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HomeMy WebLinkAboutAGMT - Ken Thompson, Inc. (Lampson Ave Sewer Replacement, Project #50215) irk F c- iii {lffb_idti •o (J4, Ojai p= 't( C, i2ty 0/2/Tom Daly, Clerk-Recut-clef 'ill7b. 11.;1 iiili''Iffi !n'Ml''lR NO FEE RECORDING REQUESTED BY 2C0'.:30010879134 II 29 am 12;18/09 276 418 N12 I AND WHEN RECORDED MAIL TO 00 0.00 0 00 0.00 0.00 0.00 0.00 CITY OF SEAL BEACH Attn: City Clerk 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 **** _1' 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. 5. A work of improvement on the property hereinafter is described as substantially completed on December 2, 2009. The work was Lampson Avenue Sewer Replacement at Seal Beach Boulevard Project No. SW0901. 6. The name of the contractor, if any, for such improvement was: Ken Thompson Inc. The date of the Contract Award was September 8, 2008, 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: Lampson Avenue at Seal Beach Boulevard. Date: /2 1/2-'09 . —/ice t 44 rignature of owner or corporate officer of owner named in paragraph 2 or agent. VERIFICATION I, the undersigned, say: the Director of Public Works declarant of the foregoing notice of completion; have read said notice of completion and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury the foregoing is true and correct. Executed on /2 - /$t D9 , 2009, at t,z1 Bea 1. (Date of Signature) 4 Director of Public Works i AN AGREEMENT FOR LAMPSON AVENUE SEWER REPLACEMENT AT SEAL BEACH BOULEVARD SPECIFICATION NO. SW0901 between = E SEAL '4E: k .:341 • R2A. -- C p ( /Nn, Ca _ City of Seal Beach 211 - 8th Street Seal Beach, CA 90740 Ken Thompson. Inc. 1785 Sampson Avenue Corona, Ca 92879 (951) 284 -2424 THIS AGREEMENT is made and entered into this 27 day of August , by and between the City of Seal Beach, a California charter city ( "City "), and Ken Thompson, Inc. ( "Contractor "). S7296- 0200 \1067022v1.doc . r RECITALS A. WHEREAS, City desires to replace Sewer lines located in Lampson Avenue at Seal Beach Boulevard, Seal Beach, California ( "Project "); and B. WHEREAS, Contractor has submitted a bid to City for the Project on August 19, 2008 ( "Exhibit A "), which exhibit contains, among other things, provisions defining the Project scope and the cost associated with such Project scope; and C. WHEREAS, City accepts Exhibit A and desires to contract with Contractor to complete the Project in accordance with Exhibit A; and D. 'WHEREAS, Contractor represents that it is experienced and skilled in the performance of the services required to undertake the work required under the Agreement, and is duly licensed to undertake the same; 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 ARTICLE I. For and in consideration of the payments and agreements hereinafter mentioned to be made and performed by said CITY, the CONTRACTOR agrees with said CITY to perform and complete in a good and workmanlike manner all the work pertaining thereto shown on the drawings and described in the Specifications and Contract Documents, therefore, to furnish at his own proper cost and expense all tools, equipment, labor and materials necessary therefore (except those materials expressly noted as to be furnished by the CITY), and to do everything required by this Agreement and the said Specifications, Drawings, and Contract Documents. ARTICLE II. For furnishing all said materials and labor, furnishing and removing all plant, temporary works or structures, tools and equipment and doing all the work contemplated and embraced in this Agreement, also for all loss and damage arising out of the nature of the work aforesaid, or from the action of the elements, or from any unforeseen difficulties which may arise or be encountered in the prosecution of the work until its acceptance by said CITY, and for all risks of every description connected with the work; also for all expenses incurred by or in consequence of the suspension or discontinuance of work; except such as in the said Specifications are expressly stipulated to be borne by the said CITY and faithfully completing the work and the whole thereof, in the manner shown and described in the said Drawings, Specifications, and Contract Documents and in accordance with the requirements of the Engineer, said CITY will pay and the CONTRACTOR shall receive in full compensation, therefore, the unit prices and the lump sum prices named in the Schedule of Work Items of the Proposal. ARTICLE III. The CITY hereby promises and agrees with said CONTRACTOR to employ and does hereby employ said CONTRACTOR to provide the materials and to do the work according to the terms and conditions herein contained and referred to for the price aforesaid, 2 S7296- 0200 \1067022v1.doc • • and hereby contracts to pay the same, at the time, in the manner and upon the conditions set forth in the Specifications and Contract Documents, and the said parties for themselves, their heirs, executors, administrators, successors and assigns, do hereby agree to the full performance of the covenants herein contained. ARTICLE IV. The advertisement for Bids, the Proposal, the Specifications, and the Drawings mentioned therein, and all addenda issued by the CITY with respect to the foregoing prior to the opening of bids, are hereby incorporated in and made a part of this Agreement. ARTICLE V. The statement of prevailing wages appearing in the General Prevailing Wage Rates is hereby specifically referred to and by this reference is made a part of this contract. It is further expressly agreed by and between the parties hereto that should there be any conflict between the terms of this instrument and the bid of proposal of said CONTRACTOR, then this instrument shall control and nothing herein shall be considered as an acceptance of the said terms of said proposal conflicting herewith. ARTICLE VI. By my signature hereunder, as CONTRACTOR, I certify that I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workmen'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. IN WITNESS WHEREOF: The Parties hereto have caused this contract to be executed the day and year first above written. CITY OF SEAL BEACH, CALIFORNIA Party of the First Part BY •l MOM City M pager ATTEST: iktd4 1 Ci Clerk BY CONTRACTOR - of the Second Vart Executive Vice President Title 1785 Sampson Avenue Corona, Ca 92879 Address Approved as to Form: A ' o rney 3 S7296- 0200 \1067022v1.doc • • AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS (Labor Code§§ 1720,1773.8,1775,1776,1777.5,1813,1860,1861,37001 The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the Following provisions of California law; 1. Contractor acknowledges that this contract is subject to the provisions of Division 2, 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 contact 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 thither agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of California Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall,as a penalty to the Agency, forfeit twenty-five dollars ($25) for each worker employed in the execution of the contract by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than 8 hours in any one calendar day and 40 hours in any one calendar week in violation of the provisions of Division 2,Part 7,Chapter 1,Article 3 of the California Labor Code. 7. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861,Contractor hereby certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code,and I will comply with such provisions before commencing the performance of the work of this contract." Date 7/4/4 g Signature S a 7 -a +'n • • • STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS [Business&Professions Code §7028.15] [Public Contract Code§20103.5] I,the undersigned, certify that I am aware of the following provisions of California law and that 1, or the entity on whose behalf this certification is given, hold a currently valid California contractor's license as set forth below (required at time of award): Business&Professions Code§7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefore, except in any of the following cases: (1) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104[now§20103.5]of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section,the court shall impose a fine of 20 percent of the price of the contract wider which the unlicensed person performed contracting work, or four thousand five hundred dollars($4,500), whichever is greater,or imprisonment in the county jail for not less than 10 days nor more,than six months,or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis,"the price of the contract" for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license,as required by Section 7029.1. However,at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect,land surveyor,or registered professional engineer to form joint ventures with licensed contractors to render services within the scope of their respective practices. (e) Unless one of the foregoing exceptions applies,a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non-responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order,verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13, inclusive. Any contract awarded to, or any purchase order issued to,a contractor who is not licensed pursuant to this chapter is void. (f) My compliance or noncompliance with subdivision(e) of this section, as added by Chapter 863 of the Statutes of 1989,shall not invalidate any contract or bid awarded by a public agency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if the public employee,officer,or employing agency made an inquiry to the board for the purposes of verifying the license status of any person or contractor and the board failed to respond to the inquiry within three business days. For purposes of this section,a telephone response by the board shall be deemed sufficient. • • Public Contract Code§20103.5: In all contracts subject to this part where federal funds are involved,no bid submitted shall be invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However,at the time the contract is awarded,the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material under any contract shall not be made unless and until the Registrar of Contractors verifies to the agency that the records of the Contractors' State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law, including,but not limited to, any appropriate disciplinary action by the Contractors'State License Board. The agency shall include a statement to that effect in the standard form of pre-qualification questionnaire and financial statement. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. 0'74502 License No.: Class: A Expiration Date: 3//v �7 Date: 9/0 a/0 8' / • 2 • • • • INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND WAIVER OF SUBROGATION AND CONTRIBUTION TITLE OF PROJECT OR WORK: Lampson Avenue Sewer Replacement at Seal Beach Boulevard Indemnitor(s)(list all names): To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend, protect, indemnify,and hold harmless the City of Seal Beach and its elected officials,officers,attorneys,agents,employees, volunteers, successors, and assigns (collectively "Indemnitees") from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses, judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys, or other professionals and all costs associated therewith (collectively "Liabilities"), arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act, error,or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors, materialmen, suppliers or their officers, agents, servants or employees,arising or claimed to arise,directly or indirectly,out of,in connection with,resulting from,or related to the above-referenced contract, agreement, license, or permit (the "Agreement") or the performance or failure to perform any term, provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent,or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify lndemnitees against any such negligence. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision,and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorneys fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass(a)Indemnitees'sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code § 2782(a) or(b) the contracting public agency's active negligence to the limited extent that the underlying Agreement is subject to Civil Code § 2782(b). This indemnity is effective without reference to the existence or applicability of any insurance coverage which may have been required under the Agreement or any additional insured endorsements which may extend to Indemnitees. Indemnitor,on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor regardless of any prior,concurrent, or subsequent active or passive negligence by the Indemnitees. In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint and several.• "Indemnitor" Name Dc's-h �el u- n9 Name: By: Eiec el76✓e Vice Ptec/de.tf By: 4:12 Its 1 • • • 3793789 ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 9/15/2008 PRODUCER Garrett/Mosier/Griffith/Sistrunk Ins. Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 12 Truman . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Irvine, CA 92620 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)559-6700 BOw8451r�re0-mosier.com INSURERS AFFORDING COVERAGE NAIC# INSURED Ken 5Thompson, Inc. INSURER At Old Republic General Insurance Corp. 24139 INSURER B: INSURER C: 1785 Sampson Avenue INSURER D: Corona, CA 92879 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 IADD'L I - POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYYI DATE IMMIDD/YYI LIMITS A GENERALLIABIUTY EACH OCCURRENCE $ 1,000,000 • COMMERCIAL GENERAL LIABILITY AlCG89970800 2/13/2008 2/13/2009 PREMISESD(E occarence) $ 300,000 CLAIMS MADE J OCCUR MED EXP(Any one person) $ 10,000 • PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ✓ POLICY 28-1: LOC A AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT ✓ ANY AUTO Al CA89970800 2/13/2008 2/13/2009 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ _/ HIRED AUTOS BODILY INJURY $ ✓ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ IOCCUR I CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WC STATU- 0TH- A WORKERS AND Al CW89970800 6/30/2008 6/30/2009 -TORY LIMITS ER ti ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ItyeCdescdbVISIO E.L.DISEASE-POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Lampson Ave. Sewer Replacement at Seal Beach Blvd., Spec No. SW0901. City of Seal Beach CERTIFICATE HOLDER CANCELLATION Lampson Ave.Sewer Replacement at Seal Beach Blvd.,Spec No.SW09D1. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Seal Beach DATE THEREOF,THE ISSUING INSURER WILL graxxxxro MAIL 30• DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BIXXXKDO)(§() X§QX;14X0(X - City Hall X88,0XXXXX0 1000XX( 00080004)0080X 004XXI XN atz0c aXS att 211 Eighth Street X0R88069/D011F0X *10 Days for Non-Payment of Premium Seal Beach CA 90740-6379 AUTHORIZED REPRESENTATIVE �, ,I '/SLZ i John Garrett (�(j/JLIUDD/•//-/ �[L/UI-.I./Jwy- ACORD 25(2001/08) ©ACORD CORPORATION 1988 • • 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 The Certificate of Insurance on the reverse side of this form 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(2001108) S CERTIFICATE -'ADDENDUM. NAMED INSURED CERTIFICATE HOLDER 9/15/2008 Ken Thompson, Inc. City of Seal Beach City Hall 211 Eighth Street Seal Beach CA 90740-6379 RE: Lampson Ave. Sewer Replacement at Seal Beach Blvd. , Spec No. SW0901. The City of Seal Beach, its elected officials, officers, attorneys, agents, employees and volunteers are added as Additional Insured per CG20100704 and CG20370704 and this insurance is primary per CGENGN00290906 attached, with respect to work performed for them by Ken Thompson, Inc. under General Liability coverage. As respects General Liability coverage, a Waiver of Subrogation is hereby included, per CG24041093 attached. As respects General Liability coverage, a General Aggregate Limit applies Per Project, per CG25030397. As respects General Liability coverage, a $5,000 Property Damage Deductible applies Per Occurrence. As respects General Liability coverage, Severability of Interest clause is included, per CG00011204. As respects Automobile Liability coverage, The City of Seal Beach, its elected officials, officers, attorneys, agents, employees and volunteers are added as Additional Insured, per CAENGN00201906 attached. As respects Automobile Liability coverage, a Waiver of Subrogation is hereby included, per CAENGN00211906 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included, per WC0403060484 attached. Created at www.eCertsONLINE.com IV-AD2(2002) • • Ken Thompson, Inc. POLICY NUMBER: AlCG89970800 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply y I to "bodily inju ry or "property damage" damage' or "personal and advertising injury" occurring after caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ • • POLICY NLIMBhR: AlCG89970800 COMMERCIAL GENERAL LIABILITY en ompson, Inc. CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Where required by written contract, but only when coverages for Completed Operations is specifically required by that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- at the location designated and described in the dude as an additional insured the person(s) or or- schedule of this endorsement performed for that ad- ganization(s) shown in the Schedule, but only with ditional insured and included in the "products-corn- respect to liability for "bodily injury" or "property pleted operations hazard". damage" caused, in whole or in part, by "your work" CG 20 37 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 UNIFORM • • OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s). Location(s)of Covered Operations Or Organization(s): • As required by written contract Information required to complete this Schedule,if not shown above,will be shown In the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other Insurance of a like kind available to the person or organization shown In the schedule above unless the other Insurance is provided by a contractor other than the person or organization shown In the schedule above for the same operation and Job location. If so,we will share with that other Insurance by • the method described in paragraph 4.c.of Section IV—Commercial General Liability Conditions. All other terms and conditions remain unchanged. • Named Insured Ken Thompson, Inc. Policy Number Al CG89970800 Endorsement No. Policy Period to Endorsement-Effective Date: 2/13/2008 2/13/2009 Producers Name: Producer Number: 9/15/2008 AUTHORIZED REPRESENTATIVE DATE • CG EN GN 0029 09 08 • • Ken Thompson, Inc. POLICY NUMBER: A1CG89970800 COMMERCIAL GENERAL LIABILITY CG 24 0410 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: WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT (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 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURANCE WHERE REQUIRED UNDER CONTRACT OR AGREEMENT • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM • The following is added to Section II—Liability Coverage,A.—Coverage,1.Who Is An Insured: d. Any person or organization to whom you become obligated to Include as an additional Insured under this policy,as s result of any contract or agreement you enter Into which • required you to furnish insurance to that person or organization of the type provided by this policy,but only with respect to liability arising out of your operations or premises owned by or rented to you. However,the Insurance provided will not exceed the lessor of: 1. The coverage or limits of this policy,or 2. The coverage or limits required by said contract or agreement Named Insured Ken Thompson, Inc. Policy Number Al CA89970800 Endorsement No. Policy Period 2/13/2008 to Endorsement Effective Date: 2/13/2009 Producer's Name: Producer Number: I £' 9/15/2008 AUTHORIZED REPRESENTATIVE DATE CA EN GN 0020 09 06 • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM The following is added to Section IV—Business Auto Conditions,A.—Loss Conditions,5.—Transfer of Rights of Recovery Against Others to Us: However,we will waive any right of recovery we have against any person a organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an"accident or loss"If: • (1) The"accident'or"loss"is due to operations undertaken In accordance with a Written contract existing between you and such person or organization;and (2) The contract or agreement was entered into prior to any"accident'or"loss.' No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization,and we reserve our rights of lien to be reimbursed for any recovery funds obtained by any injured employee. • Named Insured Ken Thompson, Inc. Policy Number Al CA89970800 Endorsement No. Policy Period 2/13/2008 to Endorsement Effective Date: 2/13/2009 Producer's Name: Producer Number: AUTHORIZED REPRESENTATIVE DATE CA EN GN 0021 09 06 • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS'COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE We have the right to recover ow payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named h 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. This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement Is 50.00 Named Insured Policy Number Endorsement No. Policy Period to Endorsement Effective Date: Producer's Name: Producer Number: 9/15/2008 AUTHORIZED REPRESENTATIVE DATE WC 99 03 15(09/06) • • 379 378 9 ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/15/2008 PRODUCER Garrett/Mosier/Griffith/Sistrunk Ins. Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 12 Truman ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Irvine, CA 92620 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (949)559-6700 www.garrett-mosier.com 0084519 INSURERS AFFORDING COVERAGE NAIC# INSURED Ken Thompson, Inc. INSURER A: Old Republic General Insurance Corp. 24139 INSURER B: INSURER C: 1785 Sampson Avenue INSURER D: Corona, CA 92879 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't( POLICY EFFECTIVE POLICY EXPIRATION ITR INSRQ TYPE OF INSURANCE POLICY NUMBER DATF IMMIDDIYYI DATE(MM/DDJYYI LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 MMISAGE COMMERCIALGENERALLIABILITY A1CG89970800 2/13/2008 2/13/2009 PR DAEES(TO EaRENTED eccurence) $ 300,000 CLAIMS MADE [✓I OCCUR MED EXP(Any one person) $ 10,000 _ PERSONAL S.ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ✓I POLICY mf LOC A AUTOMOBILE LIABILITY 7 ANY AUTO A1CA89970800 2/13/2008 2/13/2009 COMBINED SINGLE LIMIT $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) _/ HIRED AUTOS ✓ BODILY INJURY 5 NON-OWNED AUTOS Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- 0TH- A WORKERS COMPENSATION AND V TORY I IMITS FR_ n EMPLOYERS'LIABILITY A1CW89970800 6/30/2008 6/30/2009 E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,AL PRO under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Lampson Ave. Sewer Replacement at Seal Beach Blvd., Spec No. SW0901. City of Seal Beach CERTIFICATE HOLDER CANCELLATION Lampson Ave.Sewer Replacement at Seal Beach Blvd.,Spec No.SW0901. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Seal Beach DATE THEREOF,THE ISSUING INSURER WILL OCIEX%TO MAIL 30' DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,afJQ J(Il;p 'I,aXpX Qj X+XAj1o( City Hall XiPRXRCXOrxaNwX00( (t aXVOO 88)0(0ew)oezaXeWCN eTCb1904)01X$01K 211 Eighth Street XOt$Y3EXNXY091/6X •10 Days for Non-Payment of Premium Seal Beach CA 90740-6379 AUTHORIZED REPRESENTATWE �. 'I John Garrett J/r)//(IIpI�//// ACORD 25(2001/08) ©ACORD CORPORATION 1988 • • 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 The Certificate of Insurance on the reverse side of this form 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(2001/08) • • CERTIFICATE ADDENDUM' NAMED INSURED CERTIFICATE HOLDER 9/15/2008 Ken Thompson, Inc. City of Seal Beach City Hall 211 Eighth Street Seal Beach CA 90740-6379 RE: Lampson Ave. Sewer Replacement at Seal Beach Blvd. , Spec No. SW0901. The City of Seal Beach, its elected officials, officers, attorneys, agents, employees and volunteers are added as Additional Insured per CG20100704 and CG20370704 and this insurance is primary per CGENGN00290906 attached, with respect to work performed for them by Ken Thompson, Inc. under General Liability coverage. As respects General Liability coverage, a Waiver of Subrogation is hereby included, per CG24041093 attached. As respects General Liability coverage, a General Aggregate Limit applies Per Project, per CG25030397. As respects General Liability coverage, a $5,000 Property Damage Deductible applies Per Occurrence. As respects General Liability coverage, Severability of Interest clause is included, per CG00011204. As respects Automobile Liability coverage, The City of Seal Beach, its elected officials, officers, attorneys, agents, employees and volunteers are added as Additional Insured, per CAENGN00201906 attached. As respects Automobile Liability coverage, a Waiver of Subrogation is hereby included, per CAENGN00211906 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included, per WC0403060484 attached. Created at www.eCertsONLINE.com .. - IV-AD2(2002) • • • Ken Thompson, Inc. POLICY NUMBER: A1CG89970800 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury', "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of the additional insured(s) at the location of the in the performance of your ongoing operations for covered operations has been completed; or the additional insured(s) at the location(s) desig- nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 ❑ • • POLICY NWMBER: A1CG89970800 COMMERCIAL GENERAL LIABILITY en ompson, Inc. CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Where required by written contract, but only when coverages for Completed Operations is specifically required by that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- at the location designated and described in the dude as an additional insured the person(s) or or- schedule of this endorsement performed for that ad- ganization(s) shown in the Schedule, but only with ditional insured and included in the "products-com- respect to liability for "bodily injury" or "property pleted operations hazard". damage" caused, in whole or in part, by "your work" CG 20 37 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 UNIFORM OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(*)- Location(s)of Covered Operations Or Organlzation(s): As required by written contract Information required to complete this Schedule,if not shown above,will be shown In the Declarations. The insurance provided by this endorsement is primary Insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other Insurance Is provided by a contractor other than the person or organization shown In the schedule above for the same operation and job location. If so,we will share with that other insurance by • the method described in paragraph 4.c.of Section IV—Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Ken Thompson, Inc. Policy Number Al CG89970800 Endorsement No. Policy Period to Endorsement Effective Date: ) 2/13/2008 2/13/2009 Producer's Name: Producer Number: 9/15/2008 AUTHORIZED REPRESENTATIVE DATE CG EN GN 0029 09 06 • • Ken Thompson, Inc. POLICY NUMBER: A1CG89970800 COMMERCIAL GENERAL LIABILITY CG 24 0410 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: WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT (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 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ • • OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURANCE WHERE REQUIRED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM The following is added to Section II—Liability Coverage,A.—Coverage, 1.Who Is An Insured: d. Any person or organization to whom you become obligated to include as an additional Insured under this policy,as a result of any contract or agreement you enter Into which required you to furnish Insurance to that person or organization of the type provided by this policy,but only with respect to liability arising out of your operations or premises owned by or rented to you. However,the Insurance provided will not exceed the lessor of: 1. The coverage or limits of this policy,or 2. The coverage or Smits required by said contract or agreement ' Named Insured Ken Thompson, Inc. Policy Number Al CA89970800 Endorsement No. Policy Period 2/13/2008 to Endorsement Effective Date: 2/13/2009 Producer's Name: Producer Number. }nf�D�� U fil 9/15/2008 AUTHORIZED REPRESENTATIVE DATE CA EN GN 0020 09 06 • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM The following is added to Section IV—Business Auto Conditions,A.—Loss Conditions,5.—Transfer of Rights of Recovery Against Others to Us: However,we will waive any right of recovery we have against any person or organization • • with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an"accident or loss'if: • (1) The"accident or loss"is due to operations undertaken In accordance with a Written contract existing between you and such person or organization;and (2) The contract or agreement was entered into prior to any"accident or"loss.' No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization,and we reserve our rights of lien to be reimbursed for any recovery funds obtained by any injured employee. I 0 f • Named Insured Ken Thompson, Inc. Policy Number Al CA89970800 Endorsement No. Policy Period 2/13/2008 to Endorsement Effective Date: 2/13/2009 Producer's Name: Producer Number: AUTHORIZED REPRESENTATIVE DATE CA EN GN 0021 09 08 • • • OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS'COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE 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 extant that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 Named Insured Policy Number Endorsement No. Policy Period to Endorsement Effective Date: Producer's Name: Producer Number: 9/15/2008 AUTHORIZED REPRESENTATIVE DATE WC 99 03 15(09/06) • APPENDICES D Worker's Compensation Certificate of Insurance Page D-66 • • INSURANCE REQUIREMENTS The Contractor shall at all times during the terms of the Contract carry,maintain,and keep in hill force and effect a policy or policies of comprehensive general liability insurance in which the City, along with its City Council and each member thereof, and every officer,official, agent,attorney, employee or volunteer of the City, is the named insured or is named as an additional insured with the Contractor in accordance with the General Provisions. The insurance company issuing such policy(ies)must be acceptable to, and approved by, the City Engineer and City Attorney. Contractor shall maintain limits of no less than One Million Dollars($1,000,000)combined single limit coverage per occurrence for personal injury or death or property loss or damage which may arise from or relate directly or indirectly to the acts, operations or omissions of the performance of the Contractor and/or its subcontractors and/or the employees, agents, officers,officials or volunteers of either,in the performance of this Public Works Contract. Such insurance shall include coverage for all automobiles utilized by Contractor's or any subcontractor's employees or agents in the performance of the Contract. Contractor shall also provide an endorsement in the forms included in Book U. • • WORKER'S COMPENSATION CERTIFICATE OF INSURANCE WHEREAS,the CITY OF SEAL BEACH has required certain insurance to be provided by Old Republic General Insurance Corporation NOW THEREFORE,the undersigned insurance company does hereby certify that it has issued the policy or policies described below to the following named insureds and that the same are in force at this time. 1. This certificate is issued to: CITY OF SEAL BEACH, City Hall,211 EIGHTH STREET, SEAL BEACH,CA 90740-6379. 2. The insureds under such policy or policies are: Ken Thompson, Inc. 3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of California covering all operations of the named insureds,as follows: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A-1CW-899708-00 06/30/2008 06/30/2009 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the CITY OF SE CH. By: Its A orize epresentabve • • ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY Ken Thompson, Inc - 1785 Sampson Avenue,Corona CA 92879 Name and address of named insured("Named Insured"): Old Republic General Insurance Corporation - 225 South Lake Avenue, Suite 900,Pasadena CA 91101 Name and address of Insurance Company("Company"): OFFICIAL TITLE OF PROJECT: Lampson Avenue Sewer Replacement at Seal Beach Boulevard, Specification No.SW0901 Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows: 1. The City of Seal Beach, its elected officials, officers,attorneys, agents,employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the"Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third-parry claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s)or permit(%)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, return 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 performed by or on behalf of the Named Insured regardless of any prior, concurrent,or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction,interpretation,and enforcement of this contract of insurance. • • 9. This endorsement and all notices given hereunder shall be sent to Public Agency at: City Engineer City of Seal Beach 211 8th Street,tad Floor Seal Beach CA 90740 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF 9i.gowe oo Feroewrreaee THIS ENDORSEMENT ATTACHES FROM/TO 02/13/08 to 02/13/09 LIABILITY Operations 0 Prom�c+s a Comgerea General Liability 12.000.000 General Aggregate 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: IEQ Contractual Liability it Explosion Hazard 11 Owners/Landlords/Tenants g Collapse Hazard g Manufacturers/Contractors tg'Underground Property Damage g Products/Completed Operations $Pollution Liability K Broad Form Property Damage g-Liquor Liability g Extended Bodily Injury ❑ y. Broad Form Comprehensive ❑ g, General Liability Endorsement 12. A g deductible or ❑ self-insured retention (check one) of $ 5,000 applies to all coverage(s)except: (if none, so state). The deductible is applicable 0 per claim or'aper occurrence(check one). 13. This is an C}foccurrence or❑ claims made policy(check one). 14. This endorsement is effective on 02/13/08 at 12:01 A.M. and forms a part of Policy Number A-1 CG-899708-00 I Laura L.Baron (Print name), hereby declare under penalty of perjury under the laws of the State of California,that 1 have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. Executed September 2nd 20 08 ature of Authorized Representative (Original signature only; no facsimile signature or• initialed signature accepted) 559-3369 Phone No.: ( 949 ) • • ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY Ken Thompson, Inc - 1785 Sampson Avenue,Corona CA 92879 • Name and address of named insured("Named Insured"): Old Republic General Insurance Corporation - 225 South Lake Avenue,Suite 900, Name and address of Insurance Company("Company"): OFFFICAL TITLE OF PROJECT: Lampson Avenue Sewer Replacement at Seal Beach Boulevard, Specification No.SW0901 Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows: 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 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. 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 be 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 whom claim is made or suit is brought except with respect to the limits of the Company's liability. 3. 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 bad 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 exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or bold 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 full 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 govern 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,20°Floor Seal Beach CA 90740 • • 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 THIS ENDORSEMENT ATTACHES FROM/TO 02/13/08 to 02/13/09 LIABILITY Automobile Liability $1,000,000 Combined Single Limit Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: 'i Any Automobiles 0 Truckers Coverage O All Owned Automobiles ❑ Motor Carrier Act O Non-owned Automobiles 0 Bus Regulatory Reform Act O Hired Automobiles 0 Public Livery Coverage O Scheduled Automobiles ❑ O Garage Coverage 0 I I. A 'deductible or 0 self-insured retention(check one)of$ 0 applies to all coverage(s)except: (if none,so state). The deductible is applicable 0 per claim or per occurrence(check one). 12. This is an j.Qoccurrence or 0 claims made policy(check one). 02/13/08 13. This endorsement is effective on at 12:01 A.M. and forms a part of Policy Number A-1CA-899708-00 I Laura L. Baron (print name), hereby declare under penalty of perjury under the laws of the State of California,that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. September 2nd 08 Executed Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) 559-3369 Phone No.: ( 949 ) • • APPENDICES E OSHA Mining and Tunneling Unit — Underground Classifications Page D-67 • • STATE OF CALIFORNIA ARNOLD SCHWARZENEGGER,Governor DEPARTMENT OF INDUSTRIAL RELATIONS • DIVISION OF OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION MINING AND TUNNELING UNIT 6150 VAN NUYS BOULEVARD,SUITE 310 VAN NUYS,CA 91401 4333 11t I I (818)901-5420 FAX(618)901-5579 �i -I _- June 2, 2008 0 :i ''. 0 ) AKM Consulting Engineers 553 Wald Irvine, CA 92618 Attention: Ozgun Canbazoglu, Assistant Engineer Subject: Underground Classification Numbers: C103-059-08T&C104-059-08T Lampson Avenue Sewer—City of Seal Beach Dear Mr. Canbazoglu: The information provided to this office regarding the above project has been reviewed. On the basis of this analysis, an Underground Classification of"Potentially Gassy with Special Conditions" has been assigned to the runnel(s) identified in your submittal. Please provide a true and accurate copy of the Classification to the Boring/Excavation/Construction Contractor and insure that a copy of the Classification is posted at the job site. Kindly insure that the Sub-Contractor notify this office to schedule the mandated Pre-job Safety Conference with the Division prior to commencing any activity associated with the project. Also,be advised that, whenever an employee enters any bore or shaft being constructed under 30-inches in diameter, the Mining and Tunneling Unit then has immediate jurisdiction over that job. Please contact us prior to entering such spaces. If you have any questions on these subiects, please contact this office at your earliest convenience. Sincerely, James Wittry,ror.• N.47 Sara/ Tony Serpas Senior Engineer c: File • • State of California • Department of Industrial Relations DIVISION OF OCCUPATIONAL SAFETY AND HEALTH MINING AND TUNNELING UNIT Van Nuys Office RSD2 Underground Classification C104-059-081 Lampson Avenue Sewer Replacement-City of Seal Beach (NAME OF TUNNEL OR MINE AND COMPANY NAME) AKM Consulting Engineers for:the City of Seal Beach a 553 Wald•Irvine,CA 92618 (MAIUNG ADDRESSI at Lampson Avenue and Seal Beach Blvd, Seal Beach, California (LOCATION) has been classified as 'POTENTIALLY GASSY with SPECIAL CONDITIONS"' (CLASSIFICATION) as reputed by de Cal lomb Labor Code aerlbn 1955. The Division shell be notified II sufrklent quantities of flammable gas or nom haw.bean encountered underground. Cbsalnatedna are bead on the California Labor Code Pert 9.Tunnel Safety Orders end Mine Safety Orders. *"SPECIAL CONDITIONS"a" A 36" diameter by approximately 40 LF casing to be jacked from Station 13+21 to Station 13+61, City of Seal Beach, Orange County. 1.Pre-entry and on-going monitoring of the tunnel for flammable,combustible andfor toxic gas shall be provided by a Certified Gas Tester at any time personnel are permitted to enter the bore pit or the tunnel. 2. Positive mechanical ventilation shall be provided at any time a person is permitted to enter the tunnel,and at any other location where it is required for employee safety and health. 3. The Division shall be immediately notified if any Flammable Gas or Petroleum Vapor exceeds 5%of the LEL. 4. All utilities that may be in conflict with the operation shall be identified and physically located (potholed)odor to start of operations. Cale June 2,2008 J.Maley for: - S �' —T (Senior Engineer) • • State of California Department of Industrial Relations 1'1' DIVISION OF OCCUPATIONAL SAFETY AND HEALTH "?-' +)r MINING AND TUNNEUNG UNIT Van Nuys Office R5D2 Underground Classification C103-059-08T Lampson Avenue Sewer Replacement-City of Seal Beach (NAME OF TUNNEL OR MINE AND COMPANY NAME) AKM Consulting Engineers for. the City of Seal Beach of 553 Wald•Irvine,CA 92618 (MAILING ADDRESS) at Lampson Avenue and Seal Beach Blvd, Seal Beach, California .. - ... .- . . (LOCATION) tat Caen cuannedas ""POTENTIALLY GASSY with SPECIAL CONDITIONS"' (CLASSIFICATION) as required by the Cadania Labor Cods Seclbn 7935. The Division shall be netMed If sufficient auantflu of flammable pas or vapors have been encountered underground. Classifications are based on IM CMIfornle Labor Code Part 9.Tunnel Safety Orders and Mine Safety Orders. See SPECIAL CONDITIONS— A 36"diameter by approximately 200 LF casing to be jacked from Station 1+07 to Station 3+07,City of Seal Beach, Orange County. • 1.Pre-entry and on-going monitoring of tunnel for fammable,combustible and/or toxic gas shall be provided by a Certified Gas Tester at any time personnel are permitted to enter the bore pit or the tunnel. 2. Positive mechanical ventilation shall be provided at any time a person is permitted to enter the tunnel,and at any other location where it is required for employee safety and health. 3. The Division shall be immediately notified if any Flammable Gas or Petroleum Vapor exceeds 5%of the LEL. 4. All utilities that may be In conflict with the operation shall be identified and physically located (potholed)poor to start of operations. Dare June 2,2008 U.Wktry for: fir... (Sere Engineer) • • APPENDICES G Penal & Civil Penalties Page D-69 • • APPENDICES H Labor Law Requirements Page D-70 i • • EXECUTED IN DUPLICATE Bond No. 6418902 Bond Premium $5,829.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded KEN THOMPSON, INC. 1785 SAMPSON AVENUE, CORONA, CA 92879 (Name and address of Contractor) ("Principal"),a contract(the"Contract")for the work described as follows: Lampson Avenue Sewer Replacement at Seal Beach Boulevard,Specification No. SW0901 WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful performance of the Contract. NOW,THEREFORE,we,the undersigned Principal,and SAFECO INSURANCE COMPANY OF AMERICA 120 VANTTS, AT.TSO VTE.TO, CA 99656 (Name and address of Surety) ("Surety")a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of FIVE HUNDRED NINE THOUSAND SEVEN IIITNDRED TWO AND NO/100 Dollars ($ 509 702 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. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal,his,her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions and agreements in the Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and performed,all within the time and in the manner therein specified,and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers, agents, and others as therein provided,then this obligation shall become null and void;otherwise,it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received,hereby stipulates and agrees that no change,extension of time, alteration,addition or modification to the terms of the Contract,or of the work to be performed there under, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change,extension of time,alteration, addition,or modification to the terms of the Contract or to the work or to the specifications there under. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. The City is the principal beneficiary of this bond and has all rights of a party hereto. IN WITNESS WHEREOF, two (2)identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. • • Dated: AUGUST 28, 2008 "Principal" "Surety" KEN THOMPSON, INC. 4 • t /J 011 .1. 1 • ,MERICA Br - B A 1 M • /cT Its JUDITH K. CUNNINCH_,,, ATTORNEY—IN—FACT By: By: 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. • • • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On August 28, 2008 before me, Erika A. Nicholas , Notary Personally appeared Judith K. Cunningham Who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are-subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their- signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PURJURY under the laws of The State of California that the foregoing paragraph is true and correct. ERMAA j OtVAgW l WITNESS my hand and official seal. �f COMM.01552978 c`,t:y,,.-' NOTARY O ANGECC COUNTY , wt's. Signature c c (Ji_ �, ��. ( Signature of Notary Public OPTIONAL Capacity(ies)Claimed by Signer(s) ❑ Individual ❑ Partner ❑ Limited ❑ General ❑ Attorney-in-Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other Signer is Representing: SAFECO INSURANCE COMPANY OF AMERICA • POWER Safeco Insurance Companies "O R PO Box 34526 OF ATTORNEY Seattle,WA 98124-1526 KNOW ALL BY THESE PRESENTS: No. 9223 That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation,does each hereby appoint *************DENISE BENNETT;JUDITH K.CUNNINGHAM;JOHN M.GARRETT;CHARISE MAY STEVEN C.MOSIER; ERIKA A.NICHOLAS;SANDI RICARD;Irvine,California********************************************************** its true and lawful attorney(s)-in-fact,with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business,and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents this 18th January 2006 ,his,/��/� 7 day of tp�a,L< — --/k/gf�lXi r0' — STEPHANIE DALEY-WATSON.SECRETARY MIKE PETERS,PRESIDENT,SURETY CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V,Section 13.-FIDELITY AND SURETY BONDS...the President,any Vice President,the Secretary,and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations,shall each have authority to appoint individuals as attomeys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business...On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided,however,that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28,1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (l) The provisions of Article V,Section 13 of the By-Laws,and (ii) A copy of the power-of-attomey appointment,executed pursuant thereto,and (iii) Certifying that said power-of-attomey appointment is in full force and effect, the signature of the certifying officer may be by facsimile,and the seal of the Company may be a facsimile thereof." I,Stephanie Daley-Watson ,Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA,do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations,and of a Power of Attorney issued pursuant thereto,are true and correct,and that both the By-Laws,the Resolution and the Power of Attomey are still in full force and effect. IN WITNESS WHEREOF,I have hereunto set my hand and affixed the facsimile seal of said corporation this 28TH day of AUGUST • 2008 • p�CC C b\ SCE casfp �'�c°�iPO�rt��'' SJVP gyp (j ?L )) cORPORATE SEAL SE 953 C�4f" WAS ��ltp({Ydla '\S STEPHANIE DALEY-WATSON,SECRETARY Safeco9 and the Safeco logo are registered trademarks of Safeco Corporation. S-0974/DS 4/05 WEB PDF • • • • CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGEMENT State of California County of Riverside On September 2, 2008 before me, Tiffany M. Rose,Notary Public personally appeared Kenneth D. Thompson proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. TIFFANY M.ROSE !rt�i!E Commission # 1773323 �-„ Notary Public -CalItornlo `+ WITNESS my hand and official seal. � 1 Riverside County �.n^ MN CommeflosOd142011 I If -A�..-.I4�_. I 1 S Description of Attached Document: Title or Type of Document Performance Bond Document Date: August 28,2008 Number of Pages: 2 Signer(s)Other Than Named Above: Judith K. Cunningham CAPACITY CLAIMED BY SIGNER(S) RIGHT THUMBPRINT OF SIGNER INDIVIDUAL Top of thumb here I X� CORPORATE OFFICER AND TITLE: Kenneth D. Thompson, President n Partner(s) Limited General n ATTORNEY-IN-FACT n TRUSTEE(S) n GUARDIAN/CONSERVATOR OTHER: SIGNER IS REPRESENTING: Ken Thompson, Inc. EXECUTED IN DUPLI TE • Bond No. 6418902 Bond Premium IS INCLUDED IN THE PERFORMANCE BOND PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded to KEN THOMPSON, INC. 1785 SAMPSON AVENUE, CORONA, CA 92879 (Name and address of Contractor) ("Principal"),a contract(the"Contract")for the work described as follows: Lampson Avenue Sewer Replacement at Seal Beach Boulevard,Specification No. SW0901 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 SAFECO INSURANCE COMPANY OF AMERICA 120 VANTIS, ALISO VIEJO, CA 92656 (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 FIVE HUNDRED NINE THOUSAND SEVEN HUNDRED TWO AND NO/100 Dollars(5 509,702.00 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 the Unemployment Insurance Code with respect to work or labor performed under the Contract,or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the Contract, the Surety will pay for the same in an amount not exceeding the penal sum specified in this bond;otherwise,this obligation shall become null and void. This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received,hereby stipulates and agrees that no change, extension of time, alteration,addition or modification to the terms of the Contract,or of the work to be performed thereunder, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change,extension of time,alteration, addition,or modification to the terms of the • • Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§2845 and 2849. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: AUGUST 28, 2008 "Principal" "Surety" KEN THOMPSON, INC. SAFECO INSURANCE COMPANY OF AMERICA IC :k1/43-CkAjti.\ By: /6) By: e irti Its Its JUDITH K. CUNNINGHAM,` By: By: ATTORNEY—TN—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. • • f CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On August 28, 2008 before me, Erika A. Nicholas ,Notary Personally appeared Judith K. Cunningham Who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/arm subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/theme signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PURJURY under the laws of The State of California that the foregoing paragraph is true and correct. fI ERIKA uir s A. SiAg WITNESS my hand and official seal. r COMM.#1552976 \c Fsc - NOTARY PUBLIC CAUFOFNA 1y ORANGECOUNTY l� / I° 12 Signature �i . L Signature of Notary Public OPTIONAL Capacity(ies)Claimed by Signer(s) ❑ Individual ❑ Partner ❑ Limited ❑ General Z Attorney-in-Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other Signer is Representing: SAFECO INSURANCE COMPANY OF AMERICA E�`%L. Safeco Insurance Companies erg @C� m POWER PO Box 34526 CA - OF ATTORNEY Seattle,WA 98124-1526 No 9223 KNOW ALL BY THESE PRESENTS: • That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation,does each hereby appoint *************DENISE BEN NETT;JUDITH K.CUNNINGHAM;JOHN M.GARRETT;CHARISE MAY;STEVEN C.MOSIER; ERIKA A.NICHOLAS;SANDI RICARD;Irvine,California********************************************************** its true and lawful attomey(s)-in-fact,with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business,and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents this 18th day of January 2006 • 6)f4 STEPHANIE DAl FV_WATSON SF('.RFTARV MIKE PETERS PRESIDENT.SURETY CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V,Section 13,-FIDELITY AND SURETY BONDS...the President,any Vice President,the Secretary,and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations,shall each have authority to appoint individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business...On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided,however,that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (I) The provisions of Article V,Section 13 of the By-Laws,and (ii) A copy of the power-of-attorney appointment,executed pursuant thereto,and (iii) Certifying that said power-of-attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile,and the seal of the Company may be a facsimile thereof." I,Stephanie Daley-Watson ,Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA,do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations,and of a Power of Attorney issued pursuant thereto,are true and correct,and that both the By-Laws,the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF,I have hereunto set my hand and affixed the facsimile seal of said corporation his 28TH day of AUGUST 2008 ' J'(t. 4,, SJ0.P�CF COMP o actimun SEAL w SEAL T gym. af' � dst 1953 y� ten Z �'`&WASd -fox We°W e STEPHANIE DALEY-WATSON,SECRETARY Safeco®and the Safeco logo are registered trademarks of Safeco Corporation. S-0974/DS 4/05 WEB PDF I CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGEMENT State of California County of Riverside On September 2, 2008 before me, Tiffany M. Rose,Notary Public personally appeared Kenneth D. Thompson proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. TIFFANY M.ROSE ,o E Commission # 1773328 la . � Notary Public -California WITNESS my hand and official seal. 2 V jl Riverside County V fit MvCcrrm.E>W68sOc$15,20fl , - Description of Attached Document: Title or Type of Document Payment Bond Document Date: August 28,2008 Number of Pages: 2 Signer(s)Other Than Named Above: Judith K. Cunningham CAPACITY CLAIMED BY SIGNER(S) RIGHT THUMBPRINT OF SIGNER n INDIVIDUAL Top of numb here © CORPORATE OFFICER AND TITLE: Kenneth D. Thompson, President n Partner(s) Limited General n ATTORNEY-IN-FACT TRUSTEE(S) n GUARDIAN/CONSERVATOR n OTHER: SIGNER IS REPRESENTING: Ken Thompson, Inc.