HomeMy WebLinkAboutAGMT - Chapman Coast Roof Co Inc (Roof Repair Project CIP No BG1801)I
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO
CITY OF SEAL BEACH
Attn: City Clerk
211 - 8th Street
Seal Beach, CA 90740
Recorded in Official Records, Orange County
Hugh Nguyen, Clerk- Recorder
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Space of above this line for Recorder's use. JUL 1 1 2018
No Recording Fee Pursuant to Government Code Section 6103, 27383 " CITY CLERK
CITY OF SEAL 6EACH
NOTICE OF COMPLETION
Notice pursuant to Civil Code Section 9204, must be filed within 15 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: 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
May 1, 2018. The work was City Facilities Roof Repair Project No. BG1801.
6. The name of the contractor(s), if any, for such improvement was: Chapman Coast Roof
Company, Inc. The date of the Contract Award was December 11, 2017.
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: various City Facilities.
Date: 1* 1 IV&112 0 I o
Director 61 Public W rks, City of Seal Beach
Signature of owner or corporate officer of owner
named in paragraph 2 or agent.
VERIFICATION
I, the undersigned, say: the Director of Public Works declarant of the foregoing notice of
completion; have read said notice of completion and know the contents thereof; the same is true
of my own knowledge.
I declare under penalty of perjury the foregoing is true and correct.
Executed on n 8 ,0 2018, at Seal Beach, California.
(Da e of Signature)
4ct 49615rl orks, City of Seal Beach
PUBLIC WORKS AGREEMENT
FOR CITY FACILITIES ROOF REPAIR PROJECT
PROGRAM PROJECT
CIP NO. BG1801
between
City of Seal Beach
211 - 8th Street
Seal Beach, CA 90740
0
Chapman Coast Roof Co., Inc.
2301 East Orangethorpe Avenue
Fullerton,,CA 92834
THIS AGREEMENT is made as of December 11, 2017 by and between the City of Seal
Beach, a California charter city ( "City "), and Chapman Coast Roof Co., Inc., a California
corporation ( "Contractor ").
`resit,
RECITALS
A. WHEREAS, the City Council has approved the plans and specifications for
the City Facilities Roof Repair Project CIP No. BG1801 ( "Project ") with respect to design
criteria; and
B. WHEREAS, Contractor, a general contractor, has submitted a bid to City
for the Project dated November 16, 2017 in the amount of $348,045.75 ( "Accepted
Proposal" hereinafter). The Accepted Proposal is attached hereto as Exhibit G and
contains, among other things, provisions defining the Project scope.
NOW, THEREFORE, in consideration of performance by the parties of the
mutual promises, covenants, and conditions herein contained, the parties hereto agree
as follows:
AGREEMENT
1. Contractor's Services.
1.1 Scope and Level of Services. For and in consideration of the
mutual promises set forth herein, and subject to the terms and conditions set forth in
this Agreement, Contractor shall perform and complete in good and workmanlike
manner all work ( "Work ") required by this Agreement and the documents listed in
Subsection 1.2 for the Project.
1.2 Contract Documents. The "Contract Documents" that comprise the
agreement between the City and the Contractor are the: Notice Inviting Bids,
Instructions to Bidders, Accepted Proposal, Non - Collusion Affidavit, Bid Schedule(s),
List of Subcontractors, Contractor's Industrial Safety Record, Contractor's Qualification
Statement, Bid Security Forms for Check or Bond, Specifications, General and Special
Provisions and documents referenced therein, all addenda as prepared prior to the date
of bid opening setting forth any modifications or interpretations of any of said
documents, this Agreement, Exhibits attached to this Agreement, including but not
limited to the Performance Bond (Exhibit A), Payment Bond (Exhibit B), Workers'
Compensation Insurance Certificate (Exhibit C), Insurance Endorsements (Exhibit D),
Acknowledgment of Penal and Civil Penalties Concerning Contractor Licensing Laws
(Exhibit E), Labor Law Requirements (Exhibit F), Accepted Proposal (Exhibit G), and
any and all supplemental agreements executed amending or extending the Work
contemplated and that may be required to complete the Work in a substantial and
acceptable manner. These Contract Documents are hereby incorporated into this
Agreement.
1.3 The Work shall be performed in accordance with the Plans,
Specifications and other Contract Documents. Contractor shall furnish at its own
expense all labor, materials, equipment and services necessary therefor, except such
labor, materials, equipment and services as are specified in the Contract Documents to
be furnished by City.
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1.4 In the event of any material discrepancy between the express
provisions of this Agreement and the provisions of the other Contract Documents, the
provisions of this Agreement shall prevail.
2. Effective Date. This Agreement is effective as of December 11, 2017 (the
"Effective Date "), and shall remain in full force and effect until Contractor has rendered
the services required by this Agreement.
3. Payment. For performing and completing the Work in accordance with the
Contract Documents, City shall pay Contractor, in full compensation therefor, the
amount of $348,045.75, subject to any additions and deletions pursuant to the terms of
the Contract Documents. Said sum shall constitute payment in full for all work
performed hereunder, including, without limitation, all labor, materials, equipment, tools
and services used or incorporated in the Work, supervision, administration, overhead,
expenses and any and all other things required, furnished or incurred for completion of
the Work as specified in the Contract Documents. City shall make payments to
Contractor on account of the contract sum at the time, in the manner, and upon the
conditions specified in the Contract Documents. The City Manager may authorize extra
work to fund unforeseen conditions up to the amount approved at the time of award by
the City Council. Payment for additional work in excess of this amount requires prior
City Council authorization.
4. Contractor's Personnel.
4.1 All Work shall be performed by Contractor or under Contractor's
direct supervision, and all personnel shall possess the qualifications, permits, and
licenses required by state and local law and by the Notice Inviting Bids /Instructions to
Bidders to perform such Services, including, without limitation, a City of Seal Beach
business license as required by the Seal Beach Municipal Code.
4.2 Contractor shall be responsible for payment of all employees'
wages and benefits, and shall comply with all requirements pertaining to employer's
liability, workers' compensation, unemployment insurance, and Social Security.
Contractor shall fully comply with the workers' compensation law regarding Contractor
and Contractor's employees.
4.3 Contractor shall indemnify and hold harmless City and its elected
officials, officers, employees, servants, designated volunteers, and agents serving as
independent contractors in the role of city officials, from any and all liabilities, damages,
claims, costs and expenses of any nature to the extent arising from Contractor's alleged
violations of personnel practices.
4.4 Contractor is, and shall at all times remain as to City, a wholly
independent contractor. Contractor shall have no power to incur any debt, obligation, or
liability on behalf of City or otherwise act as an agent of City. Neither City nor any of its
agents shall have control over the conduct of Contractor or any of Contractor's
employees, except as set forth in this Agreement. Contractor shall not, at any time, or
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in any manner, represent that it or any of its officers, agents, or employees are in any
manner employees of City. Contractor shall pay all required taxes on amounts paid to
Contractor under this Agreement, and indemnify and hold City harmless from any and
all taxes, assessments, penalties, and interest asserted against City by reason of the
work performed pursuant to this Agreement.
4.5 City shall have the right to offset against the amount of any fees
due to Contractor under this Agreement any amount due to City from Contractor as a
result of Contractor's failure to promptly pay to City any reimbursement or
indemnification arising under this Section 4.
5. Indemnification.
5.1 Contractor's Duty. Contractor shall defend, indemnify, and hold the
City, its elected officials, officers, employees, volunteers, agents, and those City agents
serving as independent contractors in the role of City officials (collectively
"Indemnitees ") free and harmless from and against any and all claims (including, without
limitation, claims for bodily injury, death or damage to property), demands, obligations,
damages, actions, causes of action, suits, losses, bid protests, stop notices, judgments,
fines, penalties, liabilities, costs and expenses (including, without limitation, attorney's
fees, disbursements and court costs) of every kind and nature whatsoever (individually,
a "Claim," collectively, "Claims "), in any manner arising out of or incident to the
performance of the Agreement, including without limitation, the payment of all
consequential damages and attorneys' fees and other related costs and expenses.
Further, Contractor shall appoint competent defense counsel, at Contractor's own cost,
expense and risk, to defend any and all such suits, actions or other legal proceedings of
every kind arising out of or incident to the performance of the Agreement that may be
brought or instituted against Indemnitees. Contractor shall pay and satisfy any
judgment, award or decree that may be rendered against City or the other Indemnitees
in any such suit, action, or other legal proceeding arising out of or incident to the
performance of the Agreement. Contractor shall reimburse the City and the other
Indemnitees, for any and all legal expenses and costs incurred by each of them in
connection therewith or in enforcing the indemnity herein provided. Contractor's
obligation to indemnify shall not be restricted to insurance proceeds, if any, received by
Contractor or Indemnitees. This indemnity shall apply to all Claims and liability
regardless of whether any insurance policies are applicable.
5.2 Bid Protests. In addition to its obligations pursuant to Section 5.1,
Contractor shall reimburse the City for all attorneys' fees and costs incurred by City in
connection with, arising out of or incident to any bid protest.
5.3 City's Sole Negligence. Nothing in Section 5.1 shall be construed
to require Contractor to indemnify Indemnitees for that portion of any Claim to the extent
arising from the sole negligence or willful misconduct of the Indemnitees.
5.4 Nonwaiver of Riqhts. Indemnitees do not, and shall not, waive any
rights that they may possess against Contractor because of the acceptance by City, or
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the deposit with City, of any insurance policy or certificate required pursuant to this
Agreement.
5.5 Waiver of Right of Subrogation. Contractor, on behalf of itself and
all parties claiming under or through it, hereby waives all rights of subrogation against
the Indemnitees, while acting within the scope of their duties, from all claims, losses,
and liabilities arising out of or incident to activities or operations performed by or on
behalf of the Indemnitor.
5.6 Survival. The provisions of this Section 5 shall survive the
termination of the Agreement and are in addition to any other rights or remedies that
Indemnitees may have under the law. Payment is not required as a condition precedent
to an Indemnitee's right to recover under this indemnity provision, and an entry of
judgment against a Contractor shall be conclusive in favor of the Indemnitee's right to
recover under this indemnity provision.
6. Insurance.
6.1 Liability Insurance. Contractor shall procure and maintain in full
force and effect for the duration of this Agreement insurance against claims for injuries
to persons or damages to property which may arise from or in connection with the
performance of the services hereunder by Contractor, and its agents, representatives,
employees and subcontractors. The policy limits set forth below do not act as a
limitation upon the amount of indemnification to be provided by Contractor. Contractor
shall complete and execute the following documents attached as Exhibits hereto and
incorporated herein by this reference:
6.1.1 Exhibit D -1
Commercial General Liability.
Automobile Liability.
6.1.2 Exhibit D -2:
Additional Insured Endorsement -
Additional Insured Endorsement -
6.1.3 Exhibit D -3: Additional Insured Endorsement.
6.2 Minimum Scope of Insurance. Unless otherwise approved by City,
coverage shall be at least as broad as:
6.2.1 Insurance Services Office Commercial General Liability
coverage (occurrence form CG 0001).
6.2.2 Insurance Services Office form number CA 0001 (Ed.
1/87) covering Automobile Liability, code 1 (any auto).
6.2.3 Insurance Services Office form number CG 20 10 11 85
(Ed. 11/85) covering Additional Insured — Owners, Lessees or Contactors (Form B).
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6.2.4 Workers' Compensation insurance as required by the
State of California and Employer's Liability Insurance.
6.2.5 Professional Liability insurance. Unless the City waives in
the requirement for professional liability insurance, Contractor shall
provide to City the standard form issued by the carrier.
6.3 Minimum Limits of Insurance. Contractor shall maintain limits no
less than:
6.3.1 General Liability: $2,000,000 per occurrence and in the
aggregate for bodily injury, personal injury and property damage. Commercial General
Liability Insurance or other form with a general aggregate limit shall apply separately to
this Agreement or the general limit shall be twice the required occurrence limit.
6.3.2 Automobile Liability: $2,000,000 per occurrence for bodily
injury and property damage.
6.3.3 Employer's Liability: $1,000,000 per occurrence and in the
aggregate for bodily injury or disease and Workers' Compensation Insurance in the
amount required by law.
6.3.4 Professional Liability (or Errors and Omissions Insurance):
$1,000,000 per claim /aggregate.
6.4 Deductibles and Self- Insured Retentions. Contractor shall inform
City of any deductibles or self- insured retentions except with respect to any professional
liability insurance.
6.5 Other Insurance Provisions. The general liability and automobile
liability policies are to contain, or be endorsed to contain, the following provisions:
6.5.1 Except with regard to the Professional Liability (or Errors
and Omissions Liability) Policy, City, its officers, officials, employees, designated
volunteers and agents serving as independent contractors in the role of City officials,
are to be covered as additional insureds as respects: liability arising out of activities
performed by or on behalf of Contractor; products and completed operations of
Contractor; premises owned, occupied or used by Contractor; or automobiles owned,
leased, hired or borrowed by Contractor. The coverage shall contain no limitations on
the scope of protection afforded to City, its officers, officials, employees, designated
volunteers or agents serving as independent contractors in the role of City officials
which are not also limitations applicable to the named insured.
6.5.2 For any claims related to this Agreement, Contractor's
insurance coverage shall be primary insurance as respects City, its officers, officials,
employees, designated volunteers and agents serving as independent contractors in the
role of City officials. Any insurance or self- insurance maintained by City, their officers,
officials, employees, designated volunteers or agents serving as independent
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contractors in the role of City officials shall be excess of Contractor's insurance and
shall not contribute with it.
6.5.3 Contractor's insurance shall apply separately to each
insured against whom claim is made or suit is brought, except with respect to the limits
of the insurer's liability.
6.5.4 Each insurance policy required by this Section 6 shall be
endorsed to state that coverage shall not be canceled or materially modified except
after 30 days prior written notice by first class mail has been given to City.
6.5.5 Each insurance policy, except for any professional
liability policy, required by this Section 6 shall expressly waive the insurer's right of
subrogation against City and its elected officials, officers, employees, servants,
attorneys, designated volunteers, and agents serving as independent contractors in the
role of city or agency officials.
6.6 Acceptability of Insurers. Insurance is to be placed with insurers
with a current A.M. Best's rating of no less than A:VIII unless waived in writing by City's
Risk Manager.
6.7 Verification of Coverage. All insurance coverages shall be
confirmed by execution of endorsements on forms approved by the City. The
endorsements are to be signed by a person authorized by that insurer to bind coverage
on its behalf. All endorsements are to be received and approved by City before
services commence. As an alternative to City forms, Contractor's insurer may provide
complete, certified copies of all required insurance policies, including endorsements
effecting the coverage required by these specifications.
7. Liquidated Damages. Should the Contractor fail to complete the project, or
any part thereof, in the time agreed upon in the Contract, the Contractor shall reimburse
the City for the additional expense and damage for each calendar day that the Contract
remains uncompleted after the Contract completion date. It is agreed that the amount
of such additional expense and damage incurred by reason of failure to complete the
Contract is the per diem rate of $750.00 per calendar day. Such amount is hereby
agreed upon as liquidated damages for the loss to the City resulting from the failure of
the Contractor to complete the project within the allotted time and to the value of the
operation of the works dependent thereon. It is expressly understood and agreed that
this amount is a reasonable amount and is established in lieu of damages that are
incapable of calculation at the inception hereof; and this amount is not to be considered
in the nature of a penalty. The City shall have the right to deduct such damages from
any amount due, or that may become due to the Contractor, or the amount of such
damages shall be due and collectible from the Contractor or the Contractor's Surety.
Progress payments made after the scheduled completion date shall not constitute a
waiver of liquidated damages.
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8. Suspension. City may, in writing, order Contractor to suspend all or any part
of the Contractor's Services for the convenience of City or for work stoppages beyond
the control of City or Contractor. A suspension of the Services does not void this
Agreement.
9. Notices. Any notices, bills, invoices, or reports authorized or required by this
Agreement shall be in writing and shall be deemed received on (a) the day of delivery if
delivered by hand or overnight courier service during Contractor's and City's regular
business hours or by facsimile before or during Contractor's regular business hours; or
(b) on the third business day following deposit in the United States mail, postage
prepaid, to the addresses heretofore set forth in the Agreement, or to such other
addresses as the parties may, from time to time, designate in writing pursuant to the
provisions of this Section. All notices shall be addressed as follows:
If to City: City Manager
City of Seal Beach
211 8th Street
Seal Beach, California 90740
Telephone: (562) 431 -2527
Fax: (562) 493 -9857
With a copy to:
Director of Public Works
City of Seal Beach
211 8th Street
Seal Beach, California 90740
If to Contractor: Chapman Coast Roof Company Incorporated
2301 East Orangethorpe Avenue
Fullerton, CA 92834
Telephone: (714) 738 -6611
Fax: (714) 738 -0143
Attn: Rogie Cabral
10. Non - Assignability: Subcontracting. Contractor shall not assign, transfer,
or subcontract any interest in this Agreement or the performance of any of Contractor's
obligations hereunder. Any attempt by Contractor to so assign, transfer, or subcontract
any rights, duties, or obligations arising hereunder shall be null, void and of no effect.
11. Claim Dispute Resolution.
11.1 In the event of any dispute or controversy with the City over any
matter whatsoever, the Contractor shall not cause any delay or cessation in or of Work,
but shall proceed with the performance of the Work in dispute. Contractor shall retain
any and all rights provided that pertain to the resolution of disputes and protests
between the parties. The Disputed Work will be categorized as an "unresolved dispute"
WWI
and payment, if any, shall be as later determined by mutual agreement or a court of law.
Contractor shall keep accurate, detailed records of all Disputed Work, claims and other
disputed matters.
11.2 All claims arising out of or related to the Contract Documents or this
Project, and the consideration and payment of such claims, are subject to the
Government Claims Act (Government Code Section 810 et seq.) with regard to filing
claims. All such claims are also subject to Public Contract Code Section 9204 and
Public Contract Code Section 20104 et seq. (Article 1.5), where applicable. This
Contract hereby incorporates those provisions as though fully set forth herein. Thus,
Contractor or any Subcontractor must file a claim in accordance with the Government
Claims Act as a prerequisite to filing a construction claim in compliance with Section
9204 and Article 1.5 (if applicable), and must then adhere to Article 1.5 and Section
9204, as applicable, pursuant to the definition of "claim" as individually defined therein.
12. Compliance with Laws. Contractor shall comply with all applicable federal,
state and local laws, ordinances, codes and regulations in force at the time Contractor
performs the Services.
13. Non - Waiver of Terms, Rights and Remedies. Waiver by either party of
any one or more of the conditions of performance under this Agreement shall not be a
waiver of any other condition of performance under this Agreement. In no event shall
the making by City of any payment to Contractor constitute or be construed as a waiver
by City of any breach of covenant, or any default which may then exist on the part of
Contractor, and the making of any such payment by City shall in no way impair or
prejudice any right or remedy available to City with regard to such breach or default.
14. Attorneys' Fees. In the event that either party to this Agreement shall
commence any legal action or proceeding to enforce or interpret the provisions of this
Agreement, the prevailing party in such action or proceeding shall be entitled to recover
its costs of suit, including all attorneys' fees incurred in connection therewith.
15. Construction. The validity, interpretation, and performance of this
Agreement shall be controlled by and construed under the laws of the State of
California. In the event of any asserted ambiguity in, or dispute regarding the
interpretation of any matter herein, the interpretation of this Agreement shall not be
resolved by any rules of interpretation providing for interpretation against the party who
causes the uncertainty to exist or against the party who drafted the Agreement or who
drafted that portion of the Agreement.
16. Entire Agreement. This Agreement, including any other documents
incorporated herein by specific reference, represents the entire and integrated
agreement between Contractor and City. This Agreement supersedes all prior oral or
written negotiations, representations, or agreements. This Agreement may not be
amended, nor any provision or breach hereof waived, except in a writing signed by the
parties which expressly refers to this Agreement.
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17. Severability. The invalidity in whole or in part of any provisions of this
Agreement shall not void or affect the validity of the other provisions of this Agreement.
IN WITNESS WHEREOF, the parties, through their respective authorized
representatives, have executed this Agreement as of the date first written above.
CITY OF SEAL BEACH CONTRACTOR:
CHAPMAN COAST ROOF CO., INC.
By:
Atte;
By:
Appi
By:
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EXHIBIT A
FAITHFUL PERFORMANCE BOND
Exhibit A, Page 1
Executed in Triplicate
Bond No. 2123602 Bond Premium $2,986.00
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Seal Beach, has awarded the CITY FACILITIES ROOF REPAIR PROJECT
No. BG 1801.
(Name and address of Contractor)
Chapman Coast Roof Co., Inc., 2301 East Orangethorpe Ave. Fullerton, CA 92831
( "Principal "), a contract (the "Contract") for the work described as follows:
CITY FACILITIES ROOF REPAIR PROJECT No. BG 1801.
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 Great American Insurance
(Name and address of Surety)
( "Surety") a duly admitted surety insurer under the laws of the State of Califomia, as Surety, are held and firmly
bound unto the Public Agency in the penal sum of Three Hundred Forty Eight Thousand
Seventy Five and 75 100-------------------------- ---- ---------------- - - - - -- ----------- - - - - --
Dollars (S 348,075.75 _ - - -- ), 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 shalt
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 attomeys' fees in an
amount fixed by the court.
FURTHER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time,
alteration, addition or modification to the terms of the Contract, or of the work to be performed there under, or the
specifications for the same, shall in any way affect its obligations under this bond, and it does hereby waive notice
of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the
work or to the specifications there under. Surety hereby waives the provisions of California Civil Code §§ 2845 and
2849. The City is the principal beneficiary of this bond and has all rights of a party hereto. IN WITNESS
WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an
original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each
corporate party being hereto affixed and these presents duly signed by its undersigned representative(s) pursuant to
authority of its governing body.
Dated:
"Principal, "Surety„
Chapman Coast Roof Co., Inc. Great American Insurance Company
By: �n���� - ///0�,� By: IV
Its Its Kim Luu, Attorney -in -Fact
CALIFORNIA.
ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
Identity of the individual who signed the document to which this certificate
Is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange )
On December 14, 2017 before me, Alice Valle, Notary Public
personally appeared (Hare Invert nd name a in* of Uee o6kep
Linda Dominguez
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized cepaclty(ies), and that by
his/her/their signature(s) on the instrument the persori or the entry upon behalf of
which the person(s) acted, executed the instrument. I certify under PENALTY OF
PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
Signature of Notary Public (9eag
ADOnXMAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Performance Bond
(TAbordescrom dstadad doomiW4
Mile ordamfpion of ebadlad daomerntcvnfirl
Number of pages _ 2 Document Date
2015 Version WV*1.NO•.agMsaee.e0 :i 800-8738885
ALICE VALLE
Notary Public- California z
Orange County >
Commission 71 2197520
z lily Comm. Expires Jun 12,2@7
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CP41L CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California )
County of Orange )
On DEC 13 2017 before me, Jeri Apodaca, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Kim Luu
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the persona) whose name(s) is/an
subscribed to the within instrument and acknowledged to me that to /she/dwexecuted the same in
hWheNtbeixauthorized capacityftas and that by tA&*ier /Rx* signature(s) on the instrument the person(*
or the entity upon behalf of which the person(s� acted, executed the instrument.
JERI APODACA
Commission # 2081689
Notary Public - California i
Orange County
My Comm. Expires Oct 12, 2018
Place Notary Seal Above
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature
Sign f Note Public
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
-1 Corporate Officer — Title(s):
Partner — _3 Limited CJ General
Individual X Attorney in Fact
Trustee ❑ Guardian or Conservator
Other:
Signer Is Representing:
Signer's Name:
Corporate Officer — Title(s):
Partner — G Limited _J General
... Individual 0 Attorney in Fact
0 Trustee D Guardian or Conservator
Other:
Signer Is Representing:
o r .. .. ..~ :�r a :rrr Y•r
EXHIBIT B
PAYMENT BOND
Exhibit B, Page 1
Executed in Triplicate
Bond No. 2123602
PAYMENT BOND
(LABOR AND MATERIALS)
KNOW ALL PERSONS BY THESE PRESENTS that:
Included in Performance Bond
WHEREAS the City of Seal Beach, has awarded the CITY FACILITIES ROOF REPAIR PROJECT
No. BG1801.
(Name and address of Contractor)
Chapman Coast Roof Co., Inc., 2301 East Orangethorpe Ave. Fullerton, CA 92831
( "Principal "), a contract (the "Contract ") for the work described as follows:
CITY FACILITIES ROOF REPAIR PROJECT No. BG 1801.
WHEREAS, Principal is required under the terms of the Contract and the California Civil Code to secure
the payment of claims of laborers, mechanics, materiahnen, and other persons as provided by law.
NOW, THEREFORE, we, the undersigned Principal, and
750 The City Drive South, Suite 470, Oranl
Great American Insurance
(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 Three Hundred Forty Eight Thousand
SeventyFive and 75/ 100----------------------------------------------------------- ------ - - - - --
Dollars ($ 348 075.75 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 insure to the benefit of any of the persons named in Section 3181 of the California Civil
Code so as to give a tight 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 terns of the
Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of
California Civil Code §§ 2845 and 2849.
IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all
purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set
forth below, the 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”
Chap man
,,Coast Roof Co., Inc.
1 _ , °i092&1,
By: / d! i yfi 'Joy-! InGRf7
Its
a
Its
Great American Insurance Company
By: A1_9
Its Kim Luu, Attorney -in -Fact
By:
Its
(Seal) (Seal)
Note: This bond must he dated, all signatures must be notarized, and evidence of the
authority of any person signing as attorney -in -fact must be attached.
CALIFORNIA.
ALL - PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
iden* of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of thet document.
State of California
County of Orange )
On December 14, 2017 before me, Alice Valle, Notary Public
personally appeared (Here insert name and title or Ufe cricoo
Linda Dominguez
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) Is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/hedtheir signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the Instrument. I certify under PENALTY OF
PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
-- _ ALICEVALLE
Notary Public - California
Orange County
Sig furs of Notary Public fsee9 Commission n 2197s2o
< My Comm. Expires Jun 12, 2021
ADDITIONIAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Payment Bond
(iidaor de cMian dstadwd doaonei
(Tltsadescrlow detached dooaenlmlteso
Number of Pages _ 2 Document Defe
2015 Version wAW.NeXW1a&%s.00.n 900 - 8739865
INSTRUCTIONS
• 81sle end cams infanatoa mud be the 8bds whe Count' alters the doanled
,6aalh) peaaatyaPPearad 1181" In W" public for adamWedgminl
• Ode of nalmhsgon must be the dab twit tw sgrisr(s) panwYy appmmd
which malt alas be the Berne dstr tie adaowletbmerdle compldad
• The ebry public mud Film his of her name as it appears adthh his or her
car fftm Mowed bys aee and tlwn your go (air p 1154
• Pte this num(s) of dowmert sips(s) who paamdly sippsz at the eras of
11 ' r
• Mats fhe arlect siroula or ptsal 1nw by crinit of incorrect his
(Le.)natdeTey, is lera) a during the owed Wis. Fedurs to "wally Indcsts
tlrb infaahefon nay lead to npcl4n ddo Trent ramrmrlp.
• The rotaysed ispresi mstbodemad phobtmphioMynprodadble.
• bnpeilm mud not mom had or ram f sect MPlaeim mnudgm, re-eel f a
adkierd ewes pamk, otersim mrpl* a dif wedmaMedpnedtma
• 80mili s of the flossy public mud match the elgna n on as sdtr Im der of
the oaury dark.
• Addionel bdmetm is not regcbad bd amid hap b aware this
sci wtilpathi nalmeleapd er atadred to a dtrermtd000rrt
• 6emey elbdf this damned to the ablhed dmoeM wah a o pk
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California )
County of Orange )
On DEC 13 2017 before me, Jeri Apodaca, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared
Kim Luu
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(* is/am
subscribed to the within instrument and acknowledged to me that kv /she /tkoeycexecuted the same in
litWher /DbeiRauthorized capacity(bcc� and that by husttler /ttx)dx signature(s) on the instrument the person(sj
or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
LQJERI APODACA WITNESS my hand and official seal.
Commission # 2081689
No tary Public - California i
Orange County Signature rcr
My Comm. Expires Oct 12, 2018 -fg>?a UO.of Noia-k Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Corporate Officer — Title(s): _
Partner — 1—j Limited ❑ General
+ Individual X Attorney in Fact
Trustee C1 Guardian or Conservator
Other:
Signer Is Representing:
Signer's Name:
Corporate Officer — Title(s):
Partner — :.:7 Limited _I General
Individual 0 Attorney in Fact
1 Trustee `=l Guardian or Conservator
Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1 -800- 676 -6827) Item #5907
EXHIBIT C
WORKERS' COMPENSATION INSURANCE CERTIFICATE
Exhibit C, Page 1
i
;H If -T,T: � 3i illkkk]
30SCHAPMCOA
ACORM CERTIFICATE OF LIABILITY INSURANCE
DATE(MW MYYYY)
12/1312017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOTAFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policies may require an endoreemem. A statement on this certificate does not confer rights to the
CereOcate holder in lieu of such endomemem(s).
PRODUCER
Allio Mosier
BB&T Insurance Services
of Orange County
2400 Katella Avenue Ste 1100
Anaheim, CA 92806
v E� .714941.2900 Na.877- 297 -1116
amos
ADD . ler@pbandtcom
MSURERM AFFORDING COVERAGE
NAIL P
MSURERA: V- II„Fwe.—C*fl —,
20608
INSURED
Chapman Coast Roof Co. Inc.
2301 E. Orangethorpe Avenue
P.O. Box 7050
INSURER B: Rtlevea Fee eM eeFeel,ed,
11673
MsuaERC: �m�l�•n�a, -,
20443
D
PERSONAL&ADYINJLRtY
Fullerton, CA 92834
MauRER E:
GENERAL AGGREGATE
INSURER F.'
PRODUOTS- OmAP,OPAGG
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR
TYPE DF INSURANCE
hDDL
MBR
SUB
VIVO
POLICY NUMBER
POLICY EFF
MUM
POLICY SIP
UWTS
A
X1
CLAMS4AADE ❑X OCCUR
BI /PDDed:5,000
6012547716
D410112017
04/011201
EArCAH oEcccuNRENCE
$1 100,0.00
PARE 'am Ema�renn
5100000
X
NEDEXP (AM gnepomoo)
$15000
PERSONAL&ADYINJLRtY
s1000000
GENL AGGREGATE LIMIT APPLIES PER
POLICY ER TEEC O LOC
OTHER
GENERAL AGGREGATE
s2,000,000
PRODUOTS- OmAP,OPAGG
s7,000,000
S
C
AUTOMOBILEUABIUTY
X ANY AUTO
ALI-0 P 0 SCHEDULED
AUT09 AUTOS
HIREDAUTOS X I.JTOS D
X N
6012547736
0410112017
041011201
OMBBIINEDSINGLELIMI
4
1000000
BODILY INJURr(PNX pomon)
S
BODILY INJURY We' acadaoO
$
PROPERTY DAMAGE
Peraaadem
$
S
A
)(
UMBRELLA Lue . X
SICE98 LIAB
OCCUR
CLAIMS-IAADE
6012647704
112017
041011201
EACH OCCURRENCE
S6,000,000
AGGREGATE
$6.000.000
❑EO I X1 RETENTION 1O 000
S
B
MroRNERS COMPENSATION
AND EMPLOYERS LW&DTY
ANY PROPRIErOR/PARrNERIEXECUTIVEYIR
OFFlCERIMEMBER EXCLUOEDT
(M.Mebq 1p NIB
IT dermbeadox
DESCRIPTION OF OPERATIONS bolas
NIA
CHWC817574
07/2017
04!011201
X PER DTH-
E.L. EACH ACOOENT
57000000
E.L. DISEASE - EA EMPLOYEE
$1,000.000
E.L DISEASE - POLICY LIMIT I
31000,000
OESCRIPTON OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10, Addltlonel Ren SMledeN, mry be ewbbed I more wace is mclu mo)
RE: City Facilities Roof Repairs Project BG -1BO1
City of Seal Beach is named as additional insured as respects general liability as required by written
contract, per endorsement attached.
Should any policy be cancelled before the expiration date, BB&T Insurance Services Will mail 30 (thirty)
(See Attached Descriptions)
City of Seal Beach
221-8th Street
Seal Beach, CA 90740
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 01
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORR ED REPRESENTATIVE
I � ►.tar -- c^�..q°yr
190 8-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) 1 Of 2 The ACORD name and logo are regstered marks of ACORD
#5191527691M117901547
ACMOS
DESCRIPTIONS (Continued from Page 1) 1
days written notice to the cer0ficate holders which require such action per written contract or agreement,
except 10 days notice of cancellation for non - payment of premium.
(2014101)
OS19152769IM17901547
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products - Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
1. The WHO IS AN INSURED section Is amended to add as an Insured any person or organization whom the Named
Insured is required by.wrfltan contract to add as an additional insured on this coverage part, including any such
person or organization, 'ri any, specifically set forth on the Schedule attachment to this endorsement. However, such
person or organization is an Insured only with respect to such person or organization's liability for:
A. unless paragraph B. below applies,
1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts
or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's
ongoing operations as specified In such written contract or
2. bodily Injury or property damage caused in whole or in part by your work and Included in the products -
completed opsratlons hazard, and only if
a. the written contract requires the Named Insured to provide the additional insured such coverage; and
IL this eoverne part provides such coverage. -
B bodily Injury, properly damage, or personal and advertisig injury arising out of your work described in such
written contract, but only if:
1. this coverage part provides coverage for bodily Injury or property damage included within the products
completed operation haitad:and
2- the writteri contract specifically requires the Named Insured to provide additional insured coverage under
the 11-85 or 10-01 edition of CG2010 or the 10 -01 edition of CG2037.
s IL Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide
s such additional insured with:
A. coverage broader than required by the vritten contract; or
B. a higher limit of insurance than required by the written contract.
Ill. The insurance granted by this endorsement to the additional insured does not apply to bodily Injury, property
damage, or personal and ad%wtk ig injuty arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional Insured is specifically listed as an additional Insured on another
endorsement attached to this coverage part
IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS,
ii= the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional
W.— insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written
i=
CNA75079X0( (1 -15) Policy No: 6012547718
Page 1 of 2 Indorsement No: 2
VALLEY FORGE INSURANCE COMPANY Effective Date: 04101/2017
Insured Name: CHAPMAN COAST ROOF CO . , INC.
Copy,ghr C!N M RW a Reserved. I,c1,dBa mpyrWW maft t 01 trbrvanca SWV C Offs, N0., WM 115 pSM1189 n.
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products - Completed
Operations Coverage Endorsement
contract to be primary and noncontributory, this insurance will be primary and non - contributory relative solely to
Insurance on which the additional insured is a named insured.
V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LUWU" CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Oeeurrence, Offense, Claim or Suit is amended with the addition
of the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
I. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2 except as provided in Paragraph IV. of this endorsement, agree to make available any other Insurance the
additional insured has for any loss covered under this coverage part;
a send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer In the
Investigation, defense, or settlement of the claim; and
4. tender the defense and indemnity of any claim to arty other insurer or self Insurer whose policy or program
applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires
this Insurance to be primary and noncontrmutory, this paragraph (4) does not apply to insurance on which
the additional insured is a named Insured.
The Insurer has no duty to defend or indemnify an additional Insured under this endorsement until the Insurer
receives written notice of a claim from the additional insured.
VL Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to
add the following definition:
W tIon contract means a written contract or written agreement that requires the Named Insured to make a person
or organization an additional insured on this coverage part, provided the contract or agreement
A. is currently in affect or becomes effective during the term of this policy; and
B. was executed prior to:
1. the bodiq Injury or property damage; or
2. the offense that caused the personal and advertising Injury
for which the additional insured reeks coverage.
Any coverage granted by this endorsement shag apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain uncharged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective data is shown below, and
expires concurrently with said Policy.
CNA7507970((1 -15) Policy No: 5012547718
Page 2 of 2 Endorsement No: 2
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: CHAPMAN COAST ROOF CO., INC.
CopyFfd CNA All rwmlm FrWm d. InWjdes ooprVftd nw*pal of Inananm SwA= oama, Inc., Wlh ra,eMWdm
`NA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Odw Insurance conditions is amended to add the following paragraph:
This Insurance is excess over any of the other Insurance, whether primary, excess, contingent or on any other
basie.that is Property insurance covering property of others damaged from the use of elevators.
28. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:
A. Paragraph 1b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
limit, and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a
$1,000. limit
24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
It the Named Insured unintentionally tails to disclose all existing hazards at the Inception dale of the Named
brmnred's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure:
26. WAIVER OF SUBROGATION - BLANKET
Under CONDMONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to
add the following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payment the Insurer makes for injury or damage arising out af:
1. the Named trffirued s ongoing operations; or
2. your work included in the products- compkNed operations IremM.
However, this waiver applies only when the Named insured has agreed In writing to waive such rights of recovery in
a written contract or written agreement, and only if such contract or agreement:
1. is in effect or becomes effective during the term of this Coverage Perk and
2. was executed prior to the bodily it*", Property damage or personal and advertising injury giving rise to fire
Clain.
26. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP -UP) INSURANCE PROGRAMS
Note. The following provision does not apply to any public construction project in the state of Oldahoma, nor to ary
construction project in the state of Alaska, that is not permitted to be Insured under a consolidated (wrap-up)
Insurance program by applicable slate statute or regulation.
ff the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another excluslonary
endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance
Programs (C.C.I.P.) Is attached, than the following changes apply:
A. The following wording is added to the above- referenced endorsement:
With respect to a consolidated (wrap -up) Irsraance program project in which the Named Insured is or was
involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as
damages because of-
1. Bodily Injury, property damage, or personal or advertising Injury that occurs during the Named b oured's
ongoing operations at the project, or during such operations of anyone acting on the Named Insured's
behalf; nor
CNA74705XX (1 -15) Policy No: 6012547718
Page 16 of 17 Endorsement No: 1
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: CRAPMAN COAST ROOF CO., INC.
rapy�ge roan nu wens rieaeruea inmudea copynenm rre�l m irewarce sew osm, mc.. wai ae pertieebn.
Chapman Coast Roof Co. Inc. CNA63359XX
A Policy #6012547735 (Ed. 04/12)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS EXTENDED COVERAGE ENDORSEMENT
- BUSINESS AUTO PLUS -
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
1. LIABILITY COVERAGE
A. Who Is An Insured
The following is added to Section II,
Paragraph A.1., Who Is An Insured:
1. a. Any incorporated entity of which the
Named Insured owns a majority of the
voting stock on the date of inception of
this Coverage Form; provided that,
b. The insurance afforded by this
provision A.1. does not apply to any
such entity that is an "insured" under
any other liability "policy" providing
"auto" coverage.
2. Any organization you newly acquire or form,
other than a limited liability company,
partnership or joint venture, and over which
you maintain majority ownership interest.
The insurance afforded by this provision
A.2.:
a. Is effective on the acquisition or
formation date, and is afforded only
until the end of the policy period of this
Coverage Form, or the next
anniversary of its inception date,
whichever is earlier.
b. Does not appy to:
(1) "Bodily injury" or "property damage"
caused by an "accident" that
occurred before you acquired or
formed the organization; or
(2) Any such organization that is an
"insured" under any other liability
"policy" providing "auto" coverage.
3. Any person or organization that you are
required by a written contract to name as
an additional insured is an "insured" but
only with respect to their legal liability for
acts or omissions of a person, who qualifies
as an "insured" under Section II — Who Is
An Insured and for whom Liability Coverage
is afforded under this policy. If required by
written contract, this insurance will be
primary and non - contributory to insurance
on which the additional insured is a Named
Insured.
4. An "employee" of yours is an "insured"
while operating an "auto" hired or rented
under a contract or agreement in that
"employee's" name, with your permission,
while performing duties related to the
conduct of your business.
"Policy," as used in this provision A. Who Is An
Insured, includes those policies that were in
force on the inception date of this Coverage
Form but:
I. Which are no longer in force; or
2. Whose limits have been exhausted.
B. Bail Bonds and Loss of Earnings
Section II, Paragraphs A.2. (2) and A.2. (4)
are revised as follows:
1. In a.(2), the limit for the cost of bail bonds is
changed from $2,000 to $5,000; and
2. In a.(4), the limit for the loss of earnings is
changed from $250 to $500 a day.
C. Fellow Employee
Section II, Paragraph B_5 does not apply.
Such coverage as is afforded by this provision
C. is excess over any other collectible
insurance.
II. PHYSICAL DAMAGE COVERAGE
A. Glass Breakage — Hitting A Bird Or Animal —
Falling Objects Or Missiles
The following is added to Section III,
Paragraph A.3.:
With respect to any covered "auto," any
deductible shown in the Declarations will not
apply to glass breakage if such glass is
repaired, in a manner acceptable to us, rather
than replaced.
B. Transportation Expenses
Section ill, Paragraph AA.a. is revised, with
respect to transportation expense incurred by
you, to provide:
a. $60 per day, in lieu of $20; subject to
b. $1,800 maximum, in lieu of $600.
GNA63359XX Copyright, CNA Corporation, 2000. Page 1 of 3
(Ed. 04/12) Includes copyrighted material of the Insurance services Cli'm used with its permission.
CNA
C. Loss of Use Expenses
Section III, Paragraph A.4.b. is revised, with
respect to loss of use expenses incurred by
you, to provide:
a. $1,000 maximum, in lieu of $600.
D. Hired "Autos"
CNA63359XX
(Ed. 04/12)
Section III, Paragraphs B.4.c and B.4.d. are
deleted and replaced by the following:
c. Physical Damage Coverage on a covered
"auto" also applies to "loss" to any
permanently installed electronic equipment
including its antennas and other
accessories.
The following is added to Section III.
d. A $100 per occurrence deductible applies
Paragraph A.:
to the coverage provided by this provision.
5. Hired "Autos"
G. Diminution In Value
If Physical Damage coverage is provided under
The following is added to Section III,
this policy, and such coverage does not extend
Paragraph B.B.:
to Hired Autos, then Physical Damage
Subject the following, the "diminution in
coverage is extended to:
value" exclusion does not apply to:
a. Any covered "auto" you lease, hire, rent
a. Any covered "auto" of the private
or borrow without a driver; and
passenger type you lease, hire, rent or
b. Any covered "auto" hired or rented by
borrow, without a driver for a period of
your "employee" without a driver, under
30 days or less, while performing duties
a contract in that individual
related to the conduct of your business;
"employee's" name, with your
and
permission, while performing duties
b. Any covered "auto" of the private
related to the conduct of your business.
passenger type hired or rented by your
c. The most we will pay for any one
"employee" without a driver for a period
"accident" or 'loss" is the actual cash
of 30 days or less, under a contract in
value, cost of repair, cost of
that individual "employee's" name, with
replacement or $75,000, whichever is
your permission, while performing
less, minus a $500 deductible for each
duties related to the conduct of your
covered auto. No deductible applies to
business.
"loss" caused by fire or lightning.
c. Such coverage as is provided by this
d. The physical damage coverage as is
provision is limited to a "diminution in
provided by this provision is equal to
value" loss arising directly out of
the physical damage coverage(s)
accidental damage and not as a result
provided on your owned "autos"
of the failure to make repairs; faulty or
incomplete maintenance or repairs; or
the installation of substandard parts.
e. Such physical damage coverage for
hired "autos" will:
d. The most we will pay for "loss" to a
(1) Include loss of use, provided it is
covered "auto" in any one accident is
the consequence of an "accident"
the lesser of:
for which the Named Insured is
(1) $5,000; or
legally liable, and as a result of
(2► 20% of the "auto's" actual cash
which a monetary loss is sustained
value (ACV).
by the leasing or rental concern.
(2) Such coverage as is provided by
III. Drive Other Car Coverage —Executive Officers
this provision will be subject to a
The following is added to Sections II and III:
limit of $750 per "accident."
"auto"
1. Any you don't own, hire or borrow is a
E. Airbag Coverage
covered "auto" for Liability Coverage while
The following is added to Section 111,
being used by, and for Physical Damage
Paragraph B.3.:
Coverage while in the care, custody or control
"executive
of, any of your officers," except:
The accidental discharge of an airbag shall not
a. An "auto" owned by that "executive officer"
be considered mechanical breakdown.
or a member of that person's household; or
F. Electronic Equipment
CNA63359XX Copyright, CNA Corporation. 2000. Page 2 of 3
(Ed. 04112) Indudes copyrighted material of the Insurance
SerNces Office used with Its permission.
b. An "auto" used by that "executive officer"
while working in a business of selling,
servicing, repairing or parking "autos."
Such Liability and /or Physical Damage
Coverage as is afforded by this provision.
(1) Equal to the greatest of those
coverages afforded any covered "auto";
and
(2) Excess over any other collectible
insurance.
2. For purposes of this provision, "executive
officer" means a person holding any of the
officer positions created by your charter,
constitution, by-laws or any other similar
governing document, and, while a resident of
the same household, includes that person's
spouse.
Such "executive officers" are "insureds" while
using a covered "auto" described in this
provision.
IV. BUSINESS AUTO CONDITIONS
A. Duties In The Event Of Accident, Claim, Suit
Or Loss
The following is added to Section IV,
Paragraph A.2.a.:
(4) Your "employees" may know of an
"accident" or "loss." This will not mean
that you have such knowledge, unless
such "accident" or "loss" is known to
you or if you are not an individual, to
any of your executive officers or
partners or your insurance manager.
The following is added to Section IV,
Paragraph A.2.11b.:
(6) Your "employees" may know of
documents received concerning a claim
or "suit." This will not mean that you
have such knowledge, unless receipt of
such documents is known to you or if
you are not an individual, to any of your
executive officers or partners or your
insurance manager.
B. Transfer Of Rights Of Recovery Against
Others To Us
CNA63359XX
(Ed. 04/12)
The following is added to Section IV,
Paragraph A.S. Transfer Of Rights Of
Recovery Against Others To Us:
We waive any right of recovery we may have,
because of payments we make for injury or
damage, against any person or organization for
whom or which you are required by written
contract or agreement to obtain this waiver from
us.
This injury or damage must arise out of your
activities under a contract with that person or
organization.
You must agree to that requirement prior to an
"accident" or "loss."
C. Concealment, Misrepresentation or Fraud
The following is added to Section IV,
Paragraph 8.2.:
Your failure to disclose all hazards existing on the
date of inception of this Coverage Form shall not
prejudice you with respect to the coverage afforded
provided such failure or omission is not intentional.
D. Other Insurance
The following is added to Section IV,
Paragraph B.5.:
Regardless of the provisions of Paragraphs 5.a.
and 5.d. above, the coverage provided by this
policy shall be on a primary non - contributory
basis. This provision is applicable only when
required by a written contract. That written
contract must have been entered into prior to
"Accident" or "Loss."
E. Policy Period, Coverage Territory
Section IV, Paragraph B. 7.(5).(a). is revised
to provide:
a. 45 days of coverage in lieu of 30 days.
V. DEFINITIONS
Section V. Paragraph C. is deleted and replaced
by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish, mental injury or death resulting from any of
these.
CNA63359XX Copyright, CNA Corporation, 2000. Page 3 of 3
(Ed. 04/12) Includes copyrighted material of the Insurance Services office used with its permission.
GREAT AMERICAN INSURANCE COMPANY@
Administrative Office: 301 E 4TH STREET 0 CINCINNATI, OHIO 45202 0 513- 369 -5000 0 FAX 513 - 723 -2740
The number of persons authorized by
this power of attorney is not more than SEVEN
No, 0 14849
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attomey -in -fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
MIKE PARIZINO
RACHELLE PHEAULT
RHONDA C. ABEL
JAMES A. SCHALLER
Name
JERI APODACA
KIM LUU
HEATHER SALTARELLI
Address
ALL OF
NEWPORT BEACH,
CALIFORNIA
Limit of Power
ALL
$100,000,000.00
This Power of Attorney revokes all previous powers issued on behalf of the attomey(s) -in -fact named above.
IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 18TH day of NOVEMBER 1 2016
Attest GREAT AMERICAN INSURANCE COMPANY
Assistant Secretary Divisional Senior Vice President
STATE OF OHIO, COUNTY OF HAMILTON- ss: DAVID C. KITCHIN t877-377-24051
On this 18TH day of NOVEMBER 2016 before me personally appeared DAVID C. KITCHIN, to me
known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
name thereto by like authority.
I .li p
L F. r 11 w
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior Vice Presidents, Divisional ice Presidents and Divisonal Assistant Vice
Presidents, or any one of them, be and hereby is authorized, jrom time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts ofsuretyship, or other written obligations in the nature thereof to prescribe their respective duties and
the respective Limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company maybe affixed by facsimile to any power ofatiorney or certificate of either given far the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature ofsuch
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this
E
5..
S1029AF (06/15)
day of DEC 1.3 2017
Assistant Secretary
EXHIBIT D -1
ADDITIONAL INSURED ENDORSEMENT
COMMERCIAL GENERAL LIABILITY
[INSERT INSURANCE CERTIFICATE SHOWING COMMERCIAL GENERAL
LIABILITY]
Exhibit D -1, Page 1
r'
Client#: 1260333 30SCHAPMCOA
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
DATEWWWNYYY)
TYPE OF INSURANCE
12113)2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. H SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endomemem(s).
vR °°"cER
MI Allis Mosier
BB &T Insurance Services
v 714 941 -2900 c Na, 877 -297 -1116
of Orange County
Pia amosle bandt.com
DRESS
2480eim,C Avenue Ste 1100
:1000000
Anaheim, CA 92806
9206
WSURBI(a) AFFORDING COVERAGE
NAIC$
NRURERA;YauyFinaa�ComWV
20608
INSURED
Chapman Coast ROOF Co. Inc.
vuuRETe e: x.d.eea rA. ��
11673
GENLAGGREGATELIMITAPPLIESPER
PRO-
POLICY a JECT F—]LOC
OTHER:
GENERAL AGGREGATE
2301 E.OrangetholpeAvenue
INSURER C:o,meumaC ---ftC rosy
20443
$
P.O. Box 7050
°�UR°r ° `
UMBILITY
ANY AUTO
ALLOYVED SCHEDULED
AUTOS AUTOS
HIREDAUTOS X NON -0VrNED
AUTOS
Fullerton, CA 92634
MSURER E:
041011201
E�AeSIaaDSwCLELIMIT
1000000
BODILY INJURY(Perpaman)
INSURER F:
BODILY INJURY (Pa eAlmne
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�R
TYPE OF INSURANCE
IVV0
POLICYNUMBER
D
LIMITS
A
X1
COMMERCLALGENERALLIABLITY
TCWMS -MADE OCCUR
BI1PDDed:5,000
6012647716
D4101120117
041011201
EACNOGTCDRRENCE
:1000000
PR I 5 E
$100000
X
MEDEXP onapMarR)
$15000
PERSONAL &ADVINJURY
$1000,000
GENLAGGREGATELIMITAPPLIESPER
PRO-
POLICY a JECT F—]LOC
OTHER:
GENERAL AGGREGATE
31000,000
PRODUCTS - COMPtop AGG
s2,000,000
$
C
AUTOMOBILE
X
X
UMBILITY
ANY AUTO
ALLOYVED SCHEDULED
AUTOS AUTOS
HIREDAUTOS X NON -0VrNED
AUTOS
6012547735
041DII2017
041011201
E�AeSIaaDSwCLELIMIT
1000000
BODILY INJURY(Perpaman)
S
BODILY INJURY (Pa eAlmne
S
PROPERTYDAMAGE
JPsrawde N
$
S
A
X
UMBRELLA UAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
6012547704
W0112017
04/01/2018
EACHOCCURRENCE
S5.000.000
AGGREGATE
S5,000,000
DED I X RETENTIONS10000
S
B
WoRNERSCOMPENSAnmN
AND EMPLeVBtS' LIABILITY
ANY PROPRIETOR/PARTNERECUTIVE YIN
IEX
OFFICERMEMSER EXCLUDED?
(MandMery In NR)
N))ea, demfbeunmr
DESCRIPTION OF OPERATIONS bebn
N/A
CHWC817574
0112017
041011201
X PEtt oTw
E.L. EACH ACCIDENT
$1000000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
EL DISEASE -POUCY UNIT
$1000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (1°ORO 1101, Additional ltemaea Schedule, mar, be Mraebed IT mom epee[ Is required)
RE: City Facilities Roof Repairs Project BG -1801
City of Seal Beach is named as additional insured as respects general liability as required by Written
contract, per endorsement attached.
Should any policy be cancelled before the expiration date, BB &T Insurance Services Will mail 30 (thirty)
(See Attached Descriptions)
City of Seal Beach
221 -8th Street
Seal Beach, CA 90740
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
®1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101( 1 Of 2 The ACORD name and logo are registared marks of ACORD
OSIS152769IM17901547
ACMOS
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products - Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
it Is understood and agreed as follows:
I. The WHO IN AN INSURED section Is amended to add as an Insured any person or organization whom the Named
Insured is required by. written centred to add as an additional insured on this coverage part, including any such
person or organization, K any, specifically set forth on the Schedule attachment to this endorsement However, such
person or organizations an Insured only with respect to such person or organization's liability for.
A. unless paragraph B. below applies,
1. bodily bhjury, property damage, or personal and advertising injury caused in whole or in part by the acts
or omissions by or on behalf of the Named Insured and in the performance of such Named lrmured's
ongoing operations as specified In such written contract; or
2. bodily injury or property damage caused in whole or in part by your work and included in the products-
completed operations hazard, and only if
a the written contract requires the Named khsured to provide the additional insured such coverage; and
IL this coverage part provides such coverage.
B. bodily Injury, property damage, or personal and advertising injury arising out of your work described in such
written contract, but only'hf:
0 1. this coverage part provides coverage for bodily injury or property damage included within the products
0
completed operations hazard; and
2. the written contract specifically requires the Named Insured to provide additional insured coverage under
the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037.
s
U. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide
such additional insured with:
A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
III. The insurance granted by this endorsement to the additional Insured does not apply to twdlly Injury, property
damage, or personal and advertising injury arising out of:
A, the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
h� including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
S. any premises or work for which the additional insured Is specifically listed as an addltional Insured on another
endorsement attached to this coverage part.
W. Notwithstanding anything to the contrary in the section entitled COMMERCIIAL GENERAL LIABILITY CONDirIONS,
the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional
insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written
ONA75079XX (1 -15) Policy No: 6012547718
Page 1 of 2 Endorsement No: 2
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: CHAPMAN COAST ROOF CO., INC.
QiWWt Chu Ar F1Vft nesrinwd. Ir"den mpYrfphnd ffa rift m hnli8rme Sankt =W. Inc., wmt Its psm wftn.
CN CNA PARAMOUNT
dr�7�1 Contractors' General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Odw Insurance conditions is amended to add the following paragraph:
This Insurance Is excess over any of the other Insurance, whether primary, excess, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevators.
28. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:
A. Paragraph 1b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
lash; and
B. Paragraph 1.d. is amended to delete the limit of 8250 shown for daily loss of earnings and replace it with a
$1,000. limit.
24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
tl the Named Insured unintentionally fails to disclose all existing hazards at the Inception date of the Named
htaured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure:
26. WAIM OF SUBROGATION - BLANKET
Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Othere To Us is amended to
add the following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of:
1. the Named hmured's ongoing operations; or
2. ywa work included in the products-completed oparatlom hazard.
However, this waiver applies only when the Named hwred has agreed in writing to waive such rights of recovery In
a written contract or written agreement, and only if such contract or agreement:
1. is in effect or becomes effective during the term of this Coverage fart- and
2. was executed prior to the bodily minty, properly damage or personal and advertising injury giving rise to the
claim.
26. WRAP -UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAPIIP) INSURANCE PROGRAMS
Note: The following provision does not apply to any public construction project In the state of Oldahoma, nor to any
construction project in the state of Alaska, that is not permitted to be insured under a consordated (wrap-up)
insurance program by applicable state statute or regulation.
If the endorsement EXCLUSION — CONSTRUCTION WRAP -UP is attached to this policy, or another atrdusionary
endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance
Programs (C.C.I,P.) is attached, then the following changes apply:
A. The following wording is added to the above-referenced endorsement:
With respect to a consolidated (wrap -up) insurance program project in which the Named Insured is or was
involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as
damages because of:
1. Bodily Injury, property damage, or personal or advertising Injury that occurs during the Named Insured's
ongoing operations at the project, or during such operations of anyone acting on the Named Insu red's
behalf; nor
CNA74705XX (1 -15) Pollcy No: 6012547718
Page 16 of 17 Endorsement No: 1
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: CHAPMAN COAST ROOF CO., INC.
copydWa CXAA11 RV to Ruwrft& Inckides copyrlphdad ,Imlwial of Irmwaroe eerelma Otani, Inc., wrM Be pan union.
CNA63359XX
(Ed. 04/12)
C. Loss of Use Expenses
Section III, Paragraphs B.4.c and BA.d, are
Section III, Paragraph AA.b. is revised, with
deleted and replaced by the following:
respect to loss of use expenses incurred by
c. Physical Damage Coverage on a covered
you, to provide:
"auto" also applies to "loss" to any
a. $1,000 maximum, in lieu of $600.
permanently installed electronic equipment
including its antennas and other
D. Hired "Autos"
accessories.
The following is added to Section III.
d. A $100 per occurrence deductible applies
Paragraph A.:
to the coverage provided by this provision.
5. Hired "Autos"
G. Diminution In Value
If Physical Damage coverage is provided under
The following is added to Section Ill,
this policy, and such coverage does not extend
Paragraph B.6.:
to Hired Autos, then Physical Damage
Subject to the following, the "diminution in
coverage is extended to:
value" exclusion does not apply to:
a. Any covered "auto" you lease, hire, rent
a. Any covered "auto) of the private
or borrow without a driver; and
passenger type you lease, hire, rent or
b. Any covered "auto" hired or rented by
borrow, without a driver for a period of
your "employee" without a driver, under
30 days or less, while performing duties
a contract in that individual
related to the conduct of your business;
"employee's" name, with your
and
permission, while performing duties
b. Any covered "auto" of the private
related to the conduct of your business.
passenger type hired or rented by your
c. The most we will pay for any one
"employee" without a driver for a period
"accident" or "loss" is the actual cash
of 30 days or less, under a contract in
value, cost of repair, cost of
that individual "employee's" name, with
replacement or $75,000, whichever is
your permission, while performing
less, minus a $500 deductible for each
duties related to the conduct of your
covered auto. No deductible applies to
business.
"loss" caused by fire or lightning.
c. Such coverage as is provided by this
d. The physical damage coverage as is
provision is limited to a "diminution in
provided by this provision is equal to
value" loss arising directly out of
the physical damage coverage(s)
accidental damage and not as a result
provided on your owned "autos"
of the failure to make repairs; faulty or
incomplete maintenance or repairs; or
e. Such physical damage coverage for
the installation of substandard parts.
hired "autos" will:
d. The most we will pay for "loss" to a
(1) include loss of use, provided it is
covered "auto" in any one accident is
the lesser of :
the consequence of an "accident"
for which the Named Insured is
(1) $5,000; or
legally liable, and as a result of
which a monetary loss is sustained
(2) 20% of the "auto's" actual cash
by the leasing or rental concern.
value (ACV).
(2) Such coverage as is provided by
III. Drive Other Car Coverage —Executive Officers
this provision will be subject to a
The following is added to Sections II and Ill:
limit of $750 per "accident."
1. Any "auto" you don't own, hire or borrow is a
E. Airbag Coverage
covered "auto" for Liability Coverage while
The following is added to Section III,
being used by, and for Physical Damage
Paragraph B.3.:
Coverage while in the care, custody or control
of, any of your "executive officers," except:
The accidental discharge of an airbag shall not
be considered mechanical breakdown.
a. An "auto" owned by that "executive office('
or a member of that person's household; or
F. Electronic Equipment
CNA63359XX copyright, CNA Corpomfiw, 2000. Page 2 of 3
(Ed. 04112) Includes copyrighted material of the Insurance services Office used with its pennissien.
GREAT AMERICAN INSURANCE COMPANYO
Administrative Office: 301 E 4TH STREET 0 CINCINNATI, OHIO 45202 ° 513- 369 -5000 ° FAX 513- 723 -2740
The number of persons authorized by
this power of attorney is not more than SEVEN
No.0 14849
POWER OFATTORNEY
KNOWALL MEN BY THESE PRESENTS: That the GREATAMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attorney-in-fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
MIKE PARIZINO
RACHELLE PHEAULT
RHONDA C. ABEL
JAMES A. SCHALLER
Name
JERI APODACA
KIM LUU
HEATHER SALTARELLI
Address
ALL OF
NEWPORT BEACH,
CALIFORNIA
Limit of Power
ALL
$100,000,000.00
This Power of Attorney revokes all previous powers issued on behalf of the attorney(s) -in -fact named above.
IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 18TH day of NOVEMBER 2016
Attest GREAT AMERICAN INSURANCE COMPANY
,.,..
Assistant Secretary Divisional Senior Vice President
STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVID C. KrrCHIN (877-377-2405)
On this 18TH day of NOVEMBER 2016 before me personally appeared DAVID C. KITCHN, to me
known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
name thereto by like authority.
OFnnsy
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of OreatAmerican Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED. That the Divisional President, the several Divisional Senior (ice Presidents, Divisional Vice Presidents and Divisonal Assistant ice
Presidents, or any one of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts ofsuretyship, or other written obligations in the nature thereof,' to prescribe their respective duties and
the respective limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company maybe affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature ofsuch
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power ofAttomey and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this
NS
J�
S1 029A (06115)
day of DEC 13 2011
Assistant Secretary
EXHIBIT D -2
ADDITIONAL INSURED ENDORSEMENT
AUTOMOBILE LIABILITY
[INSERT INSURANCE CERTIFICATE SHOWING AUTOMOBILE LIABILITY]
Exhibit D -2, Page 1
v
Client8: 1260333
30SCHAPMCOA
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
T
°121"1
TYPE OF INSURANCE
12017
12I13Y1017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the policy(iss) must be endorsed. N SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endoreemand(s).
PRODUCER
NA$�: Allis Mosier
BB &T Insurance Services
v E,II:714941 -2900 877.297 -1116
of Orange County
ADDRESS: amosle bandtccm
2400 t(afalle Avenue Ste 1100
$1000000
Anaheim, CA 92806
NSURER(S)AFFORNNG COVERAGE
NAIC0
WSURERA:YVIUrra,e.�coernY
20508
INSURED
Chapman Coast Roof Co. Inc.
NSURER B: a. a.e� Fe C..ft M.,,
11673
�W���r
NsuRENC: �
20443
2301 E. Orengethorpe Avenue
PRODUCTS- COMPtoPAGG
s2,000,000
P.O. Box 7050
INSURER D:
C
AUTOMOBILJEUABBJn
X ANY AUTO
ALLOVAED SCHEDULED
AUTOS AUTOS
X HIREDAUiOS X AU OS ED
Fullerton, CA 92834
INSURER E:
!01/ 201704
/01/201
®BBIINEEDSINGLE LIMIT
1000000
INSURER F:
f
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT MATH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IMSR
LTR
TYPE OF INSURANCE
ADD
Nv0
POLICY NUMBER
�D
0EXP
MMIfa
A
X
CaBMERCULGENERALUABnm
CLUMSaMDE OCCUR
BI /PDDed:5,000
6012547716
101/20117
0410112011
EACH OCCURRENCE
$1000000
PREMISES Faom�irerin
(100000
X
MEDE%P one1w 0
$15000
PERSONAL& ADV INJURY
$1,000,000
GENL AGGREGATE UNIT APPLIES PER
POLICY E� JECaT 171 LOC
OTHER:
GENERAL AGGREGATE
i 000000
PRODUCTS- COMPtoPAGG
s2,000,000
$
C
AUTOMOBILJEUABBJn
X ANY AUTO
ALLOVAED SCHEDULED
AUTOS AUTOS
X HIREDAUiOS X AU OS ED
6012547735
!01/ 201704
/01/201
®BBIINEEDSINGLE LIMIT
1000000
BODILY INJURY(Pw Pw )
f
BODILY INJURY(Pw 60MMI)
f
(PPK awwNI
$
f
A
X
UMBRELLA DAB
EXCESS LIAB
X
OCCUR
CWNS -MADE
6012547704
/2017
04/011201
EACH OCCURRENCE
s6,000,000
AGGREGATE
$$000000
OED I X RETENTION $10000
f
B
INORIKERS COMPENSATION
AND EMPLOYERS' UNBILRY
ANY PROPRIETORIPARTNER/EXECUTNE YIN
OFFICERIMEMBER E %CLGDEOT
(MUWForyln Nig
nyeRIPTI OV�r
DESCRIPDON OF OPERATIONS LxIar
NIA
CHWC817574
04101112017
041011201
X PER OTH-
9TARITF SR
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1000000
EL DISEASE - POLICY LIMIT
$1,000,00
DESCRIPTION OF OPERATN)NSI LOCATIONS/ VEHICLES (ACORD 101, Mdifi it Rdmrb SOROON, may W nNclud n mom wp Nreq.ImM
RE: City Facilities Roof Repairs Project BG -1801
City of Seal Beach Is named as additional insured as respects general liability as required by written
contract, per endorsement attached.
Should any policy be cancelled before the expiration date, BB &T Insurance Services will mail 30 (thirty)
(See Attached Descriptions)
City of Sea] Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
221 -8th Street ACCORDANCE WITH THE POLICY PROVISIONS.
Seal Beach, CA 90740
01988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) 1 01`2 The ACORD name and logo are registered marks of ACORD
gS19152769M17901547 ACMOS
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products - Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
it is understood and agreed as follows:
L The WHO IS AN INSURED section Is amended to add as an Insured any person or organization whom the Nomad
Insured is required by. written contract to add as an additional insured on this coverage part, including any such
person or organization, if any, specifically set forth on the Schedule attachment to this endorsement However, such
person or organization is an Insured only with respect to such person or organization's liability for.
A. unless paragraph S. below applies,
1, bodily Injury, property damage, or personal and advertising injury caused in whole or in part by the acts
or omissions by or on behalf of the Named Insured and in the performance of such Named Itsured's
ongoing operations as specified In such written contract; or
2. bodily Injury or property damage caused in whole or in part by your work and included In the products-
completed operations hazard, and only if
a. the written contract requires the Named Insured to provide the additional insured such coverage; and
IL this coverage part provides such coverage.
S. bodily Injury, property damage, or personal and advertising injury arising out of your work described in such
written contract, but only If:
1. this coverage part provides coverage for bodily i njney or property damage included within the products
S completed operations tazard; and
0
2. the written contract specifically requires the Named Insured to provide additional insured coverage under
the 11-85 or 10-01 edition of CG2010 or the 10 -01 edition of CG2037.
s 1. Subject always to the teats and conditions of this policy, including the limits of insurance, the Insurer will not provide
such additional insured with:
6 A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
III. The insurance granted by this endorsement to the additional Insured does not apply to bodily ink", property
damage, or personal and advertising injury arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
r. including: —
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional Insured Is specifically listed as an additional Insured on another
endorsement attached to this coverage part.
IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS,
o the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional
insured whether on a primary, excess, contingent or any other basis. However, If this insurance is required by written
t>=
CNA75079)O( (1 -15) Policy No: 6012547718
Page 1 of 2 Endorsement No: 2
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: CHAPMAN COAST ROOF CO., INC.
o*rghw cNA Ar agme Rawnad. IndWas mpyrkMnd matarw of inesa ser*w oeka, ire., rwm Its pemils*n.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Outer Insurance conditions is amended to add the following paragraph:
This insurance is excess over any of the other Insurance, whether primary, excess, contingent or on arty other
basis that is Property insurance covering property of others damaged from the use of elevators.
23. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:
A. Paragraph 1b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
limit; and
B. Paragraph 1AL is amended to delete the limit of $250 shown for daily lobs of earnings and replace it with a
$1,000. limit.
24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named kraured unintentionally fails to disclose all existing hazards at the inception data of the Named
Irmured% Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure:
26. WAIVER OF SUBROGATION - BLANKET
Under CONDITIONS, the condition entitled Trarrfer Of Rights Of Recovery Against Others To Us is amended to
add the following:
The Insurer waives any rigid of recovery the Insurer may have against any person or organization because of
payments fire Insurer makes for injury or damage arising out of:
1. the Named insraed's ongoing operations; or
2. your work included in the products completed operaUorre hazadd.
However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in
a written contract or written agreement and only if such contract or agreement:
1. is in effect or becomes effective during the term of this Coverage Part; and
2. was executed prior to the bodily b", property damage or personal and advertising injury giving rise to the
cfakn.
26. WRAP -UP EXTENSION: OCIP, CCIP, OR CONSOL MATED (WRAP -UP) INSURANCE PROGRAMS
Note: The following provision does not apply to any pudic construction project In Ore state of Oldahoma, nor to arty
construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrapup)
insurance program by applicable state statute or regulation.
If the endorsement EXCLUSION — CONSTRUCTION WRAP -UP is attached to this policy, or another exclusionary
endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance
Programs (C.C.I.P.) is attached, then the following changes apply:
A. The following wording is added to the above- referenced endorsement:
With respect to a consolidated Ninapup) Insurance program project in which the Neared Ensured is or was
involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as
damages because of:
1. Bodily Injury, property damage, or personal or advertising knjury that occurs during the Named lmuted'a
ongoing operations at the project, or during such operations of anyone acting on the Named Insnred's
behalf; nor
CNA74705XX (1 -15) Pollcy No: 6012547718
Page 16 of 17 Endorsement No: 1
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: cRAPMAN COAST ROOF CO., INC.
0aprr0t CNA AU RV to FIswrvel Includes capyreMed IfalWW of Inmeeroe earNrea Office, Inc., wMI Im pemf don.
C"
C. Loss of Use Expenses
Section III, Paragraph A.4.b. is revised, with
respect to loss of use expenses incurred by
you, to provide:
a. $1,000 maximum, in lieu of $600.
D. Hired "Autos"
The following is added to Section III.
Paragraph A.:
5. Hired "Autos"
If Physical Damage coverage is provided under
this policy, and such coverage does not extend
to Hired Autos, then Physical Damage
coverage is extended to:
a.
M
C.
d.
Any covered "auto" you lease, hire, rent
or borrow without a driver, and
Any covered "auto" hired or rented by
your "employee" without a driver, under
a contract in that individual
"employee's" name, with your
permission, while performing duties
related to the conduct of your business.
The most we will pay for any one
"accident" or "loss" is the actual cash
value, cost of repair, cost of
replacement or $75,000, whichever is
less, minus a $500 deductible for each
covered auto. No deductible applies to
"loss" caused by fire or lightning.
The physical damage coverage as is
provided by this provision is equal to
the physical damage coverage(s)
provided on your owned "autos."
e. Such physical damage coverage for
hired "autos" will:
(1) Include loss of use, provided it is
the consequence of an "accident"
for which the Named Insured is
legally liable, and as a result of
which a monetary loss is sustained
by the leasing or rental concern.
(2) Such coverage as is provided by
this provision will be subject to a
limit of $750 per "accident"
E. Airbag Coverage
The following is added to Section III,
Paragraph B.3.:
The accidental discharge of an airbag shall not
be considered mechanical breakdown.
F. Electronic Equipment
CNA63359XX
(Ed. 04112)
Section III, Paragraphs B.4.c and B.4.d. are
deleted and replaced by the following:
c. Physical Damage Coverage on a covered
"auto" also applies to "loss" to any
permanently installed electronic equipment
including its antennas and other
accessories.
d. A $100 per occurrence deductible applies
to the coverage provided by this provision.
G. Diminution In Value
The following is added to Section III,
Paragraph B.S.:
Subject to the following, the "diminution in
value" exclusion does not apply to:
a. Any covered "auto" of the private
passenger type you lease, hire, rent or
borrow, without a driver for a period of
30 days or less, while performing duties
related to the conduct of your business;
and
b. Any covered "auto" of the private
passenger type hired or rented by your
"employee" without a driver for a period
of 30 days or less, under a contract in
that individual "employee's" name, with
your permission, while performing
duties related to the conduct of your
business.
c. Such coverage as is provided by this
provision is limited to a "diminution in
value" loss arising directly out of
accidental damage and not as a result
of the failure to make repairs; faulty or
incomplete maintenance or repairs; or
the installation of substandard parts.
d. The most we will pay for "loss" to a
covered "auto" in any one accident is
the lesser of:
(1) $5,000; or
(2) 20% of the "auto's" actual cash
value (ACV).
Drive Other Car Coverage — Executive Officers
The following is added to Sections II and 111:
1. Any "auto" you don't own, hire or borrow is a
covered "auto" for Liability Coverage while
being used by, and for Physical Damage
Coverage while in the care, custody or control
of, any of your "executive officers," except:
a. An "auto" owned by that "executive officer"
or a member of that person's household; or
CNA63359XX Copyright, CNA corporation, 2000. Page 2 of 3
(Ed. 04/12) Includes copyrighted materiel of the Insurence Services Office used wflh its permission.
GREAT AMERICAN INSURANCE COMPANYO
Administrative Office: 301 E 4TH STREET 0 CINCINNATI, OHIO 45202 0 513- 369 -5000 0 FAX 513 - 723 -2740
The number of persons authorized by
this power of attorney is not more than SEVEN
No.0 14849
POWER OFATTORNEY
KNOWALLMENRYTHESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attomey -in -fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
MIKE PARIZINO
RACHELLE PHEAULT
RHONDA C. ABEL
JAMES A. SCHALLER
Name
JERI APODACA
KIM LUU
HEATHER SALTARELLI
Address
ALL OF
NEWPORT BEACH,
CALIFORNIA
Limit of Power
ALL
$100,000,000.00
This Power of Attorney revokes all previous powers issued on behalf of the attorney(s) -in -fact named above.
IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 18TH day of NOVEMBER 1 2016
Attest GREAT AMERICAN INSURANCE COMPANY
asup�F...
i
Assistant Secretary Divisional Senior Vice President
STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVID C. KITCHIN (877 - 377 -2405)
On this 18TH day of NOVEMBER 2016 before me personally appeared DAVID C. KITCHIN, to me
known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
time thereto by like authority.
FAR' j•.. S,J
This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of GreatAmerican Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior Vice Presidents, Divisional Vice Presidents and Divisonal Assistant ice
Presidents, or anyone of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof to prescribe their respective duties and
the respective limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of arty of the aforesaid officers and any Secretary or Assistant Secretary of the
Company may be affixed by facsimile to any power of attorney or certificate of either given far the execution of any bond undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when soused being hereby adopted by the Company as the original signature of such
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this
M5U
3' .6
E
S1029AF (06/15)
day of DEC 13 2017
4 t' .° e. .3-,
Assistant Secretary
EXHIBIT D -3
ADDITIONAL INSURED ENDORSEMENT
[INSERT INSURANCE CERTIFICATE SHOWING PROFESSIONAL INSURANCE
LIABILITY, IF REQUIRED]
Exhibit D -3, Page 1
Client#: 1260333 30SCHAPMCOA
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
DATEW DDNYY"
TYPEDFMSURANCE
12/13/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: M the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. it SUBROGATION IS WAIVED, subject to
the terns and conditions of the pol'm y, Certain policies may require an andomemem. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsament(s).
PRODUCER
Allie Mosier
BBB:? Insurance Services
.714 941 -2900 No 877 -297 -1116
of Orange County
LL°
AODR BS amosler@bbandtcom
2400 KatBlle Av Sic 1100
venue
enue
$10-00000
Anaheim, CA
INSURERM AFFORDING COVERAGE
NAICa
MEDFXP (Anyorepmaon)
$16000
GENL
MSURERA: Yemyrem.m.m...e,e.F . eY
205
INSURED
Chapman Coast Roof Co. Inc.
NSUIiFRB: v.aweeaFti.ra,vllr�r
11673
INSURER C: a m.daD.e.p �raY
28443
2301 E.Orengethorpe Avenue
$
P.O. Box 7050
INSURER G:
ANY AUTO
AUTOS OARIED AUTOS D
HIRED AUTOS NON-0 NED
X AUTOS
Fullerton, CA 92834
° E
04/011201
COMBINED BIESI LIMIT
1000000
BODILY INJURY (Par pemon)
DISLIRFJT F:
BODILY INJURY (PerecaOnU
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTW"tiSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LM
TYPEDFMSURANCE
SUB
WVO
POLICYNUMBER
tWDM
009MUM
LIMITS
A
X
COMMERCNLraBJERALLIABLITY
CWMS�IAOE OCCUR
BI /PDDed:5,000
601264%718
1011201754/01/261
EACH OCCURRENCE
$10-00000
PREMISES Eaom np
$100000
X
MEDFXP (Anyorepmaon)
$16000
GENL
PERSONALSADVINJURY
41,000000
AGGREGATE LIMIT APPLIES PER
POLICY 51 TEECT F-1 LOC
OTHER
GENERAL AGGREGATE
S ZOOO.000
PROWCTS- COMPTPAGG
s2,000,000
$
C
AUTOMOBILELIAGILITY
X
X
ANY AUTO
AUTOS OARIED AUTOS D
HIRED AUTOS NON-0 NED
X AUTOS
6012541235
D41011201T
04/011201
COMBINED BIESI LIMIT
1000000
BODILY INJURY (Par pemon)
$
BODILY INJURY (PerecaOnU
f
PROPERTY DAMAGE
Per aonmm
f
S
A
X
UMBRELLA UAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
6012547704
101 12017
04101/201
EACH OCCURRENCE
$5,000,000
AGGREGATE
$6,000,000
DEO X RETENTION$t0000
S
B
WORKERSCOMPENSAlJA COMPENSATION
AND
OFFICERa1EMBER EXCLUDED? �
(Mandatary In NH)
rc))eARIMONwdar
OE$CRIPIION OF OPERATIONS belwr
N/A
WC817574
4101/2017
041011201
)( PER &H-
E.L. EACH ACCIDENT
51,000,000
EL. DISEASE - EA EMPLOYEE
$1,000,000
EL DI$EA$E - POLICY UNIT
$1055500
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, AddI R Imz Sche uN, may be aaaebed s more Rem m mqulmd)
RE: City Facilities Roof Repairs Project BG -1801
City of Seal Beach is named as additional insured as respects general liability as required by written
contract, per endorsement attached.
Should any policy be cancelled before the expiration date, BEIV Insurance Services Will mall 30 (thirty)
(See Attached Descriptions)
City of Seal Beach
221 -8th Street
Seal Beach, CA 90740
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
®198 &7014 ACORD CORPORATION. All riahis reserved.
ACORD 25 (2014101) 1 of 2 The ACORD name and logo are registered marks of ACORD
dS19152769/M17901647
ACMOS
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products - Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It Is understood and agreed as follows:
1. The VMO IS AN .INSURED section is amended to add as an insured any person or organization whom the Named
Insured is required by. written contract to add as an additional insured on this coverage pats, including any such
person or organization, H any, specifically set forth on the Schedule attachment to this endorsement However, such
person or organization is an Insured only with respect to such person or organization's liability for.
A. unless paragraph B. below applies,
1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts
or omissions by or on behalf of the Named Insured and in the performance of such Named Irsured's
ongoing operations as specified in such written contract; or
2. bodily Injury or property damage caused in whole or in part by your work and included In the products-
completed operations hazard, and only if
a. the written cotdract requires the Named Insured to provide the additional insured such coverage; and
b. this coverage part provides such coverage.
S. bodily Injury, property damage, or personal and advertising injury arising out of your work described in such
wrbm contract, but only ff:
s 1. this coverage pad provides coverage for bod0y injury or properly damage included within the products
completed operations hazard; and
2. the written contract specifically requires the Named Insured to provide additional insured coverage under
the 11$5 or 10.01 edition of CG2010 or the 10-01 edition of CG2037.
s ll. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide
$ such additional insured with:
a A. coverage broader than required by the wr9tsn contract; or
B. a higher limit of insurance than required by the written contract.
01. The insurance granted by this endorsement to the additional Insured does not apply to bodily Injury, property
damage, or personal and advertising tnjmy arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
Including
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional Insured is specifically listed as an additional Insured on another
endorsement attached to this coverage pad.
IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS,
the Condition entitled Otfrer Insurance, this insurance is excess of all other insurance available to the additional
insured whether on a primary, excess, contingent or any other basis. However, If this insurance is required by written
EM
CNA75079)0( (1 -15) Policy No: 6012547718
Page 1 of 2 Endorsement No: 2
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: CHAPMAN COAST ROOF CO., INC.
Capyrohf OKA Ar F[Wft fle9ervad. InrLdn mpyrfghted m aft of Ir ffe aePAM OOke, Im. WMi IM PeRNsaW.
CNA CNA PARAMOUNT'
Contractors' General Liability Extension Endorsenwit'
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Odw Insurance conditions is amended to add the following paragraph:
This insurance Is excess over any of the other Insurance, whether primary, excess, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevators.
PIE . i r. c.. . L�.lq, t,
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:
A. Paragraph ib. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
limit; and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a
$1,D00. Suitt
24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named insured red unintentionally fails to disclose all existing hazards at the inception date of the Named
tesured's Coverage Part, the Insurer will not deny coverage under this Coverage Pert because of such failure:
25. WAIVER OF SUBROGATION - BLANKET
Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery AgabW Odors To Us is amended to
add the following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of:
1. the Named hsureft ongoing operations; or
2. you work included in the products- complided operadcris turd.
However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in
a written contract or written agreement, and only if such contract or agreement:
1. is in effect or becomes effective during tine term of this Coverage Part; and
2. was executed prior to the bodily Injury, property damage or personal and advertising Injury giving rise to the
claim.
26. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS
Nate: The following provision does not apply to any public construction project in the state of Oklahoma, nor to arty
construction project in the state of Alaska, that is not permitted to be insured under a consolidated (xrapup)
insurance program by applicable state statute or regulation.
If the endorsement EXCLUSION — CONSTRUCTION WRAP -UP is attached to this policy, or another exclusionary
endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance
Programs (C.C.I.P.) is attached, then the following changes apply:
A. The following wording is added to the above-referenced endorsement:
With respect to a oorsolidated (wrap -up) Irourance program project in which the Named Insured is or was
involved, this exclusion does not apply to those sums the Named insured become legally obligated to pay as
damages because of:
1. Bodily injury, property damage, or personal or advertising i*iry that occurs during the Named Insured's
ongoing operations at the project, or during such operations of anyone acting on the Named Insured's
behalf; nor
CNA74705M 0 -15) Pollcy No: 6012547718
Page 16 of 17 Endorsement No: 1
VALLEY FORGE INSURANCE COMPANY Effective Date: 04/01/2017
Insured Name: cRAPMAN COAST ROOF CO., INC.
Cop0Wt CNA AU Rees& InquCas mprr�nea mam,lai N Iteurerce aervnxe oxm, hx.. cum, re perrthelw,.
C. Loss of Use Expenses
Section III, Paragraph AA.b. is revised, with
respect to loss of use expenses incurred by
you, to provide:
a. $1,000 maximum, in lieu of $600.
D. Hired "Autos"
CNA63359XX
(Ed. 04/12)
Section III, Paragraphs BA.c and BA.d. are
deleted and replaced by the following:
c. Physical Damage Coverage on a covered
"auto" also applies to "loss" to any
permanently installed electronic equipment
including its antennas and other
accessories.
The following is added to Section III.
d. A $100 per occurrence deductible applies
Paragraph A.:
to the coverage provided by this provision.
5. Hired "Autos"
G. Diminution In Value
If Physical Damage coverage is provided under
The following is added to Section 111,
this policy, and such coverage does not extend
Paragraph B.6.:
to Hired Autos, then Physical Damage
Subject the following, the "diminution in
coverage is extended to:
value" exclusion does not apply to:
a. Any covered "auto" you lease, hire, rent
a. Any covered "auto" of the private
or borrow without a driver; and
passenger type you lease, hire, rent or
b. Any covered "auto" hired or rented by
borrow, without a driver for a period of
your "employee" without a driver, under
30 days or less, while performing duties
a contract in that individual
related to the conduct of your business;
"employee's" name, with your
and
permission, while performing duties
related to the conduct of your business.
b. Any covered "auto" of the private
passenger type hired or rented by your
c. The most we will pay for any one
"employee" without a driver for a period
"accident" or "loss" is the actual cash
of 30 days or less, under a contract in
value, cost of repair, cost of
that individual "employee's" name, with
replacement or $75,000, whichever is
your permission, while performing
less, minus a $500 deductible for each
duties related to the conduct of your
covered auto. No deductible applies to
business.
"loss" caused by fire or lightning.
c. Such coverage as is provided by this
d. The physical damage coverage as is
provision is limited to a "diminution in
provided by this provision is equal to
value" loss arising directly out of
the physical damage coverage(s)
accidental damage and not as a result
provided on your owned "autos."
of the failure to make repairs; faulty or
incomplete maintenance or repairs; or
e. Such physical damage coverage for
the installation of substandard parts.
hired "autos" will:
d. The most we will pay for "loss" to a
(1) Include loss of use, provided it is
covered "auto" in any one accident is
the lesser of:
the consequence of an "accident"
for which the Named Insured is
(1) $5,000; or
legally liable, and as a result of
which a monetary loss is sustained
(2) 20% of the "auto's" actual cash
by the leasing or rental concern.
value (ACV).
(2) Such coverage as is provided by III.
Drive Other Car Coverage —Executive Officers
this provision will be subject to a
The following is added to Sections II and III:
limit of $750 per "accident"
1. Any "auto" you don't own, hire or borrow is a
E. Airbag Coverage
covered "auto" for Liability Coverage while
The following is added to Section 111,
being used by, and for Physical Damage
Paragraph B.3.:
Coverage while in the care, custody or control
of, any of your "executive officers," except:
The accidental discharge of an airbag shall not
be considered mechanical breakdown.
a. An "auto" owned by that "executive officer"
or a member of that person's household; or
F. Electronic Equipment
CNA63359XX Copyright, CNA Corporation, 2000. Page 2 of 3
(Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission.
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET C CINCINNATI, OHIO 45202 ° 513- 369 -5000 C FAX 513 - 723 -2740
The number of persons authorized by
this power of attorney is not more than SEVEN
No. 0 14849
POWER OF ATTORNEY
KNOWALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attomey -ln -fact, for it and in its name, place and stead to execute on behalf of the said Company, as sureTy, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
MIKE PARIZINO
Name
JERI APODACA
Address Limit of Power
ALL OF
RACHELLE PHEAULT
KIM LUU
ALL
NEWPORT BEACH, $100,000,000.00
RHONDA C. ABEL
HEATHER SALTARELLI
CALIFORNIA
JAMES A. SCHALLER
This Power ofAttomey revokes all previous powers issued on behalf of the attomey(s) -in -fact named above.
IN WITNESS WHEREOF the GREATAMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 18TH day of NOVEMBER 1 2016
Attest GREAT AMERICAN 111111 COMPANY
3: (&w
Assistant Secretary Dn,isit n it Senior Nee President
STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVRD C. KrrCHiN (877-677-2405)
On this 18TH day of NOVEMBER 2016 before me personally appeared DAVID C. KITCHIN, to me
known, being duly swom, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seat
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
name thereto by like authority.
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of GreatAmerican Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior rice Presidents, Divisional Vice Presidents and Divisonal Assistant Vice
Presidents, or anyone of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof, to prescribe their respective duties and
the respective limits oftheir authority, and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature ofany of the aforesaid officers and any Secretary or Assistant Secretary of the
Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power ofAttomey and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this day of DEC 1.3 2017 .
3`: s
Assistant Secretary
s1029AF (06/15)
EXHIBIT E
ACKNOWLEDGMENT OF PENAL AND CIVIL PENALTIES CONCERNING
CONTRACTOR LICENSING LAWS
Exhibit E, Page 1
STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES,
CONCERNING THE CONTRACTORS' LICENSING LAWS I
[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 1, 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 1
business or act in the capacity of a contractor within this state without having a license therefore, 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 1
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
cast of materials and labor famished 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 i
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 I
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 i
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 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 t
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.:- 41-Vk 7 S �_ Class: _C a l Expiration Date: 1-31—(9
Date: I — 9 — I Sf
EXHIBIT F
LABOR LAW REQUIREMENTS
Exhibit F, Page 1
AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW
REQUIREMENTS
1Labor Code §§ 1720, 1773.8, 1775, 1776,1777.5, 1813,1860,1861, 37001
The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the
Following provisions of California law:
1. Contractor acknowledges that this contract is subject to the provisions of Division 2, Part 7, Chapter I
(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 I
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 i
Relations for the work or craft in which the worker is employed for any public work done under the contract by I
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 I
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 I
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 i
of that code, and I will comply with such provisions before commencing the performance of the work of this
contract."
Date / - 2- / Or Signature ( J 6 �"Aa
EXHIBIT G
ACCEPTED PROPOSAL
Exhibit G, Page 1
Section C
PROPOSAL,
Bidders Name CHAPMAN COAST ROOF CO., INC.
TO THE HONORABLE MAYOR AND CITY COUNCIL OF THE CITY OF SEAL BEACH:
The undersigned, as bidder, declares that: (1) -this proposal is made without collusion with any other
person, firm or corporation, and that the only persons or parties interested as principals are those named
herein as sworn in the attached Non - Collusion Affidavit; (2)- bidder has carefully examined the project
Plans, Specifications, Instructions To Bidders, Proposal, Notice Inviting Sealed Bids and all other contract
documents and information furnished therefore and the site of the proposed work; and (3)- bidder has
investigated and is satisfied as to the conditions to be encountered, the character, quality and quantities of
work to be performed and materials to be furnished. Furthermore, bidder agrees that submission of this
proposal shall be conclusive evidence that such examination and investigation have been made and agrees,
in the event this contract be awarded to bidder, to enter into a contract with the City Council of the CITY
OF SEAL BEACH, to perform said proposed work in accordance with the Plans, if any, and the terms of
the Specifications, in the time and manner therein prescribed, and to furnish or provide all materials, labor,
tools, equipment, apparatus and other means necessary so to do, except such thereof as may otherwise be
furnished or provided under the terms of said Specifications, for the following stated unit prices or lump
sum price as submitted on the Bid Sheet herein.
The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial Safety
Record. This Safety Record must include all construction work undertaken in the State of California by the
bidder and any partnership, joint venture or corporation that any principal of the bidder participated in as a
principal or owner for the last five calendar years and the current calendar year prior to the date of bid
submittal. Separate information shall be submitted for each such partnership, joint venture, or corporate or
individual bidder. The bidder may attach any additional information or explanation of data which he would
like to be taken into consideration in evaluating the safety record. An explanation of the circumstances
surrounding any and all fatalities must be attached.
Accompanying this proposal is (Circle one "cash ", "a Cashier's Check ", "a certified check ", or a Bidder
on in the form furnished by the City ", as the case may be) in the amount of $ 10% an a t
equal to at least ten percent (10 %) of the total aggregate bid price based on the quantities shown and the
unit prices quoted. The undersigned bidder agrees that should bidder be awarded the Contract on the basis
hereof and thereafter fail or refuse to enter into a Contract and provide the required evidence of insurance
and bonds within 15 calendar days after written notice of the award, the cash, check or bond shall be
forfeited to the city in accordance with Public Contract Code section - 20172, except as otherwise provided
in Public Contract Code section - 20174. The undersigned agrees that in the event of such failure, the actual
amount of damages to the City would be impractical and extremely difficult to determine.
In compliance with the Notice Inviting Sealed Bids, the undersigned hereby agrees to enter into a contract
to furnish all labor, materials and supplies for this project in accordance with the Specifications, Plans other
Contract Documents which are on file in the office of the City Engineer of the CITY OF SEAL BEACH, to
the satisfaction and under the direction of the City Engineer, at the following prices: completed by the
undersigned is fixed at 55 WORKING DAYS starting from the day after the issuance of the Notice to
Proceed.
Page C -I
City of Seal Beach
California
PROPOSAL FOR
City Facilities Roof Repair Project
SPECIFICATION NO. BG1801
BID SHEET
MANDATORY JOB WALK
November 7, 2017 9:00am, Tuesday
1776 Adolfo Lopez Drive, Seal Beach, CA 90740
(1) The following is the Line Item Format per Construction Specifications Institute (CSI) Divisions.
Variation from this form requires notification and approval from the architect prior to submittal.
Approved changes will be required of all bidders.
(2) Items shall include all Material, Labor and Equipment necessary to provide a complete,
functional installation, approved by the authorities having jurisdiction.
(3) All work of installation shall be covered by the unit prices in the same manner as required by the
Drawings and inclusive Specifications.
Bid
Item
# Description $Figures Words
--
- --
1. Mobilization; complete and in place.
$ 1,500.00 One thousand five hundred dollars
...... -.__ _.- ._..._. .- .....__ ... -.._ . —_ -... ..... -._.. . ....... ......- -- -.- .............. _..................._...._..
2. Remove and replace any damaged 'h"
thick plywood; complete and in place.
$ 6.75 /$ F Six dollars and seventy five ce is per s.f.
3. Reroof all tile sections of Mary Wilson
Library/Senior Center per specification
07322 in Appendix B lete and in
pP en comp
One hundred thirty seven thousand nine
,
place_ $ 137,9as.00
hundred and twenty five dollars
4. Install roof restoration on all mechanical
well areas of Mary Wilson Library
/Senior Center per specification 07562 in
Twenty one thousand one hundred and
Appendix B, complete and m place. $ - 21,119.00—
forteen dollars
5. Reroof all Public Works East Garage per
specification 07520 in Appendix B,
p PP
Ninety one thousand nine hundred and
twenty three dollars
complete and in place. $ 91,923.00
Page C -2
6. j Reroof City Hall Tower Roof tile section
and City Hall tile repairs per specification
07321 in Appendix B, complete and in
Install roof restoration on all mechanical
well areas of City Hall per specification
07563 in Appendix B, complete and in
8. Install roof restoration on West End Pump
Station per specification 07564 in
Appendix B, complete and in place.
9. Perform roof repairs on all roof areas of
Police Department per specification
07510 in Appendix B, complete and in
36,582.00
23
16,000.00
Thirty six thousand five hundred eighty
two dollars
Treaty three thousand nine hundred
ninety five dollars
Sixteen thousand dollars
Nineteen thousand dollars
TOTAL COST FOR BID ITEMS 1 -9
$ 348,045.75 Three hundred forty eight thousand and forty five dollars and seventy ;i
figures words xve cents
IN CASE OF DISCREPANCY BETWEEN WORDS AND FIGURES, THE WORDS
SHALL PREVAIL.
NOTE: The City reserves the right to award a contract to the lowest responsible bidder in parts or in its
entirety and reserves the right to reject all bids and re- advertise, as appears to be in the best interests of the
City. A bid is required for this entire work, the estimated quantities set forth in this Bid Sheet being solely
for the purpose of comparing bids, and final compensation under the Contract will be based upon the actual
quantities of work satisfactorily completed. The unit and /or lump sum prices bid shall include all
appurtenant expenses, taxes, royalties, and fees. In the case of discrepancies in the amount bid, unit prices
shall govern over extended amounts, and words shall govern over figures. The City reserves the right to
increase or decrease the amount of any quantity shown and to delete any item from the Contract.
Page C -3
The undersigned bidder agrees that, if awarded the Contract, bidder will complete all work according to the
contract documents. The undersigned bidder is licensed in accordance with the requirements of the
. Business and Professions Code, California Contractor's License No._ 927543 Class
C39 (REQUIRED AT TIME OF AWARD).
11/13/2017 LINDA DOMINGUEZ, SECRETARY /TREASURER
Signature I Date Title
Signature Date Title
If bidder is an individual, name and signature of individual must be provided, and, if he is doing business
under a fictitious name, the fictitious name must be set forth. If bidder is a partnership or joint venture,
legal name of partnership /joint venture must be provided, followed by signatures of all of the partners /joint
venturers or of fewer than all of the partners /joint venturers if submitted with evidence of authority to act
on behalf of the partnership /joint venture. If bidder is a corporation, legal name of corporation must be
provided, followed by signatures of the corporation President or Vice President and Secretary or Assistant
Secretary, and the corporate seal. Signatures of partners, joint venturers, or corporation officers must be
acknowledged before a Notary Public, who must certify that such partners, joint venturers, or officers are
known to him or her to be such, and, in the case of a corporation, that such corporation executed the
instrument pursuant to its bylaws or a resolution of its Board of Directors.
INFORMATION REQUIRED OF BIDDER
Bidder certifies under penalty of perjury under the laws of the State of California that the following
information is true and correct:
Name of individual Contractor, Company or Corporation:
Business Address: 2301 E. ORANGETHORPE AVENUE, FULLERTON, CA 92831
Page C -4
Telephone and Fax Number: (714) 738 -6611 / FAX: (714) 738 -0143
California State Contractor's License No. and Class: LICENSE NO. 927543 / C39
(REQUIRED AT TIME OF AWARD)
Original Date Issued: 1/15/09 Expiration Date: 01/31/2019
List the name and title /position of the person(s) who inspected for your firm the site of the work proposed
in these contract documents:
ROGIE CABRAL, PROJECT MANAGER / ESTIMATOR
The following are the names, titles, addresses, and phone numbers of all individuals, firm members,
partners, joint ventures, and company or corporate officers having a principal interest in this proposal:
Name Title Address Telephone
CHAPMAN COAST ROOF CO., INC. 2301 E. Orangethorpe Ave., Fullerton, CA 92831 (714) 738 -6611
Dave Chapman, President 2301 E. Orangethorpe Ave., Fullerton, CA 92831 (714) 738 -6611
Linda Dominguez, Secretary/Treasurer 2301 E. Orangethorpe Ave., Fullerton, CA 92831 (714) 738 -6611
Julio Gonzalez, Vice President 2301 E. Orangethorpe Ave., Fullerton, CA 92831 (714) 738 -6611
Corporation organized under the laws of the State of CALIFORNIA
The dates of any voluntary or involuntary bankruptcy judgments against any principal having an interest in
this proposal are as follows:
N/A
Page C -5
All current and prior D.B.A.'s, aliases, and fictitious business names for any principal having interest in
this proposal are as follows:
CHAPMAN COAST ROOF CO., INC. 924573 EXP: 01/31/2019
COAST ROOF CO., INC. 393499 INACTIVE
DAVE CHAPMAN 821013 INACTIVE
For all arbitrations, lawsuits, settlements or the like (in or out of court) you have been involved in with
project owners (public agencies, private companies, etc...) in the past five years (Attach additional Sheets
if necessary) provide:
Provide the names, addresses and telephone numbers of the parties;
N/A
Briefly summarize the parties' claims and defenses;
N/A
State the tribunal (i.e., Superior Court, American Arbitration Association, etc.) the matter number and
N tcAome.
Have you ever had a contract terminated by the owner /agency? If so, explain.
NO.
Have you ever failed to complete a project? If so, explain.
Have you ever been terminated for cause and then had it converted to a "termination of convenience "? If
sk6xplain.
For any projects you have been involved with in the last 5 years did you have any claims or actions:
Circle One
I. By yo�, `gainst the owner?
Yes' �
2. By the owner against you?
Yes / G
Page C -6
3. By any outside agency or individual for labor compliance (i.e. failure to pay prevailing wage,
falsify certified payrolls, etc..)
4. Yes /
5. By Subcontractors (Stop Notices, etc.)
Yes / 100
6. Are any claims or actions unresolved or outstanding? Yes /(9
If yes to any of the above, explain. (Attach additional sheets, if necessary)
N/A
Failure of the bidder to provide ALL requested information in a complete and accurate manner may be
considered non - responsive.
Subscribed and swom to before me By
This day of , 20 (print name of Owner or
pe ,� -1,,- 1 Presiden f rporation /Company)
(Signature of Notary Republic) (Signature)
DAVE CHAPMAN, PRESIDENT
(Title)
(SEAL) 11/13/2017
(Date),�Q�
(Signature of Secretary of Corporation)
LINDA DOMINGUEZ, SECRETARY /TREASURER
DATE: 11/13/2017
Page C -7
CALIFORNIA_
ALL - PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this oeRificete verifies only the
Identity of the individual who signed the document to which this certificate
Is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange )
On November 13, 2017 before me Alice Valle, Notary Public
personally appeared Mere Insert name and mlearue o
Linda Dominguez and Dave Chapman
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) Is/are subscribed to the within Instrument and acknowledged to me that
he/she/they executed the same in his/hedtheir authorized capacity(les), and that by
histherAheir signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument. I certify under PENALTY OF
PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
JA I 11�i& i Notary Public A California
-` t- Orange County
OT Notary Public (aea0 Commission x 21 g7s20
My Comm. Expires lun 12.2021
ADDITMAL OPTIONAL INFORMATION
DESCRIPnM OF THE ATTACHED DOCUMENT
Proposal
Mile or dearip5m daaac ed dome"
Mbardo wWw dateced cicgreau emtlmesi
Number of Pages, Doatment Date
2015 Vemstan WIMNAa•.aryCbeaes.co :i 800.8739865
INSTRUCTIONS
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REFERENCES: Contractor must use this form!!! Please print or type.
Bidders Name CHAPMAN COAST ROOF CO., INC.
FAILURE OF THE BIDDER TO PROVIDE ALL REQUIRED INFORMATION IN A COMPLETE AND ACCURATE MANNER
MAY BE CONSIDERED NON - RESPONSIVE.
For all public agency projects you have worked on (or are currently working on) in the past 2 years in
excess of $15,000, provide the following information:
I MURRIETA VALLEY USD SUMMER 2016 ROOFING AT VARIOUS SITES
Project Name/Number
TREM R I Y TE A AN EL PE HILL . HAL URRA H O ,
Project Description VISTA MURRIETA HS, WARM SPRINGS, RAILRANCH ES, MURRIETA VALLEY HS, AND CREEKSIDE HS.
Approximate Construction Dates From to 06/2016 - 11/2016
Agency Name MURRIETA VALLEY UNIFIED SCHOOL DISTRICT
Contact Person MARK CURD
Original Contract Amount $ $2,039,600.00
Telephone (951) 696 -1600
Final Contract Amount $ $2,039,600.00
If final amount is different from original, please explain (change orders, extra work, etc.)
N/A
Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes,
briefly explain and indicate outcome of claims.
NO.
2
Project Name/Number
Project Description
INGLEWOOD UNIFIED SCHOOL DISTRICT- ROOFING AT VARIOUS SITES
GARLAND ROOFING SYSTEM AT MORNINGSIDE HS & INGLEWOOD HS
Approximate Construction Dates From 06/2016
Agency Name INGLEWOOD UNIFIED SCHOOL DISTRICT
Contact Person JOHN FENTON
to 11/2016
Telephone (310) 419 -2700
$1,793,914.00 $1,793,914.00
Original Contract Amount $ Final Contract Amount $
If final amount is different from original, please explain (change orders, extra work, etc.)
N/A
Page C -8
Did you file any claims against the Agency? Did the Agency file any claims against you /Contractor? If yes,
briefly explain and indicate outcome of claims.
NO.
3 KENNEDY HIGH SCHOOL ROOF REPLACEMENT PROJECT
Project Name/Number
Project Description HENRY'S ROOFING SYSTEM AT KENNEDY HIGH SCHOOL
Approximate Construction Dates
Agency Name
01/2016 to 08/2016
ANAHEIM UNION HIGH SCHOOL DISTRICT
Contact Person LETICIA HAUCK
Telephone (714) 999 -5454
Original Contract Amount $ $1,200,000.00 Final Contract Amount $ $1,200,000.00
If final amount is different from original, please explain (change orders, extra work, etc.)
N/A
Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes,
briefly explain and indicate outcome of claims.
NO.
4
Project Name/Number HEMET USD 2016 SUMMER ROOFING PROJECT AT VARIOUS SITES
TR A CREEK ES, FRU11VALE ES, HAMILTON-H5,---
Project Description AND VALLE VISTA ES
Approximate Construction Dates
From 05 -2016
Agency Name HEMET UNIFIED SCHOOL DISTRICT
Contact Person ANDY MCGUIRE
Original Contract Amount $ $687,107.00
to 10/2016
Telephone (951) 765 -5100
Contract Amount $ 5687,107.00
If final amount is different from original, please explain (change orders, extra work, etc.)
N/A
Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes,
briefly explain and indicate outcome of claims.
Page C -9
N/A
Project Name/Number BEACON PARK (HERITAGE FIELDS K -8) SCHOOL BID PACKAGE NO. 10 ROOFING
Project Description GARLAND ROOFING SYSTEM AT HERITAGE FIELDS K -8
Approximate Construction Dates
Agency Name
Contact Person
Original Contract Amount $
From to
Telephone( )
Final Contract Amount $
If final amount is different from original, please explain (change orders, extra work, etc.)
N/A
Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes,
briefly explain and indicate outcome of claims.
NO.
6 TEMECULA VALLEY USD ROOFING REPLACEMENT AT DO ESS AND CONFERENCE ROOM BLDGS
Project Name/Number
Project Description TREMCO ROOFING REPLACEMENT AT DO ESS AND CONFERENCE ROOM BLDGS
Approximate Construction Dates
From 06/2016 to 10/2016
Agency Name TEMECULA VALLEY UNIFIED SCHOOL DISTRICT
Contact Person STEPHEN BRIZENO
Original Contract Amount $_$210,036.00
Telephone (951) 676 -2661
Contract Amount $ $210,036.00
If final amount is different from original, please explain (change orders, extra work, etc.)
N/A
Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes,
briefly explain and indicate outcome of claims.
NO.
Page C -10
Attach additional sheets if necessary.
Attach to this Bid the experience resume of the person who will be designated as General Construction
Superintendent or on -site Construction Manager for the Contractor. *SEE ATTACHED*
Upon request, the Contractor shall attach a financial statement and other information sufficiently
comprehensive to permit an appraisal of the Contractor's current financial conditions.
*AVAILABLE UPON REQUEST*
Page C - II
EXPERIENCE AND TECHNICAL OUALIFACTIONS QUESTIONNAIRE
aev.9:11
Personnel:
The Bidder shall identify the key personnel to be assigned to this project in a management, construction supervision
or engineering capacity.
1. List Each person'sjob title, name and percent of time to be allocated to this project:
1. Rogie Cabral, Superintendent 30%
2. Juan Toro, Foremen 100%
3. Raul Rivas, Foremen 100%
4. Juan Hernandez, Foremen 100%
5. Julio Gonzalez, Project Manager 5%
6. James Simmons, Project Manager 300/6
2. Summarize each person's specialized education:
1. Rogie Cabral, Union roofers Apprentice Training Program
2. Juan Toro, Union Roofers Apprentice Training Program
3. Raul Rivas, Union Roofers Apprentice Training Program
4. Juan Hernandez, Union Roofers Apprentice Training Program
5. Julio Gonzalez, Union Roofers Apprentice Training Program
6. James Simmons, Union roofers Apprentice Training Program
3. List each person's years of construction experience relevant to the project:
1. Rogie Cabral, 33 years
2. Juan Toro, 23 years
3. Raul Rivas, 21 years
4. Juan Hernandez, 18 years
5. Julio Gonzalez, 26 years
6. James Simmons, 33 years
4. Summarize such experience:
1. Rogie Cabral, Overseas all project within the last 6 years.
2. Juan Toro, Housing Authority of LA, Valadez MS in Placentia, Banning USD,
Cerritos ES for Cypress USD.
3. Raul Rivas, Alvord USD Restoration Various Sites, Ontario Fire Station #3, Riverside Corp Yard,
Lincoln School Mod., Hopkinson ES & Rossmoor ES (Los Alamitos), Murrieta USD 5 Sites.
4. Juan Hernandez, Villa Park ES (Orange) ,Juliet Morris ES, Crescent ES, Malibu Paradigm,
Winchester School (Hemet), Temple Emanuel (LA),
5. Julio Gonzalez, Valadez MS for Placentia Yorba Linda USD, Rossmoor
ES, Hopkinson ES, Cerritos, Banning USD, Palm Springs, USD, Oceanview SO 5- sites, Los
Alamitos Weaver ES & Oak MS.
6. James Simmons, Beverly Hills HS Re-roof,, Disneyland Toy Story Midway Mania,
Collection@Riverpark (Oxnard), Kaiser Permanente Template Hospital (Ontario), Kaiser Perm.
Hospital (Anabeim), Bonita USD, Los Angeles Community College Dist 3- sites, Rowland USD,
Northridge Hospital & Mercy Hospital.
* ** *Each project will have a Project Manager, Superintendent, Foremen it will be determined at the start of the
project who will be CCRC's project team running that specific project.
DESIGNATION OF SURETIES
Bidder's nameCHAPMAN COAST ROOF CO., INC.
Provide the names, addresses, and phone numbers for all brokers and sureties from whom Bidder intends to
procure insurance and bonds (list by insurance /bond type):
COMPANY: GREAT AMERICAN INSURANCE COMPANIES
CONTACT: KIM LUU, ACCOUNT MANAGER, ALLIANT INSURANCE SERVICES IN
P: 949/660 -5964
ADDRESS: 1301 Dove St., #200, Newport Beach, CA 92660
Page C -12
ACKNOWLEDGEMENT OF ADDENDA
Bidder's name CHAPMAN COAST ROOF CO., INC.
The bidder shall signify receipt of all Addenda here, if any:
Addendum No. Date Received Signature
None
Page C -13
CONTRACTOR'S INDUSTRIAL SAFETY RECORD
TO ACCOMPANY PROPOSAL
Bidder's Name CHAPMAN COAST ROOF CO., INC.
Record Last Five (5) Full Years
Current Year of Record
The information required for these items is the same as required tot columns 3 to 6, Code 10, uccupanonal
Injuries, Summary-- Occupational Injuries and Illnesses, OSHA No. 102.
Legal Business Name of Bidder CHAPMAN COAST ROOF CO., INC.
Business Address: 2301 E. ORANGETHORPE AVE., FULLERTON, CA 92831
Business Tel. No.: (714) 738 -6611
State Contractor's License No. and Classification: 927543 / C39
Title DAVE CHAPMAN, PRESIDENT
The above information compiled from the records that are available to me at this time and I declare
under penalty of perju that he informatygis�Cye and accurate within the limitations of those records.
Signature of bidder
Date
11/13/2017 V
Current
2
2
2
2
2
Title
LINDA DOMINGUEZ, SECRETARY/TREASURER
Signature of bidder
Year of
0
0
0
00
a
1
Total
Year
Title
Record
6
5
4
3
2
No. of contracts
44
39
52
31
42
48
256
n/a
Total dollar
Amount of
* *SEE
TTACHEII
CO
TR
CT
MOUNTS **
n/a
Contracts (in
Thousands of $)
No, of fatalities
0
0
0
0
0
0
0
n/a
No. of lost
Workday
3
0
0
0
2
0
5
n/a
Cases
No. of lost
workday cases
involving
n/a
permanent
0
0
0
0
0
0
0
transfer to
another job or
termination of
employment
The information required for these items is the same as required tot columns 3 to 6, Code 10, uccupanonal
Injuries, Summary-- Occupational Injuries and Illnesses, OSHA No. 102.
Legal Business Name of Bidder CHAPMAN COAST ROOF CO., INC.
Business Address: 2301 E. ORANGETHORPE AVE., FULLERTON, CA 92831
Business Tel. No.: (714) 738 -6611
State Contractor's License No. and Classification: 927543 / C39
Title DAVE CHAPMAN, PRESIDENT
The above information compiled from the records that are available to me at this time and I declare
under penalty of perju that he informatygis�Cye and accurate within the limitations of those records.
Signature of bidder
Date
11/13/2017 V
Title
DAV CHAP N, PRESIDENT
Signature of bidder
_
Date
11113/2017
Title
LINDA DOMINGUEZ, SECRETARY/TREASURER
Signature of bidder
Date
Title
Signature of bidder
Date
Title
Page C -14
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If bidder is an individual, name and signature of individual must be provided, and, if he is doing business
under a fictitious name, the fictitious name must be set forth. If bidder is a partnership or joint venture,
legal name of partnership /joint venture must be provided, followed by signatures of all of the partners /joint
ventures or of fewer than all of the partners /joint ventures if submitted with evidence of authority to act on
behalf of the partnership /joint venture. If bidder is a corporation, legal name of corporation must be
provided, followed by notarized signatures of the corporation President or Vice President or President and
Secretary or Assistant Secretary, and the corporate seal. Signatures of partners join venturers, or
corporation officers must be acknowledged before a Notary Public, who must certify that such
partners /joint venturers, or officers are known to him or her to be such, and, in the case of a corporation,
that such corporation executed the instrument pursuant to its bylaws or a resolution of its Board of
Directors.
Page C -15
NON - COLLUSION AFFIDAVIT TO BE EXECUTED
BY BIDDER AND SUBMITTED WITH BID
State of California )SS.
County of
ORANGE )
DAVE CHAPMAN being irst duly swom, deposes and says that he or she is
PRESIDENT —Of fMAPMAN COAST ROOF CO. the party making the foregoing bid, in accordance
with Public Contracts Code Section 7106, declares that the bid is not made in the interest of, or on behalf
of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is
genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any
other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived,
or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding;
that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or
conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit,
or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public
body awarding the contract of anyone interested in the proposed contract; that all statements contained in
the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or
any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid,
and will not pay, any fee to any corporation, partnership, company, association, organization, bid
depository, or to any member or agent thereof to effectuate a collusive or sham bid.
City Facilities Roof Repair Project / SPECIFICATION NO. BG1801
Project Name:
CHAPMAN COAST ROOF CO., INC.
E., FULLERTON, CA 92831
P113/2017
Signature of bidder
LINDA DOMINGUEZ, SECRETARY /TREASURER
Title
11/13/2017
Date:
Subscribed and Sworn to before me on
(Notary Seal)
Page C -16
Signature
Notary Public
CALIFORNIA.
ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verilles only the
klenttTy of the Individual who signed the document to which this certificate
Is attached, and not the truthfulness, accuracy, or validity of that document.
State of Cahfomia
Countyof Orange )
On November 13, 2017 before me, Alice Valle, Notary Public
personally appeared (Hem WertmmeaWItleof offlad
Linda Dominguez and Dave Chapman
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) Is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(Ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the Instrument. I certify under PENALTY OF
PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
Sigreture of Notary Pubic (Soso
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCL&SgT
Non Collusion Affidavit
tTftor dmcr0cn dabaded docmh.ro
Mile ordavfprm datladed doaawtm- col)
Number of Pages, Document Date
2916 VOW= WWN.NasryCtasees.eo :i 800.6739866
ALICEVALLE
Notary Public - Califomla
Orange County
Commission p 2197520
My Comm. Expires Jun 12, 2 @I
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LIST OF SUBCONTRACTORS
TO ACCOMPANY PROPOSAL
In compliance with the provisions of Public Contract Code Section -4104, the undersigned bidder
submitting this bid proposal sets forth the name, place of business and the portion of the work to be
performed by: (1) -each subcontractor who will perform work or labor or render service to the bidder (as
general Contractor) in or about the construction of the work or improvement; and (2) -each subcontractor
licensed by the State of California who, under subcontract to the bidder, specially fabricates and installs a
portion of the work or improvement according to detailed drawings contained in the plans and
specifications, in an amount in excess of one -half of one percent of the bidder's total bid or, in the case of
bids or offers for the construction of streets, highways or bridges, in excess of one -half of one percent of
the bidder's total bid or ten thousand dollars ($10,000), whichever is greater.
Subcontractor's Name, Address,
Telephone #
Bid
Item
Number
Percent
Of Total
Bid
Description of Work
Percent of
Total Bid
KlondiKe Construction Servims
10016 Pioneer Blvd. #102
Santa Fe Springs, CA 90670
626/851 -4747
nc
Roof Demo and Abatement
58
Page C -17
CHAPMANCOAST.
Caaoman coast Roof Co.. Inc.
•omn4 11 - W. 1,4.1
Plant: 230) East OTan9e=, W Av,Hj +1 Fulleripn, GahlMnd 92831
Mail: Post Oflicc Box 7050 / FWlertan, G( Icrnlo 92834
Tr'Iepnono 714, 738 E611 I Foe 714 738 0143 / fn10A1 PnnpmOncoaP`ront cum I wW W.enapmenc0aalmpl . com
CHNICAL CAPABILRY DIR•1000002150 Juo-16
CHAIRMAN COAST ROOF CO.. W C. OBTAINED COAST ROOF CO. INC. THROUGH AN 'ASSET ONLY PURCHASE' IN JANUARY OF 2009
CHAPMAN COAST ROOF CO., INC. MAINTAINS THE SAME OFFICERS AND SAME CORE WORKFORCE WITH THE SAME EXPERIENCE
AS COAST ROOF CD..INC. CFWPMAN ROOF HAS INSURANCE AND BONGING CAPABILTIY FOR ANY SIZE JOB.
THE KEY PERSONNEL IN OUR COMPANY ARE AS FOLLOWS:
1. DAVE CHAIRMAN
PRESIDENT
45
YEARS EXPERIENCE
2. LINDA DOMINGUEZ
SECRETARY/TREASURER
20
YEARS EXPERIENCE
3. ALICE VALLE
BOOKKEEPER
19
YEARS EXPERIENCE
4. JULIO C. GONZALEZ
VICE PRESIDENT/SALES MANAGER
28
YEARS EXPERIENCE
5. JAMES SIMMONS
PROJECT MANAGER
35
YEARS EXPERIENCE
E. ROGIE CABRAL
PROJECT MANAGER
35
YEARS EXPERIENCE
7. BRANDON RODGERS
FIELD SUPERINTENDANTI SAFETY OFFICER
16
YEARS EXPERIENCE
LIST OF FOREMANS
1, SERGIO CABRAL BARRAZA
FOREMEN
25
YEARS EXPERIENCE
2. ALAN HERNANDEZ
FOREMEN
20
YEARS EXPERIENCE
1 HAUL RIVAS
FOREMEN
23
YEARS EXPERIENCE
4. JORGE RUIZ
FOREMEN
20
YEARS EXPERIENCE
MOST OF OUR JOURNEYMEN HAVE BEEN WITH US AN AVERAGE OF TWENTY (MI YEARS, WHICH INDICATES
OUR STABILITY AS A ROOFING CONTRACTOR.
OUR PERSONNEL HAVE SUCCESS'rULLY COMPLETED MANY GOVERNMENT
AS WELL AS PRIVATE PROJECTS FROM BARSTOW MARINE BASE- 11 MILLION DOLLARS TO THE
UNITED STATES POST OFFICE GENERAL MAIL FACRITY IN LOS ANGELES TOTALING 2.7 MILLION
COLLARS. WE COMPLETED THE UNITED STATES POSTS OFFICE, LONG BEACH. CA 1.5 MILLION DOLLARS.
DISNEY FEATURE ANIMATION SURSANK , CA UDOODOM- Flame, Y,Rta Lulls LED Geukr04rfo V Ii MS 51.794.535.00
PUEBLO DEL RIO (HOUSING AUTHORITY OF LA) 53.014643.00, Crean VIM Stl l Dii 201653.799.313.00.
PRODUCTION PERSONAL CAPABILITIeS
WE HAVE ALL THE KEY PEOPLE NEEDED IN OUR EMPLOYMENT TO COMPLETE ANY PROJECT. WE ORAW
OUR LABOR FORCE FROM ROOFERS UNION LOCALS a 220 AND s 35.
PLANT FACILITIES AND EQUIPMENT
WE OWN AND MAINTAIN ALL THE TOOLS, EQUIPMENT NECESSARY TO COMPLETE ANY PROJECT CONDITION.
LICENSES
CHAPMAN COAST ROOF CO.. INC. 927543 UP: 1/31!1017
COASTROOFCO.,INC. 3934W EXP: 100V201O(INACTIVE)
DAVE CHAPMAN 821013 (IN-ACTIVE)
CHAPMAN COAST ROOF CO. INC. INCORPORATED IN 11/12/1006
BANKS
BANK OF AME RICA( CHECKING) 0760945771
Anthony Sill. 888/8524000 %8141
I NE. YORBA LINDA BLVD,
4159284589
PLACEN1V, CA92870
EMAIL: a nOnry.Silla®banwLcom
INSURANCE:
Lesie 714/941 -2852
AGENT: BB 6 T INSURANCE SERVICES OF CA.
email: Ilessky @bbsnEl.m
2400 E. KATELIA AVE, SURE 1100
Billie (act. M00 714941 -21105
ANAHEIM, CA 92808
Billie EMAIL: bselvid9el@bbandLmm
WORKERS COMP: REDWOOD FIRE AND CASUALTY
General Llab:
VALLEY FORGE INSURANCE COMPANY
Pol: CHWC710309 333 FARNAM STE. 300
Pd: 6012547718
CNA PLAZA 19 SOUTH
411/16104/1/17 OMAHA, NE 66114
M1116 to 4!1/17
CHICAGO, IL SO685
40273957255
AUTOMOTIVE: CONTINENTAL CASUALTY COMPANY
EXCESS UAB:
VALLEY FORGE INSURANCE COMPANY
Pol: 6012547735 CNA PLAZA 19 SOUTH
Pd: 6012547704
CNA PLAZA 19 SOUTH
4!1/1610411/17 CHICAGO, IL 60685
41111610 411117
CHICAGO, IL 60665
BONDING COMPANY:
ALUANT INSURANCE SERVICES, INC.
AGENT:
ABianHnsurwcce Somobs, Inc.
1301 DOVE STREET, SUITE 200
Kim Luu 949/660 -5958
NEWPORT BEACH, CA 92660
EMAIL: NuLCal96ntoom
EMR201679 %M1578 %2014-67 96 201595 %2012 -1N%
BEST GUIDE RATING:
A 15
BONDING RATE: 1.5 PERCENT Bon>1in9CO'.
Groat Amancanlns.Co,
(2012- PRESENI)
BONDING CAPACITY: 6 million 750 The City Dove SoWt X 470, 0mn9e,
CA 92868 (714840 -3117)
Preidom bond company OU Republic (2006- 2012) 445 SOUTH MOORLAND ROAD, BROOKFIELD 05) 53005
CREDIT REFERENCES
ALLIED BUILDING SUPPLIES
STRUCTURAL MATERIALS
1244 N. ANAHEIM BLVD.
1201 EAST MCFAODEN AVENUE
ANAHEIM, CA. 92800
SANTA ANA, CA 9270.5
714)449 -2350 FAX: (714) 4442355
714) 567-0198 PAX: (562) 567-0193
AMERICAN LEAD
VISTA PAINT
910 E ORANGEFAIR LANE
2020 E ORANGETHORPE AVE.
ANAHEIM, CA. 92801
FULLERTON CA, 92831
714) 8714677 FAX: (714) 8714571
714) 680 -3900 FAX: (714) m&a966
GANAHL LUMBER CO
SOUTH COAST SHINGLES (SUppfiar)
1220 EAST BALL RD
2220 E SOUTH STREET
ANAHEIM, CA 92805
LONG BEACH, CA 90a05
714/239 -2206 FAX: (714)522 -8672
502) 534 -7100 FAX: (562) 634-0559
INTECH EQUIPMENT
SUBCONTRACTORS:
731 S. LUGO AVENUE
SAN BERNARDINO, CA 92408
CAL STATE ROOFING
909)386 -1071 FAX: (909) 38&1027
702 MONROE WAY
PLACENTIA. CA 92870
ROOFMASTER PRODUCTS CO.
714 )4766730
P.D. BOX 63309
LOS ANGELES, CA 90063 -0309
ROOF REMOVAL INC.
2131261 -5122 FAX: (323) 261 -8766
P.O. BOX 3512
HUNTINGTON BEACH, CA 92605
SOUTH COAST SHINGLE
71N826 =
2220 E. SOUTH STREET
LONG BEACH, CA 90605
UNITED CONTRACTORS
562)634 -7100 FAX: (562) 634-0559
334 W.OAK STREET
SAN BERNARDINO, CA 92401
909)3884400
ARCHITECTS
R2A Architecture (FuAerlon Coll)
2900 Rr6ml Street, Swat E 205, Costa Me.. CA 92626
714/435 -0360
adn: Lucien Runge
anal: hunge ®2aartheecnue wrn
Fax 71414350363
McDonald, Soutar & Paz, I
3575 Lang Beach Blvd., Long Beach, CA 90807
5621427 -5007
(Lit. Lake MS)
IN PROGRESS
Fax 51-3007
JAMES MONTGOMERY ENGINEER
PASADENA, CA,
818) 796 -9141
BLUEROCK PARTNERSHIP
NEWPORT BEACH, CA.
714) 6739300
LANG & LAMPERT
IRVINE. CA.
9490 7530201
LPA ARCHIETECTS
IRVINE, CA
9491261 -1001
210,000.00
WD Weattarpraafeg ieclmologiea/Daenield Comm. Pan,
FAX 94912661191
THIS IS A LIST OF COAST ROOFS EMPLOYEES WHO HAVE BEEN CLEARED BY THE CRIMINAL
123XtA0
RECORDSCHECK, REQUIRED BY THE MICHELLE MONTOYA SCHOOL SAFETY ACT.
IN PROGRESS
CHAPMAN DAVE
45,5901,00
Inglewood USUNimous Sttes
HERNANDEZ JUAN
6
1793,914.00
LUNA MANUEL
IN PROGRESS
5
RIVAS -PEREZ FALL
Anaheim UHSD/ Kennedy High School
IN PROGRESS
TORO JUAN
ioh3tmt1oo
CABRAL ROGACIANO
RODGERS BRANDON
AGUIIAR SERGIO
SAIL CABRAL SERGIO
CURRENT BACKLOG
PROJECT
EST COMPLETION DATE
AMOUNT
AusONJones CorptForest Lave Henitege
IN PROGRESS
5
235.896 W
LATTC/Eps
IN PROGRESS
5
13043500
Hemet USDNadoas Sites
IN PROGRESS
S
783,13200
Mumeta Valley USONeraus Sites
IN PROGRESS
5
2.069,60000
Temewla VUSDNal Sites
IN PROGRESS
$
210,000.00
WD Weattarpraafeg ieclmologiea/Daenield Comm. Pan,
IN PROGRESS
$
123XtA0
AMG& AssocmleslCrsllon Gollege
IN PROGRESS
g
45,5901,00
Inglewood USUNimous Sttes
IN PROGRESS
6
1793,914.00
Anaheim UHSO Oxlpard Academy
IN PROGRESS
5
609,846.00
Anaheim UHSD/ Kennedy High School
IN PROGRESS
&
ioh3tmt1oo
134941
W.S. CONSTRUCTION
COMPLETED 512016
$159,600.00
12219 CREEKWOOD AVENUE
CERRITOS, CA90250
Project: JONAS SALK SCHOOL
CONTACT: WADE SUNG 562/4024373
CITY OF BREA
COMPLETED 412016
$173,995,00
1 CIVIC CENTER BLVD.
BREA CA 92821
EMAIL: g88aoQcWp(brea.mt
Project. OMCBCULTURAL CENTER
CONTACT: GILUAN LOBO 7149967763
ORANGE CO, DEPT. OF EDUCATION
COMPLETED 3 /2016
$204,744.00
200 KALM'JS DRIVE
COSTA MESA, CA 92628
Project RED HILL ROOF REPLACEMENT
CONTACT CONTRACTS 8 PURCHASING 7148684000
LAKE ELSINORE UNIFIED SCHOOL DISTRICT
COMPLETED 3 /2016
$235,323.00
545 CHANEY STREET
LAKE ELSINORE. CA 92530
EMAIL: Ona.kocnceQKt,s0.k12.ce.ee
Project: TEMESCAL CANYON HS BIG GYM
CONTACT: TINA KOONCE 951Q5 TO40
GARDEN GROVE UNIFIED SCHOOL DISTRICT
COMPLETED 3/2016
$44,039.00
8211 LAMPSON AVENUE
GARDEN GROVE, CA 92 11
Project: CHAPMAN BLDG. W
CONTACT: CONTRACTS 4 PURCHASING 714863
-6442
COM[PTON COMMUNITY COLLEGE DISTRICT
COMPLETED 22016
$187,778.00
1111 EAST ARTESLA BLVD.
COMPTON, CA 50021
ProjeG'. ROOF REPAIRS VARIOUS BLDGS.
CONTACT: LINDA OWENS 310/900 -1600
LOS NIETOS UNIFIED SCHOOL DISTRICT
COMPLETED 122015
$1,249,000.00
8324 SOUTH WESTMAN AVENUE
WHRTIER. CA WW6
EMAIL: xbmmaro28 ®Omail.com
Project: VARIOUS SITES REPAIR
CONTACT: JUAN ROMERO S098154 0
MURRIETA UNIFLEO SCHOOL 04STRICT
COMPLETED 1212015
$886,606.00
41870 MCALBY CT.
MURRIETA, CA92562
EMAIL: nne Irk@mtmiete.k.l2.us
PFejeCL TOVASHAM ETA MURRIETA B AVAXT
ES CONTACT: NICK NEWKIRK 951/695-1600
SADDLEBACK VALLEY UNIFIED SCHOOL DISTRICT
COMPLETED 122015
$628,668.00
726 W. COLLINS
ORANGE, CA 92867
Project CIELO, GLEN YERMO AND PORTOIA
CONTACT: ERICK BERG 9498803LS5
CITY OF ONTARIO
COMPLETED 12/2015
$111,302.00
303 EAST B STREET
ONTARIO. CA
Project: CITY HALL ANNEX HIGH ROOF
CONTACT: CONTRACTS d PURCHASING 951238 -0381
M.P. SOUTH INC.
COMPLETED 11/2015
$104,086.00
4720 BRYSON STREET
ANAHEIM, CA 92607
EMAIL: nVWuIhinc@acILcom
Project: SAVANNA DISTRICT OFFICE
CONTACT: KAREN 11401&2188
WTI WEATHERPROOFING TECHNOLOGIES
COMPLETED 112015
$82,477.70
3735 GREEN ROAD
BEACH WOOD, 01110 44122
Project. GARFIELD ELEM. SCHOOL
CONTACT: STEPHANIE 216/7665695
`TI WEATHERPROOFING TECHNOLOGIES
COMPLETED 112015
$109,301.00
3735 GREEN ROAD
BEACHWOOD, OHIO 44122
Pmjoct. RAMONA ELEM. SCHOOL
CONTACT: STEPHANIE 216/766 -5695
LAGUNA BEACH UNIFIED SC11001 DISTRICT COMPLETED 1'V2015
$409,793.00
550 BLUMONT STREET
LAGUNA BEACH, CA 92651
PmjecL -AGU A BEACH HS & VARIOUS SITES
CONTACT: CONTRACTS & PURCHASING 9491497 -7701
CITY OF DOWNEY
COMPLETED 9 /2015
$1,528,489.76
11111 SOOKSHIRE AVE,
DOWNEY, CA 90241
EMAIL: amr)S@downeyca.org
Project CIVIC CENTER UTILITIES YARD
CONTACT: EDWARD TORRES 562/8637331
HEMET UNIFIED SCHOOL DISTRICT
COMPLETED 10/2015
$792,987.58
25350 W. LATHAM AVENUE
HEMET, CA 92545
Project DARTMOUTH &VARIO US SITES
CONTACT: CONTRACTS & PURCHASING 951//6551W
ORANGE UNIFIED SCHOOL DISTRICT
COMPLETED 9/2015
$487,262.00
726 W. COLLINS
ORANGE, CA 92667
Project EL MODENA HIGH SCHOOL
CONTACT : CONTRACTS & PURCHASING 714Ti16i440
RIO HONDO COLLEGE
COMPLETED 6/2015
$84,683.00
3600 WORKMAN MILL ROOD
WHITTIER, CA WWI
Project: SCIENCE BLDG. ROOF MAINT.
CONTACT: CONSTRUCTION SERVICES 562A0 &3413
CITY OF GLENDALE
COMPLETED I /2015
$358,429.00
633 EAST BROADWAY, ROOM 307
GLENDALE. CA 91206 -
Project: FIRE STATION N21
CONTACT: CONSTRUCTION SERVICES 8181548-3970
WEST COAST AIR
COMPLETED I2 /2014
$871,255.00
1155 PIONEER WAY, STE. 101
EL CAJON. CA 92020
Pmjecc OAK MS. (LOS AIAMITOS USE)
CONTACT: JAMES GLOWER 6191561 -8000 email: jdow @r caeeom
LOS ANGELES COMMUNITY COLLEGE
COMPLETED 1012014
$142,562.00
1301 AVENIDA CESAR CHAVEZ
MONTEREY PARK, CA 91754
Project, FINE ARTS
CONTACT: CONSTRUCTION SERVICES 213A191-2000
LOS ANGELES COMMUNITY COLLEGE
COMPLETED 1012014
$88,577.00
1301 AVENIDA CESAR CHAVEZ
MONTEREY PARK, CA 91754
PI0acCMUSIC BLDG.
CONTACT: CONSTRUCTION SERVICES 21 318 91 -2 00 0
LOS ANGELES COMMUNITY COLLEGE
COMPLETED 1012014
$58,187.00
1301 AVENIDA CESAR CHAVEZ
MONTEREY PARK, CA 91754
Pm,eA:CANOPIES,MAIN ENTERANCE
CONTACT: CONSTRUCTION SERVICES 2131891 -2000
KINSMAN CONSTRUCTION
COMPLETED 10/2014
$122,170.00
6711 NANCY RIDGE DRIVE
SAN DIEGO, CA 92121
Prolett:SADDLEBACK VALLEY COLLEGE
CONTACT: MIKE STEPHENSON 8581875 -2950
HEALTH SCIENCE & WET SEAL
WESTCOASTAR
COMPLETED 9/2014
$447,582.00
1155 PIONEER WAY. STE. 101
EL CAJON, CA 92020
Project: WEAVER ES (LOS ALAMITOS USD)
CONTACT: JAMESCLOWER 619 /551 -SWO email:jGawer@wceccom
NORTH ORANGE COUNTY GOMM. COLLEGE DIST (OM -C.W. DRIVER) COMPLETED 412014
$897,945.10C
1830 WEST ROMNEYA DRIVE
ANAHEIM, CA 92801
?,.*a: FULLERTON COLLEGE
CONTACT: CONSTRUCTION DEPT. 7 14180 817 6 8 emaA:i511eJPdeskWm = i.edu
CITY OF SANTA CLARITA
COMPLETED 3 12014
$126,889.0C
23920 VALENCIA BLVD. L300
VALENCIA. CA 91355
RojeU: JOANNEOARCYLIBRARY
CONTACT: TERRY BRICE 6511253248,3
THOMASVILLE CONSTRUCTION
COMPLETED=14
$156.210.9
1209 CANDLE WOOD DRIVE
FULLERTON, CA 92633
Project'. EL DORADO BRACH LIBRARY
CONTACT: THOMAS SON 6 2 61224 -83 5 9 EMAJL: a @lhorna lelnc.ccm
NEW CREATION
COMPLETED 2 /2014
$149,989.00
17809 CLARK AVENUE
BELLFLOWER, CA 90706
Project: WEST HEALTH FACILITY
CONTACT: EUGENE KIM 562/800.0478
PINNER CONSTRUCTION [ANAHEIM U. SO)
COMPLETED 112014
$574,259.00
1255 S. LEWIS STREET
ANAHEIM, CA 92805
Project: THOMAS EDISON RELOCATION 8 BLO,
C 6 D CONTACT: JUSTIN DAMS 714' 490-0000 email }utlrl4�pnnemansimniaRCOm
THE NAZERAN GROUP (LITTLE LAKE SCH.
DISTRICTI COMPLETED 1112013
$155,970.00
16218 VENTURA BLVD.. STE, 7
ENCINO, CA 91436
Project: LAKESIDE MSILAKE CENTER
CONTACT: VINNY NAZERIAN 81819805115 email vinnyon ensn.nel
THE NAZERIAN GROUP
COMPLETED 11 /2013
$17,820.00
16218 VENTURA BLVD., STE. 7
ENCINO, CA 91436
Pm1e 1 ALHAUSRACENTRALRITCHEN
CONTACT: MNNYNAZERIAN Olffl 5115 email vkM@na.iim.net
RIVERSIDE COMM. COLLEGE DISTRICT
COMPLETED 10/2013
$244,055.00
4800 MAGNOLIA AVE
RIVERSIDE, CA 92506
Pmjecc MORENO VALLEYCOLL STUDENT ACAD. CONTACT: CONSTRUCTION DEPT 9511571 -6100
WESTCOASTAIR
COMPLETED 812013
$363,998.00
1155 PIONEER WAY, STE. 101
EL CAJON, CA 9202D
Project: LEE ELEM.(LOS ALAMITOS USE)
CONTACT: JAMESCLOWER 6191 email: jdowcrj@ eeom
HIU ICON BUILDERS
COMPLETED 5 12013
$206,499.00
1395 FAIRPLEX DRIVER, UNIT e4
IA VERNE, CA 91750
P.ja t CANBY WOODS
CONTACT: KYLE CEDERLING 90915961040
M.P. SOUTH, INC.
COMPLETED 612013
$320,444.00
4720 BRYSO,N ST
-
ANAHEIM, CA 92807
Project STEVE LUTHER ES
CONTACT: KAREN 714!1702186 email: mpsouNinc®eotmm
M.P. SOUTH, INC.
COMPLETED 612013
$589,545.00
4720 BRYSON ST
ANAHEIM, CA 92807
PmjeR: TWIIA REID MODERNIZATION
CONTACT: KAREN 714/779 -2168 ema9: mpsou09nc®aol.mm
ECHO PACIFIC CONSTRUCTION
COMPLETED 4/2013
$4551969.00
1230 SIMPSON WAY
ESCONDIDO. CA 92029
P.JW: MELBOURNEGAUERELEMSCH,
CONTACTZPAIG SMITH 760737 -3003
COUNTY SANITATION DISTRICT OF LOS ANGELES COMPLETED42013
$16071100
1955 WORKMAN MILL ROAD
WHITTIER, CA 90801
Project: JOINT WATER POLLUTION PLANT
CONTACT: GARY BROOKS 311T&30.24=5253
RIO HONDO COLLEGE
COMPLETED 412013
$82,498.00
3600 WORKMAN MILL ROAD
WHITTIER, CA 90601
Pmjecl: CAMPUS INN BUILDING
CONTACT: JAMES TOPER 5629083141 email jpoper @mhon0p.e6u
WEST COAST AIR
COMPLETED 2/2013
$291,554.00
1155 PIONEER WAY, STE. 101
EL CAJON, CA 92020
Project LOS ALAMITIOS HS GYM
CONTACT: JAMES GLOWER 619/561 -9000 email: jdPwer®wrac.com
CITY OF ONTARIO
COMPLETED 12013
$289,006.00
1425 S. BON VIEW AVENUE
ONTARIO, CA 91761
Project: FIRESTATION AI
CONTACT: PURCHASING 909 /4274207
WEST COAST AIR
COMPLETED 82012
8152.690.00
1155 PIONEER WAY, STE. 101
EL CAIO N, CA 92020
Projecl: CESAR CHAVEZ ACADEMY
CONTACT: JAMES CLOWER 6191561 -B email' Kto r @w c.aom
THE NAZERIAN GROUP
COMPLETED 102012
$251,580.00
16218 VENTURA BLVD., STE_ 7
ENCINO, CA 91436
Pmjecl: NORTHRUP ELEMENTARY SCHOOL
CONTACT: MNNYNAZER" 6181 990 -5115 email: vinnyojta aat.net
HOUSING AUTHORITY OF LOS ANGELES
COMPLETED 32011
53,014,443.00
2600 Wit. SHIRE BLVD,
LOS ANGELES. CA 90057
P.Jecl: PUEBLO DEL RIO
CONTACT: JUAN LOPEZ 2132524264
SCHOOL DISTRICTS
GRANGE CO. DEPT. OF EDUCATION
COMPLETED 312016
$204,744.00
200 KAIMUS ORN
COSTA MESA, 0492828
Project RED HILL ROOF REPLACEMENT
CONAACT: CONTRACTS B PURCHASING 71496&4080
LAKE ELSINORE UNIFIED SCHOOL DISTRICT
COMPLETED 3/2016
5235,323.00
545 CHANEY STREET
LAKE ELSINORE. CA9253D
EMAIL: 60a.koo0ce @IeuaE.kl2.ctLtm
Project: TEMESCAL CANYON HIS BIG GYM
CONTACT: TINA KOONCE 95V253 -7040
GARDEN GROVE UNIFIED SCHOOL DISTRICT
COMPLETED 32016
$44,039.00
8211 LAMPSON AVENUE
GARDEN GROVE, CA 92841
Project: CHAPMAN BLDG, W
CONTACT: CONTRACTS 8 PURCHASING 71M6688442
LOS NIETOS UNIFIED SCHOOL DISTRICT
COMPLETED 122015
$1,249,000.00
8324 SOUTH WESTMAN AVENUE
WHITTLER, CA 90006
EMAIL: jM=..28 @9mail.can
Project: VARIOUS SITES REPAIR
CONTACT: JUAN ROMERO 9091819 -8000 -
MURRIETA UNIFIED SCHOOL DISTRICT
COMPLETED 122015
$886,606.00
41670 MCALBY CT.
MURRIETA, CA 92562
EMAIL: mavAdrk @muoiafe.k.12.us
ProjI TOVASHA -VISTA MURRIETA B AVAXT
ES CONTACT: NICKNEWKIRK 951899-1600
SADDLEBACK VALLEY UNIFIED SCHOOL DISTRICT
COMPLETED 122015
$628.668.00
726 W. COLLINS
ORANGE, CA 92867
Pmject:CIELO,GLENYERMOANDPORTOLA
CONTACT: ERICK BERG 9491580-3255
LAGUNA BEACH UNIFIED SCHOOL DISTRICT
COMPLETED 112015
$409,793.00
550 BLUMONT STREET
LAGUNA BEACH. CA 92651
PmjocL LAGUNA 9FACH PS S VARIOUS SITES
CONTACT: CONTRACTS B PURCHASING 949 1497-7701
HEMET UNIFIED SCHOOL DISTRICT
COMPLETED 1012015
$792,987.58
25350 W. LATHAM AVENUE
HEMET, CA 92545
Promo DAR -MDUTH B VARIOUS SITES
CONTACT: CONTRACTS B PURCHASING 951965-5100
GRANGE UNIFIED SCHOOL DISTRICT
COMPLETED 912015
$487,262.00
726 W. COLLINS
ORANGE, CA 92867
Pmjecl: EL MODENA HIGL SCHOOL
CONTACT: CONTRACTS & PURCHASING 714@26 -4440
COMET ON UNIFIED SCHOOL DISTRICT
COMPLETED 12015
5300111500
501 SOUTH SANTA FE AVENUE
COMPTON, CA 90221
Project: BURSCH ELEMENTARY SCH.
CONTACT . - PURCHASING DEPT. 3101638-4321
REDLANDS UNIFIED SCHOOL DISTRICT
COMPLETED 12015
S91.983.DO
20 W. LUGONIA AVENUE
REDLANDS. CA 92373
Project KINGSBURY 71-EM SCHOOL
CONTACT. PURCHASING DEPT. 909207- 53110
ROWLAND UNIFIED SCHOOL DISTRICT
COMPLETED 122314
5144.348.00
1830 S. NOGALES STREET
RO WLAND HEIGHTS, CA 91748
Project ROWLANOHS9LDG.E
CONTACT. PURCHASING DEPT. 626950.8376
BONITA UNIFIED SCHOOL DISTRICT COMPLETED 1W O14 5272,445.0
115 W. ALLEN AVENUE
SAN DIMAS, CAILIM
Project: OAK MESABONITA HS LI88 CONTACT: LANCE 909/55M131
CENTRAL KITCHEN
TEMECULAVALLEYUSO
COMPLETED 72014
5327.09/.9/
31350 RANCHO VISTA ROAD
TEMECULA. CA 92592
Project: SPARKMAN ALT. ED. CENTER
CONTACT: PURCHASING OEPT.951AD6 -2881
TEMECULA VALLEY USD
COMPLETED 112013
$288,852.00
31350 RANCHO VISTA ROAD
TEMECULA CA 92592
Project: DISTRICT OFFICEoAAREHOUSE
CONTACT: PURCHASING DEPT. 769/5324804
BONITA UNIFIED SCHOOL DISTRIC r
COMPLETED 1WO13
$181742.00
115 W. ALLEN AVENUE
SAN DIMAS, CA 91773
Proj CC OAK MEWROYNON ELEM
CONTACT: CONST. DEPT 909.971 -8320
MURRIETA VALLEY USD
COMPLETED 19/2013
$948,042.00
41 B70 MCALBY CT
MURRIETA, CA 92562
Project: MURRIETA VALLEY HS PH III
CONTACT: NICK NEWKIRK 9 5 115 9 61 69/
SADDLFBACK VALLEY USD
COMPLETED 92013
$41.07600
25631 PETER A- HARTMAN WAY
MISSION VIEJO, CA 92691
Project: LOS ALISOSELEMSCH,
CONTACT: GERRY RUMELL 949580.3255
BONITA UNIFIED SCHOOL DISTRICT
COMPLETED 62013
$880500
115 W. ALLEN AVENUE
SAN DIMAS, CA 917]3
Project: BONITA HIS GYM VENT UPGRADE
CONTACT: CONST. DEPT 8091971 -11320
SADDLEBACK VALLEY USD
COMPLETED 82013
529,12700
25631 PETER A. HARTMAN WAY
MISSION VIEJO, CA 92691
Projem OLIVE ELEMENTARY SCH.
CONTACT: GERRY RUMELL 949158032%
HUNTINGTON BEACH CITY SCHOOL DISTRICT COMPLETED52013
$73404.00
20451 CRAIMER LANE
HUNTINGTON BEACH, CA 92645
Pmiocr EADER ELEM. 8LR00
CONTACT. LORETTA 714564 -6688
BANNING U.S.O.
COMPLETED 42013
$93.000.00
151 W. WILLIAMS STREET
BANNING, CA92220
?rOjeC:SUSANB.000MBSINTERMEOWTE
CONTACT'. ROBERT GUILLEN 951522 -0200
PALM SPRINGS USO
COMPLETED 22013
5142.19100
150 DISTRICT CENTER DRIVE
PALM SPRINGS, CA 92262
Project: JAMES WORKIMAN MIDDLE SON
CONTACT: GREGG SHOEMAKER 760!322 -4115
TEMECULA VALLEY USD
COMPLETED 102012
5947454.00
31350 RANCHO VISTA ROAD
TEMECULA. CA 92592
Project VARIOUS CAMPUS REPAIRS
CONTACT PURCHASING DEPT. 7801532 -8804
SADDLEBACK VALLEY USO
COMPLETED W2012
$232724.00
25631 PETER A. HARTMAN WAY
MISSION VIEJO. CA WWI
Project LAGUNA -DEL CERRO& ESPENANZ CONTACT: TOM RILEY 949/5813255
MURRIETA VALLEY USD
COMPLETED IV2011
41B70 MCALRY CT
MURRIETA, CA 92562
Pmjsc R00F4SITES
CONTACT: NICK NEWKIRK 951189&1600
MURRIETA VALLEY USD
COMPLETED II /2011
41870 MCALEY CT
MURRIETA, CA 92562
Proj R00F RST. REPLACEMENT 5 SITES
CONTACT: NICK NEWKIRK 951/69F1600
ALVORD UNIFIED SCHOOL DISTRICT
COMPLETED IM011
10365 KELLER AVENUE
RIVERSIDE, CA 92505
Project: Restorelien Various Sites
CONTACT: PURCHASING DEPT )!51150 35025
ANAHEIM UNION HIGH SCHOOL DISTRICT
COMPLETED 2011
501 CRESCENT WAY
ANAHEIM, CA 92603
PTOACI: SAVANNA HIGH SCHOOL
CONTACT: Al- GUERRERO 11N52a941
MOORPARK UNIFIED SCHOOL DISTRICT
COMPLETED 2/2010
5291 MAUREEN LANE
MOORPARK. CA 93021
Project District ORCe Restoratloe
CONTACT: KEN HM6805/531 -6433
CHINO VALLEY UNIFIED SCHOOL
COMPLETED 2010
5130 RIVERSIDE DRIVE
CHINO, CA91710
Prol : EAGLE CANYONICANYON HILLS/
CONTACT: CAROL VERNAVA 909F 8 -1201
MAGNOLIAROWNSEND /CHINO HILLS/DISTRICT 0FF1810 NO.09 -10
FOUNTAIN VALLEY U.S.D.
COMPLETED 2010
11330 MT. HERRMANN
FOUNTAIN VALLEY. CA 92108
Project: TALBERT MIDDLE SCHOOL
C0NTACT:J0E HASTI 114668 -5682 FAX 1141668 -5895
5519,152.00
51,061,600.00
5213,132W
$66,830.00
$256,00.00
5323.306 00
5190,566.00
REFERENCE LIST
.
NAME B ADDRESS
CONTACT
TYPE
AMOUNT
PEPPER CONSTRUCTION
65 ENTERPRISE STE. 480
DAN HUFF
ALISO VIEJO. CA 926%
949126b7080
KOPPERS
180000A0
COALTAR
PORT OF LONG BEACH
1400 W. BROADWAY
LONG BEACH, CA 90802
RON SCHMIDT
562/5901192
HENRY
Mall.00
R.J. DAUM CONSTRUCTION
11581 MONARCH ST
HEROLD
GARDEN GROVE, CA 92541
714/8941300
SUR
1153,035.00
PROJ: PAC BELL
SADDLEBACK COMMUNITY COLLEGE
28000 MARGUERITE PARKWAY
PAUL VILLALBA
MISSION VIEJO. CA 92892
9491585-0680
TILE/BUR
1223,458.00
JOR: FINE ARTS BLDG
SOLTEK PACIFIC INC
2424 CONGRESS ST
ROSERTTHOMPSON
SAN DIEGO, CA92110-2888
619- 2966247
SIP[-AST
993,000A0
SADDLEBACK VALLEY USD
9491580 -3255
HENRY
25631 PETER A HARTMAN WAY
$184371.00
MISSION VIEJO, CA 92591
REFERENCE UST
NAME 6 ADDRESS
CONTACT
TYPE
AMOUNT
WESTCOAST NIELSON CONSTRUCTION
12MIIMPERIAL HIGHWAY
56284 &1950
TREMCO
1339,000 Co
SANTA FE SPRINGS, CA 90670
PCM3
CYPRESS COLLEGE LLC
71412528440
SIPLAST
3315,472.00
9200 VALLEY VIEW ST
GREG HACKETT
'
CYPRESS. CA 90630
NORWALK LA MIRADA USD
12820 PIONEER BLVD
JOHN WYSOCKI
NORWALK, CA 906532894
562/86S-N31
GARLAND
$265.470.00
EL CAJON VALLEY UNION SCHOOL DISTRICT
LOS COCHES CREEK MID SCHOOL
SUSAN OLINGER
9669 DUNBAR LANE.
513588 -366D
$707,841 CC
EL CAJON, CA 92021
MT, SAN JACINTO COLLEGE
1499 ST ATE ST
DENNIS HOGAN
GARLAN01
$94236.00
SAN JACINTO, CA 92583
95114 -6752
MANVILLE
Cllentp: 1260333
305CHAPMCOA
AUUMU,r CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDOXYYY'
3/2912016
THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder to en ADDITIONAL INSURED, the Policy(fea) must be endorsed; H IUBROGATION IS WANED, subject to
the tarns and Conditions of the policy, certain policies may require an endorsannon. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
BBB:T Insurance Services
Leslie
ME: LeBI10 Lessley
gNN • 714 xe: 877 297.9269
of Orange County
IIeSSley�bhandtcom
2400 Katella Avenue Ste 1100
Anaheim, CA 92806
INSU AFFORDING COVEIUGE NAICs
$1 000 000
IxsuRERA: Valley Forge Insurance Company 20508
INSURED
Chapman Coast Roof Co. Inc.
wsullENe: Redwood Fire and Casualty Insur
11673
wsuRER c: Continental Casualty Company
20443
2301 E. Orangethorpe Avenue
WSURSID:
AUTOMOBILE
X
X
P.O. Box 7060
INSURER E:
Fullerton, CA 92834
IxsuRERF:
04/01/207
rnvcoer_vc
__._..__. R Vj 'UN NumrStn:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Lm SURANCE DD u POLLICY EF
POLICY NUMBER MMI0 DMnS
A
EPAL WIBILITY
OOLCLIR
000
6012547718
/01/2076
04101/201
$1000000
pEoACHHpG�OEEC ♦C♦URRENCE
P MISES
$100000
X
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$15000
PERSONALBADVINJURY
$1 000 000
T APPLIES PER
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OTHER.
GENERAL AGGREGATE
52000000
PRODUCTS - COMP /OPAGG
32000000
$
C
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIREOAUTOS X KNED
6012647735
0112016
04/01/207
,0v3NEDSING LIMIT
1,000,000
BODILY INJIRtY(Nr M.)
S
BODILYINJURY(Pwecddmc)
S
PROPER DAMAGE
Per RCtldeN
$
E
A
B
1C
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CLAMS -MADE
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6012647704
CHWC710309
/0112016
01/207604101!207
04101/201
EACH OCCURRENCE
s6 000 000
AGGREGATE
$5,D00,000
DED X RETENVONSIO OOO
AND EMPLLONPENIAnON
AND EYPLOYERe' LIABILITY
OFFlPCERIMEMWR EXCLUDEOECUi1VEF7N
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( yyae, dourlc. N")
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EL EACHACCIDENT
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EL DISEASE - EA EMPLOYEE
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51000000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORO 101, AddM.O Remade sc ule, mry Le SIAcNed x more Ppm k NRulmd)
RE:
Evidence of Coverage
rconclrwrc un, rtes
Evidence of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
m 1988 -2014 ACORD CORPDRATInrJ All rIn ee .ee..,.. .
wwnu m (zUTauTI 1 Off The ACORD name and 1090 are registered marks Of ACORD
#$158923821M15892093 YMLES
11/14/2016 California Department at Industrial Relations -Contact D IR
Public Works
Public Works Contractor (P1, Q Registration Search
This is a listing of current and active PWC registrations pursuant to Division 2, Pan 7, Chapter 1 (commencing with section 1720 of the California Labor Code.)
Enter of least one search criteria
to display active registered public works contractors) matching your selections.
Registration Year,
(Current Fiscal Year. 2010117
PWC Registration Number.
11000002150 -
Contractor Legal Name:
HAPMAN COAST ROOF CO., INC. Contractor License Lockup
License Number:
4927543
County:
ORANGE
Expon as: g] Excel I � PDF
Search Results
One registered contractor found. 1
Details Legal Name Registration County City Registration Expiration
Number Date Date
View CHAPMAN COAST ROOF CO., INC. 1000002150 ORANGE FULLERTON 06/01/2016 06/30/2017
V2,20160101
Conditions of Us.: Privacy Policy Disaaimer Disabii, :y accommodation Site Help
Copy,,ght X12015 State of Cair om,e
https:// efiling .dir.ca.gm/PVVCR /Search.action 1/1
Form
tlwm9+
Request for Taxpayer
m -�
Give Form tothe
(Rev. December 20141
Identification Number and Certification
I
TTII
requester. Do not
Department
of ox: Treavry
Send to the IRS.
INe'rW Revenue Service
'
1 Name (as shown on your Income, tax return). Name is required on Ws line; do not leave cols line blank.
Chapman Coast Roof Co., Inc.
N
2 Business name(dsregarded entity name, if different from above
m
m
m
3 Check appropriate box for federal tax class cation; check only one of the following seven boxes:
4 Exemptions (modes apply only to
C
o
m
❑ individual /sole proprietor or ❑ C Corporation ,/❑ s Coepo211on ❑ Partnership , � ❑ TnsVesleta
rartam entities, not 1r1tllvltluaia; Sae
insinctlons on page 3j:
c
Ic
single - member LLC
❑ Limited liability co mpany. Enter the tax classification (C=C corporation, S=S Corporation, P=partneiship)►
Exempt ♦ Pa%'��e(tt any)
`o 2
Note. For a slrgle- memher LLC that is disregarded, do not check LUC; check the appropriate box in the Ilrre above for
Exemption item FATCA reporting
y
the tax classification of the skgle- membeowner.
code if any)
y` a
❑Other - (see insimc[rons)► -
rk¢'a:•m.aa,mo,wmareuart ✓ e. m. a51
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5 Address (number, street, and apt. or suite no.) I
Requesters name and address (optional
2301 E. Orangethorpe Ave., P.O. Box 7050
rn
m
a City, state, and ZIP cede
rn
Fullerton, CA 92834
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given online 1 to avoid
I social security number
backup withholding. For individuals, this is generally your social security number (Sage . For other a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
m -�
II��II
TTII
entities, it is your employer identification number (HIN). If you do not have a number, see How to get a
TIN on page 3.
or
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I Employer Identification number
guidelines on whose number to enter.
2 -- 3 7 3 5 4 2
Under penalties of perjury, I certify that
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a talons to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and -
4. The FATCA codes) entered on this form [if any) indicating that I am exempt from FATCA reporting is wrtect.
Certification instructions. You must crass out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all [merest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the cenificalion, but you must provide your correct TIN. See the
signature of
Here I U.S.person►
General Instructions
Section references are to the Internal Revenue Cod. unless otherwise noted.
Future developments. Information about developments affecting Foes W -9 (such
as legislation enacted after we release it) is at www.us.govihi
Purpose of Form
An individual or entity Form W -9 requester) who is required to file an informatln
miurn with me IRS must obtain your correct taxpayer identification number MN)
which may be your social security number (SSN), individual taxpayer Identification
number (ITIN), adoption taxpayer identification number (ATIN), or employer
identification wheat (EIN), to report on an Information return the amount pad to
you, or other amount reportable on an information return. Examples of information
returns include, but are rot limited to, the following'
• Form 1999 -INT (merest emend or paid)
• Form 1099 -DIV (divicends, including those from stocks or mutual funds)
• Form 1099 -MISC (varieus types of income, prizes, awards, or gross proceeds)
• Form 1099 -6 (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099 -5 (proceeds from real estate transactions)
• Form 10gi (merchant card and third party network transactions)
Date ►
• Form 1098 (home mortgage interest), 1098 -E (student ban interval, 1098 -T
(tuition)
• Farm 1 D99 -C (canceled del
• Form 1099 -A (acquisition or abandonment of seemed property)
Use Form W -9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN.
M you do not refute Form W -9 to the requaster with a nN, you might be subject
in backup withholding. See What is backup withfokfing9 on page 2.
By signing the filled-cut form, you:
1. Certify that the TIN you are giving is correct (or you are wading for a number
to be issued),
2. Certify that you are hot subject to backup wdhhalding, or
3, Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnershp income from a U.S. trade or bualness is not subject to the
withholding lax on foreign partners' share of effectively commacted income, and
4. Certify that FATCA pedals) entered on this form Of any) [indicating that you are,
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
Page 2 for further Information.
Cat. No. 10231% Form W-9 (Rev. 12 -2014)
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Bond No. N/A Bond Premium N/A
BID BOND TO ACCOMPANY PROPOSAL
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Seal Beach, has issued an invitation for bids for the work described as follows:
Citv Facilities Roof Repair Project, Specification No. FIG 1801
WHEREAS Chapman Coast Roof Co., Inc.
CA
(Name and address of Bidder)
( "Principal "), desires to submit a bid to Public Agency for the work.
WHEREAS, bidders are required under the provisions of the California Public Contract Code to furnish a form of
bidders security with their bid.
NOW, THEREFORE, we, the undersigned Principal, and
Great American Insuran
(Name and address of Surety)
( "Surety ") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly
bound unto the Public Agency in the penal sum of Ten Percent of the Total Amount Bid
Dollars ($ 10%--------------------------------------- - - - - -- ), being not less than ten percent (10 %) of the total
bid price. in lawful money of the United States of America, for the payment of which sum well and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by
these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal is awarded a
contract for the work by the Public Agency and, within the time and in the manner required by the bidding
specifications, enters into the written form of contract included with bidding specifications, furnishes the required
bonds, one to guarantee faithful performance and the other to guarantee payment for labor and materials, and
furnishes the required insurance coverage, then this obligation shall become null and void; otherwise, it shall be and
remain in full force and effect.
In case suit is brought upon this bond, Surety further agrees to pay all court costs incurred by the Public Agency in
the suit and reasonable attorneys' fees in an amount fixed by the court. Surety hereby waives the provisions of
California Civil Code y 2845.
Page C- 18
IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety, on the date set forth
below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned
representative(s) pursuant to authority of its governing body.
Dated: November 14, 2017
"Principal"
Chapman Coast Roof Co., Inc.
ap
By: (AAttA.id
Its
By:
Its
(Seal
Surety"
Great American Insurance Company
By: A
Its Kim Lou, Al
By:
Its
(Seal)
Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing
as attorney -in -fact must be attached.
Page C -19
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT •D
A notary public or other officer completing this certificate verities only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California )
County of Orange )
On NQV 14 2017 before me,
Date
personally appeared
Maria Guise, Notary Public
Hen: Insert Name and Title of the Officer
Kim Luu
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/mm
subscribed to the within instrument and acknowledged to me that lw /she/ttWexecuted the same in
Mather /tbeixauthorized capacit bmt and that by t LAner /RmiK signature(s) on the instrument the person(*
or the entity upon behalf of which the person(u) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
MARIA GUISE �(I
— Commission # 2106915 Signature k,
kn Notary Public - California ? Signature of Notary Public
San Diego County
My Comm. Expires Apr 14, 2019 ~
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
I Corporate Officer — Title(s): _
s Partner — C3 Limited 0 General
Individual X Attorney in Fact
Trustee 0 Guardian or Conservator
Other:
Signer Is Representing:
Signer's Name:
Corporate Officer — Title(s):
Partner — i Limited Cl General
Individual D Attorney in Fact
0t Trustee 71 Guardian or Conservator
` Other:
Signer Is Representing:
:rr r
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET 0 CINCINNATI, OHIO 45202 0 513- 369 -5000 0 FAX 513- 723 -2740
The number of persons authorized by
this power of attorney is not more than SEVEN
No.0 14849
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, acorporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attomey -in -fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
MIKE PARIZINO
RACHELLE PHEAULT
RHONDA C. ABEL
JAMES A. SCHALLER
Name
JERI APODACA
KIM LUU
HEATHER SALTARELLI
Address
ALL OF
NEWPORT BEACH,
CALIFORNIA
Limit of Power
ALL
$100,000,000.00
This Power of Attorney revokes all previous powers issued on behalf of the attorney(s)-in-fact named above.
IN WITNESS WHEREOF the GREATAMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 18TH day of NOVEMBER 2016
Attest GREAT AMERICAN INSURANCE COMPANY
s� e
Assistant Secretary Divisional Senior 1 ace President
STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVID C. KrrCHIN (877-377-2405)
On this 18TH day of NOVEMBER 2016 before me personally appeared DAVID C. KITCHIN, to me
known, being duly swom, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
name thereto by like authority.
t
a n li ,u
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of GreatAmerican Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior Vice Presidents, Divisional Vice Presidents and Divisonal Assistant vice
Presidents, or any one of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts o, (suretyship, or other written obligations in the nature thereof to prescribe their respective duties and
the respective limits oftheir authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company maybe rifxed by facsimile to any power of attorney or certificate of either given for the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature ofsuch
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of Tune 9, 2,008 have not been revoked and are now in full force and effect.
Signed and sealed this
9
.;;
S1029AF (06/15)
day of Nov 14 20V
Assistant Secretary