HomeMy WebLinkAboutAGMT - J. Cardenas Construction (Annual Concrete Rehab FY2001-02 Project #49675) • •
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO
CITY OF SEAL BEACH
Attn: City Clerk
211 8`b Street
Seal Beach, CA 90740
Space of above this line for Recorder's use.
***No Recording Fee Pursuant to Government Code Section 6103,27383 ****
NOTICE OF COMPLETION
Notice pursuant to Civil Code Section 3093,must be filed within 10 days after completion.
Notice is hereby given that:
1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the
property hereniafter described:
2. The full name of the owner is: City of Seal Beach
3. The address of the owner is: City of Seal Beach,211 8°'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 described as completed on 05/23/02. The work
was: Annual Concrete Rehabilitation,Project No.49675
6. The name of the contractor, if any,for such of improvement was: J. Cardenas Construction. Inc.
7. The date of the Contract was: March 25,2002.
8. The property on which said work of improvement was completed in the City of Seal Beach,County of
Orange, State of California,and is described as follows: Concrete sidewalk replacement on Main St.
and various residential areas.
Date: thG(y 7a 2.002 ���
Signature f owner or rporate officer of owner
named in paragraph 2 or his agent.
DEPUTY CITY ENGINEER
VERIFICATION
I,the undersigned,say: the Director of Public Works declarant of the foregoing notice of completion; have
read said notice of completion and know the contents thereof; the same is true of my own knowledge.
I declare under.penalty of perjury the foregoing is true and correct.
Executed on J(...)( 73 , 2002, at e .lifomia.
(Data of Signature) ,
Director •_ ' .
EXHIBIT "A"
J
• •
WHEN RECORDED RETURN TO: RECORDING REQUESTED PURSUANT TO
CITY OF SEAL BEACH GOVERNMENT CODE SECTION 6103
211 8TH STREET
SEAL BEACH, CALIFORNIA 90740
RESOLUTION NUMBER fag
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEAL
BEACH i)ECLARJNG'WORK TO BE COMPLETED AS TO PLANS AND
SPECIFICATIONS FOR PROJECT #49675, ANNUAL CONCRETE
REHABILITATION ENTERED INTO BETWEEN J. CARDENAS
CONSTRUCTION, INC. AND THE CITY OF SEAL BEACH
THE CITY COUNCIL OF THE CITY OF SEAL BEACH DOES HEREBY
RESOLVE:
WHEREAS, on March 25, 2002, the City of Seal Beach entered into a contract with J.
Cardenas Construction, Inc.
WHEREAS, the City Engineer has determined that the work has been substantially
completed in accordance with the contract documents.
NOW, THEREFORE BE IT RESOLVED by the City Council of the City of Seal Beach
as follows:
Section 1. That the work required to be performed by said Contractor has been
completed.
Section 2. That the total cost of said work is in the amount of$ 42,120.25.
Section 3. That the work is hereby accepted and approved.
Section 4. It is further ordered that a "Notice of Acceptance", Exhibit "A", be filed on
behalf of the City is in the Office of the County of Orange within 10 days of
the date of this resolution.
PASSED, APPROVED AND AI/OPTED the City Council of the City of Seal Beach at
a meeting thereof held on tat,/day o 002 by the following vote:
o__/ /
,_,
AYES: Councilmembe s ,,,., , /._ I ' . ,` 411,r_ �L% , , if ,
/
NOES: Councilmember((s�
ABSENT: Councilmembers1
,) u. &M9-
Mayor
AT�ST
(A2 !
Cityrk
I
STATE OF CALIFORNIA)
COUNTY OF ORANGE )SS
CITY OF SEAL BEACH)
1, Joanne M. Yeo, City Clerk of Seal Beach, California, do hereby certify that the foregoing
resolution is the original copy of Resolution Number eon file in the office of the City
Clerk, passed, approved, and adopted by the City Council of the it of Seal Beach, at a
regu al meeti i_ thereo held on the c day of A__ . _ , 2002.
X41 /
Clerk
•
1 '
. PLEASE COMPLETE THIS INFORMATION
RECORDING REQUESTED BY:
Recorded in Official Records, County of Orange
AND WHEN RECORDED MAIL TO: Darlene Bloom, Interim Clerk-Recorder
IIIIIIIIIIIIiIII1 16111VIII11'111111!IIIIIIIIIIIIIIIIIIINO FEE
A} lr3 110 25 R28 4
20020646329 08:05am 08/05/02
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THIS SPACE FOR RECORDER'S USE ONLY 11
TITLE OF DOCUMENT: loolot7 On ..%3p �I J
ANNUAL CONCRETE REHABILITATION
PROJECT 49675 ^^,,
ktril1/4,13)
IV�
THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION J(
(Additional recording fee applies) 91/4� CI)II
'0 059-TITLE PAGE(R7/95) `
kr
-• -arCittelt
afik
CONTRACTOR TO PRINT COMPANY BOOK II OF III -
NAME:
CONTRACT DOCUMENTS
DOCUMENTS TO SUBMIT UPON AWARD:
PUBLIC WORKS CONTRACT ACKNOWLEDGEMENT OF LICENSE LAW
PERFORMANCE BOND WORKMEN'S COMPENSATION
PAYMENT BOND • CERTIFICATE
INDEMNIFICATION AND BOLD INSURANCE'REQUIREMENTS
HARMLESS -Insert other requirements if applicable-
LABOR LAW REQUIREMENTS . .
FOR
Annual Concrete Rehabilitation FY 2001/2002 '
CITY PROJECT NUMBER:
e W
h ,fj l ;
4967
These Contract Documents an the exclusive property of the Agency and shall not be used in any manner without prior consent of the
Agency.Any reuse of these plans and specifications by Others shall be at Other's sole risk and without liability to the Agency.
CITY OF SEAL BEACH-211 EIGHTH STREET-SEAL BEACH,CA 90740-6379.
1
BOOK II OF I I 1
CONTRACT DOCUMENTS I
DOCUMENTS TO SUBMIT UPON AWARD: 1
PUBLIC WORKS CONTRACT 3
PERFORMANCE BOND 5
INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND
WAIVER OF SUBROGATION AND CONTRIBUTION 9
AGREEMENT TO COMPLY WITHCALIFORNIA LABOR LAW
REQUIREMENTS 10
STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES
CONCERNING THE CONTRACTORS' LICENSING LAWS 11
INSURANCE REQUIREMENTS • 13
WORKER'S,COMPENSATION CERTIFICATE OF INSURANCE 15
ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE
GENERAL LIABILITY 16
ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY
18
ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY 20
2
•
PUBLIC WORKS CONTRACT
Annual tConcrete Rehabilitation,F/Y� 2001/2002
AuFor the following project named CGJC (,,g,MB. f\( a6)`_ 2
,in the City of Seal Beach.
THIS AGREEMENT, made and entered into this `ate day of Aar/L 206a, by and
between the City of Seal Beach, California, hereinafter referred to as the "CITY," Party of the First Part,
and , CA,PL)exJ F S 73 ivs 1rte? '&/U
hereinafter designated as the"CONTRACTOR,"Party of the Second Part.
WITNESSETH: That the Parties do hereto mutually agree as follows:
ARTICLE L For and in consideration of the payments and agreements hereinafter mentioned to be
made and performed by said CITY,the CONTRACTOR agrees with said CITY to perform and complete
in a good and workmanlike manner all the work pertaining thereto shown on the drawings and described in
the Specifications and Contract Documents, therefore, to furnish at his own proper cost and expense all
tools, equipment, labor and materials necessary therefore (except those materials expressly noted as to be
furnished by the CITY), and to do everything required by this Agreement and the said Specifications,
Drawings,and Contract Documents.
ARTICLE II. For furnishing all said materials and labor, furnishing and removing all plant, temporary
works or structures, tools and equipment and doing all the work contemplated and embraced in this
Agreement, also for all loss and damage arising out of the nature of the work aforesaid, or from the action
of the elements, or from any unforeseen difficulties which may arise or be encountered in the prosecution
of the work until its acceptance by said CITY, and for all risks of every description connected with the
work; also for all expenses incurred by or in consequence of the suspension or discontinuance of work;
except such as in the said Specifications are expressly stipulated to be borne by the said CITY and
faithfully completing the work and the whole thereof, in the manner shown and described in the said
Drawings, Specifications, and Contract Documents and in accordance with the requirements of the
Engineer, said CITY will pay and the CONTRACTOR shall receive in full compensation, therefore, the
unit prices and the lump sum prices named in the Schedule of Work Items of the Proposal.
ARTICLE III. The CITY hereby promises and agrees with said CONTRACTOR to employ and does
hereby employ said CONTRACTOR to provide the materials and to do the work according to the terms and
conditions herein contained and referred to for the price aforesaid, and hereby contracts to pay the same,at
the time,in the manner and upon the conditions set forth in the Specifications and Contract Documents,and
the said parties for themselves, their heirs, executors, administrators, successors and assigns, do hereby
agree to the full performance of the covenants herein contained.
ARTICLE IV. The advertisement for Bids, the Proposal,the Specifications,and the Drawings mentioned
therein, and all addenda issued by the CITY with respect to the foregoing prior to the opening of bids, are
hereby incorporated in and made a part of this Agreement.
ARTICLE V. The statement of prevailing wages appearing in the General Prevailing Wage Rates is
hereby specifically referred to and by this reference is made a part of this contract. It is further expressly
agreed by and between the parties hereto that should there be any conflict between the terms of this
instrument and the bid of proposal of said CONTRACTOR,then this instrument shall control and nothing
herein shall be considered as an acceptance of the said terms of said proposal conflicting herewith.
ARTICLE VI. By my signature hereunder,as CONTRACTOR,I certify that I am aware of the provisions
of Section 3700 of the Labor Code which require every employer to be insured against liability for
workmen'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.
3
• •
IN WITNESS WHEREOF: The Parties hereto have caused this contract to be executed the day and year
first above written.
•
CITY OF SEAL B H, IFORNIA
Party of the F. •art
BY H,
City Manager
A11tST:
City Clerk
! / r
BY „ :J . iS 1
CONTRACTOR-Party of the Seco • Part
New
Title
L�rdk,—�1
��
.t?p.Baxt�aa8 �h (/ � 9?735---
Address
4
•
• •
Issued in three original counterparts
• Bond No. 832139P Bond Premium$549.00
"Premium is for comae turn&is subject to
PERFORMANCE BOND adjustment based on final contract price".
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Seal Beach,has awarded I. Cardenas Construction 14221 Whispering Sands Dr.,
Victorville, Ca 92392
(Name and address of Contractor)
("Principal"),a contract(the"Contract")for the work described as follows:
. Annual Concrete Rehabilitation. Fy 2001-2002
Project#49675
WHFREAS, 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 Indemnity Company of California 425 W.
Broadway,#I05,Glendale, Ca 91204
(Name and address of Surety)
•
• ("Surety") a:duly admitted surety insurer under the laws of the State of California, as Surety, are held and •
firmly bound unto the Public Agency in the penal sum of Twenty seven thousand, four hundred forty
eight dollars and no/00.
Dollars ($27,448.00 ), 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 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. 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 t, •5
• •
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:April 12,2002
"Principal" "Surety" •
J. Cardenas Construction Indemnity Company of California
ar
By: ditrittd/t t' BY: / "/�
1 r ►
Its Veronica L. Pratt,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.
S
6
• •
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
•
County of Riverside
On April 12,2002 before me, Nicole Kwiecien,Notary Public
DATE NAME.TITLE OF OFFICER-E.G.,"JANE DOE,NOTARY PUBLIC"
personally appeared Veronica L. Pratt
NAME(S)OF SIGNER(S)
® personally known to me - OR - C proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
NICOLE KWIECIEN capacity(ies), and that by his/her/their
Commission p 1217364
z Y : Notary Public-California E signature(s) on the instrument the person(s),
c-•%"7 San Bernardino County — or the entity upon behalf of which the
*Comm.ExpresApr26,2033 Y u P
person(s) acted, executed the instrument.
WITNESS my hand and official seal.
/i
aJ /L ✓L
SI NATURE OF NOTARY
I OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
•
❑ INDIVIDUAL
❑ CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
TITLE(S)
❑ PARTNER(S) n LIMITED
❑ GENERAL
® ATTORNEY-IN-FACT NUMBER OF PAGES
L TRUSTEE(S)
GUARDIAN/CONSERVATOR
C OTHER:
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(S)OR ENTITY(IES)
-- SIGNER(S) OTHER THAN NAMED ABOVE
S 9590(4/94)
•
•
Issued in three original counterparts
Bond No. 832139P Bond Premium 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 J. Cardenas Construction 14221 Whispering Sands Dr.,
Victorville, Ca 92392
(Name and address of Contractor)
("Principal"),a contract(the"Contract")for the work described as follows:Annual Concrete Rehabilitation
Fy 2001-2002
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 Indemnity Company of California 425 W.
Broadway,#105,Glendale, Ca 91204
(Name and address of Surety)
• ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety,are held and
firmly bound unto the Public Agency in the penal sum of Twenty seven thousand, four hundred forty
eight dollars and no/00.
Dollars($ 27,448.00 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 hefts,executors,administrators,successors,
and assigns,jointly and severally,fumlyby these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal,his,her
or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the
persons named in Section 3181 of the California Civil Code,or any amounts due under the Unemployment
Insurance Code with respect to work or labor performed under the Contract,or for any amounts required to
be deducted, withheld, and paid over to the Employment Development Department from the wages of
employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance
Code, with respect to work or labor performed under the Contract,the Surety will pay for the same in an
amount not exceeding the penal sum specified in this bond;otherwise, this obligation shall become null and
void.
This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil
Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In
case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys'
fees in an amount fixed by the court.
FURTHER, the Surety, for value received, hereby stipulates and agrees that no change,extension of time,
alteration,addition or modification to the terms of the Contract, or of the work to be performed thereunder,
or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby
waive notice of any such change, extension of time, alteration,addition,or modification to the terms of the
•
•
7
• •
Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of
• California Civil Code§§ 2845 and 2849.
IN WITNESS WHFREOF, 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: April 12,2002
"Principal" "Surety"
J. Cardenas Construction Indemnity Company of California
i
By: Ia ,� t a. By: /� ,/I� ?:/•
Its Veronica L.Pratt,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..
•
8
.r
/I
• •
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of Riverside
On April 12, 2002 before me, Nicole Kwiecien,Notary Public
DATE NAME,TITLE OF OFFICER-E.G..`JANE DOE,NOTARY PUBLIC"
personally appeared Veronica L. Pratt
NAME(S)OF SIGNER(S)
® personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
PacomKW1ECIEN signature(s) on the instrument the person(s),
Cannntalon/121764 or the entity upon behalf of which the
Non,"POW-Cafftcrnkt
c?"!.j San eemuThoCounty — person(s) acted, executed the instrument.
• WITNESS my hand and official seal.
..IGNATURE OF NOTARY
•
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
❑ INDIVIDUAL
❑ CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
TITLE(S)
❑ PARTNER(S) ❑ LIMITED
❑ GENERAL
® ATTORNEY-IN-FACT NUMBER OF PAGES
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER
• DATE OF DOCUMENT
SIGNER IS REPRESENTING: •
NAME OF PERSON(S)OR ENTITY(IES)
SIGNER(S)OTHER THAN NAMED ABOVE
i\
•
•
S 959D(4)94)
• •
POWER OF ATTORNEY FOR
DEVELOPERS SURETY AND INDEMNITY COMPANY
INDEMNITY COMPANY OF CALIFORNIA
PO BOX 19725 IRVINE,CA 92623.(949)263.3300
410 OW ALL MEN BY THESE PRESENTS, that except as expressly limited. DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY
OF CALIFORNIA,do each severally.but not jointly.hereby make,constitute and appoint
•
***GEORGE J. BURCHFIEL, MATTHEW C. WELTY, VERONICA L. PRATT, SUE BURCHFIEL,
JOINTLY OR SEVERALLY***
as the true and lawful Attorney(s)-in-Fact.to make,execute,deliver and acknowledge,fur and on behalf of said corporations as sureties,bonds,undertakings and contracts
of suretyship giving and granting unto said A ttorncy(s)-in-Fait full power and authority to do and to perform every act necessary, requisite or proper to be done in
connection therewith as each of said corporations could do,but reserving to each of said corporations fill power of substitution and revocation,and all of the acts of said
Attorney(shin-Fact,pursuant to these presents,are hereby ratified and continued,
This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Board of Directors of
DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA,eBective as of November 1,211(X):
RESOLVED,that the Chairman of the Board,the President and any Vice President of the corporation be,and that each of them hereby is.authorized to execute Powers of
Attorney,qualifying the attorney(s)named in the Powers of Attorney to execute.on behalf of the corporations.bonds,undertakings and contracts of suretyship.and that the
Secretary or any Assistant Secretary orate corporations he,and each of them hereby is,authorized to attest the execution ofany such Power of Attorney:
RESOLVED,FURTHER.that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such
Power of Attorney or certificate hearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and in the future with respect to any bond,
undertaking or contract of.surcly'ship to which it is attached.
IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these
presents to be signed by their respective Executive Vice President and attested by their respective Secretary this R't day of November,20(K).
•I)avid H.Rhodes,Executive Vice President ,,,jQEt,,,,,OF%.,y -AGOMp O FO,cC,
w'• SEAL ''•< W ocT.6 a c
n� :Cp: 1967 a•V. =ot 1936 O;
Z
Br_Walter.A.Crowell, Secretary -- %7' /OWN .' a,• 0,40r0,0\P s.
• *.,
STATE OF CALIFORNIA )
)SS_
COUNTY OF ORANGE 1
On November 5,2101)..before me, Diane J.Kawata,personally appeared David H. Rhodes and Walter A.Crowell.personally known to me(or proved to me on the basis of
satisfactory evidence) to be the persons whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their authorized
capacities,and that by their signatures on the instrument the entity upon behalf.of which the persons acted,executed the instrument.
WITNESS my hand and official seal.
I . f
�/� e ;,Ai NG IEJA(A16 926
LI ,A�n,l, l uur�7 n sa•)NOTMY RIBIS-CALIFOiNIA E
Signature �._ .--_ i�f5^:;/ L)RANGEGGUNTY
_ N9 Came Fa Jan.8,1882 I
CRRTIFICA'FIC
The undersigned. as Chief Operating Officer of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, does
hereby certify that the Ioregoing Power of Attorney remains in full force and has not been revoked,and furthermore,that the provisions of the resolutions of the respective
Boards of Directors of said corporations set forth in the Power of Attorney.are in force as of the date of this Certificate.
This Certificate is executed in the City of Irvine,California.the 12th day of April 2002
0 r---)/� yam/
David Ci, Lane.Chief Operating Officer
ID-13511 I l POO)
• •
INDEMNIFICATION AND BOLD HARMLESS AGREEMENTAND WAIVER OF
SUBROGATION AND CONTRIBUTION
TITLE OF PROJECT OR WORK:AwJukt Ct wc,P *&/Lf> br iv . F'reaGYPpc2
Indemnitor(s)(list all names):
To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend,
protect, indemnify, and hold harmless the City of Seal Beach and its elected officials, officers, attorneys,
agents, employees, volunteers, successors, and assigns (collectively "Indemnitees") from and against any
and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses,
judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys,
or other professionals and all costs associated therewith (collectively "Liabilities"), arising or claimed to
arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act,
error, or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors,
materialmen, suppliers or their officers, agents, servants or employees, arising or claimed to arise,directly
or indirectly, out of, in connection with, resulting from, or related to the above-referenced contract,
agreement, license, or permit (the "Agreement") or the performance or failure to perform any term,
provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity
provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by
Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence. This indemnity
provision shall survive the termination of the Agreement and is in addition to any other rights or remedies
which 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 an
Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision.
Indemnitor shall pay Indemnitees for any attorney's fees and costs incurred in enforcing this
indemnification provision. Notwithstanding the foregoing,nothing in this instrument shall be construed to
encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying
Agreement is subject to Civil Code§ 2782(a)or(b)the contracting public agency's active negligence to the
limited extent that the underlying Agreement is subject to Civil Code § 2782(b). This indemnity is
effective without reference to the existence or applicability of any insurance coverage which may have
been required under the Agreement or any additional insured endorsements which may extend to
Indemnitees. Indemnitor,on behalf of itself and all parties claiming under or through it,hereby waives all
rights of subrogation and contribution 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 regardless of any prior, concurrent, or subsequent active or passive negligence by
the Indemnitees. In the event there is more than one person or entity named in the Agreement as an
Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint
and several,
"Indemnitor"
Name . — Name:
1 By:
II By: `
I
WI Its
9
•
AGREEMENT TO COMPLY WITIICALIFORNIA LABOR LAW REQUIREMENTS
[Labor Code§§ 1720, 1773.8, 1775, 1776, 17773, 1813,1860, 1861,3700)
The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the
Following provisions of California law:
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 California 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 1,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 04/-40? —a ) Signature — 0/
•
10
• •
STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE
CONTRACTORS'LICENSING LAWS
[Business&Professions Code§ 7028.15]
• [Public Contract Code§20103.5]
I, 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 therefor,
except in any of the following cases:
(1) 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
the public employee, officer, or employing agency made an inquiry to the board for the purposes of
verifying the license status of any person or contractor and the board failed to respond to the inquiry within
11
•
• •
•
three business days. For purposes of this section, a telephone response by the board shall be deemed
sufficient.
Public Contract Code§20103.5: •
In all contracts subject to this part where federal funds are involved, no bid submitted shall be
invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However,at
the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of
this state. The first payment for work.or material under any contract shall not be made unless and until the
Registrar of Contractors verifies to the agency that the records of the Contractors' State License Board
indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or
contractor not so licensed shall be subject to all legal penalties imposed by law, including, but not limited
to, any appropriate disciplinary action by the Contractors' State License Board. The agency shall include a
statement to that effect in the standard form of pre-qualification questionnaire and financial statement.
Failure of the bidder to obtain proper and adequate licensing for an
award of a contract shall constitute a failure to execute the contract and
shall result in the forfeiture of the security of the bidder.
License no.: ,6poCe Class: / Expiration date: ?Oen 3
Date O1-7Oa-07 Signature 6.7{7 � f�l � •
•
•
•
12
• •
INSURANCE REQUIREMENTS
FOR CITY OF SEAL BEACH
PUBLIC WORKS CONTRACT
•
LIABILITY INSURANCE
The Contractor shall at all times during the terms of the Contract carry,maintain,and keep in full force and
effect a policy or policies of comprehensive general liability insurance in which the City, along with its
City Council and each member thereof, and every officer, official, agent, attorney, employee or volunteer
of the City, is the named insured or is named as an additional insured with the Contractor in accordance
with the General Provisions. The insurance company issuing such policy(ies) must be acceptable to, and
approved by, the City Engineer and City Attorney. Contractor shall maintain limits of no less than One
Million Dollars ($1,000,000) combined single limit coverage per occurrence for personal injury or death or
property loss or damage which may arise from or relate directly or indirectly to the acts, operations or
omissions of the performance of the Contractor and/or its subcontractors and/or the employees, agents,
officers,officials or volunteers of either, in the performance of this Public Works Contract. Such insurance
shall include coverage for all automobiles utilized by Contractor's or any subcontractor's employees or •
agents in the performance of the Contract. Contractor shall also provide an endorsement in the forms
included in Book II.
•
•
13
• •
WORKER'S COMPENSATION CERTIFICATE OF INSURANCE
WHEREAS,the CITY OF SEAL BEACH has required certain insurance to be provided by
NOW THEREFORE,the undersigned insurance company does hereby certify that it has issued the policy
or policies described below to the following named insureds and that the same are in force at this time.
1. This certificate is issued to: CITY OF SEAL BEACH, City Hall, 211 EIGHTH STREET, SEAL
BEACH,CA 90740-6379.
2. The insureds under such policy or policies are:
3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of
California covering all operations of the named insureds,as follows:
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE
4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability,
unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the
CITY OF SEAL BEACH.
By:_
Its Authorized Representative
15
• . •
•
ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY
JAVIER CARDENAS dba: J. CARDENAS CONSTRUCTION
Name and address of named insured("Named Insured"):
•
GOLDEN EAGLE INSURANCE CORPORATION P.O. BOX 85826 SAN DIEGO, CA 92186-5826
Name and address of Insurance Company("Company"):
OFFICIAL TITLE OF PROJECT:Si t<y .705 V z
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached
(the"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows:
1. The City of Seal Beach, its elected officials, officers, attorneys, agents, employees, and volunteers are
additional insureds (the above named additional insureds are hereafter referred to as the "Additional
Insureds") under the Policy in relation to those activities described generally above with regard to
operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability
for the payment of any premiums or assessments under the Policy.
2. The insurance coverage's afforded the Additional Insureds under the Policy shall be primary insurance,
and no other insurance maintained by the Additional Insureds shall be called upon to contribute with
the insurance coverage's provided by the Policy.
3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against
whom claim is made or suit is brought except with respect to the limits of the Company's liability.
4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured
under the policy against another insured under the policy. All such claims shall covered as third-party
claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing
contained in this provision shall operate to increase or replicate the Company's limits of liability as
provided under the policy.
5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms,
conditions and exclusions applicable to such insurance) includes liability assumed by the Named
Insured under the indemnification and/or hold harmless provision(s) contained in or executed in
conjunction with the written.agreement(s) or permit(s) designated above, between the Named Insured
and the Additional.Insureds.
6. The policy to which this endorsement is attached shall not be subject to cancellation, change in
coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except
after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty
(30) days prior to the effective date thereof. In the event of Company's failure to comply with this
notice provision, the policy as initially drafted will continue in full force and effect until compliance
with this notice requirement. )ho v c Mini' Op Cfbt)/a244-pox) m.2-UpO-t'4r4t xif o.092-emWa4
7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds,
while acting within the scope of their duties, from all claims, losses and liabilities arising out of or
incident to the perils insured against in relation to those activities described generally above with
regard to operations performed by or on behalf of the Named Insured regardless of any prior,
concurrent,or subsequent active or passive negligence by the Additional Insureds. •
8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity,
construction,interpretation,and enforcement of this contract of insurance.
9. This endorsement and all notices given hereunder shall be sent to Public Agency at:
Director of Public Works
City of Seal Beach
211 8th Street
Seal Beach CA 90740
16
• •
10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be
held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this
endorsement is attached. - Z000,000
1,000,000
TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF 000,000
oo,00o
THIS ENDORSEMENT ATTACHES FROM/TO 05/29/01 -05/29/02 LIABILITY 100,000
5,000
11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions
relate to the above coverages. Includes:
❑ Contractual Liability ❑ Explosion Hazard
❑ Owners/Landlords/Tenants ❑ Collapse Hazard
❑ Manufacturers/Contractors ❑ Underground Property Damage
E Products/Completed Operations ❑ Pollution Liability
❑ Broad Form Property Damage ❑ Liquor Liability
❑ Extended Bodily Injury ❑
❑ Broad Form Comprehensive ❑
E General Liability Endorsement ❑
12. A E deductible or ❑ self-insured retention (check one) of $ 500
applies to all coverage(s)except GENERAL LIABILITY
(if none, so state). The deductible is applicable ❑ per claim or E per occurrence (check
one).
13. This is an E occurrence or❑ claims made policy (check one).
14. This endorsement is effective on 04/11/02 at 12:01 A.M. and forms a part
of Policy Number CCP689313-00
•
I, FRED PRATT (print name),hereby
declare under penalty of perjury under the laws of the State of California, that I have the authority to bind
the Company-t. this endorsement and that by my execution hereof,I do so bind the Company.
Exethted APRIL ,2002
i. /
///. /I
*gnat-ire of A Ord•. -d Representative
(Original signature only; no facsim-ile signature or initialed signature
accepted)
PhoneNo.: ( 909 ) 371-8147
17
• •
•
ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY -
JAVIER CARDENAS dba: J. CARDENAS CONSTRUCTION
Name and address of named insured("Named Insured"):
GOLDEN EAGLE INSURANCE CORPORATION P.O. BOX 85826 SAN DIEGO,CA 92186-5826
Name and address of Insurance Company("Company"):
OFFFICAL TITLE OF PROJECT: /F-1 1L1/J#C COMCf¢n frof&/Lr7 �a1/°�Q 2
s(-yjOU y
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the
"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows:
The City of Seal Beach,its elected officials,officers,attorneys,agents,employees,and volunteers are additional
insureds(the above named additional insureds are hereafter referred to as the"Additional Insureds")under the
Policy in relation to those activities described generally above with regard to operations performed by or on behalf
of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments
under the Policy.
1. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no
other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance
coverages provided by the Policy.
2. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim
is made or suit is brought except with respect to the limits of the Company's liability.
3. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under
the policy against another insured under the policy. All such claims shall covered as third-party claims, i.e., in
the same manner as if separate policies had been issued to each insured. Nothing contained in this provision
shall operate to increase or replicate the Company's limits of liability as provided under the policy.
4. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and
exclusions applicable to such insurance) includes liability assumed by the Named Insured under the
indemnification and/or hold harmless provision(s) contained or executed in conjunction with the written
agreement(s)or permit(s) designated above,between the Named Insured and the Additional Insureds.
5. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage,
reduction of limits (except as the result of the payment of claims), or non-renewal except after written notice to
Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective
date thereto. In the event of Company's failure to comply with this notice provision, the policy as initially
drafted will continue in full force and effect until compliance with this notice requirementt '` n c ,tcvryr
r�-NcO—GA's
6. Company hereby waives all rights of subrogation and contribution against the Additional Insureds,while actmgtry. toya-v,utowt
within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils
insured against in relation to those activities described generally above with regard to operations performed by
or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive
negligence by the Additional Insureds.
It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction,
interpretation,and enforcement of this contract of insurance.
This endorsement and all notices given hereunder shall be sent to Public Agency at:
Director of Public Works
City of Seal Beach
211 8th Street -
Seal Beach CA 90740
7. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to
waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is
attached.
18
• •
- TYPE OF COVERAGES TO WHICH POLICY PERIOD
LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO 05/29/01 -05/29/02
LIABILITY •
BUSINESS AUTO LIABILITY
1,000,000 CSL
5,000 MEDICAL PAYMENTS
100,000 UNINSURED MOTORIST
Scheduled items or locations are to be identified on an attached sheet The following inclusions relate to
the above coverages. Includes:
O Any Automobiles ❑ Truckers Coverage
❑ All Owned Automobiles ❑ Motor Carrier Act
E Non-owned Automobiles ❑ Bus Regulatory Reform Act
E Hired Automobiles ❑ Public Livery Coverage
8 Scheduled Automobiles 0
❑ Garage Coverage ❑
11. A E deductible or ❑ self-insured retention (check one) of $ 500 applies to all
coverage(s) except: GENERAL LIABILITY
(if none,so state). The deductible is applicable 0 per claim or E per occurrence(check one).
12. This is an 81 occurrence or❑ claims made policy(check one).
13. This endorsement is effective on04/11/02 at 12:01 A.M. and forms a part of Policy
Number CCP689313-00 •
E lred Pra—i (print name), hereby
declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the
Company to this endorsement and that by my execution hereof,I do s. .=Company.
Executed APRIL I I /" ,2002
/
Signature of Authorized Representative
(Original signature only; no f. es*is il `'T= T e or initialed signature
accepted)
Phone No.: ( 909 ) 371-8147
19
•
•
•
ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY
Name and address of named insured("Named Insured"):
Name and address of Insurance Company("Company"):
OFFICIAL TITLE OF PROJECT:,WNtT, Conant ,2E,yq-eic.rT.4476.A.J
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the
"Policy") or in any endorsement now or hereafter attached thereto,it is agreed as follows:
1. The City of Seal Beach, its elected officials,officers, attorneys, agents,employees, and volunteers
are additional insureds (the above named additional insureds are hereafter referred to as the"Additional Insureds")
under the Policy in relation to those activities described generally above with regard to operations performed by or
on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or
assessments under the Policy.
2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary
insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the
insurance coverages provided by the Policy.
3. Each insurance coverage under the Policy shall apply separately to each Additional Insured
against whom claim is made or suit is brought except with respect to the limits of the Company's liability.
4. Nothing in this contact of insurance shall be construed to preclude coverage of a claim by one
insured under the policy against another insured under the policy. All such claims shall covered as third-party
claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this
provision shall operate to increase or replicate the Company's limits of liability as provided under the policy.
5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms,
conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the
indemnifica-tion and/or hold harmless provision(s) contained in or executed in conjunction with the written
agreement(s)or permit(s) designated above,between the Named Insured and the Additional Insureds.
6. The policy to which this endorsement is attached shall not be subject to cancellation, change in
coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except after written
notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the
effective dale thereto. In the event of Company's failure to comply with this notice provision, the policy as initially
drafted will continue in full force and effect until compliance with this notice requirement.
7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds,
while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the
perils insured against in relation to those activities described generally above with regard to operations performed by
or on behalf of the Named Insured regardless of any prior,concurrent,or subsequent active or passive negligence by
the Additional Insureds.
8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity,
construction, interpretation,and enforcement of this contract of insurance.
9. This endorsement and all notices given hereunder shall be sent to Public Agency at:
Director of Public Works
City of Seal Beach
211 8th Street
20
Seal Beach CA 90740
10. Except as stated above and not in conflict with this endorsement,nothing contained herein shall be
held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which
this endorsement is attached.
TYPE OF COVERAGES TO WHICH POLICY PERIOD
LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO
LIABILITY
❑ Following Form
❑ Umbrella Liability
❑
10. Applicable underlying coverages:
INSURANCE COMPANY POLICY NO.
AMOUNT
11. The following inclusions, exclusions, extensions or specific provisions relate to the above
coverages:
12. A ❑ deductible or ❑ self-insured retention (check one) of $
applies to all coverage(s)except: (if none,
so state). The deductible is applicable ❑per claim or❑ per occurrence(check one).
13. This is an ❑ occurrence or ❑ claims made policy(check one).
14. This endorsement is effective on at 12:01 A.M. and forms a part of
Policy Number
I (print name), hereby declare under
penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this
endorsement and that by my execution hereof,I do so bind the Company.
Executed ,20
Signature of Authorized Representative
(Original signature only; no facsimile signature or initialed signature
accepted)
Phone No.: ( )
21