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HomeMy WebLinkAboutAGMT - Pavement Coatings Company (Street Sealing FY05-06, Project #50177) This Document is electronically recorded by Cert Mail B Recorded in Official Records, Orange County RECORDING REQUESTED BY Tom Daly, Clerk-Recorder AND WHEN RECORDED MAIL TO IIIIIII1IIIIIIOIIIIII11IIIIIIIIIIIIIIIIIIIIIIII ll 6.00 CITY OF SEAL BEACH 2007000473436 10:19am 07/30/07 Attn: City Clerk 213 33 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. _ _ __ *** 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 hereinafter 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 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 12.2007.The work was: Annual Street Seal Program,Project 50190. --6.--The-name-of'the contractor:if any,-far such improvement was: Pavement l,oannss. Inc:The-date. of the Contract was: April 21 2007. 7. The property on which said work of improvement was completed in the City of Seal Beach, County of Orange, State of California, and is described as follows: Annual Street Seal Program, Project 50190 Date: -7721(0 7— ' bt Signature of owner or corporate oyr of owner named in paragraph 2 or his agent. VERIFICATION I.the undersigned,say: the Director of Public Works declarant of the foregoing notice of completion; have read said notice of completion and know the contents thereof;the same is true of my own knowledge. I declare under penalty of perjury the foregoing is true and correct. Executed on 7- 2 y , 2007, at Seal Beach,California. (Date of Signature) Dire�f�i'i'�'Works A FY: 05/06 STREET SEALING PROJECT 50177 For FY: 05/06 STREET SEALING PROJECT 50177, in the City of Seal Beach. THIS AGREEMENT, made and entered into this day of , 20 , by and between the City of Seal Beach, California, hereinafter referred to as the "CITY," Party of the First Part, and PAVEMENT_COATINGS CO. hereinafter designated as the "CONTRACTOR," Party of the Second Part. WITNESSETH: That the Parties do,hereto mutually agree as follows: ARTICLE I. 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 FY: 05/06 STREET SEALING PROJECT 50177,and 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 H. 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. IN WITNESS WHEREOF: The Parties hereto have caused this contract to be executed the day and year first above written. II-2 CITY OF SEAL b CH, CALIFO'4 IA Party of the .ti' JA I BY �/✓ '✓ �I City Manager ATT ST.: • 00 •I IL,, ., PAVEMENT' OArTNOS CO. ity Clerk CY // / CON K l'OR- Party of the ondPart MARSHA C00l.IDGE President Title Secretary & CFO /a,& /Pr/ cvrci; C A- a6 36 Address • II-3 Bond No. 08837275 Premium: $348.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded Pavement Coatings Co. P.O. Box 1491 Cypress, CA 90630 (Name and address of Contractor) . . ("Principal"), a contract(the"Contract") for the work described as follows: ''• .• Project No. 50177 — Annual Street Seal Program WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful performance of the Contract. NOW,THEREFORE,we,the undersigned Principal, and Fidelity and Deposit Company of Maryland 801 North Brand Blvd. Glendale, CA 91203 ,(Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Fifty Six Thousand Seven Hundred Sixteen and 96/100ths Dollars ($ 56,716.96 ), 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 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. II-4 • • Dated: "Principal" "Surety' Pavement Coatings Co. Fidelity and Deposit Company of Maryland Ax...--67a47 ._- BY: may: Its IN LI . Thornt.n, Attorney in Fact BY: /,.ft L, 11. By: Z i SC 1 '^ 4v its Preside Secretary & CFO (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. 11-5 • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On March 27, 2006 before me, Van P. Duncan, Notary Public, personally appeared Marsha Coolidge 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 acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. i 111111ttflJE!LA ttlttl44 J p v�' / a a-r F NOTARY PUBLIC-CALIFORNIA 5 2 � ORANGE COUNTY Van P. Duncan, Notary Public 2 !Ay Commlulon ExpIru&appt 21,2006 2$$$4ttN11111111t•00••••••••••• • • a; r m k s?sr .u•z .�rz s . .... t "s °rr�,...u;4w' i-tea, ns y- • ' ,i" x ,CA IF®1RNIA ALL P x RPOS[ c �,WLEDGMEN,tt1ri `�s- State of California County of Los Angeles On MAR 2 4 20U6 before me, Clarice Lee, Notary Public, personally appeared Lisa L. Thornton 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 acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. N CLARICE LEE / 3 s�•. = COMM.41489447 ` NNOito ARYPUSELIC CALIFORNM Cla .ice Lee Comm Exp sgt111iy " My m.ezpire;June 1 i,2008 Bond No. 08837 3. P • remium include with Performance Bond PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded to Pavement Coatings Co. P.O. Box 1491 Cypress, CA 90630 (Name and address of Contractor) ("Principal"),otcNo. 01/7C— Annual the work Project No. 55 • WHEREAS, Principal is required under the terms of the Contract and the Califomia:Civil Code to secure • the payment of claims of laborers,mechanics, materialmen,and other persons as provided by law. n: NOW,THEREFORE, we,the undersigned Principal,and • Fidelity and Deposit Company of Maryland 801 North Brand Blvd. Glendale, CA 91203 • (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Fifty Six Thousand Seven Hundred Sixteen and 96/1UUths Dollars ($ 56,716.96 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 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 inure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to be performed thereunder, or the specifications for the same, shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§2845 and 2849. II-6 • • IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: "Principal" "Surety" Pavement Coatings Co. Fidelity and Deposit Company of Maryland BY: a,f I Its Lhar on, Attorney in Fact By: / f ii, By: Its MARSHA BOO!4DGE Its President Secretary & CFO (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. • II-7 • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On March 27, 2006 before me, Van P. Duncan, Notary Public, personally appeared Marsha Coolidge 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 acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. VAN P. DUNCAN i 41,- /- ate p COMM. #1375838 E XV NOTARY PUBLIC•CALIFORNIA p Van P. Duncan, Notary Public 'r ORANGE COUNTY I' 1 T[a.- My Commission Es rU Sap.21,2006 1 E 111111 t • • Cie 'ex > $rvrs s ,.w-sE a sa. a r r zat» *z� k?r .5 r. n Sig s' a" ALI¢F®R'N=IA iW401RP®fE ACKN0I u GMENT .w R ice..... .wnm.a '`$,,, �r,...33mxa ..+.ww ecex..zlri�a�s�t,tl:� `.� _ 9} State of California County of Los Angeles On MAR 2 4 2006' before me, Clarice Lee, Notary Public, personally appeared Lisa L. Thornton 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 acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. w #1;E LEE ^%(X4 COMM.x1489447 = a ` NOTARY PUBLIC-CALIFORNIAD 't ,1.T' LOS ANGELES COUNTY N My Corzy. trcrti yie 71,2808 CI ice Lee • Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS:That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,a corporation of the State of Maryland,by PAUL C. ROGERS,Vice President,and T. E. SMITH,Assistant Secretary,in pursuance of authority granted by Article VI, Section 2,of the By-Laws of said Company, wit. . . 1- set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof d:-s atone nate,constitute and appoint Lisa L.THORNTON,of Los Angeles,California, its true an. u � TO?. tto.•-, Fact,to make, execute,seal and deliver, for, and on its behalf as surety,and . s - „-ilfir.at': -a . . n r, d undertakings,and the execution of such bonds or undertakings in purs -�., ent Latta;.:'g upon said Company,as fully and amply,to all intents and purposes, _ t.-, = .u e,tt�;p4 h wledged by the regularly elected officers of the Company at its office in ': r� 4. 'n- _. ,ttV�+ .:- ..' .ns. This power of attorney revokes that issued on behalf of Lisa L.T t.'rt .: . a{� tin The said Assistant .-c - . • .oa-le^y¢ttall -' . • .t the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2,of the By- cot,.j .-- is any,and is now in force.:: IN WITNESS W OF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 4th day of August, A.D. 2003. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND Aso Wok. st. u o s4 IIfO ; �4111, am [ . By: T. E. Smith Assistant Secretary Paul C. Rogers Vice President State of Maryland ) ss: City of Baltimore f On this 4th day of August, A.D. 2003, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came PAUL C. ROGERS, Vice President, and T. E. SMITH, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. — \ I I. %� / Dennis R. Hayden Notary Public My Commission Expires: February 1,2009 POA-F 012-3265C • • EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice-President,or any of the Senior Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice-Presidents, Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,...and to affix the seal of the Company thereto." CERTIFICATE 1,the undersigned,Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice-President who executed the said Power of Attorney was one of the additional Vice-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in Article VI, Section 2, of the By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate maybe signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this day of MAR 2 4 20081 , ofceikeiwu Assistant Secretary • • INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND WAIVER OF SUBROGATION AND CONTRIBUTION FY: 05/06 STREET SEALING PROJECT 50177 Indemnitor(s)(list all names): PAVEMENT COATINGS CO. 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 attorneys 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 coverages 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, liablilities, covenants and conditions under this instrument shall be joint and several. "Indemnitor"As,- Name 7bdr_ Name: � s By: MARSHA COOLIDGE By: MARSHA COOLI GE Its President Its President Secretary &CFO. .. . l Ai; Secretary & CFO II-8 0 • AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS (Labor Code§§ 1720, 1773.8, 1775, 1776, 1777.5, 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, dont-ract:is`.'sulijecir{o'.the:proJisions 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 (1) 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 subcon-tractor 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" ,f-• 21j.:. Z n ( j ht;. , -i r:w -. Date • 3 a Z Os Signature ' ' '• 'Lir'D C.:r MARSHA COOUDGE i'. President Secretary & CFO . II-9 • • 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: 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: (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 persoii.pefforining the contracting work has agreed to furnish materials and labor on an hourly basis;"the piiee`of the contract" for the purposes of this subdivision means the aggregate sum of the cost'of niatefiagr.and tlabor 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 II-10 • • 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 prequalification 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. n License no.: 3o3/PO? Class: C-3 7 Expiration date: 9/3D/'b Date ,/1�"7/O(. Signature __ , ��"" lip'.p� MARSHA COOLIDGE President Secretary & CEO • II-11 • • 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 Section 7-3 of the Standard Specifications. 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 substantially the form set forth below. ENDORSEMENT IT IS HEREBY UNDERSTOOD AND AGREED THAT THE CITY OF SEAL BEACH, ITS CITY COUNCIL AND EACH MEMBER THEREOF, AND EVERY OFFICER, OFFICIAL, AGENT, EMPLOYEE OR VOLUNTEER OF CITY SHALL BE NAMED AS JOINTLY AND SEVERALLY INSURED AS RESPECTS CLAIMS ARISING OUT OF THE FOLLOWING PROJECT: FY: 05/06 STREET SEALING PROJECT 50177 IT IS FURTHER AGREED THAT THE FOLLOWING INDEMNITY AGREEMENT BETWEEN THE CITY OF SEAL BEACH AND THE NAMED INSURED IS COVERED UNDER THE POLICY: CONTRACTOR AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS CITY COUNCIL AND EACH MEMBER THEREOF AND EVERY OFFICER, OFFICIAL, EMPLOYEE, ATTORNEYS, AGENT, AND VOLUNTEER OF CITY FROM AND AGAINST ANY AND ALL LIABILITY OR FINANCIAL LOSS RESULTING FROM ANY SUITS, CLAIMS, LOSSES OR ACTIONS BROUGHT AGAINST, AND FROM ALL COSTS AND EXPENSES OF LITIGATION BROUGHT AGAINST, CITY, ITS CITY COUNCIL AND ANY MEMBER THEREOF, AND ANY OFFICER, OFFICIAL, EMPLOYEE, AGENT, ATTORNEY OR VOLUNTEER OF CITY WHICH RESULTS, IN WHOLE OR IN PART, DIRECTLY OR INDIRECTLY, FROM ANY WRONGFUL OR NEGLIGENT ACT OR OMISSION OF CONTRACTOR OR ANY SUBCONTRACTOR, OR AN OFFICER, EMPLOYEE OR AGENT OF EITHER, OR ANYONE FOR WHOSE ACTS ANY OF THESE MAY BE LIABLE, WHILE ENGAGED IN THE PERFORMANCE OF THIS CONTRACT, EXCEPT WHERE SUCH LIABILITY OR LOSS IS SOLEY CAUSED BY THE NEGLIGENCE OR WILLFUL MISCONDUCT OF THE CITY. THE INSURANCE COVERAGE SHALL APPLY SEPARATELY TO EACH INSURED AGAINST WHOM A CLAIM IS MADE OR SUIT IS BROUGHT, EXCEPT THAT THE INCLUSION OF MORE THAN ONE INSURED SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY. THE INSURANCE COVERAGE SHALL NOT BE SUSPENDED, VOIDED, CANCELED, REDUCED IN COVERAGE OR IN LIMITS,OR OTHERWISE MATERIALLY CHANGED, UNLESS THIRTY(30) DAYS ADVANCE WRITTEN NOTICE BY CERTIFIED MAIL/RETURN RECEIPT REQUESTED HAS BEEN GIVEN TO THE CITY. THE INSURANCE COVERAGE PROVIDED BY CONTRACTOR AS SET FORTH HEREIN SHALL BE PRIMARY INSURANCE WITH RESPECT TO THE CITY, ITS CITY COUNCIL AND ANY MEMBER THEREOF, AND ITS OFFICERS, OFFICIALS, ATTORNEYS, AGENTS, EMPLOYEES II-12 AND VOLUNTEERS. ANY INSURANCE OR SELF-INSURANCE MAINTAINED BY THE CITY, ITS CITY COUNCIL OR ANY MEMBER THEREOF, OR ITS OFFICERS, OFFICIALS, ATTORNEYS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL BE IN EXCESS OF THE CONTRACTOR'S INSURANCE AND SHALL NOT CONTRIBUTE WITH IT. INSURER WAIVES ANY RIGHT OF CONTRIBUTION WITH SUCH OTHER INSURANCE WHICH MAY BE AVAILABLE TO THE CITY. INSURER WAIVES ALL RIGHTS OF SUBROGATION FOR LOSSES AGAINST THE CITY, ITS CITY COUNCIL OR ANY MEMBER THEREOF OR ITS OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEER • • II-13 • • Page Intentionally Left Blank II-14 • • • 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 II-15 • WORKER'S COMPENSATION • CERTIFICATE OF INSURANCE WHEREAS,the CITY OF SEAL BEACH has required certain insurance to be provided by PAVEMENT COATINGS COMPANY, INC. 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. I. This certificate is issued to: CITY OF SEAL BEACH, City Hall, 211 EIGHTH STREET, SEAL BEACH,CA 90740-6379. 2'. The insureds under such policy or policies are: PAVEMENT C`OATTNf:S r•C'mPANV, TIC 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 46-8637 1/1/06 1/1/07 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 BE• H. By:Gas /2297-.-1-297 Its Au rized Representative • II-15 • • ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): FY: 05/06 STREET SEALING PROJECT 50177 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 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. 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 II-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. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY 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 ❑ Products/Completed Operations ❑ Pollution Liability ❑ Broad Form Property Damage ❑ Liquor Liability ❑ Extended Bodily Injury ❑ ❑ Broad Form Comprehensive ❑ ❑ General Liability Endorsement ❑ 12. A ❑ deductible or 0 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 facsim-ile signature or initialed signature accepted) Phone No.: ( II-17 ti • • • ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY PAVEMENT COATINGS COMPANY, INC. P.O. BOX 1491, CYPRESS, CA 90630 Name and address of named insured("Named Insured"): EMPLOYERS MUTUAL CASUALTY INSURANCE COMPANY Name and address of Insurance Company("Company"): FY: 05/06 STREET SEALING PROJECT 50177 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 ott 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 requirement. 6. 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. 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 noti;es given hereunder shall be sent to Public Agency at: Director of Public Works City of Seal Beach 211 8th Street Seal Beach CA 90740 11-18 • • 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. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF $1,000,000 THIS ENDORSEMENT ATTACHES FROM/TO Auto LIABILITY 10/1/05-06 Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: Ell Any Automobiles ❑ Truckers Coverage ❑ All Owned Automobiles ❑ Motor Carrier Act ❑ Non-owned Automobiles ❑ Bus Regulatory Reform Act ❑ Hired Automobiles ❑ Public Livery Coverage ❑ Scheduled Automobiles ❑ ❑ Garage Coverage ❑ 11. A ❑ deductible or ❑ self-insured retention (check one) of$ NONE applies to all coverage(s)except: (if none,so state). The deductible is applicable ❑ per claim or ❑ per occurrence(check one). 12. This is an)J occurrence or❑ claims made policy(check one). 13. This endorsement is effective on 9-24-06 at 12:01 A.M. and forms a part of Policy Number niR15RR • I, Thomas F. Shipkey (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 March 24 ,20 06 Signature of Authorized Representative 1. e ri'+-el<19 \ � (Original signature only; no facsim-ile signature or initialed signature accepted) Phone No.: ( 714) 838-929c II-19 • • • ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): FY: 05/06 STREET SEALING PROJECT 50177 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 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 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 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 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. II-20 • • 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 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 S 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 facsim-ile signature or initialed signature accepted) Phone No.: ( ) II-21 • • • BCS0011908 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sions apply: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organization be added as an 1. "Bodily injury°, "property damage" or 'personal additional insured on your policy. Such person or and advertising injury' arising out of the organization is an additional insured only with re- rendering of, or the failure to render;-.any-. . spect to liability for 'bodily injury', 'property darn- professional - architectural, engineering or age' or 'personal and advertising injury°caused, in surveying services, including: whole or in part, by: - a. The preparing, approving, or failing to pre- 1. Your acts or omissions; or pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and specifica- behalf; tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an addi- 2. "Bodily injury' or "property damage" occurring tional insured under this endorsement ends when after: your operations for that additional insured are completed. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- • sured(s) at the location of the covered operations has been completed; or b. That portion of 'your work° out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcon- tractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ Agent's Cony • • POLICY NUMBER: BCS0011908 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION ALL LOCATIONS WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR - • • " - AGREEMENT, EXECUTED PRIOR TO THE "OCCURRENCE" TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for 'bodily injury" or "property damage' caused. in whole or in part, by 'your work' at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the 'products- completed operations hazard". • CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Agent's Copy • • ENDORSEMENT SCO'1"I'SDALE INSURANCE COMPANY' NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (12:01 A.M.STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER BCS0011908 12-31-05 PAVEMENT COATINGS COMPANY & BUD'S 04710 SWEEPING, INC THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following forms: Additional Insured—Owners, Lessees Or Contractors—Automatic Status When Required In Construction Agreement With You (CG 20 33 07/04) The insurance provided by these endorsements shall be primary and noncontributory. AUTHORIZED REPRESENTATIVE DATE UTS-39-01 (3-92) tl • Policy Number: BCS0011908 CG 24 04 10 93 Effective Date:12/29/2005 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The city of Seal Beach, its elected officials, officers, attorneys, agents, employees, and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Dec- larations as applicable to this endorsement The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition(Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and includes in the operations operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 oft ❑