HomeMy WebLinkAboutAGMT - GM Sager Construction (Pavement Restoration at 4800 Ironwood Ave)PUBLIC WORKS AGREEMENT
for
Pavement Restoration at 4800 Ironwood Avenue
between
City of Seal Beach
211 - 8th Street
Seal Beach, CA 90740
P
GM Sager Construction Co., Inc.
1380 S. East End Ave.
Pomona, CA 91766
(909) 620-9987
This Professional Services Agreement ("the Agreement") is made as of September 10,
2020 (the "Effective Date"), by and between GM Sager Construction Co., Inc., a
California corporation ("Contractor"), and the City of Seal Beach ("City"), a California
charter city, (collectively, "the Parties").
RECITALS
A. City desires certain professional pavement repair services
B. Pursuant to the authority provided by its City Charter and Seal Beach
Municipal Code § 3.20.035(D), City solicited informal bids from vendors to carry
out the Project, and obtained three written bids. Contractor has submitted an
informal bid to the City for the Project dated in the amount of $18,900.00
attached hereto as Exhibit A and incorporated herein by reference, which
constitutes the lowest acceptable quotation.
C. Pursuant to the authority provided by its City Charter and Seal Beach
Municipal Code § 3.20.035(D), City desires to engage Contractor to provide
professional pavement repair services in the manner set forth herein and more
fully described in Section 1.0.
D. Contractor represents that the principal members of its firm are qualified
California -licensed concrete contractors (License #607796, DI #1000010280)
and are fully qualified to perform the services contemplated by this Agreement
in a good and professional manner; and it desires to perform such services as
provided herein.
NOW THEREFORE, in consideration of the Parties' performance of the
promises, covenants, and conditions stated herein, the Parties hereto agree
as follows.
AGREEMENT
1.0 Scope of Services
1.1. Contractor shall provide those services (collectively "Services") set
forth in the Scope of Services attached hereto as Exhibit A and incorporated
herein by this reference. To the extent that there is any conflict between Exhibit A
and this Agreement, this Agreement shall control.
1.2. Contractor shall perform all Services under this Agreement in
accordance with the standard of care generally exercised by like professionals
under similar circumstances and in a manner reasonably satisfactory to City.
1.3. In performing this Agreement, Contractor shall comply with all
applicable provisions of federal, state, and local law.
1.4. As a material inducement to City to enter into this Agreement,
Contractor hereby represents that it has the experience necessary to undertake
the Services to be provided. In light of such status and experience, Contractor
hereby covenants that it shall follow the customary professional standards in
performing all Services. City relies upon the skill of Contractor, and Contractor's
1 of 16
staff, if any, to do and perform the Services in a skillful, competent, and
professional manner, and Contractor and Contractor's staff, shall perform the
Services in such manner. Contractor shall, at all times, meet or exceed any and
all applicable professional standards of care. The acceptance of Contractor's
work by City shall not operate as a release of Contractor from such standard of
care and workmanship.
1.5. Contractor will not be compensated for any work performed not
specked in the Scope of Services unless City authorizes such work in advance
and in writing. The City Manager may authorize extra work to fund unforeseen
conditions up to the amount approved at the time of award by the City Manager.
Payment for additional work in excess of this amount requires prior City Council
authorization.
2.0 Term
2.1. The term of this Agreement shall commence on September 10,
2020 and shall remain in full force and effect until work is fully completed unless
sooner terminated as provided in Section 6.0 of this Agreement.
3.0 Contractor's Compensation
3.1. City will pay Contractor in accordance with the cost proposal set
forth in Exhibit A for the Services but in no event will the City pay more than the
total not -to -exceed amount of Eighteen Thousand Nine Hundred and 00/100
Dollars ($18,900.00) for the Term.
3.2. Any additional work authorized by the City Manager pursuant to
Section 1.5 will be compensated in accordance with the fee schedule set forth
in Exhibit A.
4.0 Method of Payment
4.1. Contractor shall submit to City monthly invoices for all Services
rendered pursuant to this Agreement. Such invoices shall be submitted within 15
days of the end of the month during which the Services were rendered and shall
describe in detail the Services rendered during the period, the days worked,
number of hours worked, the hourly rates charged, and the Services performed
for each day in the period. City will pay Contractor within 30 days of receiving
Contractor's invoice. City will not withhold any applicable federal or state payroll
and other required taxes, or other authorized deductions from payments made to
Contractor.
4.2. Upon 24-hour notice from City, Contractor shall allow City or City's
agents or representatives to inspect at Contractor's offices during reasonable
business hours all records, invoices, time cards, cost control sheets and other
2 of 16
records maintained by Contractor in connection with this Agreement. City's rights
under this Section 4.2 shall survive for three (3) years following the termination of
this Agreement.
5.0 Payment and Performance Bonds; Guaranty
Unless otherwise expressly provided in the bid documents, or exempted by City,
prior to commencing work, Contractor shall provide a payment bond and
performance bond, each in an amount equal to 100% of the Contract price. The
bond forms required to be executed are attached hereto and incorporated by
reference herein. Pursuant to the bid documents for this Project, the performance
bond shall include Contractor's written guaranty of Contractor's work for a period
of one year following notice of completion.
6.0 Termination
6.1. This Agreement may be terminated by City, without cause, or by
Contractor based on reasonable cause, upon giving the other party written notice
thereof not less than 30 days prior to the date of termination.
6.2. This Agreement may be terminated by City upon 10 days' notice to
Contractor if Contractor fails to provide satisfactory evidence of renewal or
replacement of comprehensive general liability insurance as required by this
Agreement at least 20 days before the expiration date of the previous policy.
7.0 Party Representatives
7.1. The City Manager is City's representative for purposes of this
Agreement.
7.2. Bryson Miller is Contractor's primary representative for purposes of
this Agreement. Bryson Miller shall be responsible during the term of this
Agreement for directing all activities of Contractor and devoting sufficient time to
personally supervise the Services hereunder. Contractor may not change its
representative without the prior written approval of City, which approval shall not
be unreasonably withheld.
8.0 Notices
8.1. All notices permitted or required under this Agreement shall be
deemed made when personally delivered or when mailed 48 hours after deposit
in the United States Mail, first class postage prepaid and addressed to the party
at the following addresses:
To City: City of Seal Beach
211 -8th Street
3of16
Seal Beach, California 90740
Attn: City Manager
To Contractor: GM Sager Construction Co., Inc.
1380 S. East End Ave.
Pomona, CA 91766
Attn: Michael Sager
8.2. Actual notice shall be deemed adequate notice on the date actual
notice occurred, regardless of the method of service.
9.0 Independent Contractor
9.1. Contractor is an independent contractor and not an employee of
City. All work or other Services provided pursuant to this Agreement shall be
performed by Contractor or by Contractor's employees or other personnel under
Contractor's supervision, and Contractor and all of Contractor's personnel shall
possess the qualifications, permits, and licenses required by State and local law
to perform such Services, including, without limitation, a City of Seal Beach
business license as required by the Seal Beach Municipal Code. Contractor will
determine the means, methods, and details by which Contractor's personnel will
perform the Services. Contractor shall be solely responsible for the satisfactory
work performance of all personnel engaged in performing the Services and
compliance with the customary professional standards.
4of16
9.2. All of Contractor's employees and other personnel performing any
of the Services under this Agreement on behalf of Contractor shall also not be
employees of City and shall at all times be under Contractor's exclusive direction
and control. Contractor and Contractor's personnel shall not supervise any of
City's employees; and City's employees shall not supervise Contractor's
personnel. Contractor's personnel shall not wear or display any City uniform,
badge, identification number, or other information identifying such individual as
an employee of City; and Contractor's personnel shall not use any City e-mail
address or City telephone number in the performance of any of the Services
under this Agreement. Contractor shall acquire and maintain at its sole cost and
expense such vehicles, equipment and supplies as Contractors personnel
require to perform any of the Services required by this Agreement. Contractor
shall perform all Services off of City premises at locations of Contractor's choice,
except as otherwise may from time to time be necessary in order for Contractor's
personnel to receive projects from City, review plans on file at City, pick up or
deliver any work product related to Contractor's performance of any Services
under this Agreement, or as may be necessary to inspect or visit City locations
and/or private property to perform such Services. City may make a computer
available to Contractor from time to time for Contractor's personnel to obtain
information about or to check on the status of projects pertaining to the Services
under this Agreement.
9.3. Contractor shall be responsible for and pay all wages, salaries,
benefrts and other amounts due to Contractor's personnel in connection with their
performance of any Services under this Agreement and as required by law.
Contractor shall be responsible for all reports and obligations respecting such
additional personnel, including, but not limited to: Social Security taxes, other
retirement or pension benefits, income tax withholding, unemployment insurance,
disability insurance, and workers' compensation insurance. Notwithstanding any
other agency, State, or federal policy, rule, regulation, statute or ordinance to the
contrary, Contractor and any of its officers, employees, agents, and
subcontractors providing any of the Services under this Agreement shall not
become entitled to, and hereby waive any claims to, any wages, salaries,
compensation, benefit or any incident of employment by City, including but not
limited to, eligibility to enroll in, or reinstate to membership in, the California
Public Employees Retirement System ("PERS") as an employee of City, and
entitlement to any contribution to be paid by City for employer contributions or
employee contributions for PERS benefits.
9.4. 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
liability, damages, claims, costs and expenses of any nature to the extent arising
from, caused by, or relating to Contractor's personnel practices. or to the extent
arising from, caused by or relating to the violation of any of the provisions of this
Section 9.0. In addition to all other remedies available under law, City shall have
5of16
the right to offset against the amount of any fees due to Contractor under this
Agreement any amount due to City from Contractor as a result of Contractor's
failure to promptly pay to City any reimbursement or indemnification arising under
this Section. This duty of indemnification is in addition to Contractor's duty to
defend, indemnify and hold harmless as set forth in any other provision of this
Agreement.
10.0 PERS Compliance and Indemnification
10.1. General Requirements. The Parties acknowledge that City is a local
agency member of PERS, and as such has certain pension reporting and
contribution obligations to PERS on behalf of qualifying employees. Contractor
agrees that, in providing its employees and any other personnel to City to
perform any work or other Services under this Agreement, Contractor shall
assure compliance with the Public Employees' Retirement Law, commencing at
Government Code § 20000, the regulations of PERS, and the Public Employees'
Pension Reform Act of 2013, as amended. Without limitation to the foregoing,
Contractor shall assure compliance with regard to personnel who have active or
inactive membership in PERS and to those who are retired annuitants and in
performing this Agreement shall not assign or utilize any of its personnel in a
manner that will cause City to be in violation of the applicable retirement laws
and regulations.
10.2. Indemnification. Contractor shall defend (with legal counsel
approved by City, whose approval shall not be unreasonably withheld), indemnify
and hold harmless City, and its 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 liability, damages, claims, costs and
expenses of any nature to the extent arising from, caused by, or relating to
Contractor's violation of any provisions of this Section 10.0. This duty of
indemnification is in addition to Contractor's duty to defend, indemnify and hold
harmless as set forth in any other provision of this Agreement.
11.0 Confidentiality
Contractor covenants that all data, documents, discussion, or other information
developed or received by Contractor or provided for performance of this
Agreement are deemed confidential and shall not be disclosed by Contractor
without prior written authorization by City. City shall grant such authorization if
applicable law requires disclosure. All City data shall be returned to City upon
the termination of this Agreement. Contractor's covenant under this Section
shall survive the termination of this Agreement.
6of16
12.0 Subcontractors
No portion of this Agreement shall be subcontracted without the prior written
approval of the City. Contractor is fully responsible to City for the performance
of any and all subcontractors.
13.0 Assignment
Contractor shall not assign or transfer any interest in this Agreement whether by
assignment or novation, without the prior written consent of City. Any purported
assignment without such consent shall be void and without effect.
14.0 Inspection and Audit of Records
Contractor shall maintain complete and accurate records with respect to all
Services and other matters covered under this Agreement, including but
expressly not limited to, all Services performed, salaries, wages, invoices, time
canis, cost control sheets, costs, expenses, receipts and other records with
respect to this Agreement. Contractor shall maintain adequate records on the
Services provided in sufficient detail to permit an evaluation of all Services in
connection therewith. All such records shall be clearly identified and readily
accessible. At all times during regular business hours, Contractor shall provide
City with free access to such records, and the right to examine and audit the
same and to make copies and transcripts as City deems necessary, and shall
allow inspection of all program data, information, documents, proceedings and
activities and all other matters related to the performance of the Services under
this Agreement. Contractor shall retain all financial and program service
records and all other records related to the Services and performance of this
Agreement for at least three (3) years after expiration, termination or final
payment under this Agreement, whichever occurs later. City's rights under this
Section 14.0 shall survive for three (3) years after expiration, termination or
final payment under this Agreement, whichever occurs later.
15.0 Safety Requirements
All work performed under this Agreement shall be performed in such a manner
as to provide safety to the public and to meet or exceed the safety standards
outlined by CAL OSHA. City may issue restraint or cease and desist orders to
Contractor when unsafe or harmful acts are observed or reported relative to the
performance of the Services. Contractor shall maintain the work sites free of
hazards to persons and property resulting from its operations. Contractor shall
immediately report to the City any hazardous condition noted by Contractor.
16.0 Insurance
16.1. Contractor shall not commence work under this Agreement until it
has provided evidence satisfactory to City that Contractor has secured all
7of16
insurance required under this Section. Contractor shall furnish City with original
certificates of insurance and endorsements effecting coverage required by this
Agreement on forms satisfactory to City. The certificates and endorsements for
each insurance policy shall be signed by a person authorized by that insurer to
bind coverage on its behalf, and shall be on forms provided by City if requested.
All certificates and endorsements shall be received and approved by City before
work commences. City reserves the right to require complete, certified copies of
all required insurance policies, at any time.
16.2. Contractor shall, at its expense, procure and maintain for the
duration of the Agreement, insurance against claims for injuries to persons or
damages to property that may arise from or in connection with the performance
of this Agreement. Insurance is to be placed with insurers with a current A.M.
Best's rating no less than A:VIII, licensed to do business in California, and
satisfactory to City. Coverage shall be at least as broad as the latest version of
the following: (1) General Liability: Insurance Services Office Commercial
General Liability coverage (occurrence form CG 0001); (2) Automobile Liability:
Insurance Services Office Business Auto Coverage form number CA 0001,
code 1 (any auto); and (3) Workers' Compensation and Employer's Liability
coverages. Contractor shall maintain limits no less than: (1) General Liability:
$2,000,000 per occurrence for bodily injury, personal injury and property
damage and if Commercial General Liability Insurance or other form with a
general aggregate limit is used, either the general aggregate limit shall apply
separately to this Agreement/location or the general aggregate limit shall be
twice the required occurrence limit; (2) Automobile Liability: $1,000,000 per
accident for bodily injury and property damage; and (3) Workers'
Compensation in the amount required by law and Employer's Liability:
$1,000,000 per accident and in the aggregate for bodily injury or disease.
16.3. The insurance policies shall contain the following provisions, or
Contractor shall provide endorsements on forms supplied or approved by City
to state: (1) coverage shall not be suspended, voided, reduced or canceled
except after 30 days prior written notice by certified mail, return receipt
requested, has been given to City; (2) any failure to comply with reporting or
other provisions of the policies, including breaches of warranties, shall not
affect coverage provided to City, its directors, officials, officers, employees,
agents, volunteers and agents serving as independent contractors in the role of
City officials; (3) coverage shall be primary insurance as respects the City, its
directors, officials, officers, employees, agents, volunteers and agents serving as
independent contractors in the role of City officials, or if excess, shall stand in an
unbroken chain of coverage excess of Contractor's scheduled underlying
coverage and that any insurance or self-insurance maintained by City, its
directors, officials, officers, employees, agents, volunteers and agents serving as
independent contractors in the role of City officials shall be excess of Contractor's
insurance and shall not be called upon to contribute with it; (4) for general liability
insurance, that City, its directors, officials, officers, employees, agents,
8of16
volunteers and agents serving as independent contractors in the role of City
officials shall be covered as additional insureds with respect to the services or
operations performed by or on behalf of Contractor, including materials, parts or
equipment fumished in connection with such work; and (5) for automobile liability,
that City, its directors, officials, officers, employees, agents, volunteers and
agents serving as independent contractors in the role of City officials shall be
covered as additional insureds with respect to the ownership, operation,
maintenance, use, loading or unloading of any auto owned, leased, hired or
borrowed by Contractor or for which Contractor is responsible.
16.4. All insurance required by this Section shall contain standard
separation of insureds provisions and shall not contain any special limitations on
the scope of protection afforded to City, its directors, officials, officers,
employees, agents, volunteers and agents serving as independent contractors in
the role of City officials.
16.5. Any deductibles or self-insured retentions shall be declared to and
approved by City. Contractor guarantees that, at the option of City, either: (1) the
insurer shall reduce or eliminate such deductibles or self-insured retentions as
respects City, its directors, officials, officers, employees, agents, and volunteers;
or (2) Contractor shall procure a bond guaranteeing payment of losses and
related investigation costs, claims and administrative and defense expenses.
16.6. Each insurance policy, except for any professional liability policy,
required by this Section 16.0 shall expressly waive the insurer's right of
subrogation against City and its officials, officers, employees, servants,
attorneys, designated volunteers, and agents serving as independent contractors
in the role of City or agency officials.
17.0 Indemnification, Hold Harmless, and Duty to Defend
Contractor and City agree that City, its elected officials, officers, attorneys,
agents, employees, designated volunteers, successors, assigns and those City
agents serving as independent contractors in the role of City officials (collectively
"Indemnitees" in this Section 17.0) should, to the fullest extent permitted by law,
be fully protected from any loss, injury, damage, claim, liability, lawsuit, cost,
expense, attorneys' fees, litigation costs, defense costs, court costs and/or any
other cost arising out of or in any way related to the performance of this
Agreement. Accordingly, the provisions of this indemnity provision are intended
by the Parties to be interpreted and construed to provide the fullest protection
possible under the law to City and all other Indemnitees. Contractor
acknowledges that City would not have entered into this Agreement in the
absence of the commitment of Contractor to indemnify and protect City and the
other Indemnitees, as set forth in this Agreement.
• • AN
17.1. Indemnity. To the fullest extent permitted by law, Contractor shall,
at its sole cost and expense, protect, defend, hold harmless and indemnify City,
its elected officials, officers, attorneys, agents, employees, designated
volunteers, successors, assigns and those City agents serving as independent
contractors in the role of City officials (collectively "Indemnitees" in this Section
17.0) from and against any and all damages, costs, expenses, liabilities, claims,
demands, causes of action, bid protests, stop notices, suits, proceedings,
judgments, penalties, liens and losses of any nature whatsoever, including fees
of accountants, attorneys and other professionals, and all costs associated
therewith, and the payment of all consequential damages (collectively "Claims"),
in law or equity, whether actual, alleged or threatened, in any manner arising out
of, pertaining to, or relating to the acts or omissions of Contractor, and/or its
directors, officers, agents, servants, employees, subcontractors, materialmen,
suppliers, or contractors, or their officers, agents, servants or employees (or any
entity or individual that Contractor shall bear the legal liability thereof) in the
performance of this Agreement, including the Indemnitees' active or passive
negligence, and/or willful misconduct, except for Claims arising from the sole
negligence or willful misconduct of Indemnitees, as determined by final arbitration
or court decision or by the agreement of the Parties. Contractor shall defend the
Indemnitees in any action or actions filed in connection with any Claims with
counsel of the Indemnitees' choice, and shall pay all costs and expenses,
including all reasonable attorneys' fees and experts' costs actually incurred in
connection with such defense. Contractor shall reimburse the Indemnitees for
any and all legal expenses and costs incurred by the Indemnitees in connection
therewith.
17.2. Civil Code Exception. Nothing in this Section 17.0 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 Agreement is
subject to Civil Code Section 2782(b), provided such sole negligence, willful
misconduct or active negligence is determined by final arbitration or court
decision or by agreement of the Parties.
17.3. Subcontractor Indemnification. Contractor shall obtain executed
indemnity agreements with provisions identical to those in this Section 17.0 from
each and every subcontractor or any other person or entity involved by, for, with
or on behalf of Contractor in the performance of this Agreement. If Contractor
fails to obtain such indemnities, Contractor shall be fully responsible and
indemnify, hold harmless and defend the Indemnitees from and against any and
all Claims in law or equity, whether actual, alleged or threatened, which arise out
of, are claimed to arise out of, pertain to, or relate to the acts or omissions of
Contractor's subcontractor, its officers, agents, servants, employees,
subcontractors, materialmen, contractors or their officers, agents, servants or
employees (or any entity or individual that Contractor's subcontractor shall bear
the legal liability thereof) in the performance of this Agreement, including the
Indemnitees' active or passive negligence, except for Claims arising from the
10 of 16
sole negligence or willful misconduct of the Indemnitees, as determined by final
arbitration or court decision or by the agreement of the Parties.
17.4. Bid Protest. In addition to its obligations pursuant to Section 17.1,
Contractor shall reimburse City for all attorneys' fees and costs incurred by City
in connection with, arising out of or incident to any bid protest.
17.5. 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 Contractor.
17.6. Nonwaiver of Rights. Indemnitees do not, and shall not, waive any
rights they may each possess against Contractor because of the acceptance by
City, or the deposit with City, of any insurance policy or certificate required
pursuant to this Agreement.
17.7. Insurance Not Limitation. The obligations of Contractor under this
or any other provision of this Agreement shall not be limited by the provisions of
any workers' compensation act or similar act. Contractor expressly waives any
statutory immunity under such statutes or laws as to the Indemnitees.
Contractor's indemnity obligation set forth in this Section 17.0 shall not be limited
by the limits of any policies of insurance required or provided by Contractor
pursuant to this Agreement.
17.8. Survival. Contractor's covenants under this Section 17.0 shall
survive the expiration or termination of this Agreement.
18.0 Equal Opportunity
Contractor affirmatively represents that it is an equal opportunity employer.
Contractor shall not discriminate against any subcontractor, employee, or
applicant for employment because of race, religion, color, national origin,
handicap, ancestry, sex, sexual orientation, or age. Such non-discrimination
includes, but is not limited to, all activities related to initial employment,
upgrading, demotion, transfer, recruitment or recruitment advertising, layoff, or
termination.
19.0 Labor Certification
By its signature hereunder, Contractor certifies that it is aware of the provisions
of Section 3700 of the California Labor Code that 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 agrees to comply with such
provisions before commencing the performance of the Services.
11 of 16
20.0 Prevailing Wage and Payroll Records
If this Agreement calls for services that, in whole or in part, constitute "public
works" as defined in the California Labor Code, then Contractor shall comply in
all respects with all applicable provisions of the California Labor Code,
including those set forth in Exhibit B, attached hereto and incorporated by
reference herein.
21.0 Suspension
City may, in writing, order Contractor to suspend all or any part of the
Contractor's Services for the convenience of City or for work stoppages beyond
the control of City or Contractor. A suspension of the Services does not void
this Agreement.
22.0 Entire Agreement
This Agreement contains the entire agreement of the Parties with respect to the
subject matter hereof, and supersedes all prior negotiations, understandings, or
agreements. This Agreement may only be modified by a writing signed by both
Parties.
23.0 Severability
The invalidity in whole or in part of any provisions of this Agreement shall not
void or affect the validity of the other provisions of this Agreement.
24.0 Governing Law
This Agreement shall be governed by and construed in accordance with the laws
of the State of California.
25.0 No Third Party Rights
No third party shall be deemed to have any rights hereunder against either party
as a result of this Agreement.
26.0 Waiver
No waiver of any default shall constitute a waiver of any other default or breach,
whether of the same or other covenant or condition. No waiver, benefit, privilege,
or service voluntarily given or performed by a party shall give the other party any
contractual rights by custom, estoppel, or otherwise.
27.0 Prohibited Interests; Conflict of Interest
12 of 16
27.1. Contractor covenants that it presently has no interest and shall not
acquire any interest, direct or indirect, which may be affected by the Services, or
which would conflict in any manner with the performance of the Services.
Contractor further covenants that, in performance of this Agreement, no person
having any such interest shall be employed by it. Furthermore, Contractor shall
avoid the appearance of having any interest, which would conflict in any manner
with the performance of the Services. Contractor shall not accept any
employment or representation during the term of this Agreement which is or may
likely make Contractor "financially interested" (as provided in California
Government Code Sections 1090 and 87100) in any decision made by City on
any matter in connection with which Contractor has been retained.
27.2. Contractor further warrants and maintains that it has not employed
or retained any person or entity, other than a bona fide employee working
exclusively for Contractor, to solicit or obtain this Agreement. Nor has Contractor
paid or agreed to pay any person or entity, other than a bona fide employee
working exclusively for Contractor, any fee, commission, gift, percentage, or any
other consideration contingent upon the execution of this Agreement. Upon any
breach or violation of this warranty, City shall have the right, at its sole and
absolute discretion, to terminate this Agreement without further liability, or to
deduct from any sums payable to Contractor hereunder the full amount or value
of any such fee, commission, percentage or gift.
27.3.Contractor warrants and maintains that it has no knowledge that any
officer or employee of City has any interest, whether contractual, non -
contractual, financial, proprietary, or otherwise, in this transaction or in the
business of Contractor, and that if any such interest comes to the knowledge of
Contractor at any time during the term of this Agreement, Contractor shall
immediately make a complete, written disclosure of such interest to City, even if
such interest would not be deemed a prohibited "conflict of interest" under
applicable laws as described in this Section 27.0.
28.0 Antitrust Claims
In entering into this Agreement, 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 (Chapter 2
(commencing with Section 16700) of Part 2 of Division 7 of the California
Business and Professions Code) arising from purchases of goods, services, or
materials pursuant to the Agreement. This assignment shall be made and
become effective at the time City tenders final payment to Contractor without
further acknowledgment by the parties.
29.0 Trenching and Excavations
13 of 16
Pursuant to Public Contract Code Section 7104, if the project involves trenching
more than four (4) feet deep, Contractor shall promptly and before the following
conditions are disturbed notify the City in writing of any:
29.1. Material that Contractor believes may be material that is hazardous
waste, as defined in California Health and Safety Code Section 25117, that is
required to be removed to a Class I, Class II, or Class III disposal site in
accordance with provisions of existing law; and/or Subsurface or latent physical
conditions at the site differing from those indicated; and/or
29.2. Unknown physical conditions at the site of any unusual nature,
different materially from those ordinarily encountered and generally recognized
as inherent in work of the character provided for in the Agreement.
29.3.As required by Labor Code Section 6705 and in addition thereto,
whenever work under the Contract that involves an estimated expenditure in
excess of twenty-five thousand dollars ($25,000) for the excavation of any trench
or trenches five (5) feet or more in depth, Contractor shall submit for acceptance
by City in advance of excavation, a detailed plan showing the design of shoring,
bracing, sloping, or other provisions to be made for worker protection from the
hazard of caving ground during the excavation, of such trench or trenches. If
such plan varies from the shoring system standards established by the
Construction Safety Orders of the Division of Industrial Safety, the plan shall be
prepared by a registered civil or structural engineer employed by Contractor, and
all costs therefor shall be included in the price of the Agreement. Nothing in this
provision shall be deemed to allow the use of a shoring, sloping, or other
protective system less effective than that required by the Construction Safety
Orders. Nothing in this provision shall be construed to impose tort liability on the
City or on any City officer, agent, consultant, representative, or employee. All
plans, processing and shoring costs are Contractor's responsibility and must be
included in Contractor's bid.
30.0 Location of Existing Elements
Pursuant to Government Code Sections 4216 to 4216.9, the methods used and
costs involved to locate existing elements, points of connection and all
construction methods are Contractor's sole responsibility. Accuracy of
information furnished, as to existing conditions, is not guaranteed. Contractor, at
its sole expense, must make all investigations necessary to determine locations
of existing elements, which may include, without limitation, contacting U.S.A.
alert and other private underground locating firm(s), and/or utilizing potholes,
specialized locating equipment and/or hand trenching.
31.0 Third Party Claims Fees
Pursuant to Public Contract Code Section 9201, City has full authority to
compromise or otherwise settle any claim relating to this Agreement at any time.
14 of 16
City shall timely notify Contractor of the receipt of any third -party claim relating to
the Agreement. City shall be entitled to recover its reasonable costs incurred in
providing the notification required by Public Contract Code Section 9201(b).
32.0 Non -Collusion
Contractor hereby certifies that this bid is genuine and not a sham or collusive, or
made in the interest or on behalf of any person or business not herein named.
Contractor further certifies that Contractor has not directly or indirectly induced or
solicited any other bidder to furnish a sham bid, or any other person or business
to refrain from bidding, and Contractor has not in any manner sought by collusion
to secure itself an advantage over any other bidder. Contractor also affirms that it
has signed and submitted with its bid to City a Non -collusion Declaration as
required by Public Contract Code Section 7106.
33.0 Attorneys' Fees
If either party commences an action against the other party, either legal,
administrative or otherwise, arising out of or in connection with this Agreement,
the prevailing party in such litigation shall be entitled to have and recover from
the losing party all of its attorneys' fees and other costs incurred in connection
therewith.
34.0 Exhibits
All exhibits referenced in this Agreement are hereby incorporated into the
Agreement as if set forth in full herein. In the event of any material discrepancy
between the terms of any exhibit so incorporated and the terms of this
Agreement, the terms of this Agreement shall control.
35.0 Corporate Authority
The person executing this Agreement on behalf of Contractor warrants that he or
she is duly authorized to execute this Agreement on behalf of said party and that
by his or her execution, Contractor is formally bound to the provisions of this
Agreement.
IN WITNESS WHEREOF, the Parties hereto, through their respective authorized
representatives have executed this Agreement as of the date and year first
above written.
15 of 16
CITY OF SEAL BEACH CONTRACTOR:
Steve-Myrter, Nblic Works Director Name:
to
Its: �j : pAk& :
4
Attest:
By:
Approved as
By:
A. Steele, City Attomey
23050800
By b,,,,.,, -%.,
Name:
Its: �s►Q9—r WV
(Please note, two signatures required
for corporations pursuant to Califomia
Corporations Code Section 313 from
each of the following categories: (i) the
chairperson of the board, the president
or any vice president, and (i►) the
secretary, any assistant secretary, the
chief financial officer or any assistant
treasurer of such corporation.)
[1112019 rev.]
PROPOSAL
Bidders Name GM Sager Constrution Co., Inc.
The undersigned, as bidder, declares that: (1) -this proposal is made without collusion with any
other person, firm or corporation, and that the only persons or parties interested as principals are
those named herein as sworn in the attached Non -Collusion Affidavit; (2) -bidder has carefully
examined the Specifications, Instructions; and (3) -bidder has investigated and is satisfied as to
the conditions to be encountered, the character, quality and quantities of work to be performed
and materials to be furnished. Furthermore, bidder agrees that submission of this proposal shall
be conclusive evidence that such examination and investigation have been made and agrees, in
the event this contract be awarded to bidder, to enter into a contract with the City Council of the
CITY OF SEAL BEACH, to perform said proposed work in accordance with the Plans, if any,
and the terms of the Specifications, in the time and manner therein prescribed, and to furnish or
provide all materials, labor, tools, equipment, apparatus and other means necessary so to do,
except such thereof as may otherwise be furnished or provided under the terms of said
Specifications, for the following stated unit prices or lump sum price as submitted on the Bid
Sheet herein.
The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial
Safety Record. This Safety Record must include all construction work undertaken in the State of
California by the bidder and any partnership, joint venture or corporation that any principal of
the bidder participated in as a principal or owner for the last five calendar years and the current
calendar year prior to the date of bid submittal. Separate information shall be submitted for each
such partnership, joint venture, or corporate or individual bidder. The bidder may attach any
additional information or explanation of data which he would like to be taken into consideration
in evaluating the safety record. An explanation of the circumstances surrounding any and all
fatalities must be attached.
F4
Pavement Repair 4800 IRONWOOD AVE.
BID SHEET
No
Item Description
Unto
Measure
Est.
Qty.
Unit Price
Item Cost
1
Mobilization/Demobilization
LS.
1
$1,500.00
$1,500.00
2
Grind/removal
approximately 2" depth
Conventional Asphalt.
Sq. Ft.
1200
$2.50
$3,000.00
3
Replace/Cap roadway with
approved PG 64-10 HMA
material.
Sq. Ft.
1200
$4.00
$4,800.00
4
Deep Dig -out replacement
Sq. Ft.
400
$14.00
55,600.00
S
Traffic control I
LS.
1
$1,500.00
$1,500.00
6
Compaction
I.S.
1
$1,500.00
$1,500.00
7
Materials Disposals
Ls.
1
$1,000.00
$1,000.00
TOTAL BID PRICE (BASED ON BID SCHEDULE TOTAL OF UNIT PRICES):
$ _ 18.900.00
Total Bid Price in Numbers
Eighteen Thousand Nine Hundred Dollars and No Cents
Total Bid Price in Written Form
IN CASE OF DISCREPANCY BETWEEN WORDS AND FIGURES, THE WORDS SHALL
PREVAIL.
NOTE: The City reserves the right to award a contract to the lowest responsible bidder in parts
or in its entirety and reserves the rights to reject all bids and re -advertise, as appears to be in the
best interests of the City. A bid is required for this entire work, the estimated quantities set forth
in this Bid Sheet being solely for the purpose of comparing bids, and final compensation under
the Contract will be based upon the actual quantities of work satisfactorily completed. The unit
3
and/or lump sum prices bid shall include all appurtenant expenses, taxes, royalties, and fees. In
the case of discrepancies in the amount bid, unit prices shall govern over extended amounts, and
words shall govern over figures. The City reserves the right to increase or decrease the amount
of any quantity shown and to delete any item from the Contract.
The undersigned bidder agrees that, if awarded the Contract, bidder will complete all work
according to the contract documents.
Legal Business Name of Bidder
CTM Sager Construction Co., Inc.
Business Address
1380 S. East End Ave., Pomona, CA 91766
Business Tel. No.
909 620-9987
QZ Vice President
Signature Date Title
If bidder is an individual, name and signature of individual must be provided, and, if he is doing
business under a fictitious name, the fictitious name must be set forth. If bidder is a partnership
or joint venture, legal name of partnership/joint venture must be provided, followed by
signatures of all of the partners/joint venture's or of fewer than all of the partners/joint venture's
if submitted with evidence of authority to act on behalf of the partnership/joint venture. if bidder
is a corporation, legal name of corporation must be provided, followed by signatures of the
corporation President or Vice President and Secretary or Assistant Secretary, and the corporate
seal. Signatures of partners, joint venture's, or corporation officers must be acknowledged
before a Notary Public, who must certify that such partners, joint venture's, or officers are
known to him or her to be such, and, in the case of a corporation, that such corporation executed
the instrument pursuant to its bylaws or a resolution of its Board of Directors_
4
�
4 •� P.
J
y
y �
•j
A v C
C �
� •L
rr
yy[
L
q 9
<
Li
1
�• E ''
v 3
❑-
� c
i.
-
3
T E
0
f
j4,
ti
a Nm
ci
v
.l
r
j
•J
e
��
O=
e
J
r r ss'ce
��
.-I
•C" -r
�3
1 f 1
.�
J:
'1 tom'
� : `-
�
,
C�Ew
i7
A
..•
—
u
I I I
v t
`I
—S
•�
O ._
— Z
it b Y W
I I
V'
s
-
����
�
:�
=:goo❑�❑000❑,;oQ�oo
I
cu
�Q,
�❑OQQOC!❑C1DDQ:OO
J
rr
G
ID
v
j
C�Ew
i7
A
..•
—
u
I I I
v t
{ / \
G-
`�� §\
\(\ }\
\\
I
oc
:_-
f!
�
z
\
3
j
GMS Office
From: Janice Lipscomb
Sent: Tuesday, August 25, 2020 2:04 PM
To: sfunes@sealbeachca.gov
Cc: GMS Office
Subject: FW: Your single Unenrolled Payment to City of Seal Beach has been initiated
As requested. please see confirmation below.
Thank you,
Janice M. Lipscomb
GM Sager Construction Co., Inc.
1380 South East End Avenue, Pomona, CA 91766
909-620-9987
909-620-5288 (Fax)
Janice@gmsager.com
From: DoNotReply_SeaIBeach@transactis.net [mailto:DoNotReply_SealBeach@transactis.net]
Sent: Tuesday, August 25, 2020 1:58 PM
To: Janice Lipscomb <Janice@gmsager.com>
Subject: Your single Unenrolled Payment to City of Seal Beach has been initiated
Your One-time Payment to City of Seal Beach is being processed.
Customer Number: GM Sager Constructio
Account Name: GM Sager Construction Co.,
Inc.
Payment Account: Visa ****5093
Payment Amount:
$223.00
Fee Amount:
$6.69
Total Amount:
$229.69
Confirmation #: 3106770078
Creation Date: Tuesday, August 25, 2020
Payment Date: Wednesday, August 26, 2020
1 Item paid with this One-time Payment
Confirmation Customer Payment Total Payment
:# Number Reason Invoice Amount
1
Division Name
3106770077 GM Sager Business $223.00 $223.00 6 - Finance: Business
Constructio License License
Please DO NOT reply to this email. This email message was sent from a notification address that cannot accept incoming email.
To contact us, click here and review the Contact Us section on our web site.
ACORUa CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
`�
9r10r2020
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 Edgewood Partners Insurance Center (EPIC)
NAME: CONTACT Michelle Orton
19000 MacArthur Blvd. PH Floor'
EIHC.NAILExtI1 949-417-9131. 1 L na): 949-26&5982
Irvine, CA 92612
AooREss: mlchelle.orton@epicbrokers.com
MED EXP (Any oneperson) $15,000
INSURER (SI AFFORDING COVERAGE _ NAIC A
www.edgewoodins.com
INSURERA: National Fire Insurance Co of Hartford 20478
INSURED
INSURER B: Trans ortationInsurance Company 20494
G M Sager Construction Co., Inc.
_
1380 South East End Ave
INSURER GuideOne Mutual Insurance Com a 15032
Pn Y .______
INSURER D: Valley Fore Insurance Company 20508
Pomona CA 91766
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ✓ JET LOC
INSURER E: Continental Insurance ComDany 35289
IN.5URER F,
COVERAGES CERTIFICATE NUMBER: 57AOFA71t REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE L' P
POLICYNUMBER
POLICY EFF
POLICY EXP
LIMITS
A
COMMERCIAL GENERAL LIABILITY ✓ 5095057881
4/19/2020
4/19/2021
EACH OCCURRENCE S 1,000,000
G1_A:MS-MADE ❑✓ OCCUR
DAMAGE TO
PREMISES Ea ocwrrence $ 100,000
MED EXP (Any oneperson) $15,000
i
✓ PD Ded/Occ - $5,000
PERSONAL d ADV INJURY $1.000.000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ✓ JET LOC
PRODUCTS - COMP/OP AGG $ 2.000.D00
$
OTHER:
B
AUTOMOBILE UABB ITY6024265839
4/1912020
4/19/2021
Es (Esaccident)SINGLE u $1.000,000
BODILY INJURY (Per person) S
✓ ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident) $
i HIRED NON -OWNED
✓ AUTOS ONLY ✓ i AUTOS ONLY
PROPERTYDAMAGE $
Per accident)
^ _
E
✓
UMBRELLA LIAR
/ OCCUR
6024265656
4/19/2020
4/1912021
EACH OCCURRENCE S3,000.000
EXCESS LIAB'CLAIMS-MADE
!
AGGREGATE _13_P00 000
DED ✓ RETENTION $10.000
T _
S
1
C
WORKERS COMPENSATKIN1010007042
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBEREXCLUDED7
''.
N / A
1/1/2020
1/1/2021
�/ STATUTE ER
--- ----
E.L. EACH ACCIDENT S 1 000 OOO
----
E.L. DISEASE - EA EMPLOYE S .a 110.0 _
(Mandatory In NH)
If yesdescribe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT I S 1,000,000
D
Rented/Leased Contractors
Equipment
16024265811
i
4/1912020
4!19/2021
$200,000 per item subject to a $1,000 )ed
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is reWlmd)
Certificate Holder is Additional Insured for General Liability coverage per form CNA75079XX 10/16, including primary and noncontributory wording.
General Liability Waiver of Subrogation applies per form CNA 74705XX 01/15. Automobile Additional Insured, including primary and non-contributory
wording and waiver of subrogation applies per form CNA63359XX 04/12. Waiver of subrogation applies to Work Comp per form WC 04 03 06 4-84. All where
required by written contract and subject to all policy terms and conditions. 30 Day Advance Notice of Cancellation, 10 Day for Non -Payment of Premium
w�,� nvw�r� I.API\.fCLLA1IVIY
Ci of Seal Beach
21 Eighth Street
Seal Beach CA 90740
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
D'Asaro
U 1955-21115 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
57495920 1 •2020-2021 Master Certificate I Michelle Orton ! 9/10/2020 3:03:49 PM (PDT) I Page 1 of 4
CNA
9/10/2020
Blanket Additional Insured - Owners, Lessees or
Contractors -with Products -Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
1. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required
by written contract to add as an additional insured on this coverage part, but only with respect to liability for
bodily injury, property damage or personal and advertising injury caused in whole or in part your acts or
omissions, or the acts or omissions of those acting on your behalf:
A. in the performance of your ongoing operations subject to such written contract; or
B. in the performance of your work subject to such written contract, but only with respect to bodily injury or
property damage included in the products -completed operations hazard, and only if:
1. the written contract requires you to provide the additional insured such coverage; and
2. this coverage part provides such coverage.
If. But if the written contract requires:
A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the
10-01 edition of CG2037; or
B. additional insured coverage with "arising out of" language; or
C. additional insured coverage to the greatest extent permissible by law;
then paragraph I. above is deleted in its entirety and replaced by the following:
WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required
by written contract to add as an additional insured on this coverage part, but only with respect to liability for
bodily injury, property damage or personal and advertising injury arising out of your work that is subject to
such written contract.
III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not
provide such additional insured with:
A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage, or personal and advertising injury arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
GNA75079XX (10-16)
Insured Name:
G M Sager Construction Co., Inc.
Policy No: 5095057881
Endorsement No:
Effective Date: 04/19/2020
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
57495828 1 •2D20-2021 Master Certificate I Michelle Orton 19/10/202D 3:03:49 PM (PDT) ' Page 2 of 4
Blanket Additional Insured - Owners, Lessees or
Contractors -with Products -Completed
Operations Coverage Endorsement
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended
to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this
coverage part:
Primary and Noncontributory Insurance
With respect to other insurance available to the additional insured under which the additional insured is a named
insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a
written contract requires the insurance provided by this policy to be:
1. primary and non-contributing with other insurance available to the additional insured; or
2. primary and to not seek contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional
insured.
VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition
of the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the
investigation, defense, or settlement of the claim; and
3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer
or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part.
However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3.
does not apply to insurance on which the additional insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer
receives written notice of a claim from the additional insured.
VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended
to add the following definition:
Written contract means a written contract or written agreement that requires you to make a person or
organization an additional insured on this coverage part, provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy; and
B. was executed prior to:
1. the bodily injury or property damage; or
2. the offense that caused the personal and advertising injury;
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
CNA75079XX (10-16)
Insured Name:
G M Sager Construction Co., Inc.
Policy No. 5095057881
Endorsement No:
Effective Date: 04/19/2020
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
57495828 : •2020-2021 Master Certificate I Michelle Orton 1 9/10/2020 3:03:49 PM (PDT) I Page 3 of 4
CNA
Blanket Additional Insured - Owners, Lessees or
Contractors -with Products -Completed
Operations Coverage Endorsement
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown
below, and expires concurrently with said Policy.
CNA75079XX (10-16) Policy No: 5095057881
Insured Name:
G M Sager Construction Co., Inc.
Endorsement No:
Effective Date: 04/19/2020
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
57495828 1 •2020-2021 Master Certificate I Michelle Orton 1 9/10/2020 3:03:49 PM (PDT) I Page 4 of 4
City of Seal Beach
Page 3
Pavement Restoration - 4800 Ironwood Ave, bidding on August 10, 2020 2:00 PM (Pacific)
Printed 09/21/2020
Bid Results
Bidder Details
Vendor Name ONYX PAVING COMPANY INC.
Address 2890 E. LA CRESTA AVE
ANAHEIM, CA 92806
United States
Respondee Corey Kirschner
Respondee Title CEO, Pres, vp, sec, trea
Phone 714-632-6699 Ext.
Email Corey@onyxpaving.net
Vendor Type CADIR
License # 630360
CA DIR
Bid Detail
Bid Format Electronic
Submitted August 10, 2020 9:37:11 AM (Pacific)
Delivery Method
Bid Responsive
Bid Status Submitted
Confirmation # 222812
Ranking 0
Respondee Comment
Buyer Comment
Line Items
Type Item Code UOM
Qty
Unit Price
Line Total Comment
Section 1
1 Mobilization/Demobilization
LS
1
$1,600.00
$1,600.00
2 Grind/removal approximately 2" depth Conventional Asphalt
SF
1200
$3.50
$4,200.00
3 Replace/Cap roadway with approved PG 64-10 HMA material
SF
1200
$7.00
$8,400.00
4 Deep Dig -out replacement
SF
400
$25.00
$10,000.00
5 Traffic Control
LS
1
$9,000.00
$9,000.00
6 Compaction
LS
1
$2,000.00
$2,000.00
7 Materials Disposals
LS
1
$1,800.00
$1,800.00
City of Seal Beach
Pavement Restoration - 4800 Ironwood Ave, bidding on August 10, 2020 2:00 PM (Pacific)
Bid Results
Type Item Code
UOM Qty
Page 4
Printed 09/21/2020
Unit Price Line Total Comment
Subtotal $37,000.00
Total $37,000.00
City of Seal Beach
Page 5
Pavement Restoration - 4800 Ironwood Ave, bidding on August 10, 2020 2:00 PM (Pacific)
Printed 09/21/2020
Bid Results
Bidder Details
Vendor Name Hardy & Harper, Inc
Address 32 Rancho Circle
Lake Forest, CA 92630
United States
Respondee Ashlie Blanchard
Respondee Title Bid Coordinator
Phone 714444-1851 Ext.
Email ablanchard@hardyandharper.com
Vendor Type CADIR
License # 215952
CA DIR
Bid Detail
Bid Format Electronic
Submitted August 10, 2020 1:26:05 PM (Pacific)
Delivery Method
Bid Responsive
Bid Status Submitted
Confirmation # 222711
Ranking 0
Respondee Comment
Buyer Comment
Line Items
Type Item Code UOM
Qty
Unit Price
Line Total Comment
Section 1
1 Mobilization/Demobilization
LS
1
$7,000.00
$7,000.00
2 Grind/removal approximately 2" depth Conventional Asphalt
SF
1200
$6.00
$7,200.00
3 Replace/Cap roadway with approved PG 64-10 HMA material
SF
1200
$7.00
$8,400.00
4 Deep Dig -out replacement
SF
400
$25.00
$10,000.00
5 Traffic Control
LS
1
$4,400.00
$4,400.00
6 Compaction
LS
1
$1,000.00
$1,000.00
7 Materials Disposals
LS
1
$1,000.00
$1,000.00
City of Seal Beach
Pavement Restoration - 4800 Ironwood Ave, bidding on August 10, 2020 2:00 PM (Pacific)
Bid Results
Type Item Code
UOM Qty
Page 6
Printed 09/21/2020
Unit Price Line Total Comment
Subtotal $39,000.00
Total $39,000.00
City of Seal Beach
Page 1
Pavement Restoration - 4800 Ironwood Ave, bidding on August 10, 2020
2:00 PM (Pacific)
Printed 09/21/2020
Bid Results
3 Bid Results
Bidder Details
Vendor Name All American Asphalt
Address 400 E 6th Street
Corona, CA 92879-1521
United States
Respondee Augustine De Los Reyes
Respondee Title Project Manager
Phone 951-736-7600 Ext.
Email publicworks@allamericanasphalt.com
Vendor Type CADIR
License # 267073
CA DIR
Bid Detail
Bid Format Electronic
Submitted August 10, 2020 1:37:10 PM (Pacific)
Delivery Method
Bid Responsive
Bid Status Submitted
Confirmation # 222700
Ranking 0
Respondee Comment
Buyer Comment
Line Items
Type Item Code UOM
Qty
Unit Price
Line Total Comment
Section 1
1 Mobilization/Demobilization
LS
1
$7,620.76
$7,620.76
2 Grind/removal approximately 2" depth Conventional Asphalt
SF
1200
$4.18
$5,016.00
3 Replace/Cap roadway with approved PG 64-10 HMA material
SF
1200
$6.33
$7,596.00
4 Deep Dig -out replacement
SF
400
$4.18
$1,672.00
5 Traffic Control
LS
1
$3,318.13
$3,318.13
6 Compaction
LS
1
$1,490.04
$1,490.04
City of Seal Beach
Pavement Restoration - 4800 Ironwood Ave, bidding on August 10, 2020 2:00 PM (Pacific)
Bid Results
Page 2
Printed 09/21/2020
Type Item Code UOM Qty Unit Price Line Total Comment
7 Materials Disposals
LS 1 $550.07 $550.07
Subtotal $27,263.00
Total $27,263.00
Company Information:
City of Seal Beach
211 Eighth Street
Seal Beach, CA
Attn: Dave Fait
Phone: (562) 431-2527
Email: dfat@sealbeachca.gov
A Disabled Veteran Business Enterprise #62540
License #929054
PROPOSAL & CONTRACT
#7791
Sob Information:
City of Seal Beach -4800 Ironwood
4800 Ironwood Ave.
Seal Beach, CA
DATE: 05/21/20
We hereby propose to furnish all labor, materials, equipment and supervision necessary to complete the following:
JOB DESCRIPTION
MOSILIZATONIDEMOBI ZATION
GRIND/REMOVE 2-.0F ASPHALT
REPLACEICAP WITH 2" OF ASPHALT
T
DEEP DIG -OUT REPLACEMENT
COMPACTION
(LS) TOTAL COST: $1,000.00
UNIT COST $1.95 per sq. ft.: $2,340.00
UNIT COST $2.92 per sq. ft.: $3,504.00
UNIT COST $7.15 per sq. ft.: $2,860.00
LS TOTAL COST: $250.00
HAULING OF MATERIAL OFF-SITE
TOTAL COST: N/C
LS TOTAL COST: $1,050.00
2300 North Batavia Street, Orange, CA 92865 " Phone; 714/283-0777 • Fax: 714/283 -27T
7 -
PROPOSAL
Bidders Namedt '�_oA- �4�
fhe undersigned, as bidder, declares that: (1) -this proposal is made without collusion with any
other person, firm or corporation, and that the only persons or parties interested as principals are
those named herein as sworn in the attached Non -Collusion Affidavit; (2) -bidder has carefully
examined the Specifications, Instructions; and (3) -bidder has investigated and is satisfied as to
the conditions to be encountered, the character, quality and quantities of work to be performed
and materials to be furnished. Furthermore, bidder agrees that submission of this proposal shall
be conclusive evidence that such examination and investigation have been made and agrees, in
the event this contract be awarded to bidder, to enter into a contract with the City Council of the
CITY OF SEAL BEACH, to perform said proposed work in accordance with the Plans, if any,
and the terms of the Specifications, in the time and manner therein prescribed, and to furnish or
provide all materials, labor, tools, equipment, apparatus and other means necessary so to do,
except such thereof as may otherwise be furnished or provided under the terms of said
Specifications, for the following stated unit prices or lump sum price as submitted on the Bid
Sheet herein.
The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial
Safety Record. This Safety Record must include all construction work undertaken in the State of
California by the bidder and any partnership, joint venture or corporation that any principal of
the bidder participated in as a principal or owner for the last five calendar years and the current
calendar year prior to the date of bid submittal. Separate information shall be submitted for each
such partnership, joint venture, or corporate or individual bidder. The bidder may attach any
additional information or explanation of data which he would like to be taken into consideration
in evaluating the safety record. An explanation of the circumstances surrounding any and all
fatalities must be attached.
2
Pavement Repair 4800 IRONWOOD AVE.
BID SHEET
No Item Description Unit of 1 Est. Unit Price
Measure Qty.
1
Mobilization/D b'I' —
Item Cost
emo i �zahon LS. 1
2 Grind/removal Sq. Ft -
approximately 2" depth
Conventional Asphalt.' (� 2-, 3t• orJ
3
Replace/Cap roadway with 1 Sq. Ft.
approved PG 64-10 HMA i
material. j
1200
21
j 4
Deep Dig -out replacement
Sq. Ft.
400 1
f 18-
5
Traffic control
LS.
1
6
Compaction
LS.
7
Hauling of materials off-site.
1 �--
_ #3,5o'--
2.8go.�
TOTAL BID PRICE (BASED ON BID SCHEDULE TOTAL OF UNIT PRICES):
Total Bid Price in Numbers
Total Bid Price in Written Form
IN CASE OF DISCREPANCY BETWEEN WORDS AND FIGURES, THE WORDS SHALL
PREVAIL.
NOTE: The City reserves the right to award a contract to the lowest responsible bidder in parts
or in its entirety and reserves the rights to reject all bids and re -advertise, as appears to be in the
best interests of the City. A bid is required for this entire work, the estimated quantities set forth
in this Bid Sheet being solely for the purpose of comparing bids, and final compensation under
the Contract will be based upon the actual quantities of work satisfactorily completed. The unit
3
and/or lump sum prices bid shall include all appurtenant expenses, taxes, royalties, and fees. In
the case of discrepancies in the amount bid, unit prices shall govern over extended amounts, and
words shall govern over figures. The City reserves the right to increase or decrease the amount
of any quantity shown and `o delete any item from the Contract.
The undersigned bidder agrees that, if awarded the Contract, bidder will complete all work
according to the contract documents.
Legal Business Name of Bidder
! P"'P'ly 1—
Business Address
23ev /'
Business Tel. No.
6)c4) 2-83 , o l��
Signature Date Title
If bidder is an individual, name and signature of individual must be provided, and, if he is doing
business under a fictitious name, the fictitious name must be set forth. If bidder is a partnership
or joint venture, legal name of partnership/joint venture must be provided, followed by
signatures of all of the partners/joint venture's or of fewer than all of the partners/joint venture's
if submitted with evidence of authority to act on behalf of the partnership/joint venture. If bidder
is a corporation, legal name of corporation must be provided, followed by signatures of the
corporation President or Vice President and Secretary or Assistant Secretary, and the corporate
seal. Signatures of partners, joint venture's, or corporation officers must be acknowledged
before a Notary Public, who must certify that such partners, joint venture's, or officers are
known to him or her to be such, and, in the case of a corporation, that such corporation executed
the instrument pursuant to its bylaws or a resolution of its Board of Directors.
PROPOSAL
Bidders Name GM Sager Constrution Co.. jug.
The undersigned, as bidder, declares that: (l) -this proposal is made without collusion with any
other person, firm or corporation, and that the only persons or parties interested as principals are
those named herein as sworn in the attached Non -Collusion Affidavit; (2) -bidder has carefully
examined the Specifications, Instructions; and (3) -bidder has investigated and is satisfied as to
the conditions to be encountered, the character, quality and quantities of work to be performed
and materials to be furnished. Furthermore, bidder agrees that submission of this proposal shall
be conclusive evidence that such examination and investigation have been made and agrees, in
the event this contract be awarded to bidder, to enter into a contract with the City Council of the
CITY OF SEAL BEACH, to perform said proposed work in accordance with the Plans, if any,
and the terms of the Specifications, in the time and manner therein prescribed, and to furnish or
provide all materials, labor, tools, equipment, apparatus and other means necessary so to do,
except such thereof as may otherwise be furnished or provided under the terms of said
Specifications, for the following stated unit prices or lump sum price as submitted on the Bid
Sheet herein.
The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial
Safety Record. This Safety Record must include all construction work undertaken in the State of
California by the bidder and any partnership, joint venture or corporation that any principal of
the bidder participated in as a principal or owner for the last five calendar years and the current
calendar year prior to the date of bid submittal. Separate information shall be submitted for each
such partnership, joint venture, or corporate or individual bidder. The bidder may attach any
additional information or explanation of data which he would like to be taken into consideration
in evaluating the safety record. An explanation of the circumstances surrounding any and all
fatalities must be attached.
Pavement Repair 4800 IRONWOOD AVE.
BID SHEET
No
Item Description
Unit of
Measure
Est.
Qty.
Unit Price
Item Cost
1
Mobilization/Demobilization
I.S.
1
$I.500.00
$1,500.00
2
Grind/removal
approximately 2" depth
Conventional Asphalt.
Sq. Ft.
1200
$2.50
$3,000.00
3
Replace/Cap roadway with
approved PG 6410 HMA
material.
Sq. Ft.
1200
$4.00
$4,800.00
4
Deep Dig -out replacement
Sq. Ft.
400
$14.00
$5,600.00
5
Traffic control
I.S.
1
$1,500.00
$1,500.00
6
Compaction
I.S.
1
$1,500.00
$1,500.00
7
Materials Disposals
I.S.
1
$1,000.00
$1,000.00
TOTAL BID PRICE (BASED ON BID SCHEDULE TOTAL OF UNIT PRICES):
Total Bid Price in Numbers
Eighteen Thousand Nine Hundred Dollars and No Cents
Total Bid Price in Written Form
IN CASE OF DISCREPANCY BETWEEN WORDS AND FIGURES, THE WORDS SHALL
PREVAIL.
NOTE: The City reserves the right to award a contract to the lowest responsible bidder in parts
or in its entirety and reserves the rights to reject all bids and re -advertise, as appears to be in the
best interests of the City. A bid is required for this entire work, the estimated quantities set forth
in this Bid Sheet being solely for the purpose of comparing bids, and final compensation under
the Contract will be based upon the actual quantities of work satisfactorily completed. The unit
and/or lump sum prices bid shall include all appurtenant expenses, taxes, royalties, and fees. In
the case of discrepancies in the amount bid, unit prices shall govern over extended amounts, and
words shall govern over figures. The City reserves the right to increase or decrease the amount
of any quantity shown and to delete any item from the Contract.
The undersigned bidder agrees that, if awarded the Contract, bidder will complete all work
according to the contract documents.
of Bidder
GM Sager Construction Co., Inc.
Business Address
1380 S. East End Ave., Pomona, CA 91766
Tel. No.
909 620-9987
Date
If bidder is an individual, name and signature of individual must be provided, and, if he is doing
business under a fictitious name, the fictitious name must be set forth. If bidder is a partnership
or joint venture, legal name of partnership/joint venture must be provided, followed by
signatures of all of the partners/joint venture's or of fewer than all of the partners/joint venture's
if submitted with evidence of authority to act on behalf of the partnership/joint venture. If bidder
is a corporation, legal name of corporation must be provided, followed by signatures of the
corporation President or Vice President and Secretary or Assistant Secretary, and the corporate
seal. Signatures of partners, joint venture's, or corporation officers must be acknowledged
before a Notary Public, who must certify that such partners, joint venture's, or officers are
known to him or her to be such, and, in the case of a corporation, that such corporation executed
the instrument pursuant to its bylaws or a resolution of its Board of Directors.
4
Attention: 1h,
h.•...r • •r:.rn: ,• lr �: rr:al
cn r�:1.r. •'
: n •
IA's Foran 300
cmnlny,,,.
rr.t� �... •1.�.
-.'.;dlh amM rinu5l be rs�nJ ora'+.drn
,.h'. I:,r,t�,l:rlt �. ,r.{;IJ'1•:•_.;
n ;ha'
.0 lr i�'.:.I..,r
Yeti/ 20JO
Work Injuries Illnesses
°""�
`''"° "'" "''°""A''' `'r"'' ° ' ""
U.S.
g of -Related
and
ncrupnnr.nal salxly antl Ir:allh
L^�rpu.us.
U.S.
e.,,-rr.
GA
'fl'. :r:
Irnl.l.nn •n.,n. {nh nrl.
'L" 11:!
I.ale ..l rnlarr Ir'MrrrM e.mr.nrnrrrd
Ir;
Ilnrrrihr injurt nr illne... prrrr.i h.dr •Ifmtnl.
enMr'MnrRn..rN QMaka.-how ONIUM
p/wN ~ MM.OM QPO Nterpl
.-•^-•�•�••-- �`+,�:•
.t.
.n „n•rr
.,l alrn•..
1 .�.. ....� ••. .,...'
.n0 u!{a�rwMlamrrAtl JirrrlM InryrW
m,Jr pronn al r• r •• .. • • •.
Ih..dEwNal►tR
Intl 3�
,,
°..Is
..I..ra
r..rls .I......
ft Jb r
.en ... r1-wn 8 ? 3
-
Ab«s5��acnlsi
IGI
(I'll(h
(J)
;t!, �,i fll 1� (3) (�) IEI IEI
L'
+
.� _Z
D
Li❑
U
....
G cS�.tscz.A
.?,
❑
❑
7
e,Q 10% cc -s' wv- D
O
U
�z
x ._; t'
p"i
h
iL 4ocas<h. Co mjS%of\
U
U
❑
❑`
.;
u LNa
rl�+�ih
_b
(ebo<ly� _cic��fa�
❑
U
a
E3�C
—
— --- — —--U
❑
U
❑
_
D
U
O
❑
_
U
D
❑
U
_. -- —
U
❑
❑
U
-'
U
❑
U
❑
❑
U
U
Ll
lell 11 b• nl.m g In
emIlayed ^� amust be used kia mam& atm!OSHA's Form 309
polecls the cerdslerlWhly of employees to the war,
Injury and Illness Incident Report " bf0 *" �p a" mwkn is b"1� usvJ h" "� °epsrt'""" caber
cv; alidtel sal al,d heath purposes. eew.arr...rs.arr.lwn«rw� A&MONwhw
.,_.. __., ..._ ... .. ,.... :... .... ... .....� ..-. .-. ,: ..n-.-...-. �. .., .,,«. ..;..... .: .. -,.-..-r. ....-•-. ..*r ..._�-..-.r. _ _... _ _.,.••.•t •m. ... �.rw.vp n.nre.. r.lsm
Ibis h:fxn .,x.7 llLrr.• f•r.ul.ul N1-1 L• one n(Ihr
MI— rM•n a rn.rd:d>Ir x(dk-
rei:rtrJ mjmv or dhxa h. --d. Ta.gclhrr aanh
1. }• ry Nark-RrGrrrd Injxnr• uw4 INxrrv. and Jn
rmparrvin�.5xrwrn, Ihr<kanl! I.dT, the
rmpinvrr and (AMA d -11k p a pxonr• -t Ihr rax•nl
-A-rrLurd x.r-N1.-n, •
101hin 7 eaknJa, rklv5 alter trx, rcu�lru
ndnmlan••n Ik.lx a nvrnd:dd.• „ark-re•LrR•.1 nqun .w
illnr5s L... ry nu r rd. 5uu mmI 1.11 not the Gu rx xr an
crpai,aknl. Gnxe ,ulr 5,nrkrt s' a1M1IR'11AII4a11.
ural:wve. •,r- mlarl 'n -w may he :xvgKahk
,uhvilalcs •lir Ix•--idcrcd an ryruc.Jrm knm.
an.• alrFnlinuc mut (-wn all rhr inlormal inn
.•rknl Is—. dux Iona.
.\uuuli..g In Nbl. L.,, 91 .A91i;md 29 CFR
1!KH. (Im IN, -,,, dI.-purg .uk•. , un —I k -I,
d5ia t:-- lit,- fax -5,, -oars lullmnng dw -m- ru
whirh ., Iw r laixs.
II v.wl Ix�r'd aaldimm;d anpi,z nu rhi{ I:w m..,w
n,a, phntax ulna .IMI .Ix as mm5 a. rrn, acrd.
kwon"tion about the employoo
Cal .......... .�s,aw _..mr._--
al ewedrrM_
51 ❑ x
fi.nalr
hllo'mathln about the physldan or other health Gare
Professhmal
a/rw dpar„ave «.wwr MnW acre l..Wwre..l _---__.�
f1 11.rrwxwr +u {h r„ a+a/ hen Jw.•rh•ir.,.Mr ria 4tlwd
•--
a 5.aexq,h.leanrnd:.,aranw.er.«..!
.� Ne
Ma.nnp6rye4wpmn.d e.e.Yb,n aw �..pr.awa•
"7 n,
'Plrrr' IMr � Ye
hllerrnaIf” about the Gaza
im Car nerb,r hsr Ihn
In Wwefxyun «Bhwa, � _� __.
Itl ttww m)d««4rte..«l —_
lal flsrd are« _
r n.r"..--- /e-,11, l.y+gbr .: r,.- 11 K1,
AM, I'm
Avant OorhKllxer,...11ranerwl«d
141 NMl — e. - mi. a- dehtf 1-0 &a/arr 9" Maid d ar .~ havik Ihr Miral. «writ «dr
vela, rgaipv,ern, ar —Ad the emplulr —vaint.Be-P-Wa.&-Oh'^caml,:r,d a kdikr xhlk
uml•q rawlirrt rwak We":'•epratha6 rhl«Iwe I.— had apra7a": -da, —pa« Ly—y.-
13? Intal NayanNl74B o 6— h. w•Inrl e«nnrd. F ee.yrha: "v'hu, I-Nk Jipprd a wN aae4, hrr
fell >b Ic a'h "WwrM na rpntt:d Mth 3lerine when paeu6teke d.r:q replareaa,t"; ^15'erter
dreelepnl arc«ra In Griot
tau Illral aeaa Uaw hrlawY«ehraaarTrll welts lr..rtnflMh,wl7 that eau alfeaaleM hoe it vr«Wnedt hr
,we aperiar drn `hen..^'•pafa.+« s«r: C,wrlrlry "arra.«d hack^, "<hadcal6urn.6avT: ^carpal
mr,ed rrrWrew.
Itl la ,40fael er awblaxaw di-f/p haaN IN arlrpfeyeatfirwaydm"—k ax«":"rtl«I«n:
".adfal ala -- If dir 1-N.w don wa ** t. (A, modrwk Jr.- is Hak.
in a1M a«rfWNdfe4 erMn and dwalp seer! Dxe ddearh -.-
'v#. �.. �. .. ... e. ur.lw4!.N ...� •v ..a..•rr,r. •plana +[4•r-ml.a+wuu.a dr.•Vu•.•MwLnx- •I'n...Y•.:•.:I.. r.rml... rl.:
. .. .•alv4r .. uxh• •.ed. 11 ua.�,.�.u,..,s, q... x. aravw. r.mrd.,ry..n,.1�4n J.�...L.."K, unl,. n,. Ka ,.w•a...,,4w ne.b.4w.4n.rnnr la Mpnr•w.,ar-n nlll•nlNeJa..r+. r. r•, N.+n.vl'11 '.. r..ryru•.n +•.e. ,.
., . IX �n,.lx d w, ...r,... y r4eu.. ^-e.x.nfr•t
!Attention h_ 1 n,u
rla .;'i 3-�
��qq 1
OSh
1 f 1:
1 mF J tt r.ac.r
Y--ar 2014
Log of Work -Related Injuries and Illnesses �'h
" '' `'
" .`d' `
U.S. Dop-Imu et or Ubar
• u� tf i :ale1, d -.d LeAdl
� -. .. .-.-..
..
f-'� •c"M OcevoarrMr<a/alr,M
_..�_._.. .......-._ _
Nurrh edwJ..r,lrwlb,
• .... m:.. ... -. r..'.1 ,r. .. .rr.. r 1 .r.d"�::'„>. .: v" t�.'�.J r !e �:.•.
r _
M ..,.r ,. 116.a ,rnl.r
..:. � .+. .'.e. _ .:.. " •'.0 J ? .
. s r .«r r tf 5n� •r (Or. Ir ar lrrt: 1 n Iir.
-
• ... .. r r.... � ,.. .. .i;.� r 1. ... e: r'•;..w . .,. J . r �:'t h
..•. _.c.Lnry .:.+. ,..,n., n .,.,.•.-z.
,:� f5rrrnwrr
"a. f.:1
;F7
ReferIM wre of
- dace tfre Wwmd or GMek fbtl'Yf11PM"rofwtM �r
.r :mprnree'r saner �.rb rrrlr• Oarc ,.r iwjnr� N'icn tha. creel xo. 1 ncecnbr rnlur}ur i Ilan, p<m fbud, ,Ruled.
Wworker va<-
greed etN- rm-aa•
-
i•i ., .l.:r•1.., rr.rr+rr mdrnX .l.,k� ., mit urrl .drjrc .ubela wlbar rlu«Ilr iojurrd
-
ef fllnn• ad p � r n II f r,c '.,..,. r
w twalrNd r'IVo k
M -�€
T_r:
UNIM1
wry Ja rNaMr OMw .er4 • lar or
Hew Wh' rmbbtlM-Y1�N.N wwlt ro,bK11M
] 5
F j ;' 0 ��
1 ..
i R
13) 14I Bbl
�v 65 . Qom% " .1� - C' `7�- - '_ = .'°?' S ❑
A
❑' l�
:1
❑ J
❑
U.
❑ ]
- ❑ ,
Ll
o
U U
J
❑
❑' [a
❑
U
❑ ❑,
,.. .. ... tit. �. .r.. r.. ...•, ur.. .. r :!r .. ..r r....r a . r( ... ....r,.
oy, w
•Ir .rt fJI rl 'F:.
CallOSHA Form 300A (Rev. 712007) Appendix B
Annual Summary of Work -Related Injuries and Illnesses
.. . . ......
i 1.2'.1—J fl1 ll, h'. .1 1 - I
: � c , f It Ito I I I " 111,.% Ii , I.,
Inial III mt,I dart, , o'. II, L,
tr I It, r rrt rritI, nnr.
IL
4 IWA I M-1 Pot
arra: ndvo,
- Is
t 4 Sc 1
-;,o "'r,
Kno—ur'l, d