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HomeMy WebLinkAboutAGMT - Pavewest Inc (Old Ranch Road Pavement Rehabilitation Project CIP No ST1703'I", RECORDING REQUESTED BY AND WHEN RECORDED CITY OF SEAL BEACH Attn: City Clerk 211 - 8th Street Seal Beach, CA 90740 Recorded in Official Records, Orange County Hugh Nguyen, Clerk- Recorder NO FEE R 0 0 1 0 4 4 2 7 8 5 8 2018000393144 2:49 pm 10/30/18 lc, v 05 2018 143 401 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00 CITY Q'RK CITY OF SEA BEACi� Space of above this line for Recorder's use. No Recording Fee Pursuant to Government Code Section 6103, 27383 NOTICE OF COMPLETION Notice pursuant to Civil Code Section 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: Citv 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 June 25, 2018. The work was Old Ranch Road Pavement Rehabilitation. CIP No. ST1703. 6. The name of the contractor(s), if any, for such improvement was: PAVEWEST. Inc. The date of the Contract Award was May 29, 2018. 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: College Park East, City of Seal Beach. Date: Dire t r _ ublic W ,_ orks ity 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 AZ4 D 2018, at Seal Beach, California. Date (of Signature) Dire or u lic s, City of Seal Beach PUBLIC WORKS AGREEMENT Old Ranch Road Pavement Rehabilitation Project CIP No. STI703 between City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 [� PAVEWEST 11700 1661' Street Artesia, CA 90701 (562) 694 -3113 (562) 694 -6263 - FAX THIS AGREEMENT is made as of May 29, 2018, by and between the City of Seal Beach, a California charter city ( "City "), and Pavewest, a General Contractor ( "Contractor "). RECITALS A. WHEREAS, the City Council has approved the plans and specifications for the Old Ranch Road Pavement Rehabilitation Project CIP No. STI703 ( "Project ") with respect to design criteria; and B. WHEREAS, Contractor has submitted a bid to City for the Project dated April 26, 2018 in the amount of $54,178.25 ( "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 Contractor's Services. 1.1 Scope and Level of Services. For and in consideration of the mutual promises set forth herein, and subject to the terms and conditions set forth in this Agreement, Contractor shall perform and complete in good and workmanlike manner all work ( "Work ") required by this Agreement and the documents listed in Subsection 1.2 for the Project. 1.2 Contract Documents. The "Contract Documents" that comprise the agreement between the City and the Contractor are the: Notice Inviting Bids, Instructions to Bidders, Accepted Proposal, Non - Collusion Affidavit, Bid Schedule(s), List of Subcontractors, Contractor's Industrial Safety Record, Contractor's Qualification Statement, Bid Security Forms for Check or Bond, Specifications, General and Special Provisions and documents referenced therein, all addenda as prepared prior to the date of bid opening setting forth any modifications or interpretations of any of said documents, this Agreement, Exhibits attached to this Agreement, including but not limited to the Performance Bond (Exhibit A), Payment Bond (Exhibit B), Workers' Compensation Insurance Certificate (Exhibit C), Insurance Endorsements (Exhibit D), Acknowledgment of Penal and Civil Penalties Concerning Contractor Licensing Laws (Exhibit E), Labor Law Requirements (Exhibit F), Accepted Proposal (Exhibit G) and any and all supplemental agreements executed amending or extending the Work contemplated and that may be required to complete the Work in a substantial and acceptable manner. These Contract Documents are hereby incorporated into this Agreement. 1.3 The Work shall be performed in accordance with the Plans, Specifications and other Contract Documents. Contractor shall furnish at its own expense all labor, materials, equipment and services necessary therefor, except such labor, materials, equipment and services as are specified in the Contract Documents to be furnished by City. 1.4 In the event of any material discrepancy between the express provisions of this Agreement and the provisions of the other Contract Documents, the provisions of this Agreement shall prevail. 2. Effective Date. This Agreement is effective as of May 29, 2018 (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 $54,178.25, 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 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. 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 maybe 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 Rights. Indemnitees do not, and shall not, waive any rights that they may possess against Contractor because of the acceptance by City, or the deposit with City, of any insurance policy or certificate required pursuant to this Agreement. 5.5 Waiver of Right of Subro ag tion. Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation against the Indemnitees, while acting within the scope of their duties, from all claims, losses, and Liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor. 5.6 Survival. The provisions of this Section 5 shall survive the termination of the Agreement and are in addition to any other rights or remedies that Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against a Contractor shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. 6. Insurance. 6.1 Liability Insurance. Contractor shall procure and maintain in full force and effect for the duration of this Agreement insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the services hereunder by Contractor, and its agents, representatives, employees and subcontractors. The policy limits set forth below do not act as a limitation upon the amount of indemnification to be provided by Contractor. Contractor shall complete and execute the following documents attached as Exhibits hereto and incorporated herein by this reference: 6.1.1 Exhibit D -1: Additional Insured Endorsement - Commercial General Liability. 6.1.2 Exhibit D -2: Additional Insured Endorsement - Automobile Liability. 6.1.3 Exhibit D -3: Additional Insured Endorsement. 6.2 Minimum Scope of Insurance. Unless otherwise approved by City, coverage shall be at least as broad as: 6.2.1 Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001). 6.2.2 Insurance Services Office form number CA 0001 (Ed. 1/87) covering Automobile Liability, code 1 (any auto). 6.2.3 Insurance Services Office form number CG 20 10 11 85 (Ed. 11/85) covering Additional Insured— Owners, Lessees or Contactors (Form B). 6.2.4 Workers' Compensation insurance as required by the State of California and Employer's Liability Insurance. 6.2.5 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. 6.4 Deductibles and Self- Insured Retentions. Contractor shall inform City of any deductibles or self - insured retentions except with respect to any professional liability insurance. 6.5 Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 6.5.1 City, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of City officials, are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of Contractor; products and completed operations of Contractor; premises owned, occupied or used by Contractor; or automobiles owned, leased, hired or borrowed by Contractor. The coverage shall contain no limitations on the scope of protection afforded to City, its officers, officials, employees, designated volunteers or agents serving as independent contractors in the role of City officials which are not also limitations applicable to the named insured. 6.5.2 For any claims related to this Agreement, Contractor's insurance coverage shall be primary insurance as respects City, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of City officials. Any insurance or self - insurance maintained by City, their officers, officials, employees, designated volunteers or agents serving as independent contractors in the role of City officials shall be excess of Contractor's insurance and shall not contribute with it. 6.5.3 Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 6.5.4 Each insurance policy required by this Section 6 shall be endorsed to state that coverage shall not be canceled or materially modified except after 30 days prior written notice by first class mail has been given to City. 6.5.5 Each insurance policy, except for any professional liability policy, required by this Section 6 shall expressly waive the insurer's right of subrogation against City and its elected officials, officers, employees, servants, attorneys, designated volunteers, and agents serving as independent contractors in the role of city or agency officials. 6.6 Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best's rating of no less than A: VIII unless waived in writing by City's Risk Manager. 6.7 Verification of Coverage. All insurance coverages shall be confirmed by execution of endorsements on forms approved by the City. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. All endorsements are to be received and approved by City before services commence. As an alternative to City forms, Contractor's insurer may provide complete, certified copies of all required insurance policies, including endorsements effecting the coverage required by these specifications. 7. Liquidated Damages. Should the Contractor fail to complete the project, or any part thereof, in the time agreed upon in the Contract, the Contractor shall reimburse the City for the additional expense and damage for each calendar day that the Contract remains uncompleted after the Contract completion date. It is agreed that the amount of such additional expense and damage incurred by reason of failure to complete the Contract is the per diem rate of $750.00 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. 8. Suspension. City may, in writing, order Contractor to suspend all or any part of the Contractor's Services for the convenience of City or for work stoppages beyond the control of City or Contractor. A suspension of the Services does not void this Agreement. 9. Notices. Any notices, bills, invoices, or reports authorized or required by this Agreement shall be in writing and shall be deemed received on (a) the day of delivery if delivered by hand or overnight courier service during Contractor's and City's regular business hours or by facsimile before or during Contractor's regular business hours; or (b) on the third business day following deposit in the United States mail, postage prepaid, to the addresses heretofore set forth in the Agreement, or to such other addresses as the parties may, from time to time, designate in writing pursuant to the provisions of this Section. All notices shall be addressed as follows: If to City: City Clerk City of Seal Beach 211 -8th Street Seal Beach, California 90740 Telephone: (562) 431 -2527 Fax: (562) 493 -9857 If to Contractor: With a copy to: Public Works Director City of Seal Beach 211 -8th Street Seal Beach, California 90740 10. Non - Assignability: Subcontracting. Contractor shall not assign, transfer, or subcontract any interest in this Agreement or the performance of any of Contractor's obligations hereunder. Any attempt by Contractor to so assign, transfer, or subcontract any rights, duties, or obligations arising hereunder shall be null, void and of no effect. 11. Compliance with Laws. Contractor shall comply with all applicable federal, state and local laws, ordinances, codes and regulations in force at the time Contractor performs the Services. 12. Non - Waiver of Terms, Rights and Remedies. Waiver by either party of any one or more of the conditions of performance under this Agreement shall not be a waiver of any other condition of performance under this Agreement. In no event shall the making by City of any payment to Contractor constitute or be construed as a waiver by City of any breach of covenant, or any default which may then exist on the part of Contractor, and the making of any such payment by City shall in no way impair or prejudice any right or remedy available to City with regard to such breach or default. 13. Attorneys' Fees. In the event that either party to this Agreement shall commence any legal action or proceeding to enforce or interpret the provisions of this Agreement, the prevailing party in such action or proceeding shall be entitled to recover its costs of suit, including all attorneys' fees incurred in connection therewith. 14. Construction. The validity, interpretation, and performance of this Agreement shall be controlled by and construed under the laws of the State of California. In the event of any asserted ambiguity in, or dispute regarding the interpretation of any matter herein, the interpretation of this Agreement shall not be resolved by any rules of interpretation providing for interpretation against the party who causes the uncertainty to exist or against the party who drafted the Agreement or who drafted that portion of the Agreement. 15. Entire Agreement. This Agreement, including any other documents incorporated herein by specific reference, represents the entire and integrated agreement between Contractor and City. This Agreement supersedes all prior oral or written negotiations, representations, or agreements. This Agreement may not be amended, nor any provision or breach hereof waived, except in a writing signed by the parties which expressly refers to this Agreement. 16. Severability. The invalidity in whole or in part of any provisions of this Agreement shall not void or affect the validity of the other provisions of this Agreement. (Intentionally Left Blank) IN w1 "INESS WHEREOF, the parties, through their respective authorized representatives, have executed this Agreement as of the date first written above. CITY OF SEAL BEACH CONTRACTOR: la illOUTTAI a D'' city Approved as to By: 6 Craig Steele, City Attorney o i Exhibit A Bond No. WCN2532261 Bond Premium $780.00 Premium is for contract term and subject to adjustment based on final contract price PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach; has awarded 90701 (Name and'address of ( "Principal "), a contract (the "Contract")- for'the work described. as follows: Old Ranch Road Pavement 'Rehabilitation`Proiect'CIP No.ST1703 WHEREAS, Principal is required under the terms of'the Contract to .furnish, a bond for the Tdithful performance of the Contract, NOW, THEREFORE; we; the undersigned, Principal, and (Name and'address of Surety) ( "Surety".) a duly admitted surety, insurer under the- laws of the State -of California; as Surety; are field and firmly bound unto the PublicrAgencyin.the'penal. sum of Fifty -Four Thousand One Hundred Seventy Eight and 25/100ths -------------------------------------- Dollars ($54,178.25 ), this amount being not `:less than the total contract piice,. in lawful money of the United Statcs.of America, for the paym6m of4hich, sum, well and truly to be made, we bind otiiselves, our heirs „executors, administrators, 'successors, and as`sighs, jointly and severally, firmly by thesepresents. THE CONDITION OF THIS "OBLIGATION IS'SUCH THAT, if the hereby bounded Principal, his, her or its heirs;: executors, administrators, successors�oi 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 within4he time.and in the manner. therein,specified,!and inalLrespeets- according to their true intent and meaning, and shall indemnify. and hold harmless >the P.ublic'. Agency,; its officers, agents; and others as therein provided, then this obligation shall,become null:and,void; otherwise, it shall be and remain in full force and effect In case suit is brought uponthis bond, Surety further agrees to pay all court costs andreasonable attorneys' fees in an amount fixedby 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 underthis'bond, and if does hereby waive notice of anysuch 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 'purposear 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'itsundersigned representative(s) pursuant to authority of its governing body. Dated: May 22, 2018 Page D -47 v::r . . , By: I Its M "Surety" Old Republ' u r V-mpany _ By: — Gla Rogers, Attorney -in -fact By: _ Its By: Its _ (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney4n -fact must be attached. Page D -48 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 San Diego On 22 May 2018 before me, Audrey Rodriguez, Notary Public ere im.n nam9 rul trtlaoteo cerJ personally appeared, Gladys Rogers who proved to me on the basis of satisfactory.evidence : to be the persons) whose name(s) is /are subscribed toPthe.within instrument and acknowledged to me that helshe /they executed the.same in his /her /their authorized capacity(ies), and that by his /her /their signature(s) on the, instrumentthe persorI or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the lawsof the State of California that the foregoing paragraph is true iand correct. AUDREY RODRIGUEZ • WITNESS my hand and official seal. -;; Commission # 2079335 1 Notary Public - California z Z San Diego County ©n 9 My Comm. Expires Sep 2, 2018 Notary Public SiqVature V (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETINGTMS.FORM '.Thisformcomplieswith cumery California'itmufesregarding notary wording and DESCRIPTION OF THE ATTACHED DOCUMENT sfneeded, shoul dbe completed and ' mtachedto the document. Acknolwedgentsfrom :other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California mnt law. (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THE SIGNER Individual (s) • Corporate Officer (Title) • Partner(s) ® Attorney -in -Fact Trustee(s) ❑ Other 2015 Version www.NotaryClasses.com 800 -873 -9865 • State and County information must be the State and County where the document signers) personally appeared before the notary public for acknowledgment, • Date of notarisation most be the date that the signet(s),personally appeared which must also be the same date the acknowledgment is completed. •'The notary public must. print. his. or ner.naine as iCappears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or,plural forms by crossing off incorrect forms (i.e. he/she/they- is /ors) or circling the correct fortes. Failure to correctly indicate this information may lead to rejection of document recording.. • ''The notary, seal impression must Cie clear and photographically reproducible. Impression must potcovertext or lines_If'seal impression- smudges, re -seal if a sufficient area permits, otherwise complete different acknowledgment form. • Signature of the notary public must match.the signature on file with the office of the county clerk. Additional information is not required but could help, to ensure this acknowledgment is not misused or attached to a differenfdocument. ,Indicate title or type of attached document, number of pages and daze. .Indicate the capacity -dad tied by dre.signa>If the claimed capacity is a corporate officer, educate the I title " "(i.e.!CEO, CFO, Secretary). • Securely attach this document to thesigned document with a staple. I OLD REPUBLIC SURETY COMPANY ** * ** POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and appoint: BROOKE LAFRENZ, MICHAEL W THOMAS, GLADYS ROGERS, AUDREY RODRIGUEZ, LARRY D COGDILL, OF SAN DIEGO, CA its true and lawful Atlomey(s )-in -Fact, with full power and authority, not exceeding $50,000,000, for and on behalf of the company as surety, to "mute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than bail lx)nds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds guarantees of installment paper and note guaranty bonds, self - insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract fronds, waste management bonds, hazardous waste remediation bonds or black lung t> nds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TEN MILLION DOLLARS ($10,000,000) ------- - - - - -- FOR ANY SINGLE OBLIGATION and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant in these presents, are ratified and confirmed. This document is not valid unless printedun colored background and is multi- colored. This appointment is made under and by aminorii of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile order and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February I8, 1982. RESOLVED that, the president; any vice- president, or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint attorneys -in- fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers nay remove any such atomey -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attorney -in -fact or agent; or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the company to such person or persons. RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 25TH day of APRIL. 2018. OLD REPUBLIC SURETY COMPANY SEAL�5r t _ Asysuni secr — j $. STATE OF WISCONSIN, COUNTY OF WAUKESHA -SS ^M',.,.+^"` President On this 25TH day of APRIL, 2018 , personally came before me, Alan Pavlic and Jane emEZ y , to me known to be the individuals and officers of die OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly swom, did severally depose and say; that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. -y /n Notary Public My commission expires: 9/28/2018 CERTIFICATE (Expiration of notary commission does not Invalidate this Instrument) I, the undersigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin curpomtion, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, am now in force. 74-0051 wr Signed and sealed at the City of Breld, WI this e_d_ day of „u,i �• %re„rwp C � ' r Aiss1Y 1 CALIFORNIA ALL- PURPOSE ACKNOWLEDGMENT CIVIL 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 Los A r) a c.,/ -eA )) II / On �r�.2y 2alg beforeme, Pa- LL j�� D[G7_,r, �OfAry ablic- Oate Here Insert Name and Ti le of the Officer personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personK whose nam&N Wa(e subscribed to the within instrument and acknowledged to me that he/SIvAhgy executed the same in hisfie0heir authorized capacity(tes), and that by his/her/t1heir signatures) on the instrument the person*,, or the entity upon behalf of which the personKacted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph fr PAT BOLD. » ' is true and correct. xAY COMM #2136660 > WITNESS m hand and official seal. W ; Notary Public - Callfomia z y ORANGECOUNTY My Comm ;ssmUpit�1 n.9,7020 3 \ / �, Signature '/ C td Signature of Notary 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 — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact • Trustee ❑ Guardian or Conservator • Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Other: Signer Is ❑ Guardian or Conservator Representing: 02014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1- 800 - 876 -6827) Item #5907 Bond No. WCN2532261 Bond Premium $780.00 Premium is for contract term and subject to adjustment based on final contract price PERFORMANCE BOND KNOW ALL PERSONS BY THESE. PRESENTS that; WHF.RRAS the Citv of Seal Beach. has awarded. ( "Principal "), a contract (the "Contract') for the work described_ as follows: 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 undersianed,Princival, and ( "Surety") a duly admitted surety insurer under the laws of the State of California, as Surety,.are held and firmly bound unto the Public Agency in the penal sum of Fifty -Four Thousand One Hundred Seventy Eight and 25/ 100ths-------------------------------- - - - - -- Dollars .($54,178.25 1, 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 performall the undertakings, terms, covenants, conditions and agreements in the Contract and any alteratiom thereof made; as ,therein provided, on the Principal's part to be kept and performed, all within`the time and in the mannerthereimspecified, 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, them this obligation shall become null and void; otherwise "it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER, the Surety, for value received,. herebystipulates 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 affect its obligations under this bond, and if 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 aparty hereto. IN WITNESS WHEREOF, twa(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 undersigned representative(s) pursuant to authority of itsgoverning body. Dated: May 22, 2018 Page D -47 a f Its "Surety" Old Rep M' U' ompany GI •s Rogers, Attorney - in=tact T By: Its By: _ Its (Seal) (Seal) Note: This bond must be dated; all signatures must be notarized, and evidence of the authority of any person signing as attomey -in -fact must be attached. Page D -48 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 valiclity.of that document. State of California County of San Diego On 22 May 2018 .6efore,me, Audrey Rodriguez, Notary Public (Hera inse name and tale of the o Cer) personally appeared, Gladys Kogers , 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 tome that he /she /they executed the same in his /her /their authorized capacity(ies),.and that by his /her /their signature'(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my'h nd and official seal. Notary Publics 6 ature ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document cominued) Number of Pages _ Document Date CAPACITY CLAIMED BY THE'SIGNER ❑ Individual (s) ❑ Corporate Officer le ❑ Partner(s) ® Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version wwvd.NotaryClasses.c6m 8OM73 -9865 AUDREY RODRIGUEZ ` Commission # 2079335 a =m Notary public • California Z San Diego County > My Comm. Expires Sep 2, 2018 (Notary PublicSealj .INSTRUCTIONS FOR COMPLETING TIES FORM Thisform romplies with tuner¢ California statutes regarding notary wording and, 'if needed, should be compleled'ard'mtached to the document. Acknolwedgents from other states may be completed for documents being rem to that state so long ar the weeding not require the California notary to violate California notay law. State and County inf6miauon'.mu3 be'the State and County.where the document signei(s) pcsonallyappeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same daze the acknowledgment is completed. • The notary public musfprinChis or heename as it appears within his or her commission followed by a comma and their your title (notary public). Print the ntune(s) of docummffsigner(s) who;personally'appear at the time of notarization., • Indicate the correct singular or, plural forms by crossing off incorrect forms (i.e. he/shcNxg, =.is /are), or circling the correct forms: Failure to correctly indicate this informationmay.lead to rejection of documentrecording. • The n`ota'ry =seal;irnpression musi'be cleat kid photographically reproducible. Impressaon,mustnotcovertext or Imes.,If'seal impression smudges, re -seal if a. sufficient area permits, otherwise complete a different acknowledgment form. Signature ofthe notary public must matchahesignature on file with the office of the countyclerk. t• Additional information is not required, but could help to ensue this acknowledgrnmi is not misused Or attached to a different' (locument. ,Indicate title or type of attached' document, number of pages and due. '••r Indicate the capacity claimed by the signed If the claimed capacity is a coiporate officer, indicate. the title Q cXEO, CFO; Secretary). • Securely atiadt this document to the signed document with a staple. OLD REPUBLIC SURETY COMPANY ** * ** POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and appoint: BROOKE LAFRENZ. MICHAEL W THOMAS, GLADYS ROGERS, AUDREY RODRIGUEZ, LARRY D COGDILL, OF SAN DIEGO, CA its true and lawful Attomy(s )-in -Fact, with full power and authority, not exceeding $50,000,000, for and on behalf of the company as surety, to execute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizaa ces or other written obligations in the nature thereof, (other than bail bonds, bank depository bonds, mortgage deficiency bonds mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self - insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds, hazardous waste remediation bonds or black lung bends), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TEN MILLION DOLLARS (SI0,000,000) - - - - -- FOR ANY SINGLE OBLIGATION and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confined. This document is not valid unless printedon colored background and is multi - colored. This appointment is made under and by authori ty of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile under and by the authority 17the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18, 1982. RESOLVED that, the president, any vice - president, or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attorney -in -fact or agent; or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the company to such person or persons. RESOLVED Ft JRTHER. that the signmurc ol'any authorized officer and the seal ollhe company may he affixed by facsimile to any Power of Attorney or certification Cher sof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 25TH day of APRIL, 2018. OLD REPUBLIC SURETY COMPANY l S7;7 SEAL j //0* .w+ STATE OF WISCONSIN, COUNTY OF WAUKESHA -SS `"*...�.� President On this 25t4 day of APRIL, 2018 , personally came before me, Alan Pavlic and Jane E-C , to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. y/ /1 � +ptAai r LS041t._ Notary Public My commission expires: 9 /28/2018 CERTIFICATE (Expiration of notary commission does not Invalidate this Instrument) 1, the undersigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. 74-0051 z iupi s Signed and sealed at the City of Rrookfield. WI this 22nd day of May , 201 _ S ; Macula CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT CIVIL 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 On m d.a 2 4 . _�O 1 s- before me, Date Here Insert Name and Title of the Officer personally appeared DO N A-W MAN ct P.,j Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person' k whose nameN Ware subscribed to the within instrument and acknowledged to me that hefshefthey executed the same in his/her/their authorized capacity(ies), and that by his /hsr/their signaturef4on the instrument the person(, or the entity upon behalf of which the person(*-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. i° TAT BY �.0 -,DE WITNESS m hand and official seal. COMM #2136660 n Y xe kNOlanf Public - California 0 y.y1D n wmim ECOl1NTY My COmmissw�FaPi:n kn.9, 2010 - Signature Signature of Notary 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 — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Exhibit B Bond No. WNN2532261 PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,.has awarded Pavewestlncorpor 11700 (Name and Premium .included in Performance Bond ( "Principal'), a contract (the "Contract ") for.the work described as follows: Old Rench Road Pavement Rehabilitation Project CIP No. ST1703 WHEREAS, Principal is required under the terms of the Contract and the California.Civil Code to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law. NOW, THEREFORE, we; the undersigned Principal,. and Old Republic Surety Company 14728 Pipeline Avenue, Suite E Chino Hills, CA 91709 (Name and address of Surety) ( "Surety ") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum'of Fifty-Four Thousand One Hundred Seventy Eight and 251100ths - - - - -- ----------------- - - - - -- Dollars ($ _54 178.25 this.amount being not less than filly 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 orassigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the Califomia 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 I Department from the wages of employees of the Principal and subcontractors'pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the - Contract, the Surety will pay for the same in an amount not exceeding the penal sum specified in this bond; otherwise, this obligation shall become null and void. This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as• %to give a right of.action to such persons or their assigns' in any suit brought upon the bond. In case suit is brought upon this -, bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work - .to:be performed thereunder, or the specifications for the'same, shall in any way affect its obligations under this bond, and it does hereby waive notice of any such change, extension.of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. Page D -50 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 aftixed'and these presents-duly signed by its undersigned representative(s) pursuant to authority of its governing body. Dated: Mar 22, 2015 "Principal" Pavewestlncor orated �p By: By: Its By: "Surety" Old Repub ' u eq ompauy By: Gla ys Rogers, Attorney -in -fact By: Its By: Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. Page D -51 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 San Diego On 22 May 2018 before me, Audrey Rodriguez, Notary Public (Here insert name and trteo the p Carl personally appeared Gladys Rogers who proved to me on the basis of :satisfactory- evidence:to be the persons) whose name(s) is /are subscribed torthe:within:i'nstrument and acknowledged to'me'that he /she /they executed the same in his /her /their authorized ca pacity(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'cori RMU RODRIGUEZ n # 2079335 lic - California 1MTNESS my'hand and official seal. go county D pires Sep 2, 2018 f -AlhJA" Notary' Public St Wture 0 (Notary Public Seal) I I1 101i X11 19 rL111 PTION OF THE ATTACHED (title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THESIGNER ❑ Individual (s) ❑ Corporate Officer e ❑ Partner(s) ® Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version www.NotaryClasses.com.800 -873 -9865 'INSTRUCTIONS FOR COMPLETING THIS FORM :)N This form complies with curem California statutes regarding notary wording and if needed, should be completed and'atiached to the document. Aclmolwedgemsfrom other states may be completed for documents: being sent to that state so long as the wording Hoes not require the California notary to violate California rotary law. • State and County information most 'be' the State and County:where the document signers) personally appeared before the notary public for acknowledgment. • Date of nofarization'must be The date that The signers) personally appeared which must also be the same date the adcnowledgr is completed. • The notary pubtic,.must prinf.his.iir her,name as it appears within his or her commission followed by a comma and then.your title (notary public). • Print the name(s) of document sigmr(s) who personally appear at the time of notarization. • Indicate the correct singular orpluml Corns by crossing off incorrect fours (i.e. Wshe /Nag}'. =is /aea) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal :impression must` be clear end photogriphically reproducible. Impression must . not cover text or lines.,lf "seal hnpressma smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature ofthe notary public must match. the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or aitached to a t ifferentdocument. 4 .Indicate title or type of attached document, number of pages and date. Indicate the capacity, "clahned.by the signer.".If the claimed capacity is a corporate officer; indicate the title (i.e.�CEO, CFO;: Secretary). • Securely attach this document to the signed document with a staple. * OLD REPUBLIC SURETY COMPANY ** * ** POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and appoint: BROOKE LAFRENZ, MICHAEL W THOMAS, GLADYS ROGERS, AUDREY RODRIGUEZ. LARRY D COGDILL, OF SAN DIEGO, CA its true and lawful Attomey(s) -in -Fact, with full power and authority, not exceeding $50,000,000, for and on behalf of the company as surety, to execute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than hail bonds, bank depository bonds, mortgage deficiency, bonds, mortgage guaranty bonds guarantees of installment ppaaper and note guaranty bonds, self- insurance workers compensation bonds gasommeurg payment of benefits, asbestos abatement contract fronds, waste management bonds, hazardous waste remediation bonds or black lung bonds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TEN MILLION DOLLARS ($10,000,000) ------ - - - - -- FOR ANY SINGLE OBLIGATION and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This document is not valid unless printedon colored background and is multi - colored. This appointment is made order and by mthori[ of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18, 1982. RESOLVED that, the president, any vice - president, or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint attomeys -in- fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may remove any such attomey -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attorney -in -fact or agent; or (iii) when duly executed and sealed (if a seal be required) by one or mom attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the company to such person or persons. RESOLVED FURTHER, that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 25TH day of APRIL. 2018. OLD REPUBLIC SURETY COMPANY iuy . t 7-Z A .M S6 %� SEAL STATE OF WISCONSIN, COUNTY OF WAUKESHA -SS "�s.,,,w"' ' President On this 25TH day of APRIL, 2018 , personally came before me, Alan Pavlic and Jane a nicy to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly swom, did severally depose and say; that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. Notary Public My commission expires: 9/28/2018 CERTIFICATE (Expiration of notary commission don not Invalidate this Instrument) 1, the orders igned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. 74-0051 0�131 w Signed and sealed a[ the City of Brookfield, WI dtis� day of u�r�' xausuni (j/J' VENBROOK INSURANCE SERVICES CALIFORNIA ALL- PURPOSE ACKNOWLEDGMENT CIVIL 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 Lo S a.),,-,/ -t,*r- On �CuV,201f befor eme, f) )a T &1�12, /n tArf ablic- 4Date Here Insert Name and Title of the Officer personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s� whose names is /ar4Q subscribed to the within instrument and acknowledged to me that he /sh@/ hey executed the same in his/herlMeir authorized capacity(ies), and that by his/her/tReir signatures} on the instrument the person(sk or the entity upon behalf of which the person(s)t acted, executed the instrument. PAT BOLDE £ F; COMM 7!2136660 b Notary Public - California ORANGECOUNTY My Commisw E piles hn.9, 2010 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 4�& & C&, Signature of Notary 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 — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1- 800 - 876 -6827) Item #5907 Bond No. y5 NN2532261 pond Premium included in Performance Bond PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,bas awarded to Pavewest Incorporated ( "Principal'), a contract (the "Contract ") for.the work described as follows: Old Ranch Road Pavement.Rehabilitation Proiect CIP No, ST 1703 WHEREAS, Principal is required under.the terms'of ttte Contract and the California Civil Code to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law. NOW, THEREFORE, we, the (Name CA ( "Surety ") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Fifty -Four Thousand One Hundred Seventy Eight and 25/ 100ths--------------------------------- - - - - -- _ Dollars (S 54,178.25 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 Contracts 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 vyill, pay for the same in an amount not exceeding the penal sum specified in this bond; otherwise, this obligation shall'becomenull and void. This bond shall insure to the benefit of anyof,the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or theirassigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety fivther- 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 worklto be perforated thereunder, or the specifications.for the same, shall in any way affect its obligations under this bond, and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of Califnmia Civil Code §§ 2845 and 2849. Page D -50 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,corpomte party being hereto affixed and these presents duly signed by its undersigned representative(s) pursuant to authority of its governing body. Dated: May 22, 2018 "Principal" By: It "Surety" Old Rep�rk u e Co pang _ . By: Glad, Rogers, Attorney -in -fact - - - By. Its By: Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. Page D -51 ALL- PURPOSE CERTIFICATE OF:ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the'documen( to which this certificate is'attached, and not the truthfulness; accuracy, or validity of that document. State of California } County of San Diego On 22 May 2018 before me, Audrey Rodriguez, Notary Public (Here .insert name and raget the o cer personally appeared, Gladys Rogers who proved to me on the basis of satisfacto.ry,evidence 1b be the person(s) whose name(s),is /are subscribed to the.rwithin' instrument and acknowledged to me1hat he /she /they executed the same in his/her /their,authorized capacity(ies)r!and that by his /her /their signature(s) on the, instrument; he person(s), or the entity upon behalf.of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJLIRY-under the laws of the State of California that the foregoing paragraph is ti`ueaand corfect: AUUREY RODRIGUEZ Commission # 2079335 ' WITNESS my' nd and official seal. Z Notary Public - California z A ' San Diego County I 7/I1` My Comm. Expires Sep 2, 2018 Notary. Public. nature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COWLETINGTHIS.FORM ... .. _... - ._- Thisform complies with cwr,errt'Cabfarma.rtarmes regarding notary wording and. DESCRIPTION OF THE ATTACHEUbdGWENT 'ifneeded, sliou ldbecompletedmrd'Niachedtoti documem.'Acbtolwedgentsfrom other states may becompleted for documents baing seat to that state so long as the wording does fiat require the Catiforma notary to violate California notary law. (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date CAPACITY CLAIMED BY THEiSIGNER ❑ Individual (s) ❑ Corporate Officer le ❑ Partner(s) ® Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version www.NotaryClasses.com.800 -873 =9865 7 .State end County tnfoonation must be'We State and County the. document signcr(s) personally appeared before the notary public for acknowledgment. • Dale of notarization must be The chic that the signer(s),personallyappeared which must also be the same date the acknowlMgment is completed. • 'Tbe notary public- must.print:his: or, her. name as it appeals within his or her commissienfollowed by a comma and than your title motarypublic).. Print the name(s)' o$.documenC "signer(s). who'personally appear at the time of no[arieation:. • Indica[e•ihe correct singular or plural forms by crossing off incotrect1onns (i.e. he/shv *ve - -is tars) or circling the connect forms: Failure lo_correctly indicate this information mayr 6ci to rejection "of document recording: _ _ • Ilia notary seal ;impression must be cle_ -_ ar. and photographically repiedudbie. Impression must not-cover text or 1mes,If'seal; impression smu lges; re -scal if a sufficient area permits, otherwise complete a differenPacknowledgment form. 'Signature of the notary public musi mstch.die signature on file with the office of the county clerk'. Additional information is not required but could .help to ensure this acknowledgment is not misused'oratlached in a different' document. :Indicate title or type of attached document, number of pages and date. Indicate'the capacity claimed by the sigdcrrlf.the claimed rapacity is a corporate officer, nidicate'the title (i.e!CEO, CFO,- Seixetary). • Securelyattadi thissdocumenito the signed documentwith a staple: # * OLD REPUBLIC SURETY COMPANY ** * *# POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and appoint: BROOKE LAFRENZ, MICHAEL W THOMAS. GLADYS ROGERS, AUDREY RODRIGUEZ, LARRY D COGDIU, OF SAN DIEGO, CA its true and lawful Attomey(s )-in -Fact, with full power and authority, not exceeding 550,000,000, for and on behalf of the company as surety, to execute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than bail bonds, bank dory bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self- insurance workers compensation guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds, hazardous waste remediation bonds or black lung bonds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED TEN MILLION DOLLARS ($10,000,000) - - - - - - -- FOR ANY SINGLE OBLIGATION and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This document is not valid unless printedon colored background and is multicolored. This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18, 1982. RESOLVED that, the president, any vice- president, or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary; or (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attorney -in -fact or agent; or (iii) when duty executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the company to such person or persons. RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company; and such signature and seal when so used shall have the more tome and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 25TH day of APRIL. 2018. OLD REPUBLIC SURETY COMPANY Ayseeax Beta' SEALr^ STATE OF WISCONSIN, COUNTY OF WAUKESHA -SS . ..... President On this 25TH day of APRIL, 2018 , personally came before me, Alan Pavlic and I ane emEC� eY , to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly swom, did severally depose and say; that they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. A Notary Public My commission expires: 9/28/2018 CERTIFICATE (Expiration of notary commission does not Invalidate this Instrument) 1, the undersigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. 74 -0051 Signed and sealed at the City of Brookfield, W I this 9�7nrl day of _. May f $ SEAL S 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 n ) Countyof COS /- +rlGtloj ) /� ) On Cuw2�, I before me, P-Al &lOL %!DfA-YUTLL1IC Date Here Insert Name and itle of the Officer personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personN whose named isllaro subscribed to the within instrument and acknowledged to me that he/Shelthey executed the same in his/her /their authorized capacity(ibm) nd that by his /her /ttteicsignature(s } on the instrument the person(s), or the entity upon behalf of which the person(s),acted, executed the instrument. PAT 1301-DE a� eg »....««.... x,1a,�} ,_. COMM 12136660 n n ttia 'I Notary Public Calrfornia ¢ FP ORANGE COUNTY My Commissw F Pare 1m 9 1020 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 C & Signature of Notary 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 — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Other: Signer Is ❑ Guardian or Conservator Representing: V<'V ' V<'V ' Exhibit C Ac"R& CERTIFICATE OF LIABILITY INSURANCE L i DATE (MM /DL)NYYY) 5/22/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGRATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Towers Watson CONTACT NAME: Ontario _ 12980 Metcalf Ave Suite 500 PHONE (A/C, No Ext): (909)28Z-7540 FAX (A/C, NO): (360) 828 -0699 Overland Park KS 66213 EMAIL ADDRESS: Angela.Scott@ cott @bbsihq.com wide INSURERS) AFFORDING COVERAGE NAIC # (MMIDDIYYYY) INSURER A: ACE American Insurance Company 22667 INSURED INSURER Barrett Business Services, Inc. LICIF INSURER C PAVEWEST, INC. INSURER D. I LL 11700 166th STREET INSURER E. ARTESIA, CA 90701 INSURER 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUES OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADEL BUBB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR wide (MMIDDIYYYY) (MMIDDIVYVV) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occureaw) $ COMMERCIAL GENERAL LIABILITY ClAIM9MADE ❑OCCUR MED EXP(Anyoneperson) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE 5 GERL AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AUG $ POLICY PROD- LOG $ ECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT E. accident) $ ALL OWNED AUTOS AUTOS BODILY INJURY (Per person) $ BSCHEDULEO HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE It DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 11/01/17 11/01/2018 �/ WCSTATU- OTH LIABILITY YIN C6446278A TORY LIMITS ER E. L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/PARTNERI EXECUTIVE Y OFFICERIMEMBER EXCLUDED? N/A X Covered Stales: E.L. DISEASE - EA EMPLOYEE $2,000.000 tory in NH( If yes, describe under DESCRIPTION OF OPERATIONS below CA E.L. DISEASE - POLICY LIMIT $2,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ADDED 101, Additional Remarks Schedule, it more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SEAL BEACH EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 211 8TH STREET AUTHORIZED REPRESENTATIVE SEAL BEACH CA 90740 Authorized 03., AS /r/L Rep c) 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: A ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED: Barrett Business Services, Inc. L /C /F Lockton Affinity PAVEWEST, INC. POLICY NUMBER 11700 166th STREET ARTESIA, CA 90701 RWC C6440278A CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 11/01/17 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: CITY OF SEAL BEACH ADDRESS: 211 8TH STREET SEAL BEACH CA 90740 OLD RANCH ROAD PAVEMENT REHABILITATION PROJECT CIP NO. ST1703 ACORD 101 (2008/01) a) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC. L /C /F j PAVEWEST, INC. Policy Number 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Symbol: RWC Number: C6440278A Policy Period Effective Date of Endorsement 11 -01 -2017 TO 11 -01 -2018 11 -01 -2017 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy . CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $ 0 Authorized Agent WORKER'S COMPENSATION CERTIFICATE OF INSURANCE. WHEREAS, the CITY OF SEAL BEACH has required certain insurance to be provided by NOW TIIEREFORE, the undersigned'uisurance company does hereby certify that it has issued the policy or policies described below to ttre following named insureds and that lire same are in force at this time. I. This certificate is issued to: CITY OF SEAL BEACH, City Hall, 211 EIGHTH STREET, SEAL BEACH, CA 90740 -6379. 2. The insureds under such policy or policies are: �/n i 2--ut� 3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of California covering all operations of the named insureds, as follows: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE C,61Atio2�8PA I � w \ I k�I i Il0 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the CITY OF SEAL BEACH. By _3�, AS Its Authorized Representative Page D -53 1 WORKER'S COMPENSATION CERTIFICATE OF INSURANCE. WHEREAS, the CITY OF SEAL BEACH has required certain insurance to be provided by NOW TIIEREFORE, the undersigned'uisurance company does hereby certify that it has issued the policy or policies described below to ttre following named insureds and that lire same are in force at this time. I. This certificate is issued to: CITY OF SEAL BEACH, City Hall, 211 EIGHTH STREET, SEAL BEACH, CA 90740 -6379. 2. The insureds under such policy or policies are: �/n i 2--ut� 3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of California covering all operations of the named insureds, as follows: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE C,61Atio2�8PA I � w \ I k�I i Il0 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the CITY OF SEAL BEACH. By _3�, AS Its Authorized Representative Page D -53 Exhibit D ACORLIr CERTIFICATE OF LIABILITY INSURANCE 111.1 DATE (MM DD YYYY) 5123/2018 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 policylies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Venbrook Insurance Services CA Lic OD80832 6320 Canoga Avenue, 12th Floor Woodland Hills, CA 91367 CONTACT PHONE FAX -EAM s EaU 818- 598 -8900 (mac Nm: 818 -598 -8910 ADDRESS: INSURERS AFFORDING COVERAGE NAIC0 ✓ INSURERA: Navigators Insurance Company 42307 vnvorvenbrook.com INSURED Pavewest, Inc. 11700 166th Street INSURERS: Watford Insurance COmpa_ny 25585 INSURERC: Scottsdale Insurance Company 41297 INSURER O: Hartford Fire Insurance Company 19682 Artesia CA 90701 INSURER E: INSURER F $50.000 ✓ COVERAGES CERTIFICATE NUMBER: 42047431 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AODL SUBR POLICY NUMBER MMUC YEFF XP MOUCYIYYYY LIMITS A ,/ COMMERCIAL GENERAL LIABILITY ✓ ✓ LA18CGL2129741C 2/17/2018 211712019 EACH OCCURRENCE $1000000 CLAIMS -MADE J OCCUR DAMAGE TO RENTED PREMISES Ea owvnence $50.000 ✓ MED EXP (Any one person) $ Excluded BI /PD Ded: $5,000 ✓ BFPD/XCU /Contractual PERSONAL B ADV INJURY $1000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICYZJEa FLOC PRODUCTS - COMPIOP AGO $2000000 $ OTHER: B AUTOMOBILEUABIUTY ✓ ✓ WIC1000461 -00 2/17/2018 2/17/2019 coM Ea adent B') LE LIMIT IN El I $1,000,000 BODILY INJURY (Per person) $ ✓ ANY AUTO BODILY INJURY (Bar acpdent) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED ✓ AUTOS ONLY ✓ AUTOS ONLY PROPERTYDAMAGE Per moident IS I$ C UMBRELLA LIAR ,/ OCCUR XLS0104140 2/1712018 2/17/2019 EACH OCCURRENCE $5000000 AGGREGATE $5000000 ✓ EXCESS LIAR CLAIMS -MADE OED I RETENTION$ Is WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR IEXECUTIVE /PARTNER STATUTE ER EA. EACH ACCIDENT $ OFFICERIMEMBEREXCLUDI NIA (Mandatory In NH) EL OISEASEEA EMPLOYEE 4 E.L. DISEASE - POLICY LIMIT $ It yes, desvlbe under DESCRIPTION OF OPERATIONS below D Contractors Equipment 72UUMJH5099 2/17/2018 2/17/2019 Limit $766,708 DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be abet had if more space is required) RE: Old Ranch Road Pavement Rehabilitation Project C I P No. ST 1703 " SEE ATTACHED ADDENDUM " CERTIFICATE HOLDER CANCELLATION City of Seal Beach 211 8th Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Seal Beach CA 90740 AUTHORIZED REPRESENTATIVE I (WH) April Johnson ©1968.2015 ACORD CORPORATION. All rights resery ed. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 42047431 1 18 -19 GS /AL /E% /Con[ Equip I OIK) Gabziela Covarrubias 1 5/33/2018 9:53:03 AN IPVPI I Page 1 of 8 AGENCY CUSTOMER ID: LOC #: ACIl ® ADDITIONAL REMARKS SCHEDULE Page of L AGENCY NAMED INSURED st I P117av B00 nc Venbrook Insurance Services CA Lic OD80832 1we 6th Street Artesia CA 90701 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Seal Beach ADDRESS: 211 8th Street Seal Beach CA 90740 RE: Old Ranch Road Pavement Rehabilitation Project CIP No. ST1703 City of Seal Beach, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of City officials are named as Additional Insured under the General Liability and Automobile Liability policy if required by written contract with the Named Insured but only for coverages and limits provided by the policy and the additional insured endorsement. Primary and Non - Contributory coverage applies to General Liability and Automobile Liability. Waiver of Subrogation applies to General Liability and Automobile Liability. -10 Days Notice of Cancellation for Non - Payment of Premium, 30 Days All Others ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 92097931 1 10 -19 GL/Al/EX/Cont equip 1 (wx) caerieia C.I rube.. 1 5/21 /2o1e 9:53:03 AN (P.T) I Page 2 oe 6 COMMERCIAL GENERAL LIABILITY Pavewest, Inc. CG 20 38 04 13 LA18CGL2129741C THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above we completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This Insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 42047431 I GGi2©L.3$,94c43 equip 1 iwH can_.eia cgAnSUMrICe2SeEViCO83 0ffi6e ;Plnc.l 2412 oc a Page 1 of 2 b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 42047431 ECG NL38,04CIa Equip I (wx) Gabrlela 0QJnsu5anceB)ewiceslOffiae�dnc.1 432 of 8 Page 2 of 2 Pavewest, Inc. COMMERCIAL GENERAL LIABILITY LA18CGL2129741C CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART 6Y9:1=111114=1 Name Of Person Or Organization: Any person or organization when you and such person or organization have agreed in writing in a contract or agreement that you will waive any right of recovery against such person or organization Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or ..your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 42047431 1 18 -19 GL /N. /EX /Con[ Equip I (WH) Gabriela Covarrubias 1 5/23/2015 9:53:03 AM (PDT) I Page 5 of 6 Pavewest, Inc. LA18CGL2129741C COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 9209]931 1 18 -19 GL /AL /E% /Con[ Equip I INE) Gabriela Cova—bias 1 5/23/2018 9:53:03 AM (PM) I Page 6 of 8 Page 1 of 1 Pavewest, Inc. WIC1000461 -00 THIS ENDORSEMENT CHANGES THE POLICY — PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT PRIMARY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to SECTION II — LIABILITY COVERAGE only, Who is An Insured is amended to include as an Additional Insured any person(s) or organization(s) whom you are required to add to this policy as an Additional Insured under a written agreement in effect or becoming effective during the policy period. This insurance applies only to "bodily injury" and "property damage' that occurs subsequent to execution of the written agreement and subsequent to the issuance of a certificate of insurance indicating such person(s) or organization(s) as Additional Insured(s). The insurance provided hereby to the Additional Insured(s) is limited as follows: 1. The coverage afforded hereby to such Additional Insured is limited to imputed liability specifically resulting from the conduct of the Named Insured for which the Additional Insured was held liable. 2. The limits of insurance applicable to the insurance afforded hereby are those specified in the written agreement or in the Declarations or Schedules of this policy, whichever is less. The limits of insurance applicable to the insurance afforded hereby are not inclusive and not in addition to the limits of insurance shown in the Declarations or Schedules of this policy. 3. Any coverage provided under this endorsement for any Additional Insured will never be broader than coverage provided to any Named Insured. Any other policy terms, conditions, limitations, exclusions, and definitions apply to this endorsement WIC AUTO CW 0013 (10/17) "Includes copyrighted material of Insurance services Office, Inc. with its permission" Page 1 of 1 42047931 1 1e -19 GL /AL /ix /cone equip I (W ) eabriela cevorrubias 1 5/23/2016 9:53:03 M (POT) I Page 7 of 9 Pavewest, Inc. WIC1000461 -00 THIS ENDORSEMENT CHANGES THE POLICY — PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM We agree to waive any and all subrogation claims or rights of recovery against any person(s) or organization(s) if there is an executed written agreement with that person(s) or organization(s) which requires a Waiver of Subrogation Clause from the Named Insured, except for "losses" which are due in whole or part to the negligence or errors and omissions of such person(s) or organization(s). All other terms and conditions of the policy remain unchanged. WIC AUTO CW 0014 (10/17) "Includes copyrighted material of Insurance Services Office, Inc. with its permission" Page 1 of 1 42047431 1 16 -19 GL /AL /5x /cont equip I ( �H) Ga rlela covarrveiae 1 s /z] /zme 9:1]:03 . (PiXr) I Pate 6 of 8 Exhibit E STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS [Business & Professions Code § 7028.15] [Public Contract Code § 20103.5] I, the undersigned, certify that I am aware of the following provisions of California law and that 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 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 work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months, or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract" for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect, land surveyor, or registered professional engineer to form joint ventures with licensed contractors to render services within the scope of their respective practices. (e) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non - responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order, verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13, inclusive. Any contract awarded to, or any purchase order issued to, a contractor who is not licensed pursuant to this chapter is void. (f) Any compliance or noncompliance with subdivision (e) of this section, as added by Chapter 863 of the Statutes of 1989, shall not invalidate any contract or bid awarded by a public agency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if the public employee, officer, or employing agency made an inquiry to the board for the purposes of verifying the license status of any person or contractor and the board failed to respond to the inquiry within Page D -62 three business days. For purposes of this section, a telephone response by the board shall be deemed sufficient. Public Contract Code § 20103.5: In all contracts subject to this part where federal funds are involved, no bid submitted shall be invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However, at the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material under any contract shall not be made unless and until the Registrar of Contractors verifies to the agency that the records of the Contractors' State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law, including, but not limited to, any appropriate disciplinary action by the Contractors' State License Board. The agency shall include a statement to that effect in the standard form of pre - qualification questionnaire and financial statement. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. License No.: g (2g () (4 C) Class: a Expiration Date: 12 —3 1 — I R Date: 5-22-11 M M.T of A tJ (U,S IGAA -y Page D -63 Exhibit F AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS [Labor Code §§ 1720, 1771, 1773.8, 1774, 1775, 1776, 1777.5, 1813, 1815, 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 law. 3. Contractor agrees to comply with the provisions of California Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the Agency, forfeit not more than fifty dollars ($50) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the Director of Industrial Relations for the work or craft in which the worker is employed for any public work done under the contract by Contractor or by any subcontractor. 4. Contractor agrees to comply with the provisions of California Labor Code Section 1776 which require Contractor and each subcontractor to (1) keep accurate payroll records, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the Agency of the location of the records. The Contractor is responsible for compliance with Section 1776 by itself and all of its subcontractors. 5. Contractor agrees to comply with the provisions of California Labor Code Section 1777.5 concerning the employment of apprentices on public works projects, and further agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of California Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the Agency, forfeit twenty -five dollars ($25) for each worker employed in the execution of the contract by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than 8 hours in any one calendar day and 40 hours in any one calendar week in violation of the provisions of Division 2, Part 7, Chapter 1, Article 3 of the California Labor Code. 7. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861, Contractor hereby certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self - insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract." Date ,j4 Signa[ur Page D -65 Exhibit G Section C PROPOSAL Bidders Name ['rvhul & &�T . kmc TO THE HONORABLE MAYOR AND CITY COUNCIL OF THE CITY OF SEAL BEACH The undersigned, as bidder, declares that: (I) -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 idder's Bond 'n the form furnished by the City", as the case may be) in the amount of $ fib, CY.) - , an amount equal to at least ten percent (10 %) of the total aggregate bid price based on the quantities shown and the unit prices quoted. The undersigned bidder agrees that should bidder be awarded the Contract on the basis hereof and thereafter fail or refuse to enter into a Contract and provide the required evidence of insurance and bonds within 15 calendar days after written notice of the award, the cash, check or bond shall be forfeited to the city in accordance with Public Contract Code section - 20172, except as otherwise provided in Public Contract Code section - 20174. The undersigned agrees that in the event of such failure, the actual amount of damages to the City would be impractical and extremely difficult to determine. In compliance with the Notice Inviting Sealed Bids, the undersigned hereby agrees to enter into a contract to furnish all labor, materials and supplies for 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 10 WORKING DAYS starting from the day after the issuance of the Notice to Proceed. Page C -I OLD RANCH ROAD PAVEMENT REHABILITATION CIP No. ST1703 BID SHEET Item Description Unit Quantity Unit Price Extended Price No. (in Figures) (in Figures) Mobilization and Demobilization; including but not limited to: 1. cleanup and placement of construction period BMP's, LS 1 X00 l' f $ b�J� obtaining a Caltrans Permit complete and in place. Traffic Control; including but not 2' limited to: preparing a traffic control plan, provide two changeable message boards, LS 1 $ 11! J �y $ W 5 provide and maintain traffic control, complete and in place. 3. Cold Mill; perform 2" cold mill of existing A.C. pavement, complete and in place. SF 18,000 $ 3 U Asphalt Concrete (A.C.); furnish 4. and install pavement leveling course (PG 64 -10); complete and TON 275 1 z $1 in place. 5 Striping; furnish and install striping, pavement markings and markers, complete and in place. LS 1 � $ ; t S() c3 6. Adjust to Grade; adjust existing utility manhole to finish grade, complete and in place. EA 4 $ l giC.o $6(00o 7. Adjust to Grade; adjust existing utility valve covers to finish grade, complete and in place. EA 3 nl;( $ 190.0 TOTAL BID PRICE (ITEMS NO. 1 THROUGH 7) WOR r'e,-, -f604 FIGURES IN CASE OF DISCREPANCY BETWEEN WORDS AND FIGURES, THE WORDS SHALL PREVAIL. Page C -2 NOTE: The City reserves the right to award a contract to the lowest responsible bidder in parts or in its entirety and reserves the right to reject all bids and re- advertise, as appears to be in the best interests of the City. A bid is required for this entire work, the estimated quantities set forth in this Bid Sheet being solely for the purpose of comparing bids, and final compensation under the Contract will be based upon the actual quantities of work satisfactorily completed. The unit and/or lump sum prices bid shall include all appurtenant expenses, taxes, royalties, and fees. In the case of discrepancies in the amount bid, unit prices shall govern over extended amounts, and words shall govern over figures. The City reserves the right to increase or decrease the amount of any quantity shown and to delete any item from the Contract. The undersigned bidder agrees that, if awarded the Contract, bidder will complete all work according to the contract documents. The undersigned bidder is licensed in accordance with the requirements of the Business and Professions Code, California Contractor's License No.- :0gL1F'Otic( Class '. &.*V. csq (REQUIRED AT TIME OF AWARD). Signature Date Signature Date If bidder is an individual, name and signature of individual must be provided, and, if he is doing business under a fictitious name, the fictitious name must be set forth. If bidder is a partnership or joint venture, legal name of partnership /joint venture must be provided, followed by signatures of all of the partners /joint venturers or of fewer than all of the partners /joint venturers if submitted with evidence of authority to act on behalf of the partnership /joint venture. If bidder is a corporation, legal name of corporation must be provided, followed by signatures of the corporation President or Vice President and Secretary or Assistant Secretary, and the corporate seal. Signatures of partners, joint venturers, or corporation officers must be acknowledged before a Notary Public, who must certify that such partners, joint venturers, or officers are known to him or her to be such, and, in the case of a corporation, that such corporation executed the instrument pursuant to its bylaws or a resolution of its Board of Directors. Page C -3 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: �A1 'y 9 Bus iness Add ress: � I'--? o ) /(tpq �i TL% Tij,kl�Y• -qo/ t-i I Telephone and Fax Number: SG"Z- 16q- 3i 13 6---V % 76Z qG3 4-0,4 1 i. California State Contractor's License No. and Class: -A 51L VO4C `i � �;,..• (REQUIRED AT TIME OF AWARD) Original Date Issued: Expiration Date: lei 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: 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 D�+�a 7V- l/ (SCi-3! /3 Corporation organized under the laws of the State of��..": %vid$ The dates of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal are as follows: Page C -4 All current and prior D.B.A.'s, aliases, and fictitious business names for any principal having interest in this proposal are as follows: T 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: Provid the names, ad % dresses and telephone numbers of the parties; Briefly summarize the parties' claims and defenses; NIA State the tribunal (i.e., Superior Court, American Arbitration Association, etc.) the matter number and outcome. Have you ever had a contract terminated by the owner /agency? If so, explain. tji7 Have you ever failed to complete a project? If so, explain. 1�i 0 Have you ever been terminated for cause and then had it converted to a "termination of convenience "? If so, explain. NJ 0 For any projects you have been involved with in the last 5 years did you have any claims or actions: Circle One 1. By s / you a ainst the owner? Ye 2. By the owner against you? Yes No Page C -5 3. By any outside agency or individual for labor compliance (i.e. failure to pay prevailing wage, falsifyin certified payrolls, etc..) 4. Yes No 5. By Subcontractors (Stop Notices, etc.) Yes /I loo 6. Are any claims or actions unresolved or outstanding? Yes No . If yes to any of the above, explain. (Attach additional sheets, if necessary) Failure of the bidder to provide ALL requested information in a complete and accurate manner may be considered non - responsive. Subscribed and sworn to before me By �yJ�} v- This 25k, , day of /� d y_J_� , 20 16 (print name of Ow(ier or 1 Pr t of Corporation/Company) ChP 12tACt 1 (Signature of Notary Rep lic) ignature) (Title (SEAL) 4-2 (Date) (Signature of Secretary of Corporation) Page C -6 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 cra _ —'z— "- •r-r" ,,-�— �. �'c� -rte a�ao� �- �.�a��ao- .=r:�s See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1 -6 to be completed only by document signer[s], not Notary) -- - -- - - - - - -- -- - - - - -- - - - - -- — - -- ------- - - - - -- 3 - - - - - - - - - - - - - - -------- - - - - --- - - - - - - - Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 WS nna�l PAT BOLDS COMM N2736660 n No Public -California- OR S ORANGE COUNTY iYaty�s My Commission Exµres lzrt 9,2 Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 25 f'1-^ day of /-\p r,1 20 /9 , by Date Month Year (1) y (and (2) � ), Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature `�. 'IC7v Signature of Notary 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: Signer(s) Other Than Named Above: Document Date: 02014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1- 800 - 876 -6827) Item #5910 REFERENCES: Contractor must use this formlll Please print or type. Bidders Name Pmrtu,>zti'T 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: 1 _ ProjectName/Number RVK BIFACh (7/}r/^ LC)'i Project Description dfkftn P /M1 I1 Lit -r_-v /� / G - i✓+i>I IDoyki'+1'%76LAS Approximate Construction Dates From to ��!-7 — / ?7 / 7 Agency Name Contact Person 11,12 - Telephone (zip() ��C- •-j S'M Original Contract Amount $ f / 2_ (yt7 , /!j Final Contract Amount $ // Z. ew . /s7 If final amount is different from original, please explain (change orders, extra work, etc.) Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. 2 ProjectName/Number I/A101Cc ] GchZnt 6 CA Project Description w Approximate Construction Dates From A - to 24/f, Agency Name Lon, 3%?aa Gam. }'Fs'igJ �L) x %�- t%tSr -1T Contact Person Telephone (s=) i'r' 7 -7750 K /ti'S-f Original Contract Amount $ i 77, 2E`), -JO Final Contract Amount $ 177, 24-'7, QV If final amount is different from original, please explain (change orders, extra work, etc.) Page C -7 Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. 3 Project Name/Number KF FIE (P, F L5i16'?*i -e Project Description 4 Approximate Construction Dates From (2 -f! "7v to i 1'2-0 rf Agency Name Lc-. JJCla a,,L/Z'1jQAD Contact Person ScG —CY' /-i Telephone (4W (; 2 Z - -7"740 Original Contract Amount $ Z72 Final Contract Amount $ Z72� q4", 3_ r e, If final amount is different from original, please explain (change orders, extra work, etc.) Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. 4 Project Name/Number TA4A (3cY(3�v /A - Project Description AA4 jLA- 5 k%- %�/��%+i G- L'vt.!• °a'I/L `%7cN �"k!•)c(/ Approximate Construction Dates From '- / '- to 5 f/ ? J Agency Name (/G G, f`rcKl:�IyL�c�� %mot! Contact Person /—.-7- Telephone (q b C - `% �F) Original Contract Amount $ . ��7 L Final Contract Amount $ If final amount is different from original, please explain (change orders, extra work, etc.) Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. Page C -8 Project Name/Number 1•AAW,'I. 14 rtxl 6,4, ' A,6 611[S,;410 Project Description Ab�w_l ,_ t' fi y fi� r t u �t� ri :51 Approximate Construction Dates From to t Agency Name Contact Person t% rr� (n//}r`j— aLl Telephone (J Z% i Original Contract Amount $ / i 117?1L Final Contract Amount $ / r % /Y1I' c If final amount is different from original, please explain (change orders, extra work, etc.) Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. Project Name/Number j �%� ^�Q i—A'lGv•••�' /i'IAGZ - S :6'1+yKJ' �_t�`L� Project Description Approximate Construction Dates From to - zcwz' Agency Name Contact Person `'��cL5' -/:1LL Telephone ( i4SW9E'3 - -0 &0 Original Contract Amount $2-,"3 i % "L Final Contract Amount $ 2r .3,4AI L If final amount is different from original, please explain (change orders, extra work, etc.) Did you file any claims against the Agency? Did the Agency file any claims against you/Contractor? If yes, briefly explain and indicate outcome of claims. Page C -9 Attach additional sheets if necessary. Attach to this Bid the experience resume of the person who will be designated as General Construction Superintendent or on -site Construction Manager for the Contractor. Upon request, the Contractor shall attach a financial statement and other information sufficiently comprehensive to permit an appraisal of the Contractor's current financial conditions. Page C -10 KEY PERSONNEL Mr. Mangan has over 23 years' experience in commercial construction and site improvement. As a licensed General Contractor and Field Superintendent he is proficient in all facets of cost estimating, structural concrete, grading, paving and equipment maintenance. He has recently completed major projects such as the Simi Valley Town Center for Whiting Turner, The Victoria Gardens Mall in Rancho Cucamonga for VCC Construction, Super Wal -Mart Center in Calexico, California and many more projects of this scale. In addition, he oversees the construction of smaller, ongoing projects, with the help of his dispatch and construction foremen and project managers. Mr. English has over 20 years' experience in commercial construction and site improvement. As a Field Superintendent he is proficient in all facets of cost grading and paving. He has the ability to always complete the project on schedule and maintain an excellent relationship with all other contractors and code jurisdiction agencies to ensure the successful completion of the project. DESIGNATION OF SURETIES Bidder's name P&1Zajiils1 3VILt V- 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): ►�- .iL'�' � 1 � 5�&�1 /�.- r'w6�ily =eL S i•T� 1 > c� �C'`�c'• �7G�1 -T�i�? ni � �� �['< Si +2 =r�r' Cc�► Iti7 ?p+z6 SL,., 46, F aicz rirztic - u tzGg C(C<< 36*7 -2c/5- Page C -11 ACKNOWLEDGEMENT OF ADDENDA Bidder's nameIZ�i.'fLS'i The bidder shall signify receipt of all Addenda here, if any: Addendum No. Date Received Signature It shall be the sole responsibility of the Contractor to acknowledge all addendums on the project. If the Contractor acquired the bid package from an online plan room the City recommends checking with the Public Works Department for addendums prior to the bid opening date. Page C -12 CONTRACTOR'S INDUSTRIAL SAFETY RECORD TO ACCOMPANY PROPOSAL Bidder's Name ?A,4z-k 1i��1 Sruc Record Last Five (5) Full Years Current Year of Record The information required for these items is the same as required for columns 3 to 6, Code 10, Occupational Injuries, Summary-- Occupational Injuries and Illnesses, OSHA No. 102. Legal Business Name of Bidder ji,4'ak" � jj 7A CL Business Address: j p• yClo I �'j� StYi�n"T/�!i�;/J�l.'1 c9 Business Tel. No.: Z [ _ g,� j State Contractors License No. and Classification: 96 ,041q Title G'f P,')3L %L• U_L4 1 The above information was compiled from the records that are available to me at this time and I declare under penalty of neriy • tI+y aUhe 9afi,3F 7,#on is true and accurate-within the limitations of those records. Signature of bidder Date Title Signature of bidder Date Title Signature of bidder Date Title Signature of bidder Date Title Page C -13 Current 2 2 2 2 2 Year of o 0 0 0 0 Total Year Record 7 6 5 4 3 No. of contracts I43 5ZY 5° 1 370 36$ ,3Q0 a I q Total dollar (,.3 11 I I I7 17- Amount of Contracts (in n1L MIL HIL ml MIL MIL Htt_ Thousands of $) No. of fatalities d b O O O U O No. of lost Workday 0 / V U O O 1 Cases No. of lost workday cases involving permanent transfer to O O O O O O D another job or termination of employment The information required for these items is the same as required for columns 3 to 6, Code 10, Occupational Injuries, Summary-- Occupational Injuries and Illnesses, OSHA No. 102. Legal Business Name of Bidder ji,4'ak" � jj 7A CL Business Address: j p• yClo I �'j� StYi�n"T/�!i�;/J�l.'1 c9 Business Tel. No.: Z [ _ g,� j State Contractors License No. and Classification: 96 ,041q Title G'f P,')3L %L• U_L4 1 The above information was compiled from the records that are available to me at this time and I declare under penalty of neriy • tI+y aUhe 9afi,3F 7,#on is true and accurate-within the limitations of those records. Signature of bidder Date Title Signature of bidder Date Title Signature of bidder Date Title Signature of bidder Date Title Page C -13 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 -14 NON- COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California )SS. County of , being first duly sworn, deposes and says that he or she is of 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. Lk-i� (af'rw4 h >2:��•�c( - l h1 3iZ.<7ixT /�*ty l � i'i� ifi�t Si � 7v 3 Project Name: Address 1 ttte Signature Date: Subscribed and Sworn to before me on (Notary Seal) Page C -15 Signature 6x4— 4+6/1 U .� Notary Public CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1 -6 to be completed only by document signer[s], not Notary) 5 Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) 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 LUS 110 c� PAT BOLDE 1 wCOMM #2136660 n Notary C-California9 ORANGE COUNTY MyCommkswn Expires Jan. 9, ]OtO� Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this of S day of a I prj'( 20 f y by Date Month Year (1) DonAl of M M g a. — (and (2) ). Name(s) of Signers) proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature - Signature of Notary 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: Document Date: Number of Pages: Signer(s) Other Than Named Above: ©2014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1 -800- 876 -6827) Item #5910 LIST OF SUBCONTRACTORS TO ACCOMPANY PROPOSAL In compliance with the provisions of Public Contract Code Section -4104, the undersigned bidder submitting this bid proposal sets forth the name, place of business and the portion of the work to be performed by: (I) -each subcontractor who will perform work or labor or render service to the bidder (as general Contractor) in or about the construction of the work or improvement; and (2) -each subcontractor licensed by the State of California who, under subcontract to the bidder, specially fabricates and installs a portion of the work or improvement according to detailed drawings contained in the plans and specifications, in an amount in excess of one -half of one percent of the bidder's total bid or, in the case of bids or offers for the construction of streets, highways or bridges, in excess of one -half of one percent of the bidder's total bid or ten thousand dollars ($10,000), whichever is greater. Subcontractor's Name, Address, Telephone # Bid Item Number Percent Of Total Bid Description of Work Percent of Total Bid Page C -16 Bond No. Bond Premium BID BOND TO ACCOMPANY PROPOSAL KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach, has issued an invitation for bids for the work described as follows: Old Ranch Road Pavement Rehabilitation Project CIP No. ST1703 tom: (Name and address of Bidder) ( "Principal "), desires to submit a bid to Public Agency for the work. WHEREAS, bidders are required under the provisions of the California Public Contract Code to furnish a form of bidder's security with their bid. NOW, THEREFORE, we, the undersigned Principal, and (Name and address of Surety) ( "Surety") a duly admitted surety insurer under the laws of the State of Califomia, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Dollars ($ ), 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 § 2845. Page C -17 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: "Principal" By: Its By: Its (Seal) Surety" (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attomey -in -fact must be attached. Page C -18 By: By: Its Its (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attomey -in -fact must be attached. Page C -18 Bond No. NIA Bond Premium NIA 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: Old Ranch Road Pavement Rehabilitation Project CIP No ST1703: Bid Date: April 26, 2018 Pavewest Incorporated (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 famish a form of bidder's security with their bid. NOW, THEREFORE, we, the undersigned Principal, and Old Republic Surety Compan (Name and address of Surety) ( "Surety') a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Ten Percent of the total amount of the bid------- - - - - -- Dollars ($ 10% of the total amount of the bid--- - - - - -- }, 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 § 2845. Page C -17 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: April 25, 2018 "Principal" Pavewest Incorporated By "? } By: h (Seal) Surety" Old Republic Surety Company J& Rick Rehrer, Attorney -in -fact M 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 -18 ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies oniy the identity of the individual who signed the document to which this certficate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Bernardino } On 4/25/2018 before me, Tina Downey Notary Public ere lose name an a e o t e o ¢er personally appeared Rick Rehrer 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. TINA DOWNEV Notary Public - California WITNESS my hand and official seal. Le San Bernardino county Commission N 2219731 M Comm. Ea fires Now 21, 2021 (Notary Public Seal) :)N OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages _ Document Date - CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) E3 Attorney -in -Fact ❑ Trustee(s) ❑ Other 2015 Version Mw NotaryClasses. cum 800- 873 -9865 INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document. Acknolu edgents from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. • State and County information must be the Stale and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. helshe/theyr Is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. . Indicate title or type of attached document, number of pages and date. • Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. a s AV & L 9 pig ' s .. ya S, d• c \. OL` b °REPUBLIC SURETYrCOMPVNY ' x a �° 'k A r POWER OF`ATTORNEI agl x s 93 ,' ao That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock uisurance corporation does make constitute and s = �' KNOW ALL MEMBY>THESE PRESENTS appoint: ' "RICK REHRER, OF CHINO, CA - s s ,, xi ' a r , ._ � a i m ,aa x � '• � � L � f � � o- ., .?, sc 6 �' <d °a „-: its tnie and lawfm Attomey(s) -in -Fact, with full power and au[honTy, not ezceedmg $50 000;000 for and behalf of the company as surety, to execute and deliver "'. and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than bail ...bonds, bank depository bonds, mortgage deficiency bonds, mortgage;guaranty bonds, guarantees of installment gaper and note guaranty bonds self-insurance workers abaierri' bonds,Hwaste.managemcnt onds haz rdous watitzremedtatmn bgndsaor black lung ento nsaron'honds�guam�nteeim; payment of�benne benefits, asbestos C nuact r abonds), as follows; „' AN AMOUNT NOT TO EXCEED ...� , CALL WRITTEN INSTRUMENTS IN FIFTY MILLION DOLLARS ($50 000 000) -------------------- - - - --- FOR ANY SINGLE OBLIGATION F 6 `� 3a'•� [ 9 k €*n4Q+. e *a "$ F Ed'.. 4E v and to bind OLD'REPUBLIC SURETY COMPANY thereby,;and all of the acts of said Attorneys m Fact, pursuant to these presents, are ratified and confirmed a�' document is= not valid unless prinledoi' colored backgrom(i and is multi color ed This appomtinent is made undegand by authority of the board of directors at`a`speciafnnecting held'on February 18,1' 1982. This Power of Attorney is signed and sealed -by facsimile -under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18, 1982. a "RESOLVED ilia[ the president any vice president, m assistant vice president m conlunchon wuh [he secretary or any assistant secretary,•may appoint ttomeyg m'- factor agents with auttionty as= defined or hint tad m the instrument eviden`ang the appototment m eachcase, for and on behalf of the company to exeeute, andrdeI've' end affix the seal -yof the mpany to bondsa, underakings, recogniz•.ances, and sureTyshrp obhgaUOns,of all kinds, and said officers may remove any such attomey- m_fact or agent and revoke any Power of Attomey previously granted to such person. i RESOLVED FURTHER, that any bond und"entaking, recogmzance or suretyshipaobligahon shall be valid a d binding upon the "Company ' (i) when signed by the president, any vicepresidem or assistant vme� parnsident, and attested and scaled (if a seal be 'any secretary or assistant sa secretary; or 4 4",, s a s t a,,rh . - ..:„ a >w s (n) when signed by -the president, any vicepresident or assistant vice president, secretary, or assistant secretary; and countersigned and sealed (if a seal be required) by a duly authorized attomey -in fact or agent, or v—(in) when duly executed and sealed (if areal be required) by one or;more attomeys m -fact or agents p evidence&by the Power of Attomey" issued by the company to such person or persons., s a bra ad the linuts of the authority RESOLVED FURTHER, that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attomey or= f -- `certification thereof authorizing the execution and delivery of my bond, undertaking recognizance of othensuretyslup obligations of thaecompany; and'such s � 4 'y, a signature and seal when so used shall have the same force and effect as though manually affixed ,.Rb V A d $ ,g 9 Zfi.,` 3 S =3 4 IN WITNESS;WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be +� affixed Itus '-:'5TH "" ,'day of JANUARY, 2017':., "a s OLD REPUBLIC SURETY COMPANY SLAL ` "z < a a� Asysia Sec a s. V v e i 0 STATE OF WISCONSIN, COUNTY OF WAUKESHA -SS'' - c President =5TH " xi JANUARYb2017 persona came before me 'Alan Pavlro. a a a =` a 'and >5 On this „. day of _ p Y - s, a, lane' erney -` 'to me knows to be'the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above s s' awinstrument,'and they each acknowledged the a ecution of the same, - and' -being by me duly,swom,, did severally depose and "say; that they are -she said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers - were duly affixed and subscribed to the said rnshument by,the authonty.ofthe board of drectors of said corporabon.44 , � � � .k •. .. - a , x _ v: •'at4otery Public "' s 'Ak■vp My commission expires 9/28/2018 `a *•-`* % -'H s a �; '� z a a ; (Expiration of notary comm e commission does not invalidate this instrumnt) CERTIFICATE r i, the undersiged,- assistant secretary of the OLD REPUBLIC SURETY, COMPANY, a Wisconsin egrpomnon CERTIFY That the foregoing"and attaoh� Power "of Attomey i emainsrrr'fiill force and has not been revoked; and furttiermorc, that the Resolutions of the board of daecfors set forth in the Power of Anoraney;'are now in force. ^ C ,t,h - a LJ a 74 3544 m a l�su.e'^ -t, Signed and sealed atlhe Chy ofBmokfield W[a[his °v day of -YI ,,d -��'O 'r SEAL . ■ lJ p C £ G i� z 15Y51-0nl Sc W y yy} ff ' OLD REPUBLIC SURETY COMPANY JZ 22262 (5 -10) INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND WAIVER OF SUBROGATION AND CONTRIBUTION TITLE OF PROJECT OR WORK: OLD RANCH ROAD PAVEMENT REHABILITATION PROJECT CIP NO. ST1703 Indemnitor(s) (list all names): To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend, protect, indemnify, and hold harmless the City of Seal Beach and its elected officials, officers, attorneys, agents, employees, volunteers, successors, and assigns (collectively "Indemnitees") from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses, judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys, or other professionals and all costs associated therewith (collectively "Liabilities "), arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act, error, or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors, materialmen, suppliers or their officers, agents, servants or employees, arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to the above - referenced contract, agreement, license, or permit (the "Agreement ") or the performance or failure to perform any term, provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify lndemnitees against any such negligence. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorneys fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code § 2782(a) or (b) the contracting public agency's active negligence to the limited extent that the underlying Agreement is subject to Civil Code § 2782(b). This indemnity is effective without reference to the existence or applicability of any insurance coverage which may have been required under the Agreement or any additional insured endorsements which may extend to Indemnitees Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor regardless of any prior, concurrent, or subsequent active or passive negligence by the Indemnitees. In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint and several. "Indemnitor" _Name,IDI i I -_.� i �� /. Page D -67 Name: By: Its