from original,please explain(change orders, extra work, etc.) Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. • Page C-11 • Attach additional sheets if necessary. Attach to this Bid the experience resume of the person who will be designated as General Construction Superintendent or on-site Construction Manager for the Contractor. Upon request, the Contractor shall attach a financial statement and other information sufficiently comprehensive to permit an appraisal of the Contractor's current financial conditions. • • Page C-12 irg • • CURED-IN-PLACE-PIPE (C.I.P.P.))TOP HAT VERIFICATION: Contractor must use this form!!! Please print or type. CC) Name 4tn Q tt>Ls e l:mar TM-c. ' Cl FAILURE OF THE BIDDER TO PROVIDE ALL REQUIRED INFORMATION IN A COMPLETE AND ACCURATE MANNER MAY BE CONSIDERED NON-RESPONSIVE. CONTRACTOR SHALL HAVE SUCCESSFULLY INSTALLED AT LEAST 50,000 LINEAR FEET OF THE PRODUCT BID WITHIN THE U.S. ACCORDING TO THE CURED-IN-PLACE-PIPE (C.I.P.P.) SPECIFICATION. THE CONTRACTOR SHALL ALSO HAVE A MINIMUM OF 1,500 SUCCESSFUL TOP HAT TYPE SERVICE LATERAL SEALING SYSTEM INSTALLATIONS IN THE U.S. ACCORDING TO THE TOP HAT SPECIFICATION. For Cured-In-Place-Pipe (C.I.P.P.) and/or Top Hat projects you have completed, provide the following information: 1 1 ' Project Name/Number and Location 5 , Go At— ._. / , 4- v�4 Ply. • Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements LAPP &" x Z L.F R,,+w6Irvia l.c, 15 -G. 760 • Owner's Name (..; n t COb 6WL4q /CO 4-0) /toga G 7 Contact Person Person 6 HAAS Telephone(gyp 6U,, (39e Original Contract Amount$ 623 9 2-k.ac Final Contract Amount$ G 31 6 Z6.co If final amount is different from original,please explain(change orders, extra work,etc.) Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. • Page C-13 2 • Project Name/Number and Location Ij;Oe ,c , r'6# P gr.r5 e Lbq rr-s Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements GI PP 6"t.sc>,o CF Lt,l.re,(> +ro4nEc1 ti l 00 Owner's Name C-. ✓ ryc Qu✓,G/f,: Contact Person eat.a__a 4( La-.0 Telephone 824._ 5-1/1._ Original Contract Amount$ t sr-ell Sri, elo Final Contract Amount$ I r't 6r1-m If final amount is different from original,please explain(change orders, extra work, etc.) • Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. • Page C-14 • Project Name Number and Location • L'W' PLO w 11' j. - cLik. j Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements GIP? C., 4 2, 9-000 CF Island = 3 6.0 Owner's Name CI LT nh" 4 t(ya-w tk s Contact Person 3 i - (At G//e- Telephone(?(') 5- - 6.9/7 Original Contract Amount$ QG[, , Coo Final Contract Amount$ q04. Fj& oo If final amount is different from original,please explain(change orders,extra work, etc.) • Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. • Page C-15 4 • Project Name Number and Location AMmyYl ( H ova o gKt, +1I Spaeec. / j6uek5 Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements " GiPP 8 x 27 Cee7 e./f. 4;.•.b 11u Gad _ It 13o Owner's Name (//n II-Ft .4 Contact Person <✓t,CQ-'f (CC.. iI4orc. Telephone(574 175: 9200 Original Contract Amount$ 1 I Cr 11 2--116 Final Contract Amount$ („tat,2140 If final amount is different from original,please explain(change orders,extra work, etc.) • Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. • Page C-16 • CURED-IN-PLACE-PIPE (CLP.P.) / TOP HAT VERIFICATION: Contractor must use this form!!! Please print or type. SOUTHWEST PWELPIEAND Bidders Name VIENCHLESS CORP. FAILURE OF THE BIDDER TO PROVIDE ALL REQUIRED INFORMATION IN A COMPLETE AND ACCURATE MANNER MAY BE CONSIDERED NON-RESPONSIVE. CONTRACTOR SHALL HAVE SUCCESSFULLY INSTALLED AT LEAST 50,000 LINEAR FEET OF THE PRODUCT BID WITHIN THE U.S. ACCORDING TO THE CURED-IN-PLACE-PIPE(C.1.P.P.)SPECIFICATION. THE CONTRACTOR SHALL ALSO HAVE A MINIMUM OF 1,500 SUCCESSFUL TOP HAT TYPE SERVICE LATERAL SEALING SYSTEM INSTALLATIONS IN THE U.S. ACCORDING TO THE TOP HAT SPECIFICATION. For Cured-In-Place-Pipe (C.I.P.P.) and/or Top Hat projects you have completed, provide the following information: 1 Project Name/Number and Location REFA$1LtTAT10N Pilaf-AGE F— 1797CI -SAnolEtre Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements (. " DtA - 6,898 LP CI PP $" DIA - 107,887 t.P GI PP l0" 1)t4 — 214o9LP e-hoe • 2, S84 MP HATS cl PP Owner's Name CITY OF $Pqt Dttap Contact Person Ketoses bu'oNT Telephone( ) 619. 98o•6'ti Original Contract Amount$ 4,at T, 7 T7.o o Final Contract Amount$ 71713 5 So.0-3 If final amount is different from original, please explain(change orders,extra work,etc.) CHMI(.s moot, A- 1 MD t( ADbt Two Pet- t_ fres b mP µA'rS Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. NO • Page C-I3 Project Name/Number and Location PIPSLtaat. RENA$ALtT*Ttol-t, PI waa H-1, Kogy3( e— SAN bttbo Project Description Including Pipe Diameters mtti'PdtK 1 op Hat Lateral Repairs and Reinstatements weir••,3 inn en. Czn 01A - 211 Sao t-P ate? So DIR - 23l000 L.F ell)? 10" DIA - 652 LP ewe IS" DIA - 4,473 LP ctPP • 1 1 212 Toe i447.5 Owner's Name C ill OP SA-AI b t tbo Contact Person 1/Ieto2 C* 4:11.4 frS Telephone( ) (019•a80. 925• Original Contract Amount$ 4111R 145° Final Contract Amount$ Si 4 Ili 138 5 If final amount is different from original,please explain(change orders,extra work,etc.) ADDEb LF rba C 9P • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. NO • Page C-14 • 3 Project Name/Number and Location SEWeL Rewsiummoa PNAsa .1 - IC - SAN bitGo Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements 81," DtA - 4Cal *as 1,-F- C►PP tou 0 to - 27.8 i` cif(' Soo — to P kirk"(S Owner's Name C(T Y OF 5 erm Di E60 //,, Contact Person MtCHSfit. TIkOH*S Telephone( ) (at S. S CI. 'l8(o'i) Original Contract Amount$ 31,2.22 t 3S1. 0o Final Contract Amount$ 31, 6401,122 If final amount is different from original,please explain(change orders,extra work,etc.) C titt+tfrE 0e-0EQ S. 1 A otb I-F Nub 1'°P 44•11$ • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. ll0 • Page C-l5 • 4 Project Name/Number and Location W*STE W A(eg.. mono (2E11 Pez EGT F't a St() 4892 SrttJTR tPre6AI A t cA- Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements !a" NA - 16t 000 LE etPP 8" tsta - ►71 471 LE- c% e 71 - IhP niviS Owner's Name CM/T Y OF Sdru i A tA{Z-gdtLA- Contact Person +4tltlbrti DA T-LEESE Telephone( ) 9oS . 5G4 . S424 Original Contract Amount S t t art 8 <G a6 • 00 Final Contract Amount S 84'51'76 3.00 If final amount is different from original,please explain(change orders,extra work,etc.) WEemCSQ LE FOR, t--%NtNG-- . A++D age es t, uo. of 'ibP 'i*t S • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. NO • Page C-I6 • 5 Project Name/Number and Location SSRP 113 CE$Ar&. CtHNat AARtA+%L ,Pr SZC tt 848 CITY OF Lai ANGEt.ES Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements RE%%Ap7 BY CIPP 31413 1, F of E' Mb (2" DIA Bawer. hatN) Owner's Name CITY OF Log io-eLes /SNO Cot &trwctto4U Contact Person LP ict L Au E N Telephone( ) 62-4 • 29y• OSSS Original Contract Amount$ 12'4 t Pe + .po Final Contract Amount$ (2 41 g 6 l. Oa If final amount is different from original,please explain(change orders,extra work,etc.) • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. NO • Page C-17 • 6 Project Name/Number and Location PI Pa LAN E tES*3tt.t4A-tioa Nide. A- %et SAO D le -c Project Description Including Pipe Diameters and Lengths, and Number of Tip Hat Lateral Repairs and Reinstatements 8" Dt - V1 10S2 LF . CwP 33 ti At) Uo erS t2everr9 244 toe k+tTS Owner's Name CM( Of SMJ D tacro Contact Person CMRRi.E5 EVf% Telephone( ) 85$. 495. 1915 Original Contract Amount$ t t fe56 t 34 8 •oo Final Contract Amount$ t t 375 t tic)•00 If final amount is different from original,please explain(change orders,extra work,etc.) o►bwGE oaoe4. REwc:✓O l.F Fo(L etbilm3. • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. NO • Page C-IS • g Project Name/Number and Location Se-Wet- eteKNR4, 2€%4R5t%TATsON WEST Via Lt_'(woeD # fool 385 -I o Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements $" DtA — 241?7o LF- or CtPP 12" Cote — 354 of CifP 684 — '1be PMTS Owner's Name C.tr( OF WEST 4oLL`l woo Contact Person SWOOLoW PettLSTE.%N Telephone( ) 3'Z3. 84$ . 6375 Original Contract Amount$ 1 t fo 24 L 9 61 , 00 Final Contract Amount$ 114641 g6ga.Oc If final amount is different from original,please explain(change orders,extra work,etc) CHINO ere- odA62 S t 11/400 PM TO HAFTS • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. No S Page C-20 • 7 Project Name/Number and Location FPEL• me RE.A*Ott-ttotTto/J P14ASE L'1 5.00 Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements 8" DIA - 4o, es; LP c.tc'e 755 — TOP M75 Owner's Name C\7`( OP SAN bIE4-o / ICTA CoeS1tUC110 (WC Contact Person Telephone( ) Ct I9 • S(e Z • 94 Col Original Contract Amount S It S 8 7 I %%O. 00 Final Contract Amount S It SS' 1(e o o . 0i If final amount is different from original,please explain(change orders,extra work,etc.) C H&J J ue 0t0442. td( htsbE.D 1-F Fc R.ErM46. Daub -roe I4 TS • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. tJco • Page C-19 • 9 Project Name/Numberand Location SSRP KogA SusSETPkAt4 R1sta1GGLen - log fbro sg sac 11873 Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements 8" SEwe?, PIA t11S87 LF- of- CIPP get SEwn. Stf.dCTut}t_ Dt(} 111141-F OF CAPP 1 S TOP I#*TS, Owner's Name CtTM of LoS P*3GE.LE S / heTTM64.s /Tie STCw+t 1.T Co Contact Person Creme._ ig PtbA•It* Telephone( ) 562 • 595. 547( Original Contract Amount S 407, WI . o o Final Contract Amount$ 4 t 4 1341 .ov • If final amount is different from original,please explain(change orders,extra work,etc.) Ct4vr#J6+-t- to LF FOR RE.4 -M5 . • Did you file any claims against the Agency?Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. N0 • Page C-21 to Project Name/Number and Location SS£P x.02 Ra SStP f.11 sSZC Pt1$71;Zt SZC1ZO4lb LOS PvN6P�LES Project Description Including Pipe Diameters and Lengths, and Number of Top Hat Lateral Repairs and Reinstatements g" DIA IM 7'to LF otr ewe 8" DIA STft-wcXu&At. IIS70 Le OF CIPP Owner's Name C%1'( OF LOS RN 6•F La S / g Attu rn IN C Contact Person M W.a Gt o 84-.1 4C Telephone( ) Cri ai• 3SS • l3Sn Original Contract Amount S 3417 t 610 M Final Contract Amount$ 432 t 137.o0 If final amount is different from original,please explain(change orders,extra work,etc.) Cwsw*C ORAGR. tM0e0 LF.. Pot 2E14AG. • Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor?If yes, briefly explain and indicate outcome of claims. 130 Attach additional sheets if necessary. i Page C-22 • DESIGNATION OF SURETIES Bidder's name 5A/✓ro/v t�JIA-'rat i t' Provide the names,addresses, and phone numbers for all brokers and sureties from whom Bidder intends to procure insurance and bonds(list by insurance/bond type): lj�ANO✓L/L l4/_S r/RN AI r 64ev0 .Z /✓t.4C HRmit pi/Her 2 Ad.//ogn s s,-ia AA-A / r s 92 707 7/4,- y/3` 3 trot Mixer Inv??4, /3o.vo/Ay /Ay/O W J Co464,9A° irlfro A2.- Ane-,,o Cr? 7//a3- G,ZG- 7WH 94,30 • • Page C-23 ACKNOWLEDGEMENT OF ADDENDA • Bidder's name S54—Cp,V- e r9/,/k /frc. The bidder shall signify receipt of all Addenda here, if any: Addendum No. Date Received Signature 7156 / Qc / )0/2 Vaa ,,� • • Page C-24 CONTRACTOR'S INDUSTRIAL SAFETY RECORD • TO ACCOMPANY PROPOSAL Bidder's Name .52:7/vCont Eite-y -✓te2t/v1 /.✓C Record Last Five(5)Full Years Current Year of Record Current 2 2 2 2 2 Year of 0 0 0 0 0 Total Year t t 0 0 0 Record 1 0 9 8 7 No. of contracts 227 Zit' /qp , r /6o /60 i /00 Total dollar Amount f Contracts(in / 1)4 ,ffki. if Si ;d S/�13 , 741 S3, ssf Thousands of$) No. of fatalities O O p O O O No. of lost Workday O 0 v Cases 0 O 0 O No. of lost workday cases involving permanent 0 G transfer to 0 0 O 0 0 another job of • termination of employment The information required for these items is the same as required for columns 3 to 6,Code 10, Occupational Injuries, Summary--Occupational Injuries and Illnesses, OSHA No. 102. Legal Business Name of Bidder 5,9.-co.v en.-fm.-e-ten I.ry i,-0/ _ Business Address: ca in e--yn.,-et,c or. Nv,vZ win n .3..w+ Business Tel.No.: 7/y R.y/ 2 3 23 State Contractor's License No. and Classification: 7 3/ 7 9.7 -17 Title f ,,± The above information was compiled from the records that ace available'to me at this time and I declare under penalty of perjury that the information is true and accurate within the limitations of those records. Signature of bidder Date d� - /2 Title /7?<sm034,,'- Signature of bidder &:tiA„, ,Q.tj, • - Date /O-/F- /2, - Title Serge-r/97 Signature of bidder Date Title Signature of bidder Date • Title Page C-25 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 • S•,r•r;r• �..•-rr r rr •.•••r• • r-r-r r rr• rr r. r••• .- rr 5' rr r.•r•rrry C )) tState of California 9 ( 9 County of naA L1E 3 r g On to(he ( IZ before me, CI.,AM..cs S. Camitsws , mcsrA&V 1?otS,,1 , Y.' Date Here Insert Name and Title of the Officer • S r personally appeared et'A As 'b; gc.NL,A t n° tJ,1.t4. b.aantAtsro r Name(s)of Signer(s) Y S r rwho proved to me on the basis of satisfactory r evidence to be the person(s) whose name(s) Ware r subscribed to the within instrument and acknowledged t• - to me that f}e/skre/they executed the same in 5 r. hjg/f1Ar/their authorized capacity(ies), and that by ,� CHARLES B. PARSONS hjs/her/their signature(s) on the instrument the S Commission # 1943036 S r. `a -�ac Notary Public •California i person(s), or the entity upon behalf of which the 1 4 Orange County D person(s) acted, executed the instrument. i My Comm.Expires Jul 30,2015 C I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing 5 r paragraph is true and correct. r 5 r WITNESS my hand and of eat. s 4110 ? 5 Signature: ¢ �'�. S • Place Notary Seal Above Signature of Notary Public n, OPTIONAL r Though the information below is not required by law, it may prove valuable to persons relying on the document t and could prevent fraudulent removal and reattachment of this form to another document. S . Description of Attached Document y r, Title or Type of Document: 1) • Document Date: Number of Pages: 1. Signer(s) Other Than Named Above: s Ce Capacity(ies) Claimed by Signer(s) s f Signer's Name: " Signer's Name: 1, t) ❑ Corporate Officer — Title(s): ❑Corporate Officer — Title(s): 1. ❑ Individual RIGHT THUMBPRINT ❑ Individual RIGHT THUMBPRINT • OF SIGNER, OF SIGNER 4 • ❑ Partner — ❑Limited D General Top of thumb here ❑ Partner — ❑Limited ❑General Top of thumb here • ❑ Attorney in Fact ❑Attorney in Fact j ❑ Trustee ❑Trustee S • ❑ Guardian or Conservator ❑Guardian or Conservator S S ❑ Other: ❑Other: 5 .. 9 • Signer Is Representing: Signer Is Representing: y I', y • r C.. 9 2010 National Notary Association.NationalNotary.org•1-800-US NOTARY(1-800-876-6827) Item#5907 If bidder is an individual, name and signature of individual must be provided, and, if he is doing business • under a fictitious name, the fictitious name must be set forth. If bidder is a partnership or joint venture, legal name of partnership/joint venture must be provided, followed by signatures of all of the partners/joint ventures or of fewer than all of the partners/joint ventures if submitted with evidence of authority to act on behalf of the partnership/joint venture. If bidder is a corporation, legal name of corporation must be provided, followed by notarized signatures of the corporation President or Vice President or President and Secretary or Assistant Secretary, and the corporate seal. Signatures of partners join venturers, or corporation officers must be acknowledged before a Notary Public, who must certify that such partners/joint venturers, or officers are known to him or her to be such, and, in the case of a corporation, that such corporation executed the instrument pursuant to its bylaws or a resolution of its Board of Directors. • • Page C-26 NON-COLLUSION AFFIDAVIT TO BE EXECUTED • State of California BY BIDDER AND SUBMITTED WITH BID )SS. County of ORA•r9er CM'ris Oi er.-2/n/470 , being first duly sworn, deposes and says that he e--she is se-can-Pi-Ay ofsp.vro.vri.,n-erne;.,', the party making the foregoing bid, in accordance with Publit Contracts Code Section 7106, declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price,or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true;and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof; or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company, association, organization, bid depository,or to any member or agent thereof to effectuate a collusive or sham bid. O I �r .5 na .✓/iv _ / . c O 0 Project Name: . - 5Rtv'CON 4---,4.1/NL'tl/Al /NO Legal Business Name of Bidder ,cein <-`•-9/•vewe. On:. Nvfr-7072-0.r iY • rW CAL q'A 6617 Business Address • 7iy ey Busjne No. Sigma ofbidiel rvic/< 12 fr (svL"70 Title 12/TO-r,Oewr Date: /o- /C- /Z Signature of bidder Title -CL^tR<Toly Date: /0-- lam- iZ Subscribed and Sworn to before me on (Notary Seal) Signature 0 n Notary Public ....,. CHARLES 8. PARSONS ` a :r„..is,t Commission # 1943036 z ••it . � Notary Public-California i Orange County D M Comm.Ex ices Jul 30,2015 • Page C-27 LIST OF SUBCONTRACTORS • TO ACCOMPANY PROPOSAL In compliance with the provisions of Public Contract Code Section-4104, the undersigned bidder submitting this bid proposal sets forth the name, place of business and the portion of the work to be performed by: (I)-each subcontractor who will perform work or labor or render service to the bidder (as general Contractor) in or about the construction of the work or improvement; and (2)-each subcontractor licensed by the State of California who, under subcontract to the bidder, specially fabricates and installs a portion of the work or improvement according to detailed drawings contained in the plans and specifications, in an amount in excess of one-half of one percent of the bidder's total bid or, in the case of bids or offers for the construction of streets, highways or bridges, in excess of one-half of one percent of the bidder's total bid or ten thousand dollars($10,000),whichever is greater. Subcontractor's Name, Address, Bid Percent Description of Work Percent of Telephone# Item Of Total Total Bid Number Bid 1.17 C S- r�C-AN 'N - cI6 R 4, Q- " vc_P Co.,5 -' c±- - Iy c R'a mac 2-4 • Pe(pw,Nnc2 ?ding 5 3 CC N C iPP 3 ¢c(1 0)IQS S Q k P, ,' 3 350) \oe 35 d/v I Page C-28 • Bond No. 145 65 68 • Bond Premium iII bbsu BID BOND TO ACCOMPANY PROPOSAL KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has issued an invitation for bids for the work described as follows: Qld Town Sewer Lining(C.I.P.P.)Project City CIP0 SS9901-2.State Protect No.C-06-5310.120 WHEREAS SANCON ENGINEERING, INC. 5841 ENGINEER DRIVE, HUNTINGTON BEACH, CA 92649 (714) 891-2323 (Name and address of Bidder) ("Principal"),desires to submit a bid to Public Agency for the work. WHEREAS,bidders are required under the provisions of the California Public Contract Code to furnish a form of bidder's security with their bid. NOW,THEREFORE,we,the undersigned Principal,and HANOVER INSURANCE COMPANY 2 Mac Arthur Place, 2nd Floor. Santa Ana ('A 927n'7 (714) 415-3808 • (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California,as Surety,are held and firmly bound unto the Public Agency in the penal sum of TEN PERCENT OF THE TOTAL AMOUNT OF THE BID IN DOLLARS Dollars($ 10% OF TOTAL BID AMOUNT ),being not less than ten percent(10%) of the total bid 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 01?THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal'is awarded a contract for the work by the Public Agency and, within the time and in the manner required by the bidding specifications, enters into the written form of contract included with bidding specifications, furnishes the required bonds, one to guarantee faithful performance and the other to guarantee payment for labor and materials, and furnishes the required insurance coverage,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 incurred by the Public Agency in the suit and reasonable attorneys' fees in an amount fixed by the court. Surety hereby waives the provisions of California Civil Code§2845. • Page C-29 IN WITNESS WHEREOF, this instrument has been duly executed by Principal end 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: OCTOBER 22, 2012 "Principal" Surety" SANCON ENGINEERING, INC. HANOVER INSURANC: COMPANY • By 6,/,,l4 ✓l7 By: Michael R. Langan Its �///fs/i7C17 17540.7001 ° Its Attorney in Fact By: pY �S�Y� 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 atttomey-in-fact must be attached. • • Page C-30 CALUFORIBDA ALL-PURPOSE ACKNOWLEDGMENT crA.crA...:r.:.^.:a=5".cc>crca rc.^Merccciy^ti-47,.c-A- c ncrcrcc:ramcr.M.r,^.cxf,(4cT:.e -.on�:zr-N—tc ab^.:-!t:r.« • State of California } County of Los Angeles On Oct. _22 , 2012 before me, Kendra Michelle Boots , Notary Pubs is . Date - Here'need Name and Title of the Officer personally appeared Michael R. Langan Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person($) whose name(0 is/a subscribed to the — within instrument and acknowledged to me that KENDRA MICHELLE BOOTS h executed the same in his authorized ,--s � COMM. # 1951463 capacity(ti�j, and that by his/f 'signature(9j on the•to a - a NOTARY PUBLIC • CALIFORNIA• rn instrument the person(, or the entity upon behalf of > �.:'-�,.f persona),is LOS ANGELES COUNTY which the erson acted, executed the instrument. i My Comm.Expires Oat 7,2016 ni I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. e----�-- WITNESS my hand and official seal. `�a 1y SignatQrfs!/��w� eo NOary Pubic • Plea:Notary Seal A b o v e Signature Though the information below is not required try taw,it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this fore to another document. Description of Attached Document Title or Type of Document: Bid Bond Document Date: Number of Pages: Signer(s)Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signers Name: Michael R. Langan Signers Name: ❑ Individual 0 Individual O Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑ Limited 0 General ❑Partner—❑Limited 0 General _ Attorney in Fact c Imr+ER— ❑Attorney in Fact Top ol thumb here ❑ Trustee Top o thumb he e 0 Trustee • Guardian or Conservator 0 Guardian or Conservator n Other: ❑Other: Signer Is Representing: Signer Is Representing: PAS : ate- 5_c . URAN o MPANY • 02007 National may Association•9350 be SotoAva..PO.am 2402•ChaLaroM,CA 91313-2402•w,na4aliaiuMola,y.o5 Item 95907 Reader Call To1Ree 1-906876-W THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY . CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY ' KNOW ALL MEN BY THESE PRESENTS:That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint MICHAEL R.LANGAN Of Pasadena,CA and each is a true and lawful Attomey(s)-in-fad to sign,execute,seal,acknowledge and deliver for,and on its behalf, and as its act and deed any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds, recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Ten Million and No/100(510,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: "RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such writings so executed by such Attomeys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice President and an Assistant Vice President,this 12th day of July, 2010. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY ", [� �+' "" CITIZENS- SURANCE COMPANY OF AMERICA " " BFALe t ///- / Its 1877®it F. }J l €r` 11)'74 �-'" ' 6 '' Mary Jeanne •(id- ]r on. ice Pres'de I ' Robert K.Grennan,Assistan ice President •THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER )ss. On this 12th day of July, 2010 before me came the above named Vice President and Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority a and direction of said Corporations. I' '—r,. 9`"; 47 (9 .. Wa4e2 `QM gs=frsrwa Notary Public • My commission expires on November 3,2011 I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED, That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company,shall be binding on the Company to the same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile" (Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14, 1982 Massachusetts Bay Insurance Company;Adopted September 7, 2001 - Citizens Insurance Company of America) n GIVEN under my hand and the seals of said Companies,at Worcester, Massachusetts,this 2211 ay of ®c'-, ,20/z. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITI•S INSI CE CO PANY OF ERICA • e Step.' .Braul, Assistant Vice Pm'!nn - CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT • .c,,. 7 , , ,,_ _ 7.M.O-t` . .M-M.-M.....,co cv, . ,..exe.,M.,c ,�C, •o.?t..M..M..F`.A. z•CY— ..et,c, n2 -M..ex State of California ' County of Ot"'`9 e } On before me, OW &toewaw a‘, INOFan6 ?o(oti c Iv Date Here Insert Name and Title of the Officer I, rFGG.o(as I)` terevuaaIto personally appeared , Name(s)of Signer(s) h$I who proved to me on the basis of satisfactory evidence to be the person(S) whose name(e) is/ara subscribed to the within instrument and acknowledged l i to me that he/Sfi executed the same in his/Lath it authorized capacity(a), and that by ihis/Cr signatures) on the instrument the person( , or the entity upon behalf of which the , person(Wacted, executed the instrument. I I certify under PENALTY OF PERJURY under the Vivi GOENAWAN laws of the State of California that the foregoing • ' Commission # 1894893 Q Yom . 5- -. Notary Public-California D paragraph is true and corrects '° z •q1`'' Orange County • 3_ _ _ _ My Comm. Expires Jul 9,2014E WITNESS my hand and offiR I.f .I it' 19 I L Signature: )1 Place Notary Seal Above Signature of No 7 Public , OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document •Title or Type of Document: f e 7f CA lii0(Ad Document Date: Number of Pages: -:' Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) 1 Signer's Name: MIciAO "s r Olbgo-addu t("D Signer's Name: Corporate Officer—Title(s): .?rt Sitil-Lfl ❑Corporate Officer—Title(s): ❑ Individual RIGHT THUMBPRINT ❑Individual RIGHT THUMBPRINT OF SIGNER OF SIGNER I ❑ Partner—❑Limited ❑General Top of Thumb here ❑Partner—❑ Limited ❑General Top or thumb here '' ❑ Attorney in Fact ❑Attorney in Fact ,I ii, ❑ Trustee ❑Trustee ❑ Guardian or Conservator ❑Guardian or Conservator t ❑ Other: ❑Other: ' gI I I Signer Is Representing: Signer Is Representing: , I • 0.^209 Natonal;N:Notary •N�_SSA.�%'� NOTARY(1-800-87 - 8C.N=.S. Item#507 ®2009 National Notary Association•NalionalNOtary.org•1-800-US NOTARY(1-800-8]6-682]) Item k590] Oct. 15. 2012 2 : 43PM No. 4828 P. 1/2 • of ceigeat Department of • Public Works October 15,2012 Addendum No. 1 Old Town Sewer Lining (C.I.P.P.) Project No SS0901 -2 Attention all Bidders and Plan Holders: The following revisions, additions and/or deletions are hereby made a part of the bid documents. Plan and Specification Clarifications • QUESTION: Section 2655 Part 2 / B-1 "Minimum wall thickness of 6mm" is in conflict with "Contractor to be responsible for determining required wall thickness based on ASTM F1216". Suggest eliminating the minimum 6mm requirement and relying on the remaining language. RESPONSE: Delete the 6t" sentence ("CIPP minimum design thickness shall be 6.0 millimeters") of Section 02655 Part 2 Subsection B Item 1 QUESTION: Video is not provided for all locations where CIPP spot repairs are required and only noted on plans. For example (2) repairs between F20-394 and F21-397 no video or log sheets provided what length of CIPP spot repair should be bid? For CIPP spot repairs that are shown on the plans and log sheets / video — — —are-we-to-assume-the-length-of-repair-is-to-cover-the nearest-single-defect-or shall-it— — -- — cover several defects nearby ie MH F02-271 to MH F02-270. RESPONSE: The Contractor shall reference the Video logs provided and determine the length of CIPP spot repair needed to cover the entire length of the deficiency in accordance with detail 1 of sheet 15, QUESTION: Video is not provided for over 60% of the work. Are we to assume that all of these lines are linable with no special cleaning, no point repairs, no protruding laterals etc. No video was provided for heavy cleaning area • specifically (as an example). RECEIVED 10-15-' 12 15: 05 FROM- TO- SANCON ENGINEERING P0001/0002 Oct. 15. 2012 2 : 43PM No. 4828 P. 2/2 RESPONSE: All video logs performed for the project are provided and are • available on the following FTP site. The Contractor is responsible for downloading information from the FTP site. The City does not warrant that access or ease of access of information will be afforded to the Contractors in all cases. A digital video disk (DVD) of the video logs may also be picked up from the City of Seal Beach City Hall. Video logs are provided for the contractor's convenience in assessing the scope of work effort but only represent conditions at the time of recording. The Contractor is responsible for performing the work in accordance with the Contract documents as defined in the Special Provision, Technical Specifications and Plans regardless of the conditions depicted in the video logs. Instructions for FTP Usage: 1. Copy the "FTP Link" link into the address bar of windows explorer 2. Enter username (Case sensitive – all lowercase) 3. Enter password (Case sensitive – all lowercase, no spaces) ftp://gateway.phx.civiltec.corn User name is: sealbch Password is: contractor-sb Receipt of this addendum must be acknowledged by signing below and inserting it • into the Contractor's proposal. Bids submitted without this signed addendum shall be considered informal. END OF ADDENDUM By order of the ity of Seal Beach, —211■Ith- f't - /0 (y J:. e-ring 'rvis.•n Date S • RECEIVED 10-15-'12 15: 05 FROM- TO- SANCON ENGINEERING P0002/0002 Oct. 19. 2012 4: 09PM No. 4869_--P. 1/11 -;C: .f.;..` C1 of.cea.Q e '�. �C61 ,a ., `n Department F:..e Q¢' NNW Warn • fans transminal • To: SanconEngineering Fax: (714) 891-2524 From: City of Seal Beach—Public Works Dept. Date: 10/19/2011 Re: Sewer Lining Project Pages: 10 ❑ Urgent EaFor Review 0 Please Comment ❑ Please Reply ❑ Please Recycle . . . . . . . . . . 0 Addendum# 2 for Old Town Sewer Lining Project No. SS0901-2 Cio o!Seal Beach-21164 Street—Seal Beach,C4 90740 Telephone: (562)431-2527 ext. 1331, Fox(562) 430-8763 • RECEIVED 10-19-'12 16: 32 FROM- TO- SANCON ENGINEERING P0001/0011 Oct. 19. 2012 4: 09PM No. 4869 P. 2/11 Cf a�ce Department of Public Works October 19, 2012 Addendum No. 2 Old Town Sewer Lining (C.I.P.P.) Project No SS0901 -2 Attention all Bidders and Plan Holders: The following revisions, additions and/or deletions are hereby made a part of the bid documents. Plan and Specification Clarifications • QUESTION: Why does the City require UV light for curing if Greenbook. allows for hot steam and hot water? Hot Steam or Hot Water could potentially be less expensive. RESPONSE: The City prefers Ultraviolet curing methods instead of either hot steam or hot water because both of those methods have more inherent risk of back- ups into residential properties. The potential difference in curing costs is offset by the lesser risk during curing. QUESTION: The bid date is October 24.2012 and this includes a Good- Faith-Effort and I did not find the project bid 15 days before this time. Can the bid be moved back to November 131" or later? RESPONSE: The City is required by law to place bids in our local paper, The Sun. First advertisement was run in the sun on 9/27/2012. In addition, the City sends copies of the Plans and Specifications to all of our project to both the Dodge Reports and Bid America. Those packages were sent out on the week of September 241h. The City has deadlines we must meet with regards to our funding source. As such, we will not be changing the date of bid opening from October 24, 2012. • . QUESTION: Page D-63, Part 2, Materials, calls out Sancon100 Urethane Mortar Lining for manhole lining. This product is a sole source bid item. Will the City RECEIVED 10-19-' 12 16:32 FROM- TO- SANCON ENGINEERING P0002/0011 Oct. 19. 2012 4: 10PM No. 4869 P. 3/11 allow for other manhole lining manufacturers and installers? Will Cor-Guard Epoxy • be allowable? RESPONSE: The manhole lining system allow for an approved equal as stated on D-63. The contractor who is the apparent low bidder shall provide technical information relating to the product to be utilized that is an equivalent to that specified in 03315 Part 2 Section A within the time frame allowed by contract documents (Page D-10) prior to any award. In addition, Cor-guard Epoxy is not approved as an equal for this project. The City wishes for a flexable coating system, and the Cor-Guard is not that. QUESTION: The bid package specifies both 100 working days and 30 working days for this project. Which one is it? RESPONSE: This project will have 100 working days. QUESTION: Is there Professional Liability Insurance required for this project? • RESPONSE: No, there is no Professional Liability Insurance required for this project. QUESTION: The removal of intruding laterals must be performed prior to Sewer Lining, which takes place before bid item 3. We suggest the City stipulate a • bid item for Removal of Intruding Laterals. RESPONSE: . There are only five locations that are calling for the sawcut of a • protruding lateral. These locations are along lines that are only required to be cleaned and jetted per note 9. Payment for removal of protruding laterals will be a part of the linear foot length of pipe improved through just the cleaning effort noted by note 9. Also, top hat repair work is to include necessary rehabilitation services including sawcutting of protruding laterals and that payment of these rehabilitation services is to be included in the price of the top hat repair (bid Item No. 3). Note 9 specifies sawcutting of protruding laterals only to rehabilitate the connection for locations where atop hat repair is not required and should be included in the linear foot price of removing hard deposits from the sewer (Bid Item 12). QUESTION: Page C-31 DBE Information- Good Faith Efforts states that the "Local Agency Bidder-DBE Commitment" Form needs to be turned in•either with the • bid or before.the 2nd day after the bid. I can't locate this form in the bid package. Is it in the bid package? RESPONSE: No, those pages were not included mistakenly in the bid • package, but are a part of this addendum. RECEIVED 10-19-' 12 16:32 FROM- TO- SANCON ENGINEERING P0003/0011 Oct. 19. 2012 4: 10PM No. 4869 P. 4/11 Clean Water State Revolving Fund Loan Program DBE Instructions • • Hispanic American consists of individuals with origins from Puerto Rico, Mexico, Cuba, or South or Central America. Only those persons from Central and South American countries who are of Spanish origin, descent, or culture should be included in this category. Persons from Brazil, Guyana, Surinam or Trinidad, for example, would be classified according to their race and would not necessarily be included in the Hispanic category. In addition, this category does not include persons from Portugal, who should be classified according to race. In cases where a firm is owned and controlled by a minority woman or women, the percentage may be credited towards DBE participation, or allocated, but may not be credited fully to both. Recipient-An agency(County, City, Special District, etc.) applying for a SRF loan to construct a project. Contractor-Refers to any recipient of funds who will participate in some phase of construction. The contractor receiving funds directly from the recipient for construction is the prime contractor. Contractors working for the prime contractor are subcontractors. Project Manager.-Is the DFA staff responsible for managing the project. The Project/Contract Manager is responsible for review during the planning, design and construction contract development phases. Section 7: DBE Forms • The following forms are provided to report project DBE information. They are available in electronic form from Barbara August at (916) 341-6952 or baugust @waterboards.ca.gov. If you have any questions about completing these forms or when to turn them in, please contact Ms. August. All Forms,where applicable, must have original signature and date. The following table provides information on who completes each form and where the forms are to be sent: Form# Description Completed By Submit To Forward To 1 Solicitation Prime Recipient DFA with AOA 2 Bids Received List Prime Recipient DFA with AOA 3 (Act A) Contractor Certification DBE Subs Prime Recipient, DFA w/AOA 4(Att B) Selected Subcontractors Prime(with bid) Recipient DFA with AOA 5 Summary Prime Recipient DFA with AOA 6 Positive Effort Recipient DFA w/AOA Certification • 10 • January 2009 RECEIVED 10-19-' 12 16: 32 FROM- TO- SANCON ENGINEERING P0004/0011 ; Oct. 19. 2012 t R9 w R S P. 5/11 • § \ o. c4 Q / f �[ � / ) i /) \ \ t 1 ) o ) 6 ( § o . a ] \ U § t 2 � © ] £ 0 00 < — A in \ \ \ <4 ( ) en- \ ( \ e / & [ § � c ) \ u 7 7 Ja ) pi ) % £ j k ] • • ) %) ( Ci Q f RECEIVED 10-19-' 12 16: 32 FROM- TO- SANCON E GwIENERIg eae0RmJ Oct. 19. 2012 4: 10PM No. 4869 P. 6/11 Clean Waier Stare Revolving Fund Loan Program DBE Instructions FORM 2 • DISADVANTAGED BUSINESS ENTERPRISE (DBE) "GOOD FAITH"EFFORT BIDS RECEIVED LIST Contractor Name Category Task Bid Amount Selected Explanation for Not (DBE) Description (Check) Selecting • Form with information required to be submitted with the AOA package. • 79 RECEIVED 10-19-' 12 16:32 FROM- TO- SANCON ENGINEERING P0006/0011 Oct. 19. 2012 4: 10PM No. 4869 P. 7/11 Clean Water Stare Revolving Fund Loan Program DBE Instructions • FORM 3 (Attachment A) DISADVANTAGED BUSINESS ENTERPRISE (DBE) CONTRACTOR CERTIFICATION Firm Name: Phone: Address: Principal Service or Product: Bid Amount$ PLEASE INDICATE PERCENTAGE OP OWNERSHIP 0 DBE �%Ownership f � Prime Contractor • 0 Supplier of Material/Service O Subcontractor U Broker • D Sole Ownership 0 Corporation 0 Partnership 0 Joint Venture Certified by: Title: DBE Sub (ORIGINAL SIGNATURE AND DATE REQUIRED) Name: Date: IMPORTANT: CONTRACTORS CAN NO LONGER SELF-CERTIFY, THEY MUST BE CERTIFIED BY EPA, SMALL BUSINESS ADMINISTRATION (SBA), DEPARTMENT OF TRANSPORTATION (DOT) OR BY STATE, LOCAL, TRIBAL OR PRIVATE ENTITIES WHOSE CERTIFICATION CRITERIA MATCH EPA'S. PROOF OF CERTIFICATION MUST BE PROVIDED. A COPY OF THE CONTRACTOR CERTIFICATION MUST BE SUBMITTED WITH THIS FORM, THIS FORM MUST BE SUBMITTED WITHIN 10 WORKING DAYS AFTER THE BID OPENING DATE. S 14 rand arv'/U0Q RECEIVED 10-19-' 12 16:32 FROM- TO- SANCON ENGINEERING P0007/0011 Oct. 19. 2012 4: 10PM No. 4869 P. 8/11 Clean Water State Revolving Fund Loan Program DBE Instructions • FORM 4 (Attachment B) PRIME CONTRACTOR/RECIPIENT SELECTED DISADVANTAGED BUSINESS ENTERPRISE (DBE) CONTRACT RECIPIENTS NAME CONTRACT NO.OR SPECIFICATION NO. PROJECT DESCRIPTION • PROJECT LOCATION PRIME CONTRACTOR INFORMATION NAME AND ADDRESS(Include ZIP Code.Falcro%Employer Tax ID F) ❑ MBE ❑ WBE PHONE AMOUNT OP CONTRACTS DBE INFORMATION O NONE. O DBE NAME AND ADDRESS(Include ZIP Code,) O SUBCONTRACTOR ❑SUPPLIER/SERVICE O JOINT VENTURE ❑BROKER AMOUNT OP CONTRACT S PRONE • WORK TO SE PERFORMED ❑DBE NAME AND ADDRESS(Include ZIP Code) O SUBCONTRACTOR 0 SUPPLIER/SERVICE ❑JOINT VENTURE 0 BROKER AMOUNT OP CONTRACT S PHONE WORK TO BEPERFORMED ❑DBE NAME AND ADDRESS(Include ZIP Code,) O SUBCONTRACTOR ❑SUPPLIER/SERVICE 0 JOINT VENTURE ❑BROKER AMOUNT OFCONTRACT S PHONE WORK TO RE PERFORMED TOTAL DBE AMOUNT: S TOTAL WBE AMOUNT: S SIGNATURE OF PERSON COMPLETING FORM: TITLE: PHONE: DATE: *Negative reports are required. ORIGINAL SIGNATURE AND DATE REQUIRED.,Faitnrc to complete and submit this • form with the bid will cause the bid to be rejected as non-responsive. 15 • :Carman,9.AO9 RECEIVED 10-19-' 12 16: 32 FROM- TO- SANCON ENGINEERING P0008/0011 Oct. 19. 2012 4: 10PM No. 4869 P. 9/11 Clear Water State Revolving Fund Loan Program DBE Instructions • FORM 5 SUMMARY OF BIDS RECEIVED FROM SUBCONTRACTORS, SUPPLIERS, AND BROKERS (DBE & NON-DBE) THIS SUMMARY IS PREPARED BY THE PRIME CONTRACTOR • Type of Job Company Name Selected Bid Amount DBE NON-DBE • List type of jobs alphabetically,from low to high in each category and selected low bidder. • 16 January 2009 RECEIVED 10-19-' 12 16:32 FROM- TO- SANCON ENGINEERING P0009/0011 Oct. 19. 2012 4: 10PM No. 4869 P. 10/11 Clean Water State Revolving Fund Loon Program DBE Instructions FORM 6 DISADVANTAGED BUSINESS ENTERPRISE.(DBE) POSITIVE EFFORT CERTIFICATION BY APPLICANT/RECIPIENT I. The apparent successful low bidder on Clean Water State Revolving Fluid Program funded project number C-06- is (name of bidder) 2. Before the State Water Resources Control Board-Division of Financial Assistance can consider requests for an Approval of Award (AOA)to any bidder the applicant/recipient must certify to the following: DISADVANTAGED BUSINESS ENTERPRISE(DBE) The bidder has obtained %of DBE participation for this contract. Also submitted are Forms 3 and 4 that contain a complete list of those DBE firms subcontracted with or with whom other types of agreements were made, The list includes the names of the firm,address,phone number and dollar amount involved. The following affirmative steps as required by 40 CPR 35.3150(d)have been taken: (1) The contractor divided total requirements when economically feasible,into small tasks or quantities to permit maximum participation of disadvantaged business enterprise businesses. (2) The contractor established delivery schedules, where the requirements of the work permitted,which encouraged participation by disadvantaged business enterprise businesses. • (3) The contractor included qualified disadvantaged business enterprise businesses on solicitation lists. (4) The contractor assures that disadvantaged business enterprise businesses were solicited, whenever they were potential sources. (5) The contractor used the services and assistance of the Small Business Administration and the Office of Minority Business Development Agency of the U.S.Department of Commerce. It must be understood that the applicant/recipient in its role as a public trustee assumes primary responsibility to achieve an acceptable level of DBE utilization. This primacy responsibility is a basic condition of the award of any Clean Water State Revolving Fund financial assistance. Where an application/recipient fails to meet its obligations under these requirements the applicant/recipient may be declared non-responsive and may have funding either annulled,suspended or terminated. In accepting these responsibilities,I hereby certify to the above. Name of Applicant/Recipient Signature of Authorized Representative Date Name and Title of Authorized Representative This form must be submitted with the AOA package. S 17 January 2009 RECEIVED 10-19-' 12 16:32 FROM- TO- SANCON ENGINEERING P0010/0011 Oct, 19. 2012 4: 11PM No. 4869 P. 11/11 • Receipt of this addendum must be acknowledged by signing below and inserting it into the Contractor's proposal. Bids submitted without this signed addendum shall be considered informal. END OF ADDENDUM By order of the Cit of Seal Beach, /0�� � 112 eer g i ision r late `leo , K 401111" • ��-v• N�lviy RECEIVED 10-19-' 12 16: 32 FROM- TO- SANCON ENGINEERING P0011/0011 EPA FORM 6100-4 • Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form a e" E" nvironmental ` Protection Agency BID/PROPOSAL NO. PROJECT NAME: SSO9 k — Z 0LaIcw-, .S4.)er Lt,, I") Pcojeci- NAME OF PRIMEBIDDER/PROPOSER EMAIL ADDRESS �'lC,,‘ 63 4Ce,r\.\' NI r^^ e S�-�c . c, ;,,� ADDRESS: 55`tt Ev c Dr- . 1 kLie‘hA36-i Prat Cc 9Uyc■ TELEPHONE No: --) ly _ vi l - 2,17,2_3 FAX NO. —1 I`i —1'0. — ZSLM subcontractors' will be used on this project: COMPANY NAME, TYPE OF WORK TO BE ESTIMATED CURRENTLY ADDRESS, PHONE PERFORMED DOLLAR CERTIFIED AS AN NUMBER,AND E-MAIL AMOUNT MBE OR WBE? ADDRESS • SND Co"Sk.lvch0 V-L: 6„ JGP 4 Iooto"° No t M,,ho1es (Sletr.lno1e A834Ae%)1,- g._ ,t-- N:,o4eS A 33 v.>u Oa ..., . I SW P,pelt.,e -roc ■ ,.1--5 sssto0, n). Pei cory PI1)6 lAC CCTV/ k 32_ 000 N.J.:, I certify under penalty of perjury that the forgoing statements are true and correct. In the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302(c). .tom f2-1/4-912 Signature of Prime Contractor Date ti Gl".0'^6- Q r.)es+ VC\Ata38- Print Name Title t • Contractor is defined as a company,firm,joint venture,or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance Page C-40 EPA FORM 6100-3 Disadvantaged Business Enterprise Program • DBE Subcontractor Performance Form atEnvironmental Protection Agency NAME OF SUBCONTRACTOR: PROJECT NAME: elf( Ze _t e /7u5 n9fr“c( ✓(1 _r✓tc, �)id Tb w✓� c2> ADDRESS: Z /l0 6 e /1 t L? 24-ye, CONTRACT NO. 2+1(644c) 1£4 7/OC TELEPHONE NO: EMAIL ADDRESS: P CONT CTOR NAM : (` cry\ea\ G'r.ecrin5 J CONTRACT NO. ITEMS OF WORK OR DESCRIPTION OF SERVICES PRICE OF WORK BID TO PRIME SUBMITTED TO PRIME CONTRACTOR S Solo I — 2 're�r-(4L aNti L• ; 4. 2 °co , OQ 13$'13 ✓G4> Swx-C VA cbco I.r%OSZ`rvLtr'otn f Nc nJlf $ l000 . 00 • al 1t ,rike,vtent Currently certified as an MBE or WBE under EPA's DBE Program? Yes /cNo Prime Contractor Name: Subcontractor Name: ricer eA3t 5A)b ,,ichrkt_ 64 111✓*C , Prime Contra or ignature Subco .ct. Sig sv°`e 13ro,rek Marcic/ jo- Z y tZ G711-Ph'f i 6-7/y I2--- Title/Date Title/Da Contractor is defined as a company,firm,joint venture,or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance • Page C-38 Oct 24 2012 8: 07AM MANHOLE AJUSTING INC . 3235588055 p . 1 10-24-' 12 07: 4 FROM-SANCON ENGINEERING T-775 P0011/0001 F-525 EPA NORM 6100.3 • Disadvantaged Business Enterprise Program A DUE Subcontractor Performance Form Environmental Protection Agency NAME OF tlECONTRAC7'OTt: PROJECT NAME; I MAaho AQ(USTt ►1 INc, ScuWEP CANAL (MPPoU P �JI ADDRESS: CONTRACT N0. 9500 'sty 4)D CaP SSogol—�PRW, Cot,53raIRo TELEPH0 NO: EMAIL ADDRESS: 4bef �ltizrnetiAC C3�)5 6 -Botx� C3z3) 556-8055,�xe '� PRIME CO TRACTOR NAME: CONTRA NO. MS op WORK OR DESCRIPTION OF SERVICES PRJCIg OF WORK BID TO PRIME SUBMITTED TO PRIME CONTRACTOR /A c. �1 V-RA r 33, 3 • I ' Currently cen ilea ea an MBE or WEE under RPA'a D8E Progrem9 Yes^ C No ?rime Con.it-ctor Name! SlikQEMIcianniti ///1 M�FN �/} ln. 'r e 3Iv ry i_�,c SOLE icrti.iU$rod4 I .41 III 1/ ,_ P ctor Signature Suboontra or 8nature Edit-el ft'o,.,,...-- G4,1y -EST IMkm4/Io(24(I2. Title/Date Tide/Date conflict is defined .,a oompeny, rm. Dint venturo,or Indlvlduat wbo snore Iab an agretma art Icontreoior to Dravida serving pumwnt loan EPA sward of financial aniee ' Page C-38 ) I I RECEIVED 10-24-'12 08: 08 FROM- 3235588055 TO SANCON ENGINEERING P0001/0001 Environmental Protection Agency Disadvantaged Business Enterprise Program • DBE Subcontractor Performance Form NAME OF SUBCONTRACTOR' PROJECT NAME Vc:r r,,,,4,_ et 1 g c L..n_ rc 1,,,,✓ Lid i CtO Xbw a 1)cc.ic! �:c.0 i. , ADDRESS {� / BID/PROPOSAL NO. J Slo( f.✓4n,-c Aver dya2 Kr//• CA. %ldy9 S50961 -2- TELEPHONE NO. E-MAIL ADDRESS -1(`I 3 So -zX> \ GC.-K- to_ e el o u cat-1 PRIME CONTRACTOR NAME ticGh 6,. -vc - j Lfog CONTRACT ITEM OF WORK OR DESCRIPTION OF SERVICES PRICE OF WORK ITEMNO. BID TO PRIME SUBMITTED TO M PRIME CONTRACTOR )tA %tier-\ Ll 'GknN;.�y .AAi cc.N 1tt' Stw di yZL ,vo S Ct[n»;,/ q,r! ccv- 1 Sc »r 1 )s I. L cltt;i,..7 Ai k Cc Ill 7 " S.cv-s ti 12, nia (• Gb -1 Cl �^"^'!t AI , CCN [,'t 5..c� .r Sz� l • it cif( se“- Rylas5 •7 �g i fg OW.co It 124.1‘40 a:n1 OA/ a ot(oc.T f Cit. .. sue---i sz e'o 1 . r° Currently e tic as an MBE or WBE undei EPA's DBE Program? Yes 2( No Signature of Prime Contractor Date Print Dame Title /Z /i-l\,• _. _ / 0 - 2:5—ft Signature of Subcontractor Date Cti;r-t._ GLASShcn -JV— r Ai1/t Print Name Title • • 'Subcontractor is defined as a company,firm,joint venture,or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. . EPA FORM 6100-3 (DBE Subcontractor Performance Form) • OCT-23-2012 12: 13 P.001/001 OMB Control No: • Approved: Approval Expires: . Environmental • Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form NAME OP SUBCONTRACTOR' PROJECT NAME catm. kwetkcIiotAi^R. oit1. 'Cvv+. cant Li^'yy ADDRESS BID/PROPOSAL NO. 2Z\\ S. U ...k that lorr,u.CA gcsca TELEPHONE NO. E-MAIL ADDRESS 310'37)2t4-4- RQ01.6a. Sl..ie e1 t., .Las. PRIME CONTRACTOR NAME S0.v%Co✓s, Cit.-Neer 1 73 c CONTRACT ITEM OF WORK OR DESCRIPTION OF SERVICES PRICE OF WORK ITEM NO. BID TO PRIME PRIME MrrED TO CONTRACTOR CONTRACTOR 3 L w A e t c-` Ses`s 'fop W- • • -w ertified t WEE under EPA's DBE Program? Yes No Signature of Prim` ontractor Date •1 Ck■ft, -� ?r ,e_cf (1/41\k,v-eley- J Print Name Title 4AOF 101211kt Signature of Subcontractor Date Print Name U Title _ • 'Subcontractor is defined as a company,firm,joint venture,or individual who enters into an agreement with a contractor to provide a'rvicess pursuant to an EPA award of financial assistance. EPA FORM 6100-3(DBE Subcontractor Performance Form) RECEIVED 10-23-' 12 12: 14 FROM- TO- SANCON ENGINEERING P0001/0001