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Home My WebLink AboutAGMT - American Asphalt South (2010 Slurry Seal ST1006) Recorded in Official Records, Orange County RECORDING BY Tom Daly, Clerk- Recorder IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII No FEE AND WHEN RECORDED MAIL TO 2011000092701 11:24 am 02/18/11 CITY OF SEAL BEACH 7 Sec4 N12 1 Attn: City Clerk 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 211 - 8th Street Seal Beach, CA 90740 Space of above this line for Recorder's use. * ** No Recording Fee Pursuant to Government Code Section 6103, 27383 * * * * r NOTICE OF COMPLETION Notice pursuant to Civil Code Section 3093, must be filed within 10 days after completion. Notice is hereby given that: 1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the property hereinafter described: 2. The full name of the owner is: City of Seal Beach. 3. The address of the owner is: 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. work of improvement on the property_ hereinafter is described as substantially completed on__ _ _ ___ __ + December 17. 2010. The work was 2010 Annual Slurry Seal Project No. ST1006. 6. The name of the contractor(s), if any, for such improvement was: American Asphalt South, Inc. The date of the Contract Award was October 25. 2010. 7. The property on which said work of improvement was completed in the City of Seal Beach, County of Orange, State of California, and is described as follows: Various locations Citywide. Date: ZII4 1 1( Director of Public Works, City of S = I Beach Signature of owner or corporate icer 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 Z iq / ( , 2011, at Seal Beach, California. Date of Signature) ; a lli, P . ,„/"" Director of Public Works, City of S l Beach AN AGREEMENT • FOR 2010 ANNUAL SLURRY SEAL PROJECT CIP NO. ST1006 between • *: : City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 & American Asphalt South, Inc. 14436 Santa Ana Avenue Fontana, CA 92337 (909) 427 -8276 THIS AGREEMENT is made and entered into October 25, 2010, by and between the City of Seal Beach, a California charter city ( "City "), and American Asphalt South, Inc., a ( "Contractor "). Page D -40 • RECITALS A. WHEREAS, the City Council has approved the plans and specifications for the 2010 Annual Slurry Seal Project, CIP No. ST1006 ( "Project ") with respect to design criteria; and B. WHEREAS, Contractor has submitted a bid to City for the Project dated October 7, 2010 in the amount of $100,642.00 ( "Accepted Proposal" hereinafter). The Accepted Proposal is attached hereto as Exhibit G and contains, among other things, provisions defining the Project scope. NOW, THEREFORE, in consideration of performance by the parties of the mutual promises, covenants, and conditions herein contained, the parties hereto agree as follows: AGREEMENT 1.0 Contractor's Services. 1.1 Scope and Level of Services. For and in consideration of the mutual promises set forth herein, and subject to the terms and conditions set forth in this Agreement, Contractor shall perform and complete in good and workmanlike manner all work ( "Work ") required by this Agreement and the documents listed in Subsection 1.2 for the Project. 1.2 Contract Documents. The "Contract Documents" that comprise the agreement between the City and the Contractor are the: Notice Inviting Bids, Instructions to Bidders, Accepted Proposal, Non - Collusion Affidavit, Bid Schedule(s), List of Subcontractors, Contractor's Industrial Safety Record, Contractor's Qualification Statement, Bid Security Forms for Check or Bond, Specifications, General and Special Provisions and documents referenced therein, all addenda as prepared prior to the date of bid opening setting forth any modifications or interpretations of any of said documents, this Agreement, Exhibits attached to this Agreement, including but not limited to the Performance Bond (Exhibit A), Payment Bond (Exhibit B), Worker's Compensation Insurance Certificate (Exhibit C), Insurance Endorsements (Exhibit D), Acknowledgment of Penal and Civil Penalties Concerning Contractor Licensing Laws (Exhibit E), Labor Law Requirements (Exhibit F), Accepted Proposal (Exhibit G) and any and all supplemental agreements executed amending or extending the work contemplated and that may be required to complete the work in a substantial and acceptable manner. These Contract Documents are hereby incorporated into this Agreement. 1.3 The Work shall be performed in accordance with the Plans, Specifications and other Contract Documents. Contractor shall furnish at its own expense all labor, materials, equipment and services necessary therefore, except such labor, materials, equipment and services as are specified in the Contract Documents to be furnished by City. Page D -41 1.4 In the event of any material discrepancy between the express provisions of this Agreement and the provisions of the other Contract Documents, the provisions of this Agreement shall prevail. 2.0 Effective Date. This Agreement is effective as of October 25, 2010 (the "Effective Date "), and shall remain in full force and effect until Contractor has rendered the services required by this Agreement. 3.0 Payment. For performing and completing the work in accordance with the Contract Documents, City shall pay Contractor, in full compensation therefor, the amount of $100,642.00, 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. 4.0 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 and employees, servants, designated volunteers, and agents serving as independent contractors in the role of city officials, from any and all liabilities, damages, claims, costs and expenses of any nature to the extent arising from Contractor's alleged violations of personnel practices. 4.4 Contractor is, and shall at all times remain as to City, a wholly independent contractor. Contractor shall have no power to incur any debt, obligation, or liability on behalf of City or otherwise act as an agent of City. Neither City nor any of its agents shall have control over the conduct of Contractor or any of Contractor's employees, except as set forth in this Agreement. Contractor shall not, at any time, or in any manner, represent that it or any of its officers, agents, or employees are in any manner employees of City. Contractor shall pay all required taxes on amounts paid to Contractor under this Agreement, and indemnify and hold City harmless from any and all Page D -42 • • taxes, assessments, penalties, and interest asserted against City by reason of the work performed pursuant to this Agreement. 4.5 City shall have the right to offset against the amount of any fees due to Contractor under this Agreement any amount due to City from Contractor as a result of Contractor's failure to promptly pay to City any reimbursement or indemnification arising under this Section 4. 5.0 Indemnification. 5.1 Contractor's Duty. Contractor shall indemnify and hold the City, its elected officials, officers, employees, volunteers, agents, and those City agents serving as independent contractors in the role of City officials (collectively "Indemnitees ") free and harmless from and against any and all claims (including, without limitation, claims for bodily injury, death or damage to property), demands, obligations, damages, actions, causes of action, suits, losses, bid protests, stop notices, judgments, fines, penalties, liabilities, costs and expenses (including, without limitation, attorney's fees, disbursements and court costs) of every kind and nature whatsoever (individually, a "Claim;" collectively, "Claims "), in any manner arising out of or incident to the performance of the Agreement, including without limitation the payment of all consequential damages and attorneys fees and other related costs and expenses. Further, Contractor shall appoint competent defense counsel, at Contractor's own cost, expense and risk, to defend any and all such suits, actions or other legal proceedings of every kind arising out of or incident to the performance of the Agreement that may be brought or instituted against Indemnitees. Contractor shall pay and satisfy any judgment, award or decree that may be rendered against City or the other Indemnitees in any such suit, action, or other legal proceeding arising out of or incident to the performance of the Agreement. Contractor shall reimburse the City and the other Indemnitees, for any and all legal expenses and costs incurred by each of them in connection therewith or in enforcing the indemnity herein provided. Contractor's obligation to indemnify shall not be restricted to insurance proceeds, if any, received by Contractor or Indemnitees. This indemnity shall apply to all Claims and liability regardless of whether any insurance policies are applicable. 5.2 Bid Protests. In addition to its obligations pursuant to Section 5.1, Contractor shall reimburse the City for all attorney fees and costs incurred by City in connection with, arising out of or incident to any bid protest. 5.3 City's Sole Negligence. Nothing in Section 5.1 shall be construed to require Contractor to indemnify Indemnities for that portion of any Claim to the extent arising from the sole negligence or willful misconduct of the Indenmities. 5.4 Nonwaiver of Rights. Indemnitees do not, and shall not, waive any rights that they may possess against Contractor because of the acceptance by City, or the deposit with City, of any insurance policy or certificate required pursuant to this Agreement. Page D -43 5.5 Waiver of Right of Subrogation. Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation against the Indemnitees, while acting within the scope of their duties, from all claims, losses, and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor. 5.6 Survival. The provisions of this Section 5 shall survive the termination of the Agreement and are in addition to any other rights or remedies that Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Contractor shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. 6.0 Conflict of Interest. 6.1 Consultant 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. Consultant further covenants that, in performance of this Agreement, no person having any such interest shall be employed by it. Furthermore, Consultant shall avoid the appearance of having any interest, which would conflict in any manner with the performance of the Services. Consultant shall not accept any employment or representation during the term of this Agreement which is or may likely make Consultant "financially interested" (as provided in California Government Code § §1090 and 87100) in any decision made by City on any matter in connection with which Consultant has been retained. 6.2 Consultant further warrants and maintains that it has not employed or retained any person or entity, other than a bona fide employee working exclusively for Consultant, to solicit or obtain this Agreement. Nor has Consultant paid or agreed to pay any person or entity, other than a bona fide employee working exclusively for Consultant, 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 Consultant hereunder the full amount or value of any such fee, commission, percentage or gift. 6.3 Consultant warrants and maintains that it has no knowledge that any officer or employee of City has any interest, whether contractual, noncontractual, financial, proprietary, or otherwise, in this transaction or in the business of Consultant, and that if any such interest comes to the knowledge of Consultant at any time during the term of this Agreement, Consultant 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 subsection. Page D -44 • • 7.0 Insurance. 7.1 Liability Insurance. Contractor shall procure and maintain in full force and effect for the duration of this Agreement insurance against claims for injuries to persons or damages to property and professional negligence which may arise from or in connection with the performance of the services hereunder by Contractor, and its agents, representatives, employees and subconsultants. 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: 7.1.1 Exhibit D -I: Additional Insured Endorsement - Commercial General Liability 7.1.2 Exhibit D -2: Additional Insured Endorsement - Automobile Liability 7.1.3 Exhibit D -3: Additional Insured Endorsement 7.2 Minimum Scope of Insurance. Unless otherwise approved by City, coverage shall be at least as broad as: 7.2.1 Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001). 7.2.2 Insurance Services Office form number CA 0001 (Ed. 1/87) covering Automobile Liability, code 1 (any auto). 7.2.3 Insurance Services Office form number CG 20 10 11 85 (Ed. 11/85) covering Additional Insured — Owners, Lessees or Contactors (Form B). 7.2.4 Worker's Compensation insurance as required by the State of California and Employer's Liability Insurance. 7.2.5 Professional Liability Insurance. Contractor shall provide to City the standard form issued by the carrier. [May not be necessary for certain projects.] 7.3 Minimum Limits of Insurance. Contractor shall maintain limits no Tess than: 7.3.1 General Liability: $2,000,000 per occurrence and in the aggregate for bodily injury, personal injury and property damage. Commercial General Liability Insurance or other form with a general aggregate limit shall apply separately to this Agreement or the general limit shall be twice the required occurrence limit. Page D -45 • • 7.3.2 Automobile Liability: $2,000,000 per occurrence for bodily injury and property damage. 7.3.3 Employer's Liability: $1,000,000 per occurrence and in the aggregate for bodily injury or disease and Workers' Compensation Insurance in the amount required by law. 7.4 Deductibles and Self- Insured Retentions. Contractor shall inform City of any deductibles or self - insured retentions except with respect to any professional liability insurance. 7.5 Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 7.5.1 City, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of city or agency 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 or agency officials which are not also limitations applicable to the named insured. 7.5.2 For any claims related to this Agreement, Contractor's insurance coverage shall be primary insurance as respects City, its officers, officials, employees, designated volunteers and agents serving as independent contractors in the role of city or agency 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 or agency officials shall be excess of Contractor's insurance and shall not contribute with it. 7.5.3 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. 7.5.4 Each insurance policy required by this clause 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. 7.5.5 Each insurance policy, except for any professional liability policy, required by this clause 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. Page D -46 • • 7.6 Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best's rating of no less than A:VII unless waived in writing by City's Risk Manager. 7.7 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. 8.0 Liquidated Damages. Should the Contractor fail to complete the project, or any part thereof, in the time agreed upon in the Contract, the Contractor shall reimburse the City for the additional expense and damage for each calendar day that the Contract remains uncompleted after the Contract completion date. It is agreed that the amount of such additional expense and damage incurred by reason of failure to complete the Contract is the per diem rate $750.00 per calendar day. Such amount is hereby agreed upon as liquidated damages for the loss to the City resulting from the failure of the Contractor to complete the project within the allotted time and to the value of the operation of the works dependent thereon. It is expressly understood and agreed that this amount is a reasonable amount and is established in lieu of damages that are incapable of calculation at the inception hereof; and this amount is not to be considered in the nature of a penalty. The City shall have the right to deduct such damages from any amount due, or that may become due to the Contractor, or the amount of such damages shall be due and collectible from the Contractor or the Contractor's Surety. Progress payments made after the scheduled completion date shall not constitute a waiver of liquidated damages. 9.0 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. 10.0 Notices. Any notices, bills, invoices, or reports authorized or required by this Agreement shall be in writing and shall be deemed received on (a) the day of delivery if delivered by hand or overnight courier service during Contractor's and City's regular business hours or by facsimile before or during Contractor's regular business hours; or (b) on the third business day following deposit in the United States mail, postage prepaid, to the addresses heretofore set forth in the Agreement, or to such other addresses as the parties may, from time to time, designate in writing pursuant to the provisions of this Section. All notices shall be addressed as follows: If to City: City of Seal Beach - City Clerk 211 8th Street Seal Beach, California 90740 Telephone: (562) 431-2527 Fax: (562) 493 -9857 Page D -47 • • With a copy to: Public Works Director City of Seal Beach 211 8th Street Seal Beach, California 90740 If to Contractor: American Asphalt South, Inc. 14436 Santa Ana Avenue Fontana, CA 92337 Telephone: (909) 427 -8276 Fax: (909) 427-8279 • 11.0 Non - Assignability; Subcontracting. Contractor shall not assign, transfer, or subcontract any interest in this Agreement or the performance of any of Contractor's obligations hereunder. Any attempt by Contractor to so assign, transfer, or subcontract any rights, duties, or obligations arising hereunder shall be null, void and of no effect. 12.0 Compliance with Laws. Contractor shall comply with all applicable federal, state and local laws, ordinances, codes and regulations in force at the time Contractor performs the Services. 13.0 Non - Waiver of Terms, Rights and Remedies. Waiver by either party of any one or more of the conditions of performance under this Agreement shall not be a waiver of any other condition of performance under this Agreement. In no event shall the making by City of any payment to Contractor constitute or be construed as a waiver by City of any breach of covenant, or any default which may then exist on the part of Contractor, and the making of any such payment by City shall in no way impair or prejudice any right or remedy available to City with regard to such breach or default. 14.0 Attorneys' Fees. In the event that either party to this Agreement shall commence any legal action or proceeding to enforce or interpret the provisions of this Agreement, the prevailing party in such action or proceeding shall be entitled to recover its costs of suit, including all attorneys' fees incurred in connection therewith. 15.0 Construction. The validity, interpretation, and performance of this Agreement shall be controlled by and construed under the laws of the State of California. In the event of any asserted ambiguity in, or dispute regarding the interpretation of any matter herein, the interpretation of this Agreement shall not be resolved by any rules of interpretation providing for interpretation against the party who causes the uncertainty to exist or against the party who drafted the Agreement or who drafted that portion of the Agreement. Page D -48 • • 16.0 Entire Agreement. This Agreement, including any other documents incorporated herein by specific reference, represents the entire and integrated agreement between Contractor and City. This Agreement supersedes all prior oral or written negotiations, representations, or agreements. This Agreement may not be amended, nor any provision or breach hereof waived, except in a writing signed by the parties which expressly refers to this Agreement. (Intentionally Left Blank) Page D -49 • • IN WITNESS WHEREOF, the parties, through their respective authorized representatives, have executed this Agreement as of the date first written above. CITY OF SEAL BEACH CONTRACTOR: err I By: David N. C tity Manager Name: e �C t r Title: V /I Ce eshieio/ _ , Attest: _ 1 / — By: 1./... L. .AL .• By: i Si. Lin. a Devine, City Clerk Name' . e / J _ Title: .x[YeTGh/ r. Approved as to Form: o f i By: v `_ 01') I . -09 • uinn M. Barrow, City Attorney Page D -50 • BondNo. 12072818 Bond Premium S704.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach, has awarded American Asphalt South, Inc. 14436 Santa Ana _ Fontana, CA 92337 (Name and address of Contractor) ("Principal "), a contract (the "Contract ") for the work described as follows: .20l 0 t� ual Slurry Seal Proiect. CIP# SI' L 06 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 The Guarantee Company of North America USA 1800 Sutter Street. Suite 880 Concord, CA 94520 (Name and address of Surety) ("Surety ") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of One Hundred Thousand Six Hundred Forty -Two and 00 /10 D ollars ($ 100,642.00 ). 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, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. TYIE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal, his, her or its beirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions and agreements in the Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and performed, all within the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers, agents, and others as therein provided, then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTF[ER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to be performed there under, or the specifications for the same, shall in any way affect its obligations under this bond, and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications there under. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. The City is the principal beneficiary of this bond and has all rights of a party hereto. IN WXTNESS 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. Page D -52 4 11 1 4 11 Datcd: October 27, 2010 "principal" "Surety" American Asphalt South, Inc. The Guarantee Company of North America USA By. By: seitilttA ZtS izabeth Teats, ttorney -in -Fact Its Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. Page D-53 ! • • CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT . - 't� -- 'rf`C`.C` .Tr�tk-a,-.r .z.e: K"r`f%k: "Fs` Ar:e•- .-ee;.Gar;Cic=.: , 4 - z3R[:S�.e.,xtf:�i'•`>,r'.4 , -.6 .F. \; ire( -7c. - 44.7-K`C+. :Ciu G R tI State of California ( ) ss. if' County of Sea & r f7a4 lei I n � ( On Q� �� /� before me, fi�[hc•tl.� En 7r; A", el - /Vi�T3sy � , Dare N and Title of Officer (e g , " "Jane Doe. Notary Publer personally appeared y true'- 4 ,10—e. Pe i ty' Name(s) of Signer(s) ersonall a ear � ,,P S X proved to me on the basis of satisfactory evidence r r? to be the person(s) whose name(s) krare A RICHARD ENTRIKIN subscribed to the within instrument and N , _, pM COMM. #1854481 ri acknowledged to me that be/Olt/they executed (4 2 , , J 1 NOTARYPUBUC- CALIFORNIA 53 the same in b+S'/-heltheir authorized J Q t 'f ' r BAN BERNARDINO COUNTY N acit ieS ca , m n M Ea P YC ) and that b y - 1�is%J�er /their j t _ : _ _ _ . . _ _ _ _ _ _ signature(s) on the instrument the person(s), or 4 the entity upon behalf of which the person(s) $1 acted, executed the instrument. j P WITNESS my hand and official seal. l i hgnature of Notary Public i9 I of OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent ( fraudulent removal and reattachment of this form to another document. el 1' � Description of Attached Document 0 -1 Title or Typp of Document: l Document Date: Number of Pages: t ,. 1 ( Signer(s) Other Than Named Above: (y ( Capacity(ies) Claimed by Signer Signer Name: ) (• RIGHT THUMBPRINT tv ;,. - OF SIGNER. ;: f ❑ Individual Top of thumb here 0 let, ❑ Corporate Officer — Title(s): k4 ❑ Partner — ❑ Limited ❑ General ;; (' ❑ Attorney -in -Fact ji I ❑ Trustee th ❑ Guardian or Conservator ( ❑ Other: S • ( •I 1. Signer Is Representing: '.I fs.' = - G` 4 i:_ '- - --C, <; _ - = ' '� - ` - ate- -- ,o-ar a v -,, - ,r _ _ '0 'w ..-44- - e'" ...'r, 01999 National Notary Association • 9350 De Soto Ave . P 0 Box 2402 • Chatsworth, CA 91313.2402 • www natonalnotary erg Prod. No 5907 Reorder. Call Toll -Free 1-800-876-6827 • . Bond No. 12072818 Bond Premium Included In Performance Bond PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that WHEREAS the City of Seal Beach, has awarded to American Asphalt South, Inc. 14436 Santa Ana _ Fontana CA 92337 (Name and address of Contractor) ( "Principal"), a contract (the "Contract ") for the work described as follows: 2010 Annual Slurry Seal Project. CIP# ST1006. WHEREAS, Principal is required under the terms of the Contract and the California Civil Code to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law. NOW, THEREFORE. we, the undersigned Principal, and The Guarantee Company of North America USA 1800 Sutter Street, Suite 880 Concord, CA 94520 (Name and address of Surety) ( "Surety") a duly admitted surety insurer under the laws ot'the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of One Hundred Thousand Six Hundred Forty -Tw and 00/100 Dollars ($ 100,642.00 this amount being not less than fifty percent (50 %) of the total contract price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal, his, her or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the California Civil Code, or any amounts due under tbo Unemployment Insurance Code with respect to work or labor performed under the Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the Contract, the Surety will pay for the same in an amount not exceeding the penal sum specified in this bond; otherwise, this obligation shall become null and void. This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time. alteration, addition or modification to the terms of the Contract, or of the work to be performed thereunder, or the specifications for the same, shall in any way affect its obligations wider this bond, and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Page D -55 • • Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof. have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto axed and these presents duly signed by its undersigned represcntativc(s) pursuant to authority of its governing body. Dated: October 27, 2010 "Principal' "Surety" American Asphalt South, Inc. The Guarantee Company of North America USA • �Ga $y. 8y: / ; C lizabeth Teats, Attorney -in -Fact By --- $y: Its . y► Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney -in -fact must be attached. Page D -56 , • • CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT 1' f ' State of California 1 i C / ss. ' f County of Sart &r /Ici ld1nv - 1 . ( r¢ On [ e,ir� 2 e?))/e. before me, �i itty . n r!� , �'ra kr — /Vr�Ta r , P , Ct'r Dael Name and Title of Officer (e g "Jane Doe, Notary Pubb (4 personally appeared I-. y 1r'- 5 fe 4. 1i Th Pe - ..i. - , s ?? Name(s) of Signer(a) 4 4 - • 1 i , proved to me on the basis of satisfactory ( evidence ' to be the person(s) whose name(s) Fare -w. • RICHARD EN TRIKIN subscribed to the within instrument and '1 ('•' ul t ` COMM. #1854481 3 acknowledged to me that bei /they executed ( 2 " • , NOTARYPUBLIC - CALIFORNIA the same in J ILl their authorized r SAN BE RN ARDINO COUNTY N ` •\ My capacity(ies), and that by .h157(M'f?I' /their $1 (« _ _ _ _ _ _ _ _ _ _ _ signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) r acted, executed the instrument. 2 WITNESS my hand and official seal., 1 I., . Signature of Notary Public I OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent ( fraudulent removal and reattachment of this form to another document 1 7 ( Des cription of Attached Do Pi a Title or Typg of Document: Document Date: Number of Pages: ‘ii K Signer(s) Other Than Named Above: 3 1 Capacity(ies) Claimed by Signer ( Signer's Name: �t OF SIGNER*, 4 ( ❑Individual Top of thumb here j ❑ Corporate Officer — Title(s): RIGHT THUMBPRINT ❑ Partner — ❑Limited ❑General o ❑ Attomey -in -Facts i. ❑ Trustee ❑ Guardian or Conservator �i ❑ Other: l I Signer Is Representing: (9 . 45�'k `e• eE^�`� '�' '.'�4�t^"�c.�4�"' _ -••-,- ..g." _ - •" _ _ - �• ,, e' °-Y'"� =,. c' -4gt .L��i;'�C? `�G'�"�jS:�/vi✓ /J� 0 1999 National Notary Association • 9350 De Soto Ave , PO Box 2402 • Chatsworth, CA 91313 -2402 • www nabonatnotary.org Prod. No 5907 Reorder Call Toll -Free 1.800 - 876.6827 • • THEGHAFAHIFE THE GUARANTEE COMPANY OF NORTH AMERICA USA . M1FAN1 ni NORTH AHERIU 11,A Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS. That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint Barbara Midstokke, Renee Ramsey, Richard W. Pratt, John Hopkins, Elizabeth Teats, Susan Lee, Barbara Beeny, Nancy Luttenbacher, Phillip 0. Watkins, Keith T. Schuler Interwest Insurance Services, Inc. its true and lawful attomey(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the pnncipal office. The Power of Attomey is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31 day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1. To appoint Attomey(s)-in-fact, and to authonze them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and 2 To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below 3. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days pnor to the modification or revocation Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 31" day of December 2003, of which the following is a true excerpt RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and its corporate seal to be affixed by its authorized officer, this 2nd day a ,► L ' "ne e q, of February, 2010 i ` THE GUARANTEE COMPANY OF NORTH AMERICA USA ' N 4 A ' STATE OF MICHIGAN Stephen C. Ruschak, Vice President Randall Musselman, Secretary County of Oakland On this 2 day of February, 2010 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duly swom, said that each is the herein descnbed and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of said Company Cynthia A Takai IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee Notary _7 rn Public, State of Michigan Company of North America USA offices the day and year above written. " .,. County of Oakland /A� ruei to mil / � _A,L o- My Commission Expires February 27, 2012 '� Acting in Oakland County I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. IN WITINESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 27th day of October , 2010 ce triA j` Randall Musselman, Secretary CALLORNIA ALL- PURPIE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Butte On October 27, 2010 before me, Tami Pieper- Jones, Notary Public (Here insert name and title of the officer) personally appeared Elizabeth Teats who proved to me on the basis of satisfactory evidence to be the persons whose name(8) is /art subscribed to the within instrument and acknowledged to me that bt /she /t)ey executed the same in lafs/her /trh it authorized capacity(if'), and that by 13.K/her /their signatures on the instrument the person(), or the entity upon behalf of which the person(S) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. TAMI PIEPER -JONES WITNESS my hand and official seal. M3: COMM # 80615 • "J L NOTARY PUB LIC CALIFORNIA " 3 r COUN OF BUTTE � = Comm. Expires Nov. 7, 2013 i (Notary Seal) Signature of Notary Public ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgement completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document The only exception is of a Perfomance & Payment Bonds document is to be recorded outside of California In such instances, any alternative (Title or description of attached document) acknowledgment verbiage as may he printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in American Asphalt South, Inc. California (m e certifying the authorized capacity of the signer) Please check the (Title or description of attached document continued) document carefully for proper notarial wording and attach this form if required Number of Pa es 4 Document Date 10/27/2010 • State and County information must be the State and County where the document g signer(s) personally appeared before the notary public for acknowledgment • Date of notarization must be the date that the signer(s) personally appeared which The Guarantee Company of North America USA must also be the same date the acknowledgment is completed (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public) • Print the name(s) of document signer(s) who personally appear at the time of notarization CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i e ❑ Individual (s) he /she /they, is tare) or circling the correct forms Failure to correctly indicate this information may lead to rejection of document recording ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible Impression must not cover text or lines If seal impression smudges, re -seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form CI Partner(s) • Signature of the notary public must match the signature on tile 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 ❑ Other -* Indicate title or type of attached document, number of pages and date * Indicate the capacity claimed by the signer lithe claimed capacity is a corporate officer, indicate the title (i c CEO, CFO, Secretary) • Securely attach this documcnt to the signed document 2008 Version CAPA v12.10.07 i • WORKER'S COMPENSATION CERTIFICATE OF INSURANCE WHEREAS, the CITY OF SEAL. BEACH has required certain insurance to be provided by SeaB.right Insurance NOW THEREFORE, the undersigned insurance company does hereby certify that it has issued the policy or policies described below to the following named insureds and that the same are in force at this time. I. This certificate is issued to: CITY OF SEAL BEACH, City Hall, 211 EIGHTH STREET, SEAL BEACH, CA 90740.6379. 2. The insureds under such policy or policies are: American Asphalt South, Inc. 3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of California covering al) operations of the named insureds, as follows: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE RR 19 n32A7 01 /01 /10 01 /01/11 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, unless and until thirty days' advance written notico thereof has been served upon the City Clerk of the CITY 02 7, BEACH. BY: (fiA Its Authorized Representati Page D•58 • • ADDITIONA'? INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY American Asptia1LSnuth, Inn 14436 Santa An Ava: Fontana, CA P2337 Name and address of named insured ( "Named Insured"): Financial Pacific Ins. Co. P.O. Box 292220, Sacramento. CA 95829 Name and address of Insurance Company ("Company"): OFFICIAL TITLE OF PROJECT: 2010 ANNUAL SLURRY SEAL PROJECT CIP N0. ST1006 Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy ") or in any endorsement now or hereafter attached theieta, it is agreed as follows: 1. The City of Seal Beach, its elected officials, officers, attorneys, agents, employees, and volunteers arc 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 shalt be called upon to contribute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third -party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or pennit(s) designated above, between the Named Insured and the Additional insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non- renewal except after written notice to Public Agency, by certified mail, retum receipt requested, not less than thirty (30) days prior to the effective date thereof. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations pet formed by or on behalf of cite Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. S. 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 aU notices given hereunder shall be sent to Public Agency at: Page D -60 • 1 City Engineer City of Scat Beach 211 8th Street, 2" Floor Seal Beach CA 90740 I0. Except as stated above and not ut 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 10 which this endorsement is attached. TYPE OF COVERAGES TO MUCH POLICY PERIOD LIMITS OF 2 mill gen agg THIS ENDORSEIv1ENTATTACHES FROMITO 01/01/1 12/31/14 LIAI3ILI'IY 1 mill ea. occ. 11. Scheduled items or locations are to be Identified on an attached sheet. The following inclusions relate to the above coverages. Includes: X Contractual Liability X Explosion Hazard lg Owners/Landlords/Tenants tj'( Collapse Hazard rg Manufacturers /Contractors X Underground Property Damage Products/Completed Operations X Pollution Liability X( broad Form Property Damage 34 Liquor Liability X Extended Bodily Injury X Broad Form Comprehensive • Xi General Liability Endorsement 12. A AL deductible or 0 self - insured retention (check one) of S 1,000 _ applies to all coverage(s) except: NA (if none, so state). The deductible is applicable 0 per claim or C per occurrence (check one). 13. This is an Roccurrcnce or 0 claims made policy (check one). 14. This endorsement is effective on ...01 /01 / Q, ,•. „ .. •_ at 12:01 A.M. and forms a part of Policy Number I, t anclpin t Leifker (print narne), 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, 1 do so bind the Company. Executed t4nvembb( , 2010 ✓ j � ignature of Authorize • epresenrative (Original signature only; no facsiinile signature or initialed signature accepted) Phone No.; (9 ) f3 Page D-61 e • • ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY American Asphalt Smith In 14438 Santa AnaAvs;...Esntana,�A P2337 Name and address of named insured ( "Named Insured "): Eia -racial Pacific Ina, �4 P, Q. Box 292220: Sacramento CA 95829 Name and address of Insurance Company ( "Company"): OFFICIAL TITLE OF PROJECT: 2010 ,4NNUA L SLCRRVSrat, PROrEcr CIP No. ST1006 Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy "j or in airy endorsement now or hereafter attached thereto, it is agreed as follows: The City of Seal Beach, its elected officials, officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional [nsuteds ") 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. 1. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall he called upon to contribute with the insurance coverages provided by the Policy. 2. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whotn claim is made or suit is brought except with respect to tie limits of the Company's liability, 3. Nothing hi this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third -parry claittts, i.e,, in the same manner as if separate policies had been issued to each insured Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 4. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusiorxs applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insureds. 5. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non - renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in fall force and effect until compliance with this notice requirement. 6. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. It is hereby agreed that the laws of the State of California shall apply to and govem the validity, construction, interpretation, and enforcement of this contract of insurance. This endorsement and all notices given hereunder shall be sent to Public Agency at: City Engineer City of Seal Beach 211 8th Street, 2'" Floor Seal Beach CA 90740 Page D-63 . . 7. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF $1,000,000 THIS ENDORSEMENT ATTACHES FROM/ TO 01/01/10- 12/31/10 LIABILITY Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: X Any Automobiles 0 Truckers Coverage (X All Owned Automobiles Motor Cairier Act IX Non -owned Automobiles 0 Bus Regulatory Reform Act X Hired Automobiles 0 Public Livery Coverage Ql; Scheduled Automobiles u C! Garage Coverage J 11. A X deductible or 0 self-insured retention (check one) of S 500 applies to all coverage(s) except: NA _ (if none, so state). The deductible is applicable 0 per claim or Ci per occurrence (check one). 12. This is an',tri occurrence or 0 claims made policy (check one). 13. This endorsement is effective on 01 /01/1 0 at 12:01 A.M. and forms a part of Policy Number 1811632A • 1, (print name), hereby declare under penalty of perjury under the Iaws 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 November 15 _ , 20in Signature of Authorized Representative C f . / (Original signature only; no facsimile signature or initialed signature accepted) Phone No.: (916 )609-R416 Page D -64 a . • ® ACCORD (MM /DDIYYYY) �.....� CERTIFICATE OF LIABILITY INSURANCE 1 10/27/2010 PRODUCER Phone: 916 - 488 -3100 Fax: 916- 979 -7992 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION InterWest Insurance Services (AMERI22) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE icense #0B01094 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR L L ice se American River Dr, #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sacramento CA 95864 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERAFinancial Pacific Ins Company 31453 American Asphalt South, Inc. INSURERB SeaBright Insurance Company 15563 14436 Santa Ana Ave. Fontana CA 92337 INSURERC INSURER D. INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRQ TYPE OF INSURANCE DATE (MM/DD/YYYYI DATE (MM/DD/YYYY) A X GENERAL LIABILITY 180632A 1/1/2010 1/1/2011 EACH OCCURRENCE S1,000,000 DAMAGE TO COMMERCIAL GENERAL LIABILITY PREMISES (Ea $ 100, 000 CLAIMS MADE Ix ( OCCUR MED EXP (Any one person) $ 5.000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY n PF a LOC A X AUTOMOBILE LIABILITY 180632A 1/1/2010 1/1/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUT OTHER THAN EA ACC $ AUTO ONLY AGG $ A EXCESS / UMBRELLA LIABILITY 924028A 1/1/2010 1/1/2011 EACH OCCURRENCE $5,000,000 TI OCCUR I1 CLAIMS MADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ X RETENTION $ none $ WORKERS COMPENSATION WC STATU- OTH- B BB1103297 1/1/2010 1/1/2011 X ITORYLIMITSI ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 1.000.000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: FY 2010 ANNUAL SLURRY SEAL PROJECT #ST1006. CITY OF SEAL BEACH, ITS OFFICERS, OFFICIALS, EMPLOYEES AND ANY OTHER PERSON /ENTITY AS REQUIRED BY WRITTEN CONTRACT NAMED AS ADDITIONAL INSURED (GL /AUTO), PRIMARY WORDING, GL /AU /WC WAIVERS ATTACHED. CERTIFICATE HOLDER CANCELLATION 10 - DAY NOTICE FOR NON- PAYMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER City of Seal Beach - City Clerk NAMED TO THE LEFT. 211 8th Street Seal Beach CA 90740 AUTHORIZED REPRESENTATIVE / - y ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . • • • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) ' • • POLICY NUMBER: 180632A ASDA AU 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Name of Person or Organization: RE : FY 2010 ANNUAL SLURRY SEAL PROJECT #ST1006 . CITY OF SEAL BEACH, ITS OFFICERS, OFFICIALS, EMPLOYEES AND ANY OTHER PERSON /ENTITY AS REQUIRED BY WRITTEN CONTRACT NAMED AS ADDITIONAL INSURED (GL /AUTO), PRIMARY WORDING, The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV BUSINESS AUTO CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above be- cause of payments we make for bodily injury or property damage arising out of losses or accidents which occur during the policy period. This waiver applies only to liability you assume pursuant to a contract with the person or organization shown in the schedule. ASDA AU 07 02 Page 1 of 1 . �. • • POLICY NUMBER: 180632A COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: RE: FY 2010 ANNUAL SLURRY SEAL PROJECT #ST1006. CITY OF SEAL BEACH, ITS OFFICERS, OFFICIALS, EMPLOYEES AND ANY OTHER PERSON /ENTITY AS REQUIRED BY WRITTEN CONTRACT NAMED AS ADDITIONAL INSURED (GL /AUTO), PRIMARY WORDING, GL /AU /WC WAIVERS ATTACHED. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 . • • POLICY NUMBER: 180632A COMMERCIAL GENERAL LIABILITY Named Insured: American Asphalt South, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: RE: FY 2010 ANNUAL SLURRY SEAL PROJECT #ST1006. CITY OF SEAL BEACH, ITS OFFICERS, OFFICIALS, EMPLOYEES AND ANY OTHER PERSON /ENTITY AS REQUIRED BY WRITTEN CONTRACT NAMED AS ADDITIONAL INSURED (GL /AUTO), PRIMARY WORDING, GL /AU /WC WAIVERS ATTACHED. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization is held liable for your work" for that person or organization by or for you. This endorsement applies to the following work: Description of Job: See Above Location of Job: See Above Al only Effective from: Effective Date:1 /1/2010 Expiration Date: 1/1/2011 When this endorsement applies, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess to the insurance afforded by this endorsement. CG 201011 85 Modified (07 -01) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Ill • POLICY NUMBER: 180632A ASDA AU 07 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE NAMED INSURED: American Asphalt South, Inc. 14436 Santa Ana Ave. . Fontana CA 92337 ADDITIONALINSURED:RE: FY 2010 ANNUAL SLURRY SEAL PROJECT #ST1006. CITY OF SEAL BEACH, ITS OFFICERS, OFFICIALS, EMPLOYEES AND ANY OTHER PERSON /ENTITY AS REQUIRED BY WRITTEN CONTRACT NAMED AS ADDITIONAL INSURED (GL /AUTO), PRIMARY WORDING, GL /AU /WC WAIVERS WHO IS AN INSURED (SECTION II) is amended to include as an insured the organization shown in the Schedule above, but only with respect to the operation of vehicles owned by the named insured and operated on behalf of the named insured. This endorsement does not apply to any operations for other than the named insured. Each person or organization named above is an insured for liability coverage, but only to the extent that person or organization qualifies as an insured under the Who Is An Insured provision of Section II Liability Coverage. The additional insured is not required to pay for aiy premiums stated in the policy or earned from the policy. Any retum premium, if applicable, declared by us shall be paid to you. You are authorized to act for the additional insured in all mailers pertaining to this insurance. We will mail the additional insured notice of any cancellation of this policy. If the cancellation is by us, we will give thirty days notice to the additional insured. The additional insured will retain any right of recovery as a claimant under this policy. ASDA AU 07 01 Page 1 of 1 • • WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from US.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be * % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. *The premium charge for this endorsement shall be 2% of the premium developed in the State of Califomia, but not less than $500 policy minimum premium. This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/10 Policy No. 661103297 Endorsement No. 9 Insured American Asphalt Repair & Resurfacing Co Inc Policy Effective Date 01/01/10 Insurance Company SeaBright Insurance Company Countersigned By / / .` : • WC 04 03 06 (Ed. 4-84) 51998 by the Workers' Compensation Insurance Rating Bureau or California. AR rights reserved. • • 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 1 am aware of the following provisions of California law and that 1, or the entity on whose behalf this certification is given, hold a currently valid California contractor's license as set forth below (required at time of award): Business & Professions Code § 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefore, except in any of the following cases: (1) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104 now § 20103.5) of the Public Contract Code. (b) if a person has been previously convicted of the offense described in this section, the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months, or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract" for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (cI) 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 corn' actor and the board failed to respond to the inquiry within three business days. For purposes of this section, a telephone response by the board shall be deemed sufficient. Public Contract Codc § 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 four 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.: 7 V`7 1 6 �_ Class: A Expiration Date: f 30 WI Date:_�r t G 'LO tO • AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS [Labor Code §§ 1720, 1773.8, 1775, 1776, 1777.5, 1813, 1860, 1861, 3700] The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the Following provisions of California law: 1. Contractor acknowledges that this contract is subject to the provisions of Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code relating to public works and the awarding public agency ( "Agency ") and agrees to be bound by all the provisions thereof as though set forth in full herein. 2. Contractor agrees to comply with the provisions of California Labor Code Section 1773.8 which requires the payment of travel and subsistence payments to each worker needed to execute the work to the extent required by law. 3. Contractor agrees to comply with the provisions of California Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the Agency, forfeit not more than fifty dollars ($50) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the Director of Industrial Relations for the work or craft in which the worker is employed for any public work done under the contract by Contractor or by any subcontractor. 4. Contractor agrees to comply with the provisions of California Labor Code Section 1776 which require Contractor and each subcontractor to (1) keep accurate payroll records, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the Agency of the location of the records. The Contractor is responsible for compliance with Section 1776 by itself and all of its subcontractors. 5. Contractor agrees to comply with the provisions of California Labor Code Section 1777.5 concerning the employment of apprentices on public works projects, and further agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of California Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the Agency, forfeit twenty -five dollars ($25) for each worker employed in the execution of the contract by the Contractor or by any 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 Califomia Labor Code. 7. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861, Contractor hereby certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self - insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract." Date ei4ier ��, Signature J ,A ' 1/.h• rR t,240 ! Page D -67 • INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND WAIVER OF SUBROGATION AND CONTRIBUTION TITLE OF PROJECT OR WORK: 2010 Annual Slurry Seal Project, CIP# ST1006 Indemnitor(s) (list all names): ittr;e4 %,*4// .%u/ Zhc To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend, protect, indemnify, and hold harmless the City of Seal Beach and its elected officials, officers, attorneys, agents, employees, volunteers, successors, and assigns (collectively "Indemnitees ") from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses, judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys, or other professionals and all costs associated therewith (collectively "Liabilities "), arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act, error, or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors, materialmen, suppliers or their officers, agents, servants or employees, arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to the above - referenced contract, agreement, license, or permit (the "Agreement") or the performance or failure to perform any term, provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indenmitees and shall operate to fully indemnify Indemnitees against any such negligence. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorneys fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code § 2782(a) or (b) the contracting public agency's active negligence to the limited extent that the underlying Agreement is subject to Civil Code § 2782(b). This indemnity is effective without reference to the existence or applicability of any insurance coverage which may have been required under the Agreement or any additional insured endorsements which may extend to Indemnitees. Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor regardless of any prior, concurrent, or subsequent active or passive negligence by the Indemnitees. In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint and several. " Indemnitor" �^l Name T 4' /r �/ Name: , t 'd vl t' J By: � 7 )7 ts X� <<M� d Page D -68