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AGMT - G2 Construction Inc (2019 Environmental Cleanup Program Proj CIP No SD2001)
RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO CITY OF SEAL BEACH Attn: City Clerk 211 - 8th Street Seal Beach, CA 90740 Recorded in Official Records, Orange County Hugh Nguyen, Clerk -Recorder 1I II111 III 1111111111 Il IR III IIII IIII!IIIII I I VIII NO FEE *$ R 0 0 1 1 5 7 3 2 5 6$ 2020000125517 2:44 pm 03119/20 65 Sec4A N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00 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: City of Seal Beach. 3. The address of the owner is: 211 — 8th Street, Seal Beach, CA 90740. 4. The nature of the interest or estate of the owner is: In Fee. The City of Seal Beach. 5. A work of improvement on the property hereinafter is described as substantially completed on February 18, 2020. The work was 2019 Environmental Cleanup Program CIP No. SD2001. 6. The name of the contractor(s), if any, for such improvement was: G2 Construction, Inc. The date of the Contract Award was January 13, 2020. 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: V *ous citywide locations. Date: 3 b z a Direct ofublic Works, P.E, City of Seal Beach Signature of owner or corporate officer of owner named in paragraph 2 or agent. VERIFICATION I, the undersigned, say: the Director of Public Works declarant of the foregoing notice of completion; have read said notice of completion and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury the foregoing is true and correct. Executed on MAcdl J D , 2020, at Seal Be California. (Date of Signature) Director of Public Works, City eal Beach PUBLIC WORKS AGREEMENT 2019 ENVIRONMENTAL CLEANUP PROGRAM PROJECT CIP NO. SD2001 between City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 G2 Construction, Inc. 1352 E. Borchard Avenue Santa Ana, CA 92705 (714) 448-8080 THIS CONTRACT ("Contract") is made as of January 13. 2020, by and between the City of Seal Beach, a California charter city ("City"), and G2 Construction. Inc., a California Corporation and General Contractor ("Contractor'). RECITALS A. WHEREAS, the City Council has approved the plans and specifications for the 2019 Environmental Cleanup Program ("Project"), CIP SD1901, with respect to design criteria; and B. WHEREAS, Contractor has submitted a Bid to City for the Project dated December 17, 2019 in the amount of $108,722 ("Bid" hereinafter). The Bid is attached hereto as Exhibit H, and contains, among other things, provisions defining the Project scope; and C. WHEREAS, Contractor's California State Contractor's license number is #801253, and Contractor's DIR registration number is #1000021760. NOW, THEREFORE, in consideration of performance by the parties of the mutual promises, covenants, and conditions herein contained, the parties hereto agree as follows: CONTRACT 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 Contract, Contractor shall perform and complete in good and workmanlike manner all work ("Work") required by this Contract 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 Sealed Bids, Instructions to Bidders, Accepted Bid Proposal Form, Non -Collusion Declaration, 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, applicable grant and permit requirements, all addenda as prepared prior to the date of Bid opening setting forth any modifications or interpretations of any of said documents, this Contract, Exhibits attached to this Contract, 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), Indemnification and Hold Harmless Contract (Exhibit G), Accepted Bid (Exhibit H), and Non -Collusion Declaration Form (Exhibit 1), 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 Contract. 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 Contract and the provisions of the other Contract Documents, the provisions of this Contract shall prevail. 2. Effective Date. This Contract is effective as of January 13, 2020 (the "Effective Date"), and shall remain in full force and effect until Contractor has rendered the Work required by this Contract. 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 $108,722, 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 Contract. 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 Contract, 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 Contract. 4.5 City shall have the right to offset against the amount of any fees due to Contractor under this Contract any amount due to City from Contractor as a result of Contractor's failure to promptly pay to City any reimbursement or indemnification arising under this Section 4. 5. Indemnification. 5.1 Contractor's Duty. Contractor shall defend, indemnify, and hold the City, its elected officials, officers, employees, volunteers, agents, and those City agents serving as independent contractors in the role of City officials (collectively "Indemnitees") free and harmless from and against any and all claims (including, without limitation, claims for bodily injury, death or damage to property), demands, obligations, damages, actions, causes of action, suits, losses, bid protests, stop notices, judgments, fines, penalties, liabilities, costs and expenses (including, without limitation, attorney's fees, disbursements and court costs) of every kind and nature whatsoever (individually, a "Claim," collectively, "Claims"), in any manner arising out of or incident to the performance of the Contract, 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 Contract that may be brought or instituted against Indemnitees. Contractor shall pay and satisfy any judgment, award or decree that may be rendered against City or the other Indemnitees in any such suit, action, or other legal proceeding arising out of or incident to the performance of the Contract. 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 Civil Code Exception. Nothing in this Section 5-3 shall be construed to encompass Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Contract is subject to Civil Code Section 2782(a) or the City's active negligence to the limited extent that the underlying Contract Documents are subject to Civil Code Section 2782(b), provided such sole negligence, willful misconduct or active negligence is determined by agreement between the parties or by the findings of a court of competent jurisdiction. 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 Contract. 5.5 Waiver of Right of Subrogation. Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation against the Indemnitees, while acting within the scope of their duties, from all claims, losses, and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor. 5.6 Survival. The provisions of this Section 5 shall survive the termination of the Contract 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 Contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the services hereunder by Contractor, and its agents, representatives, employees and subcontractors. The policy limits set forth below do not act as a limitation upon the amount of indemnification to be provided by Contractor. Contractor shall complete and execute the following documents attached as Exhibits hereto and incorporated herein by this reference: 6.1.1 Exhibit D-1 Commercial General Liability. Additional Insured Endorsement - 6.1.2 Exhibit D-2: Additional Insured Endorsement - Automobile Liability. 6.1.3 Exhibit D-3: Additional Insured Endorsement - Professional Liability. 6.1.4 Exhibit D-4: Additional Insured Endorsement - Excess Liability. 6.2 Minimum Scope of Insurance. Unless otherwise approved by City, coverage shall be at least as broad as: 6.2.1 Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001). 6.2.2 Insurance Services Office form number CA 0001 (Ed. 1/87) covering Automobile Liability, code 1 (any auto). 6.2.3 Insurance Services Office form number CG 20 10 11 85 (Ed. 11/85) covering Additional Insured—Owners, Lessees or Contactors (Form B). 6.2.4 Workers' Compensation insurance as required by the State of California and Employer's Liability Insurance. 6.3 Minimum Limits of Insurance. Contractor shall maintain limits no less than: 6.3.1 General Liability: $2,000,000 per occurrence and in the aggregate for bodily injury, personal injury and property damage. Commercial General Liability Insurance or other form with a general aggregate limit shall apply separately to this Contract 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 Workers' Compensation/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 Contract, 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-Vill 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, within sixty (60) working days following the Notice to Proceed, 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 $500.00 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 Contract. 9. Notices. Any notices, bills, invoices, or reports authorized or required by this Contract 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 Contract, or to such other addresses as the parties may, from time to time, designate in writing pursuant to the provisions of this Section. All notices shall be addressed as follows: If to City: City Clerk City of Seal Beach 211 -8th Street Seal Beach, California 90740 Telephone: (562) 431-2527 Fax: (562) 493-9857 With a copy to: Public Works Director City of Seal Beach 211 -8th Street Seal Beach, California 90740 If to Contractor: G2 Construction, Inc. 1352 E. Borchard Avenue Santa Ana, CA 92705 Telephone: (714) 448-8080 Attn: John R. Alvarado 10. Non -Assignability; Subcontracting. Contractor shall not assign, transfer, or subcontract any interest in this Contract or the performance of any of Contractor's obligations hereunder. Any attempt by Contractor to so assign, transfer, or subcontract any rights, duties, or obligations arising hereunder shall be null, void and of no effect. 11. Claim Dispute Resolution. 11.1 In the event of any dispute or controversy with the City over any matter whatsoever, the Contractor shall not cause any delay or cessation in or of Work, but shall proceed with the performance of the Work in dispute. Contractor shall retain any and all rights provided that pertain to the resolution of disputes and protests between the parties. The Disputed Work will be characterized as an "unresolved dispute" and payment, if any, shall be as later determined by mutual agreement or a court of law. Contractor shall keep accurate, detailed records of all Disputed Work, claims and other disputed matters. 11.2 All claims arising out of or related to the Contract Documents or this Project, and the consideration and payment of such claims, are subject to the Government Claims Act (Government Code Section 810 et seq.) with regard to filing claims. All such claims are also subject to Public Contract Code Section 9204 and Public Contract Code Section 20104 et seq. (Article 1.5), where applicable. This Contract hereby incorporates those provisions as though fully set forth herein. Thus, Contractor or any Subcontractor must file a claim in accordance with the Government Claims Act as a prerequisite to filing a construction claim in compliance with Section 9204 and Article 1.5 (if applicable), and must then adhere to Article 1.5 and Section 9204, as applicable, pursuant to the definition of "claim" as individually defined therein. 12. Antitrust Claims. In entering into this Contract, Contractor offers and agrees to assign to City all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Sec. § 15) or under the Cartwright Act (Business and Professions Code Section 16700 et seq.) arising from purchases of goods, services, or materials pursuant to the Contract. This assignment shall be made and become effective at the time City tenders final payment to Contractor without further acknowledgment by the parties. 13. 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. 14. Non -Waiver of Terms. Rights and Remedies. Waiver by either party of any one or more of the conditions of performance under this Contract shall not be a waiver of any other condition of performance under this Contract. 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. 15. Attorneys' Fees. In the event that either party to this Contract shall commence any legal action or proceeding to enforce or interpret the provisions of this Contract, each party shall be responsible for their own attorneys' fees. 16. Construction. The validity, interpretation, and performance of this Contract shall be controlled by and construed under the laws of the State of California, with venue in Orange County, California. In the event of any asserted ambiguity in, or dispute regarding the interpretation of any matter herein, the interpretation of this Contract 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 Contract or who drafted that portion of the Contract. 17. Workers' Compensation. 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 Labor Code Section 1861, by signing this Contract, the Contractor 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 workers' 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." 18. Prevailing Wages. The City and the Contractor acknowledge that the Project is a public work to which prevailing wages apply. 19. Entire Contract. This Contract, including any other documents incorporated herein by specific reference, represents the entire and integrated agreement between Contractor and City. This Contract supersedes all prior oral or written negotiations, representations, or agreements. This Contract may not be amended, nor any provision or breach hereof waived, except in a writing signed by the parties which expressly refers to this Contract. 20. Severability. The invalidity in whole or in part of any provisions of this Contract shall not void or affect the validity of the other provisions of this Contract. 21. Titles and Headings. The titles and headings used in this Contract are for convenience only and shall in no way define, limit or describe the scope or intent of this Contract or any part of it. 22. Authority. Any person executing this Contract on behalf of Contractor warrants and represents that he or she has the authority to execute this Contract on behalf of Contractor and has the authority to bind Contractor to the performance of its obligations hereunder. 23. Counterparts. This Contract may be executed in counterpart originals, duplicate originals, or both, each of which is deemed to be an original for all purposes. IN WITNESS WHEREOF, the parties, through their respective authorized representatives, have executed this Contract as of the date first written above. CITY OF SEAL BEACH Approved as to For '�Q �C/Untr `94 By: Craig teeie, City Attorney CONTRACTOR 6c;? By. Narne:, %G A'w r G1SQ �gXJGUAJ Title: SCom%4x (Please note. two signatures1required for corporatrons p,irsuant to California Corporatfons Code Section 313. EXHIBIT A FAITHFUL PERFORMANCE BOND ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 05/06/2019 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 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 Marsh USA, Inc.PHONE 4400 Comerica Bank Tower CONTACT Shane Lu FAX N Ext): A'C'No): ADDRESS: shane.lu@marsh.com 1717 Main Street Dallas, TX 75201-7357 12/05/2018 Attn: dallas.certs@marsh.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Ironshore Specialty Ins. Company 25445 CN102137489-G/DBS-GAWX+-18- NOC INSURED Gadand/DBS, Inc. INSURER B : Travelers indemnity Co 25656 INSURER C : Liberty Insurance Underwriters Inc. 19917 3800 East 91 st Street Cleveland, OH 44105 INSURER D: Travelers Property Casualty Company of America 25674 INSURER E : Aspen American Insurance Company 43460 AUTOMOBILE XiANY xiOWNED X INSURER F : Som o International COVERAGES CERTIFICATE NUMBER: HOU-003519698-01 REVISION NUMBER: 1 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 ADDL SUBR POLICYNUMBER POLICY EFF MMID POLICY EXP MM/DD LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE FX] OCCUR Manashi Mukhedee __TALM%A.0 D" 002589903 12/05/2018 12/05/2019 EACH OCCURRENCE $ 1,000,000 PREMISES EaEoccu encs $ 500,000 MED EXP (Any one person) $ 10,000 X SIR -$100,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PET 7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE XiANY xiOWNED X LIABILITY AUTO SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 810 2L22250616-03 G 12/05/2018 12/05/2019 COMBINED SINGLE LIMIT $ 1 000 000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 1000021688-09 12/05/2018 12/05/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A UB -5G220236-18 12/05/2019X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E F Inland Marine Inland Marine IMZ325418 (Ded: $50,000) ARL30000500801 (Ded: $25, 000) 12/05/2018 12/05/2018 12/05/2019 12/05/2019 Installation Floater 900,000 Leased/Rented Equip 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Seal Beach is included as additional insured where required by written contract with respect to General Liability and Auto Liability. CERTIFICATE HOLDER CANCELLATION City of Seal Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 211 - 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Seal Beach, CA 90740 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee __TALM%A.0 D" @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Bond No. 1001140579 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach ("City"), has awarded to G2 Construction, Inc. 1352 East Borchard Avenue Santa Ana, California 92705 ("Principal") (Name and address of Contractor) a contract (the "Contract") for the Work described as follows: 2019 ENVIRONMENTAL CLEANUP PROGRAM (SD2001) (Project name) WHEREAS, Principal is required under the terms of the Contract to furnish a Bond for the faithful performance of the Contract. NOW, THEREFORE, we, the undersigned Principal, and American Contractors Indemnity Company 801 S. Figueroa St., Suite 700 Los Angeles CA90017 (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the City in the penal sum of one Hundred Eight Thousand, Seven Hundred Twenty Two Dollars and 00/ 100 Dollars ($ 108,722.00 ), this amount being not less than the total Contract Price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, successors executors and administrators, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal, his, her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and provisions in the Contract and any alteration thereof made as therein provided, on the Principal's part, to be kept and performed at the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall indemnify and save harmless the City, its officers, agents and employees, as therein stipulated, then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. As a part of the obligation secured hereby and in addition to the face amount specified therefor, there shall be included costs and reasonable expenses and fees, including reasonable attorneys' fees, incurred by City in successfully enforcing such obligation, all to be taxed as costs and included in any judgment rendered. Surety hereby waives any statute of limitations as it applies to an action on this Bond. The Surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract or of the Work to be performed thereunder or the specifications accompanying the same shall in anywise affect its obligations under this Bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the Work or to the specifications. Surety hereby waives the provisions of California Civil Code Sections 2845 and 2849. The City is the principal beneficiary of this Bond and has all rights of a party hereto. 13 IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s) pursuant to authority of its governing body. Dated: January 21, 2020 "Principal" G2 Construction, Inc. 1352 East Borchard Avenue Santa. Arv, California 92705 Ag , J�N4v i7. AL 4,60V By: Note: Its "Surety" American Contractors Indemnitv Comnan 801 S. Figueroa St., Suite 700 Los Angeles, CA90017 By: Megan Runde ei Its Attorney -In -Fact By: Its (Seal) ` _ ��" '� (Seal) r vim; This Bond must be executed in duplicate and dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. DATE OF BOND MUST NOT BE BEFORE DATE OF CONTRACT. Surety companies executing Bonds must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the State where the project is located. 14 EXHIBIT B PAYMENT BOND 15 Bond No. 1001140579 PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach ("City"), State of California, has awarded to G2 Construction, Inc. 1352 East Borchard Avenue Santa Ana, California 92705 ("Principal") (Name and address of Contractor) a contract (the "Contract") for the Work described as follows: 2019 ENVIRONMENTAL CLEANUP PROGRAM (SD2001) (Project name) WHEREAS, under the terms of the Contract, the Principal is required before entering upon the performance of the Work, to file a good and sufficient payment Bond with the City to secure the claims to which reference is made in Title 3 (commencing with Section 9000) of Part 6 of Division 4 of the Civil Code. NOW, THEREFORE, we, the undersigned Principal, and American Contractors Indemnity Company 801 S. Figueroa St., Suite 700 Los Angeles, CA90017 (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 City and all contractors, subcontractors, laborers, material suppliers, and other persons employed in the performance of the Contract and referred to in Title 3 (commencing with Section 9000) of Part 6 of Division 4 of the Civil Code in the penal sum of One Hundred Eight Thousand, Seven Hundred Twenty Two Dollars and 00/ 100 Dollars ($108,722.00 ), for materials furnished or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to this Work or labor, that the Surety will pay the same in an amount not exceeding the amount hereinabove set forth, and also in case suit is brought upon this Bond, will pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including reasonable attorneys' fees, incurred by City in successfully enforcing this obligation, to be awarded and fixed by the court, and to be taxed as costs and to be included in the judgment therein rendered. It is hereby expressly stipulated and agreed that this Bond shall inure to the benefit of any and all persons, companies, and corporations entitled to file claims under Title 3 (commencing with Section 9000) of Part 6 of Division 4 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this Bond. Upon expiration of the time within which the California Labor Commissioner may serve a civil wage and penalty assessment against the principal, any of its subcontractors, or both the principal and its subcontractors pursuant to Labor Code Section 1741, and upon expiration of the time within which a joint labor management committee may commence an action against the principal, any of its subcontractors, or both the principal and its subcontractors pursuant to Labor Code Section 1771.2, if the condition of this Bond be fully performed, then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. 16 The Surety hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the Contract or the Specifications accompanying the same shall in any manner affect its obligations on this Bond, and it does hereby waive notice of any such change, extension, alteration, or addition. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative (s) pursuant to authority of its governing body. Dated: January 21, 2020 "Principal" G2 Construction, Inc. 1352 East Borchard Avenue Santa Ana alifornia 92705 3»+w 12. 4t -AAA" Its /;k 'r By: "Surety" American Contractors Indemnity Company 801 S. Figueroa St., Suite 700 Los Angeles, CA90017 By: Megan Runde Its Attorney -In -Fact By: Its Its C (Seal) �� (Seal) r �, w C, Note: This Bond must be executed in duplicate and dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. DATE OF BOND MUST NOT BE BEFORE DATE OF CONTRACT. Surety companies executing Bonds must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the State where the project is located. 17 TOKK} MARL NE HCC POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, Texas Bonding Company, an assumed name of American Contractors Indemnity Company, United States Surety Company, a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the "Companies"), do by these presents make, constitute and appoint: Aaron West, Aksel Firat or Megan Runde of Scottsdale, AZ its true and lawful Attomey(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, _recognizances, undertakings or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed *****Three Million***** Dollars ( ***$3,000,000.00*** ). This Power of Attorney shall expire without further action on April 231d, 2022. This Power of Attorney is granted under and by authority of the following resolutions adopted by the Boards of Directors of the Companies: Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys) -in -Fact to represent and act for and on behalf of the Company subject to the following provisions: Attomey-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attomey-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized oiler and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. IN WITNESS WHEREOF, 1St day of June, 2018. State of California County of Los Angeles The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS UNITED S Lt1 $SURET):fw.. PANY k _V _W \i 121.1,"N o atF/tip¢ art. 47 v 4'ti a y +uroa` 'rFoF"*�// f'�*n *w Daniel P. Aguilar, Vice President �..............� �... � gib......... � � ..._.... 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 On this 1St day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Daniel P. Aguilar, Vice President of American Contractors Indemnity Company, Texas Bonding Company, United States Surety Company and U.S. Specialty` insurance Company who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on, 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 fldd corrot.. WITNESS my hand and official seal. wwuo. uR a (A ll_ LeaMlles Cmbx, � ,. • Commpalon t t226 Sig nature(seal) IAy gamin. E �kes+l9s u, 2Qu �' 1, Kia Lo, Assistant Secretary V American Contractors Indemnity Company, Texas Bonding Company,' -VM States-S€y Company and U.S. Specialty Insurance Company, do hereby certify that the above and foregoing is a true and C&k* f t po r of Attorney, executed by said Companies,_ which is still in full force and effect; furthermore, the resolutions of the Burda fjaectors, set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this 9_day of avac� bl ,,,,Ua/M/Nb/, �N\I"Ibb Corporate Seals 00"0119%;t��� oo> vo oho i �v8 s r ` Bond No. 16011 y05 �9 4;� </ �� 4 � kit,_ .f:;,�:g o`�..ti .•l 3s ' , s Kio Lo, 4ASecretaAgency No. 9833 `,+re'••-i�V�,� *� -• -rY bla"P* N**tb� ,\tl\O\ AWN/Nlltq\MP9/4/bb� WA~ HOCSMMPOAM019 visit tmhoc.corn/surety for more information ANNEWOMEN CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of On U;1-0 before me, "Lj�/A -TI 1N- NVAI-Y NOW' -, ere Insert name ane e OT the o cer personally appeared �jOl-jN '�. A -LVA -V" , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/a;4 subscribed to the within instrument and acknowledged to me that he/sPA/theey executed the same in his/ber/their authorized capacity(ies), and that by his/her/tWr 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 iaws of the State of California that the foregoing paragraph is true and correct. REBECCA IRAN commission No. 2500553WITNESS my hand and official seal. NOTARY FUSLIC.CAIIFORNIA 1 U*'. ORANGE COUNTY y Comm. Expires Sept. 24. 2023 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed, should be completed and attached to the document. Acknowledgments 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. (Title or description of attached document) • State and County information must be the State and County where the document P` rf u pM fp �S signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which (Tile or description of attached document continued) 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 Number of Pages 10 Document Date 1commission 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. Ite/she/dwy- is /are ) or circling the correct forms. Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. Corporate Officer • The notary seal impression must be clear and photographically reproducible. x( 70 - pi? -W PC -N-1 Impression must not cover text or lines. If seal impression smudges, re -seal if a Title sufficient area permits, otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney -in -Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. E] Other 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). "015 V8'Si0'S YrlldVd.NC3t ryGlasses.com 80 0-873-9865 • Securely attach this document to the signed document with a staple. EXHIBIT C WORKER'S COMPENSATION INSURANCE CERTIFICATE 18 WORKERS' COMPENSATION CERTIFICATE OF INSURANCE WHEREAS, the City of Seat Beach ("City") has required certain insurance to be provided by: G2 UO-TR-LAUT10 N ING NOW THEREFORE, the undersigned insurance company does hereby certify that it has issued the policy or policies described below to the following named insureds and that the same are in force at this time: 1. This certificate is issued to: City of Seal Beach City Hall 211 8 t Street Seal Beach, California 90740 The insureds under such policy or policies are: jF7M/-4Hi M �TIkkWA-i HTML Fhb UM PA'Nl'0S 2. Workers' 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 Elate KL000.155 _ 2411201cl 2 1 /2n2U By: Its Authorized Re esentative 19 BERKSHIRE HATHAWAY HOMESTATE COMPANIES Berkshire Hathaway Homestate Insurance Company Brookwood Insurance Company Continental Divide Insurance Company Cypress Insurance Company Oak River Insurance Company Redwood Fire and Casualty Insurance Company r w `R P.O. Box 881236, San 0l ,co, CA 94188 ow, in Witness Whereof, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative President President Berkshire Hathaway Homestate Insurance Company Cypress Insurance Company Brookwood Insurance Company Oak River Insurance Company Continental Divide Insurance Company Redwood Fire and Casualty Insurance Company 74p -a Secretary ILM 0314 0711 EXHIBIT D-1 ADDITIONAL INSURED ENDORSEMENT COMMERCIAL GENERAL LIABILITY [INSERT INSURANCE CERTIFICATE SHOWING COMMERCIAL GENERAL LIABILITY] 20 ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY 1352 E • 0otu4A PO kvS rat rn 4:Tt 4wr of l I�rc.. M. fl�, C* X12.%b4i Name and address of named insured ("Named Insured'): MT (,WA -I=t Ugf#9 47C PAS l 000 }Ivwf V_D pk vD . s-rE:. 30oi Po Bo)( 15H3o ADM Ieft-L 1R9(A VtC cArAph N'1 W. LAU9,E-I.. AI T 07,094 Name and address of insurance company ("Company"): CWM"-G1W, Cay -N fit. 14"10-T-1 Uy e rbl✓ General description of agreement(s), permit(s), license(s), and/or activity(ies) insured: Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy") or in any endorsement now or hereafter attached thereto, it is agreed as follows: 1. The City of Seal Beach ("City"), its elected officials, officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall be covered as third -party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non -renewal except after written notice to City, by certified mail, return receipt requested, not less than thirty (30) Days before the effective date thereof. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or 21 incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation, and enforcement of this contract of insurance. 9. This endorsement and all notices given hereunder shall be sent to City at: City Manager City of Seal Beach City Hall 211 8" Street Seal Beach, CA 90740 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH THIS POLICY PERIOD LIMITS OF ENDORSEMENT ATTACHES FROM/TO LIABILITY L0MMe*4,(ft C-4eNe L 2J 1 114(01- 2 % 2'020 {Cj 000 . o 0 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: ❑ Contractual Liability ❑ Owners/LandlordsfTenants ❑ Manufacturers/Contractors ❑ Products/Completed Operations ❑ Broad Form Property Damage ❑ Extended Bodily Injury ❑ Broad Form Comprehensive ❑ General Liability Endorsement ❑ Explosion Hazard ❑ Collapse Hazard ❑ Underground Property Damage ❑ Pollution Liability ❑ Liquor Liability A. 12. A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s) except: if none, so state). The deductible is applicable ❑ per claim or ❑ per occurrence (check one). 13. This is an ❑ occurrence or ❑ claims made policy (check one). 14. This endorsement is effective on at 12:01 a.m. and forms a part of Policy Number I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof, I do so bind the Company. Executed 20 �-I - � Pr�t�Igv�4MG-nil Signature of Authorized Representative 22 Telephone No.: (_) 23 (Original signature only; no facsimile signature or initialed signature accepted) Q�71: - , Policyholder Message ire f W* Named Insured: G2 CONSTRUCTION INC Policy Nigmber:-'`~, 000033399-01 Dear Policyholder:. Our Corporate Headquarters' and Northeast Regional Branch Office mailing address is: Admiral Insurance Company (A Berkley Company) Mt. Laurel Corporate Park 1000 Howard Blvd., Suite 300, P.O. Box 5430 Mt. Laurel, NJ 08054 Our telephone number: General: (856) 429 —9200 If you need to report a claim please direct it: By regular or overnight mail to; Admiral Insurance Company (A Berkley Company) Mt. Laurel Corporate Park 1000 Howard Blvd., Suite 300 P.O. Box 5430 Mt. Laurel, NJ 08054 Attention: New Claim Clearly state it is a "NEW CLAIM". 11. By Email to; admclaims@admiralins.com Do not email claims to ANY claims individual III. By FAX to; Fax #: (856) 429-3630 Attention: New Claim Clearly state it is a "NEW CLAIM". (.a�iF R. Brrkl�y Camjwnr FM 30 1102 15 �J Page 1 or 1 0 ADMIRALINSURANCE COMPANY A Stock Company COMMERCIAL LINES POLICY THIS POLICY IS NOT OBTAINED PRIMARILY FOR PERSONAL, FAMILY OR HOUSEHOLD PURPOSES. THIS POLICY CONSISTS OF: - DECLARATIONS - COMMON POLICY CONDITIONS - ONE OR MORE COVERAGE PARTS. A COVERAGE PART CONSISTS OF: - ONE OR MORE COVERAGE FORMS - APPLICABLE FORMS AND ENDORSEMENTS In Witness Whereof, we have caused this policy to be executed and attested and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative Secretary President an 1000 Howard Blvd., Suite 300, P.O. Box 5430 Mi. Laurel, N108054 Telephone (856) 429-9300 Facsimile (856) 429-8611 JA1001 (03/13) b W A. ur,wrry (. xqw„ r ADMIRAL INSURANCE COMPANY COMMON POLICY A STOCK COMPANY DECLARATIONS (herein called the Company) Policy No.: CA000033399-01 Rencwa]/Rewrite of: NEW N>imed lnsnred and Mailing Address G2 CONSTRUCTION INC 1352 EAST BORCHARD AVE. SANTA ANA, CA 92705 POLICY PERIOD: From 02/01/2019 to 0210 1 /2020 At 12 01 A M Standard Time at the address of the ,Named Insured as stutcd herein TETE NAMED INSURED IS: Corporation BUSINESS DESCRIPTION: Manufacturing and Installing of Sidewalk Debris Gates A11DIT PERIOD: Annual IN RETURN FOR THE PAYMENT OF THE PREivIIUM .AND SUBJECT TO ALL TI IE TERMS OF T141S POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY, THIS POLICY CONSISTS OF THE FOLLOWING COVERAGES FOR WHICH A PREMIUM IS INDICATED. ThIIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. Commercial General Liability Coverage Products/Compleled Operations Liability Coverage Form(s) and Endorsement(s) made a part of this policy at inception: REFER TO SCHCDL9_E OI: DORMS. AI 00 18 03 98 515,000.00 PREMIUM: $15,000.00 TERRORISM PREMIUM: TOTAL PREMIUM: $15.000.00 This policy is not binding unless countersigned by Admiral Insurance Company or its authorized representative. Counlersigned On: 2/ 19113019 13y:---j.�2f" At: Seattle, WA Authorized Rem c ative TIIESE COMMON POLICY DECLA"'I IONS ANDTHE COMMERCIAL GI:XERAL 1_IABILI I Y COVERAGE P IRT DECLAItATIONS (OR PRODUCTS.COMPL.t'TEDOPERATIONS LIABILITY COVERAGE PART DECLARATIONS). TOGFTIIER WI rI1'TIIC CONINION POI ICY CONDI FIONS COVERAGE PARF(S►. FORMS) AND ENDORSEStrNT1S) IF ANY, ISSUED "10 FORM A PART r1ICRCOr cokfPI,F11. TI1F A11OVE NU1N131ERCD POLICY, a lt. R. Brrktry Co,rpan7 DE20010700 b Page I of 1 EXHIBIT D-2 ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY [INSERT INSURANCE CERTIFICATE SHOWING AUTOMOBILE LIABILITY] 24 ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY 1352 C—. 1 a09z+ K -D Avz, C�2 "N,711 CI ON I INC . SW P, AV At CA -12-7b5 Name and address of named insured ("Named Insured'): 27110 `jG'iPT-E*-W N kve S7£ (o -o ,5T?-Atgk1,[A INSUR-flt41,C Ali U -j TometA -n I C is - zw` Name and address of insurance company ("Company'): 1RkA9 N C_,e7s "To General description of agreement(s), permit(s), license(s), and/or activity(ids) insured. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy") or in any endorsement now or hereafter attached thereto, it is agreed as follows: 1. The City of Seal Beach ("City"), its elected officials, officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall be covered as third -party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non -renewal except after written notice to City, by certified mail, return receipt requested, not less than thirty (30) Days before the effective date thereto. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. 25 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation, and enforcement of this contract of insurance. 9. This endorsement and all notices given hereunder shall be sent to City at: City Manager City of Seal Beach City Hall 211 8th Street Seal Beach, CA 90740 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH THIS POLICY PERIOD LIMITS OF ENDORSEMENT ATTACHES FROM/TO LIABILITY �Z�Iy4o�i Z�t ?,old- 2�1 JU2-0 J, pDo, o0o . bo 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: J Any Automobiles i/ All Owned Automobiles d Non -owned Automobiles ❑ Hired Automobiles ❑ Scheduled Automobiles ❑ Garage Coverage ❑ Truckers Coverage ❑ Motor Carrier Act ❑ Bus Regulatory Reform Act ❑ Public Livery Coverage Fol 12. A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s) except: (if none, so state). The deductible is applicable ❑ per claim or ❑ per occurrence (check one). 13. This is an ❑ occurrence or ❑ claims made policy (check one). 14. This endorsement is effective on Policy Number at 12:01 a.m. and forms a part of I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof, I do so bind the Company. Executed , 20 PT Signature of Authorized Representative (Original signature only, no facsimile signature Telephone No.: (_) or initialed signature accepted) TALiberty Mutual. INSURANCE Policyholder Information Named Insured & Mailing Address Agent Mailing Address & Phone No. G2 CONSTRUCTION, INC. (951) 676-2229 1352 E 13ORCHARD AVGAC11 TA INSURANCE AGENCY SANTA ANA. CA 92705 11-rRSON AVE STE 100 T- 2 590-2669 copj baa r e. Deur Policyholder. We know you work hard to build your business. We %ork lostethcr with y&Dr-agent, Your STRACHOTA INSURANCE AGENCY (9.51) 676-2229 tCommercial to help protect the things you care about. Thank you for selecting us. Documents e go= Enclosed are your insurance documents consisting of. • Business Auto To find your specific coverages. Iimits of liability, and premium, please refer to your Declarations pagcts). if you have any questions or changes Ilia[ may affect your insurance needs, please contact your Agent at (951) 676-2229 Detach the ID Card located at the back of the policy Verify that all information is correct If you have any chan,,es, please contact your Assent at (951) 676-2229 Reminders In case of a claim, call your Agent or 1-800-362-0000 You Need To Know A1, 1'O I.D. C;%RDS ARE INCLUDED AT TIIE HACK OF THE POLICI and can be used as evidence of insurance and provide you with infortnation on what to do in case of an accident. . CONTINUED ON NEXT PACE To report a claim, calf your Agent or 9-800-362-0000 DS 70 20 01 08 .yU7Ci2Ua1. Coverage is Provided In; Ohio Security Insurance Com anY - a stock company INSURANCE Common Policy Declarations Named Insured Agent G2 CONSTRUCTION, INC. 1352 E BORCHARD AVE SANTA ANA, CA 927055 Policy Number: BAS (20) 57131811 Policy Period: From 0=1/2019 To 02/0112020 12:01 am Standard Time at Insured Mailing Location (951) 676-2229 STRACIIOTA INSURANCE AGENCN' 27710 JEFI-ERSON AVE STE 100 TEMECULA, CA 92590-2669 POLICY FORMS AND ENDORSEMENTS This section lists all the Forms and Endorsements for your policy. Reler to these documents as needed for detailed infomiation concerning your coverage. FORM NUMBER TITLE STATE(S) Applicable AC 00 31 Of 14 Changes In Your Policy AC 04 O1 11 16 Primary and NonContributory - Other Insurance Condition CA AC 21 16 11 16 California Uninsured Motorists Coverage - Bodily lnjurn CA AC 84 60 06 14 State Application Of Terrorism L'•xelusion Endorsements CA AC 84 70 05 IS Punitive or Exemplary Damages Exclusion - CA CA CA 00 O1 03 06 Business Auto Coverage Form CA CA 01 43 05 17 California Changes CA CA 03 05 02 97 California Changes - Waiver of Collision Deductible CA CA 04 24 04 06 California Medical Payments CA C% 20 48 02 99 Designated Insured CA CA 23 45 1116 Public or Livery Passenger Conccyance and On - Deni -Ind Delivery Services CA Exclusion CA CA 23 84 01 06 Exclusion of Terrorism CA 23 86 01 06 Exclusion of Terrorisin Aboke Minimum Statutory Limits CA CA 23 88 01 06 Alaska Exclusion of Terrorism Above Minimum Statutory Limits CA CA 23 92 01 06 Washington Exclusion of Ierrorism CA CA 85 47 12 93 Temporary Substitute Auto - Physical Damage Insurance CA CA 85 49 0908 Exclusion of Namcd Person CA CA 85 53 12 93 Recreational Trailers and Boat Trailers CA CA 88 10 01 13 Business Auto Coverage Enhancement Endorsement CA IL 00 17 It 98 Common Policy Conditions CA CA In witness whereof, we have caused this policy to be signed by our authorized officers. Nlark Touhey Paul Condrin Secretary President To report a clakn, call your Agent or 1-800-362-0000 DS 70 21 It 16 Ib10R 57131811 POLSVCS 280 NCAOPPNO INSURER COPY 003842 PAGE 12 OF 80 EXHIBIT D-3 ADDITIONAL INSURED ENDORSEMENT [INSERT INSURANCE CERTIFICATE SHOWING PROFESSIONAL INSURANCE LIABILITY, IF REQUIRED] 27 Gemini Insurance Company a Berkley Company 475 Steamboat Road Greenwich, CT 06830 ARCHITECTS, ENGINEERS, CONSTRUCTION MANAGERS & DESIGN BUILD PROFESSIONAL LIABILITY INSURANCE — -- DECLAR,T1pN5 {Claims• de h»g„�_ Policy No: HPM-DP-00309-03 1. Named Insured: G2 Construction, Inc. Principal Address: 1352 E BORCHARD AVE SANTA ANA CA 92705-4413 of: HPM-DP-00309-02 '8rarOp ure Broker FO -42,59.00 Sbr-plus Lines Tax: $233.85 Stampin'Office Fee: $15.59 2. Policy Period: 2/27/2019 to 2/27/2020 both days at 12:01 A.M. Standard Time at the address of the Named Insured as stated herein 3. Insurance is effective with GEMINI INSURANCE COMPANY 4. Limits of Liability (Including Claims Expenses), unless the Policy is otherwise endorsed: (A) Each Claim: $2,000,000 (B) Policy Period Aggregate: $2,000,000 2/27/2015 except 2/27/2019 for limits of (C) Retroactive Date: liability $1,000,000/$1,000,000 excess $1,000,000/51,000,000 (D) Self Insured Retention Each Claim: $ 10,000 (E) Policy Period Aggregate Self Insured Retention: S30,000 (F) Rate: Flat (G) Premium: $7,500 Policy Fee: $295 (H) Minimum Earned Premium: 25% of the premium shown in G above 5. Forms attached hereto and special conditions: See attached Schedule of Forms and Endorsements Dated: February 26, 2019 CAuthorized Re + esgntative EXHIBIT D-4 ADDITIONAL INSURED ENDORSEMENT [INSERT INSURANCE CERTIFICATE SHOWING EXCESS INSURANCE LIABILITY POLICY, IF REQUIRED] 28 ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY 135 E. A VEE CoNs-[9,M(I(ON , (MC• `�;IkrnA- PNH, CR 011'70c- Name 127oSName and address of named insured ("Named Insured"): N"LAU1ZfL 09 PP9 7E Pfif-K p1DMIRAI. INS�N�'NLE CbMPAiN`I LFMK-L. K -L oT 0S -D" , �0 1� SaX 9(30 Name and address of insurance company ("Company"): Extoth 0 "MI-1 1-1 General description of agreement(s), permit(s), license(s), and/or activity(ies) insured. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy") or in any endorsement now or hereafter attached thereto, it is agreed as follows: 1. The City of Seal Beach ("City"), its elected officials, officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought, except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall be covered as third -party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non -renewal except after written notice to City, by certified mail, return receipt requested, not less than thirty (30) Days before the effective date thereto. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with 29 regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation, and enforcement of this contract of insurance. 9. This endorsement and all notices given hereunder shall be sent to City at: City Manager City of Seal Beach City Hall 211 Eighth Street Seal Beach, California 90740 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH THIS POLICY PERIOD LIMITS OF ENDORSEMENT ATTACHES FROM/TO LIABILITY (Amma4ii n MY -6 IJ � Pii lil'L y '11, l m - 2I 12020 2, poo/ oo o - 00 ❑ Following Form ❑ Umbrella Liability 11. Applicable underlying coverages: INSURANCE COMPANY POLICY NUMBER AMOUNT PQM(9-kt 1IVS1Ar'p1Vzfi tUMp" &YphpOp llnW;-( 2, DOD, 000.00 12. The following inclusions, exclusions, extensions or specific provisions relate to the above coverages: 13. A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s) except: (if none, so state). The deductible is applicable ❑ per claim or ❑ per occurrence (check one). 14. This is an ❑ occurrence or ❑ claims made policy (check one). 15. This endorsement is effective on at 12:01 a.m. and forms a part of Policy Number 30 I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof, I do so bind the Company. Executed 20 _ Set A17 "6P Signature of Authorized Representative (Original signature only; no facsimile signature Telephone No.: (_) or initialed signature accepted) 31 CEP TI ,. ADMIRAL Message Signature-, Named Insured: G2 CONSTRUCTION INC Policy um 7GX00000198-TzDt- Dear Policyholder: Our Corporate Headquarters' and Northeast Regional Branch Office mailing address is: Admiral Insurance Company (A Berkley Company) Mt. Laurel Corporate Park 1000 Howard Blvd., Suite 300, P.O. Box 5430 Mt. Laurel, NJ 08054 Our telephone number: General: (856) 429 -9200 If you need to report a claim please direct it: By regular or overnight mail to, Admiral Insurance Company (A Berkley Company) Mt. Laurel Corporate Park 1000 Howard Blvd., Suite 300 P.O. Box 5430 Mt. Laurel, NJ 08054 Attention: New Claim Clearly state it is a "NEW CLAIM". If. By Email to; admclaims@admiralins.com Do not email claims to ANY claims individual III. By FAX to; Fax #: (856) 429-3630 Attention: New Claim Clearly state it is a "NEW CLAIM �,y Fh130 1102 15 V Page l of 1 13 ADMIRAL INSURANCE COMPANY Stock Company EXCESS LIABILITY POLICY THIS POLICY IS NOT OBTAINED PRIMARILY FOR PERSONAL, FAMILY OR HOUSEHOLD PURPOSES. THIS POLICY CONSISTS OF: DECLARATIONS EXCESS POLICY FORM SCHEDULE OF "UNDERLYING INSURANCE" - APPLICABLE FORMS AND ENDORSEMENTS In Witness Whereof, we have caused this policy to be executed and attested and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative `fir Secretary President anoeter 1000 Howard Blvd., Suite 300, P.O. Bos 5430 Mt. Laurel, NJ 08054 Telephone (856) 429-9200 Facsimile (856) 429-8611 JX4622 (03/13) ' R X, Lirr�irrGompanr e� I ADMIRAL INSURANCE COMPANY A STOCK COMPANY Policy No.: GX000001983-01 Named Insured and Mailing Address G2 CONSTRUCTION INC 1352 EAST BORCHARD AVE. SANTA ANA, CA 93705 COMMERCIAL EXCESS LIABILITY POLICY DECLARATIONS Renewal/Rewrite of: POLICY PERIOD: From 02'01 2019 10 0101 2030 11 I? A M Standard I ime at the ajdre-, oi'tla Named Insured as stated hire„ In return for the payment of the premium and subject to all the terms of this policy, we agree %Nith you to provide the insurance as stated in this policy. THE NAMED INSURED IS: O Individual; 0 Partnership; © Corporation; ❑ Joint Venture; 11 LLC: 13 Other AUDIT PERIOD: ❑ Annual 13 Semi -Annual 0 Quarterly 0 Monthly O N A LIMITS OF INSURANCE: Each Loss Event Limit: $2,000,000 Policy Aggregate Limit: $?,000,000 PREMIUM: Advance Premium: S6.244.00 Terrorism Premium: $0,00 Total Premium: $6,244.00 MINIMUM RETAINED PREMIUM: Company to retain no less than 250a of the Total Premium if the Insured cancels FORMS AND ENDORSEMENTS MADE A PARE' OF THIS POLICIAT INCEPTION: See Schedule of Forms Al 00 18 03 98 This policy is not binding; unless countersigned by Admiral Insurance Company or its Authorized Representative. Countersigned On: 02 19 2019 At: Seattle, WA By:.�� Autharizcd Re a ativc IN D.„ 0603 bn 9 13e,k1cr Co.p,,rr EXHIBIT E ACKNOWLEDGMENT OF PENAL AND CIVIL PENALTIES CONCERNING CONTRACTOR LICENSING LAWS 32 STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS [Business & Professions Code § 7028.15] [Public Contract Code § 20103.5] I, the undersigned, certify that I am aware of the following provisions of California law and that I, or the entity on whose behalf this certification is given, hold a currently valid California contractor's license as set forth below (required at time of award): Business & Professions Code § 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license 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 three 33 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.:_'8G I,'s.3 Class:X 6CT, (Z 40 Expiration Hate'. go Date: 1,;2lePOO SP -34 EXHIBIT F LABOR LAW REQUIREMENTS SP -35 AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS [Labor Code §§ 1720, 1773.8, 1775, 1776, 1777.5, 1813,1860, 1861, 37001 The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the Following provisions of California law: 1. Contractor acknowledges that this Contract is subject to the provisions of Division 2, Fart 7, Chapter 1 (commencing with Section 1720) of the California Labor Code relating to public works and the awarding public agency ( Agency") and agrees to be bound by all the provisions thereof as though set forth in full herein. 2. Contractor agrees to comply with the provisions of California Labor Code Section 1773.8 which requires the payment of travel and subsistence payments to each worker needed to execute the Work to the extent required by law. 3. Contractor agrees to comply with the provisions of California Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the Agency, forfeit not more than fifty dollars ($50) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the Director of Industrial Relations for the work or craft in which the worker is employed for any public work done under the Contract by Contractor or by any subcontractor. 4. Contractor agrees to comply with the provisions of California Labor Code Section 1776 which require Contractor and each subcontractor to (1) keep accurate payroll records, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the Agency of the location of the records. The Contractor is responsible for compliance with Section 1776 by itself and all of its subcontractors. 5 Contractor agrees to comply with the provisions of California Labor Code Section 1777.5 concerning the employment of apprentices on public works projects, and further agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of California Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the Agency. forfeit twenty-five dollars ($25) for each worker employed in the execution of the Contract by the Contractor or by any 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 A 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 Wnrk of this r'.nntrar`t " Date lz9_1_ Signature SP 36 EXHIBIT G INDEMNIFICATION AND HOLD HARMLESS AGREEMENT SP -37 INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND WAIVER OF SUBROGATION AND CONTRIBUTION OFFICIAL TITLE OF PROJECT: 2019 Environmental Cleanup Program Proiect CIP SD2001 Indemnitor(s) (list all names): A11V /2 . A L vA d �� Ce �+/s1R v �.T a�/ 1,✓� . 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, materialrnen, 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 Contract") or the performance or failure to perform any term, provision, covenant, or condition of the Contract, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence. This indemnity provision shall survive the termination of the Contract and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorney's fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Contract is subject to Civil Code § 2782(a) or (b) the contracting public agency's active negligence to the limited extent that the underlying Contract 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 Contract or any additional insured endorsements which may extend to Indemnitees. Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waves 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 Contract as an Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint and several. "Indemnitor" e Name ✓ �O �C ' A Name: __ _ By -- By. — s Its SP -38 EXHIBIT H ACCEPTED BID SP -39 DBE, MBE, & SBE Certified CONSTRUCTION, INC. Lic. #801253 - A, C8, C60 1352 E. Borchard Ave. Santa Ana, CA 92705 714.748.4242 Page 1 of 2 PROPOSAL: G2 CPS -Mod T M & ARS -CL TM City of Seal Beach 2019-2020 STORM WATER POLLUTANT CAPTURE PROJECT OCTA Measure M2 Environmental Cleanup Program, Tier 1 Customer: City of Seal Beach Prepared: 12/17/2019 Public Works Department City Hall, 211 Eighth St. Seal Beach, CA 90740 Contact: Denice Bailey 562.431.2527 x1330 By: Eric H. Taylor Iris Lee, Deputy Public Works Director / City Engineer 714.679.2550 562.431.2527 Iris Lee <ilee@sealbeachca.gov> etaylor@G2Construction.com DESCRIPTION City of Seal Beach, full -capture CPS -Mod TM and ARS -CL rm curb screen catch basin installation. Per the City's request, G2 proposes to install devices in 55 catch basins in 7 unique geographic areas of the City (See included Maps). A total of 52 G2 CPS -Mod TM full -capture systems (State Waterboard certified) are included, and 99 unique ARS -CLT'" screens. Each catch basin will receive between 1 and 6 unique ARS-CLTm screens depending on the curb -opening width. Six of the 7 the geographic Areas are located in Priority Land Use (PLU) space (industrial, commercial, arterial roads, etc.) with the greatest amount of trash and transportation related pollutants, as specified by the OCTA M2 Tier 1 grant. This proposal utilizes 132's master purchase agreement with OCPW, MA -080-15011198 for Trash and Debris Capture Devices for the City of Seal Beach OCTA ECP grant application for 2019-20. The City is eligible for this piggyback contract like all Orange County cities, which guarantees the best product, service, and pricing. Products and services include custom fabrication and installation of CPS -Mod and ARS -CL devices made of 304 stainless steel (approved for OCTA Measure M2 funding) . Plus warranty. c Geo Si ARS G2 ARS- G2 CPS - 3 00 Area PLU Address de Of XStreet Latitude Longitude Screens CL Model Mod Model Total Cost 1 1 Yes Seal Beach Blvd W N Lampson 33.7789 -118.0721 1 ARS -CL 5 G2 -CPS -7.0 $1,456 1 Yes Seal Beach Blvd E N Lampson 33.779120 18.0719047 1 ARS -CL 5 G2 -CPS -7.0 2 $1,456 1 Yes Seal Beach Blvd E N Lampson 33.7790271 18.0719047 1 ARS -CL 5 existing 3 $706 1 Yes Seal Beach Blvd E N Lampson 33.7792 -118.0719 1 ARS -CL 5 existing 4 $706 1 Yes 12490 Seal Beach Blvd E N St. Cloud Dr. 33.7805 -118.0719 1 ARS -CL 5 G2 -CPS -7.0 5 $1,456 1 Yes 12460 Seal Beach Blvd E 33.7813 -118.0719 1 ARS -CL 5 G2 -CPS -7.0 6 $1,456 1 Yes 12420 Seal Beach Blvd E S Town Center Dr. 33.7818 -118.0719 1 ARS -CL 5 G2 -CPS -7.0 7 $1,456 1 Yes 12380 Seal Beach Blvd E IN Town Center Dr. 33.7822 -118.0719 1 ARS -CL 5 G2 -CPS -7.0 8 $1,456 1 Yes Seal Beach Blvd E 133.7832 -118.0719 1 ARS -CL 5 G2 -CPS -7.0 9 $1,456 1 Yes Seal Beach Blvd E 33.7850 -118.0719 2 ARS -CL 7 N/A 10 $1,115 2 Yes 13001 N Gate Rd W N Seal Beach Blvd 33.7722 -118.0777 1 ARS -CL 5 G2 -CPS -4.2 11 $1,336 2 Yes 2492 N Gate Rd E N Seal Beach Blvd 33.7724 -118.0776 1 ARS -CL 5 G2-CPS4.2 12 $1,336 2 Yes 3131 N Gate Rd E IN Seal Beach Blvd 33.7730 -118.0776 1 ARS -CL 5 G2 -CPS -4.2 13 $1,336 2 Yes 2450 N Gate Rd Sou EFoxberg Rd. 33.7740 -118.0862 1 ARS -CL 5 G2 -CPS -4.2 14 $1,336 2 Yes 2450 N Gate Rd Sou E Foxberg Rd. 33.7740 -118.0861 3 ARS -CL 14 G2 -CPS -7.0 15 $2,513 16 3 Yes 2440 N Gate Rd Sou 33.7738 -118.0776 1 ARS -CL 5 G2 -CPS -4.2 $1,336 Page 1 of 2 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 3 Yes Apollo Or E N Saturn Way 33.7557 -118.0873 1 ARS -CL 5 G2 -CPS -7.0 $1,456 $1,456 $1,456 $1,456 $1,456 $1,865 $1,456 $1,865 $1,456 $1,456 $1,865 $1,456 $1,865 $1,865 $1,865 $3,701 $3,701 $2,753 $2,753 $1,865 $1,865 $1,336 $1,865 $1,456 $5,121 $4,401 $1,865 $2,753 $1,865 $1,456 $1,865 $1,336 $1,336 $1,745 $1,745 $1,865 $1,336 $1,336 $1,456 3 Yes Apollo Or E N Apollo Ct 33.7584 -118.0873 1 ARS -CL 5 G2 -CPS -7.0 3 Yes 1799 Apollo Ct N W Apollo Or 33.7584 -118.0876 1 ARS -CL 5 G2 -CPS -7.0 3 Yes 1790 Apollo Ct S W Apollo Or 33.7583 -118.0877 1 ARS -CL 5 G2 -CPS -7.0 3 Yes 1729 Apollo Ct N W Apollo Or 33.7584 -118.0886 1 ARS -CL 5 G2 -CPS -7.0 3 Yes 1740 Apollo Ct S W Apollo Or 33.7583 -118.0888 2 ARS -CL 7 G2 -CPS -7.0 3 Yes 1779 Apollo Ct S W Apollo Or 33.7583 -118.0897 1 ARS -CL 5 G2 -CPS -7.0 3 Yes 1709 Apollo Ct N W Apollo Or 33.7584 -118.0900 2 ARS -CL 7 G2 -CPS -7.0 4 Yes 1770 Saturn Way N W Apollo Or 33.7556 -118.0894 1 ARS -CL 5 G2 -CPS -7.0 4 Yes 1770 Saturn Way S 1W Apollo Or 33.7555 -118.0893 1 ARS -CL 5 G2 -CPS -7.0 4 Yes 1770 Saturn Way N W Apollo Or 33.7556 -118.0880 2 ARS -CL 7 G2 -CPS -7.0 4 Yes 1770 Saturn Way S W Apollo Or 33.7555 -118.0880 1 ARS -CL 5 G2 -CPS -7.0 5 Yes 625 Bolboa Dr. W N Bolsa Ave. 33.7452 -118.0995 2 ARS -CL 7 G2 -CPS -7.0 5 Yes 601 Balboa Dr. E N Bolsa Ave. 33.7452 -118.0993 2 ARS -CL 7 G2 -CPS -7.0 5 Yes 548 Balboa Dr. E N PCH 33.7444 -118.0994 2 ARS -CL 7 G2 -CPS -7.0 5 Yes 1201 Bolsa Ave S E Balboa 33.7450 -118.0991 5 ARS -CL 21 G2 -CPS -7.0 5 Yes 1202 Bolsa Ave N E Balboa 33.7450 -118.0992 5 ARS -CL 21 G2 -CPS -7.0 5 Yes 1349 Crystal Cove Way S at Crystal Place 33.7430 -118.0986 4 ARS-CL14x G2 -CPS -7.0 5 Yes 1649 Emerald Cove We S at Emerald Place 33.7419 -118.0965 4 ARS-CL14x G2 -CPS -7.0 6 Yes 4003 Basswood St. W S Lampson Ave 33.7761 -118.0632 2 ARS -CL 7 G2 -CPS -7.0 6 Yes 4003 Basswood St. E S Lampson Ave 33.7761 -118.0631 2 ARS -CL 7 G2 -CPS -7.0 6 Yes 3570 Aster W S I Basswood St. 33.7756 -118.0621 1 ARS -CL 5 G2-CPS4.2 6 Yes 3580 Aster E End Basswood St. 33.7758 -118.0621 2 ARS -CL 7 G2 -CPS -7.0 6 Yes 4041 Lampson Ave. W N Bassood St. 33.7765 -118.0633 1 ARS -CL 5 G2 -CPS -7.0 6 Yes 3789 Aster S E Candleberry 33.7777 -118.0601 6 ARS -CL 28 2x G2 -CPS -7 6 Yes 3793 Aster S E Candleberry 33.7778 -118.0600 5 ARS -CL 21 2x G2 -CPS -7 6 Yes 3799 Aster S 1E lCandleberry 33.7779 -118.0599 2 ARS -CL 7 G2 -CPS -7.0 6 Yes 3800 Aster N E Candleberry 33.7779 -118.0599 4 ARS-CL14x G2 -CPS -7.0 6 Yes 4157 Candleberry Ave N at Aster St. 1 33.7780 -118.0597 2 ARS -CL 7 G2 -CPS -7.0 6 Yes 4227 Lampson Ave W N Candleberry 33.7805 -118.0577 1 ARS -CL 5 G2 -CPS -7.0 6 No 4200 Elder Ave N E Ironwood 33.7791 -118.0587 2 ARS -CL 7 G2 -CPS -7.0 7 No 269 Harvard Ln W S College Park Dr. 33.7816 -118.0938 1 ARS -CL 5 G2 -CPS -4.2 7 No 265 Harvard Ln W S College Park Dr. 33.7815 -118.0938 1 ARS -CL 5 G2 -CPS -4.2 7 No 104 Stanford W N College Park Dr. 33.7759 -118.0938 2 ARS -CL 7 G2-CPS4.2 7 No 101 Stanford E N College Park Dr. 33.7760 -118.0936 2 ARS -CL 7 G2 -CPS -4.2 7 No 134 College Park Or S E Purdue Cir 33.7758 -118.0936 2 ARS -CL 7 G2 -CPS -7.0 7 1 No 101 Loyola Plaza W N College Park Dr. 33.7752 -118.09543 1 ARS -CL 5 G2 -CPS -4.2 7 No 100 Loyola Plaza E N College Park Dr. 1 33.7752 -118.0953 1 ARS -CL 5 G2 -CPS -4.2 7 1 No 99 College Park Or IS IW Loyola Plaza 1 33.7748 -118.0960 1 ARS -CL 5 G2 -CPS -7.0 ARS -CL Catch Basins 55 ARS -CL Screens 99 CPS -Mod Catch Basins 52 CPS -Mod Screens 54 Pricing from OCTA MA -080-15011198 with Volume discounts for 21-100 devices. Terms & Conditions: Pricing based on OCPW/ OCTA Master Pricing with Volume Discounts (21-100). Pricing does not include project bonding, licence or business fees. Final design configurations and costs to be revised after final field evaluations. Sub -Total $98,982 Traffic Control $6,000 Catch Basin Cleaning $2,340 Combo -Discount -$2,600 Mobilization $4,000 Total Project Cost $108,722 Page 2 of 2 EXHIBIT I NON -COLLUSION DECLARATION FORM SP -40 NON -COLLUSION DECLARATION FORM TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID [PUBLIC CONTRACT CODE SECTION 71061 The undersigned declares: I am the ���s1�W of�.tlsi/l p'h� party making the foregoing Bid. The Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The Bid is genuine and not collusive or sham. The Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham Bid. The Bidder has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham Bid, or to refrain from bidding. 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. All statements contained in the Bid are true. 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, to any corporation, partnership, company, association, organization, Bid depository, or to any member or agent thereof, to effectuate a collusive or sham Bid, and has not paid, and will not pay, any Person or entity for such purpose. Any person executing this declaration on behalf of a Bidder that is a corporation, partnership, joint venture, limited liability company. limited liability partnership. or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the Bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on [date], at j�d &'i [city], �i fi�N1�t [state]. Project Name: cIr7 of-JEAL �-Z.e�H ,I.*I �',vvl�oNrlEti��tL c ,.�„� 1�/u!�2.rr►�f _C.��'S�goo Leg I Business Naaie of Bidder _ Business Address _ _ _/3 S� _ E_• _ /3aRCfct�.� _�✓F,_ ��vfe �tiA CA • 9�2vs_-__ Business Tel rJo. Signature: _. Signature. Printed Name 4/V�/ �`LyA�'� Printed Name. Date- Date This form must be notarized. SP -41 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of 07 "I (19u- On u On T)"- .201 20"1 before me, 'F- K &A Tl;fti�J --W-TA-PI P�t131.1 c , Insen name a o e ser personally appeared J 01 f'N ?- • , 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 iaws of the State of California that the foregoing paragraph is true and correct. EBECCA TRAM ISGIonWITNESS my hand and official seal. coat V PUS C- 2300553 NOTANY tAIICALMONMIA ORANGE COUNTY rZ Aly COMM. E11096 Np. 24.2023 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed, .should be completed and attached to the document. Acknowledgments 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 LA7q Of SE;AL I? I raw. (Title or description of attached document) • State and County information must be the State and County where the document N - p OLL L6' O 1,J signer(s) personally appeared before the notary public for acknowledgment. l• • Date of notarization must be the date that the signer(s) personally appeared which (Tide or description of attached document continued) must also be the same date the acknowledgment is completed. IZ I Zo I I • The notary public must print his or her name as it appears within his or her Number of Pages 1 Document Date 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 notari7ation. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural ibrms by crossing off incorrect forms (i.e. he/she/ihey,- is /are ) or circling the correct forms. Failure to correctly indicate this ❑ Individual (s) information may [cad to rejection of document recording. �( Corporate Officer • the notary seal impression must be clear and photographically reproducible. JW N � hkv 1114120 f4sA DC -W Impression must not cover text or lines. If seal impression smudges, re -seal if a -- (Title) sufficient area permits, otherwise complete a different acknowledgment form. S • Signature of the notary public must match the signature on file with the office of El Partner (s) ) the county clerk. ❑ Attomey-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other 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. CFO, CFO, Secretary). t01 L'e3'Stiv t+:•: ti's Plotary('lases.cem 8C%ii-i3''-aYtiS • Securely attach this document to the signed document with a staple.