HomeMy WebLinkAboutAGMT - Noble Company, R.J (Annual Pavement Rehab) •
;PUBLIC WORKS CONTRACT
Annual Paving Rehabilitation, FY 2000 /2001
For the following project named Annual Paving Rehabilitation FY 2000/2001
,in the City of Seal Beach. City Project Number: 49673
THIS AGREEMENT, made and 'entered into this 2 day of O 1, by and
between the City of Seal Beach, California, hereinafter re erred WO
to as the "CITY,' arty of the First Part,
and R.J. NOBLE COMPANY
hereinafter designated as the "CONTRACTOR," Party of the Second Part.
WITNESSETH: That the Parties do hereto mutually agree as follows:
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, 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.
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BOOK II OF II 1
CONTRACT DOCUMENTS 1
DOCUMENTS TO SUBMIT UPON AWARD: 1
PUBLIC WORKS CONTRACT 3
PERFORMANCE BOND 5
INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND
WAIVER OF SUBROGATION AND CONTRIBUTION 9
AGREEMENT TO COMPLY WITHCALIFORNIA LABOR LAW
REQUIREMENTS 10
STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES
CONCERNING THE CONTRACTORS' LICENSING LAWS 11
INSURANCE REQUIREMENTS 13
• WORKER'S COMPENSATION CERTIFICATE OF INSURANCE 15
ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE
• GENERAL LIABILITY 16 •
ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY
18
ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY 20
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IN WITNESS WHEREOF: The Parties hereto have caused this contract to be executed the day and year
first above written.
CITY OF SE • :: • ALIFORN
Party of the irst P
BY ja
City Man.
R.J. NOB COMPANY
Clerk
BY
CO -4' CTOR of the Second Part
Michae <I. Carver, President
Title
15505 E. Lincoln Aver nranga__,CA 92865
Address
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Bond No. Bond Premium
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Seal Beach, has awarded
(Name and address of Contractor)
( "Principal "), a contract (the "Contract ") f it described as follows:
WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful
performance of the Contract.
NOW, THEREFORE, we, the undersigned Principal, and
(Name and address of Surety)
( "Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and
firmly bound unto the Public Agency in the penal sum of
Dollars ($ ), 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 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. 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
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• EXECUTED IN TRIPLICATE
Bond No. 83 SB 103609195 BCM Bond Premium
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS that:
• WHEREAS the City of Seal Beach, has awarded R. J . NOBLE COMPANY
15505 E. LINCOLN AVE. ORANGE CA 92865
(Name and address of Contractor)
("Principal "), a contract (the "Contract' ") for the work described as follows:
ANNUAL PAVING REHABILITATION
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 TRAVELERS CASUALTY AND SURETY
COMPANY OF AMERICA 21688 GATEWAY CENTER DRIVE, DIAMOND BAR. CA
917.5
(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 TWO HUNDRED TWENTY —SEVEN
THOUSAND NINE HUNDRED SIXTY —THREE AND 17/100
Dollars ($ 227,963.17 ), 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, finniy by these presents.
THE CONDITION Or THIS OBLIGATION 1S 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 perforni 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 he 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 he 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. 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 •
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Surety, on the date set forth below, the name of each corporate party being hereto affixed and these
rreaent dvly signed 6y ite undorsigned repreaesuatk e(s) pursuant to authority of its goverAing boJy.
Dated:
"Principal" "Surery"
R.J. NOBLE COMPANY TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
ripi • By: BY: 1Ir! �- -
IZSNAELJ . CARVER L. MICHAE 3ri 3%,TONG, AT N EY —IN —FACT
PRESIDENT
By: B
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.,
6
STATE OF CALIFORNIA
SS.
COUNTY OF ✓RIVERSIDE
1/4/On Y`! _ , before me, -- R. STANDLEY
PERSO NALLY APPEARED ----MICHAEL D. STONG----
•
personally known to me (car - e
may-ea. e) to be the person(>:)-whose name'-_-}
is/ere subscribed to the within instrument and acknowl-
edged to me that he/she/they executed the same in his/
her/their authorized capacity(ies), and that by his/hPr/ a R. STANDLEY
-their signature@ on the instrument the persons or the 0 'COMM.#1263272
entity upon behalf of which the person(s) acted, executed (7){!..
`fS NOTARY PUBLIC•CAUFORNIA j'
the instrument. ¢ 4 . RIVERSIDE COUNTY
rucia;=„iit;_o.„-' My,:24n.Expirs June 7,2001
WITNESS my hand and official seal.
W! _
Signature ' `iell This area for Official Notarial Seal
OPTIONAL
•
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
❑ INDIVIDUAL
CORPORATE OFFICER
• TITLE OR TYPE OF DOCUMENT
T❑LE(s)
L PARTNER(S) I I LIMITED
ATTORNEY-IN-FACT NUMBER OF PAGES
U TRUSTEE(S)
GUARDIAN/CONSERVATOR
El OTHER:
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAVE OF PE°SONIS)Oi E:!TITY(!E5I
SIGNER(S) OTHER THAN NAMED ABOVE
1D-^" '°°.6/94 ALL-PURPOSE ACKNOWLEDGEMENT
State of CALIFORNIA RIGHT THUMBPRINT(Optional)
County of ORANGE
i
On 06/01/01 before me, Pamela Kitchens .
0
(DATE) (NAME/TITLE OF OFFICER-i.e.'JANE DOE.NOTARY PUBLIC') o
Michael J. Carver, President of
personally appeared
INAMEISI OF SIGNER'S')
R.J. Noble Company CAPACITY CLAIMED BY SIGNER'S)
❑INDIVIDUALIST
OCORPORATE
xcl personally known to me -On- ❑ OFFICER'S)
[moped to me oil the MILES)
basis of satisfactory ❑PARTNER'S) DLIMITED
evidence to be the OGENERAL
personK) whose names) ❑ATTORNEY IN FACT I
e
is/ate subscribed to the ❑TRUSTEE'S)
• within instrument and DGUARDIAN/CONSERVATOR II
acknowledged to me that DOTHER:
he/shc/they executed the
same in his/her/their
authorized capacity(ies), SIGNER IS REPRESENTING: 1
and that by histter/their (Name of Person's)orEntityresi
signature(csl on the R.J. NOBLE COMPANY i
instrument the person(sl, I
or the entity upon behalf
of which the person(o)
acted, executed - the
9`"�"y PAMELA KITCHENS RIGHT THUMBPRINT(Optional)
b s.3 COMM. #1285317 o instrument.
d �, NOTARYPUBUC.CAt1FORNIA oA
ORANGECOUNTY Witness my hand and official seal. W
IMy Commission Expires November 24,2004 f i
o
FU
(SEAL) � �
0
s.
9�. PE o
I 'SIGN TU E OF NOTARY) III
CAPACITY CLAIMED BY SIGNER'S)
DINDIVIDUALIS)
❑CORPORATE
ATTENTION NOTARY OFFICER(S)
The information requested below and in the column to the right is OPTIONAL. IrI"`SI
Recording of this document is not required by law and is also optional.
It could, however, prevent fraudulent attachment of this certificate to any ❑PARTNERISI ❑LIMITED
unauthorized document. ❑GENERAL
❑ATTORNEY IN FACT 1
1 THIS CERTIFICATE Title or Type of Document DTRUSTEEIS) 11
MUST BE ATTACHED DGUARDIAN/CONSERVATOR
TO THE DOCUMENT Number of Pages Date of Document DOTHER:
1 DESCRIBED AT RIGHT: I
Signer(s)Other Than Named Above
SIGNER IS REPRESENTING: 1
(Name of Person's) or Entity lieu
1
1
WOLCOTTS FORM 63240 Rev.3.94 (price class B-2AI 1 994 WOLCOTTS FORMS.INC.
ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATION/TWO FINGERPRINTS
7 1111111111 I II
77 63IN 8
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EXECUTED IN TRIPLICATE •
Bond No. 83 SB 103609195 BCM Bond Premium
PAYMENT BOND
(LABOR AND MATERIALS)
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Seal Beach,has awarded to R.I. NOBLE COMPANY
15505 E. LINCOLN AVE. , ORANGE, CA 92865
(Name and address of Contractor) •
("Principal"),a contract(the"Contract") for the work described as follows
ANNUAL PAVING REHABILITATION
WHEREAS,Principal is required under the terms of the Contract and the California Civil Code to secure
the payment of claims of laborers,mechanics,matenalmen,and other persons as provided by law.
NOW,THEREFORE,we,the undersigned Principal,and TRAVELERS CASUALTY AND SURETY
COMPANY OF AMERICA, 21688 GATEWAY CENTER DRIVE, DIAMOND BAR; CA
91765
(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 TWO HUNDRED TWENTY—SEVEN
THOUSAND NINE HUNDRED SIXTY—THREE AND 17/100
Dollars(S 227,963.17 this amount being not less than fifty percent
(50%)of the total contract pricc,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
ease suit is brought upon this bond, Surety further aerees 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
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Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of
California Ctvtt Code CC 2845 and 2849.
L\ 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:
"Principal" "Surety"
R.J. NOBLE COMPANY TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
'ARVER ; , ,I T BY: WI
Its . Its MIC ''.a '' STONG, i fTTORNEY—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. •
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INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND WAIVER OF •
SUBROGATION AND CONTRIBUTION
TITLE OF PROJECT OR WORK: ANNUAL PAVING REHABILITATION FY 2000/2001
Indemnitor(s) (list all names): City Project Number: 49673
R.J. NOBLE COMPANY
•
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 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 lndemnitees 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) Indenmitees' 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
lndemnitees. 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 R.J.. NOBLE COMPANY Name:
By: c 1 - By:
Its Mich J. Carver Its
President
9
• • • •
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
fe h below, the name of each corporate p.• being hereto fixed and these presents duly signed by
un•, signed representative(s)pursuant to . thorny of its governs.p body.
Date..
"Principa" "Surety"
By: By:
Its Its
By: By:
It 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.
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STATE OF CALIFORNIA
COUNTY OF //RIVERSIDE
I- SS.
On f� l � _ ., before me, R. STANDLEY
PERSONALLY APPEARED MICHAEL D. STONG ---
personally known to me (car. -_ 1 - of
- - - - _ - --) to be the person!._}-whose name(. -
is/are subscribed to the within instrument and acknowl-
edged to me that he/El-to/they executed the same in his/ -
her/their authorized capacity(ies), and that by his/hPr/
their R, STANDLEY
their signature(a) on the instrument the person*), or the
N(-c, d,h.-'a COMM. #1263272 a
entity upon behalf of which the person(s) acted, executed ¢r ° o//} NOTARY PUBLIC-CALIFORNIA
the instrument. ¢� \_` �' RIVERSIDE RIVERS COUNTY
�3v�✓ *ty-C RIVE SIDE Juno7,2004
as
WITNESS my haanndd and official seal.
AI
Signature
/ �.� �L This area for Official Notarial Seal
� 1/ -
OPTIONAL
•
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
❑ INDIVIDUAL
❑ CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
TITLES)
❑ PARTNER(S) Lu LIMITED
ri (_C4iCO;.I
11( ATTORNEY-IN-FACT NUMBER OF PAGES
❑ TRUSTEE(S)
L GUARDIAN(CONSERVATOR
❑ OTHER:— —_
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(S)OR ENTI TY(IES)
SIGNER(S) OTHER THAN NAMED ABOVE
•
IO-0$1 Rev.6194 ALL-PURPOSE ACKNOWLEDGEMENT
TRAVELER CASUALTY AND SURETY COMPANY OF AWICA
T ERS CASUALTY AND SURETY COMPAN
ARMLNGTON CASUALTY COMPANY
Hartford, Connecticut 06183-9062
TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS
Naperville,Illinois 60563-8458
POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT
KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY' COMPANY,
corporations duly organized under the laws of the State of Connecticut, and having their principal offices in the City of Hartford,
County of Hartford, State of Connecticut, and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, a
corporation duly organized under the laws of the State of Illinois, and having its principal office in the City of Naperville, County of
DuPagc, State of Illinois, (hereinafter the "Companies') bath made, constituted and appointed, and do by these presents make,
constitute and appoint: Michael D. Stong, Shawn Bionic or Susan C. Monteon * *
of Riverside, CA, their true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and
acknowledge, at any place within the United States, or, if the following line be filled in, within the area there designated
the following instrument(s):
by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the
nature of a bond, recognizance, or conditional undertaking and any and all consents incident thereto
and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the duly authorized officers
of the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and
confirmed.
This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are
now in full force and effect:
VOTED: That the Chairman,the President,any Vice Chairman,any Executive Vice President, any Senior Vice President, any Vice President,any
Second Vice President, the'treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact
and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe
to sign with the Company's name and seal with the Company's seal bonds, recognizances,contracts of indemnity,and other writings obligatory in
the nature of a bond, recognizance,or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such
appointee and revoke the power given him or her.
VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President
may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is
in writing and a copy thereof is filed in the office of the Secretary.
VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President, any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or ally
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary,or(b)duly executed(under seal, if
required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or
by one or more Company officers pursuant to a written delegation of authority.
This Power of Attorney and Certificate of Authority is signed and sealed by facsimile under and by authority of the following
Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY, FARMINGTON CASUALTY COMPANY and
TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS,which Resolution is now in full force and effect:
VOTED: That the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any
power of attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for
purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such power of attorney
or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and
certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached.
(8-97)
•
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I
•
State of CALIFORNIA RIGHT THUMBPRINT(Optional) I
County of ORANGE
•
On 06/01/01 before me, Pamela Kitchens
o
(DATEI INAMUTITLE OF OFFICER-i.e.-JANE DOE.NOTARY PUBLIC') a
personally appeared
Michael J. Carver, President of
INAMEISI OF SIGN ERISII
R.J. Noble Company CAPACITY CLAIMED BY SIGNER(S)
❑INDIVIDUAL(ST
❑CORPORATE
)gd personally known to me -Oil- ❑ proved to n)e oil the- OFFICER(S) I1r1E51
basis of satisfactory ❑PARTNERISI LIMITED
evidence to be the / ❑GENERAL
personO whose name(.$) DATTORNEY IN FACT
is/ate subscribed to the ❑TRUSTEE(S)
I within instrument and ❑GUARDIAN/CONSERVATOR
acknowledged to me that DOTHER:
he/she/they executed the
same in his/her/their
authorized capacity(ies), SIGNER IS REPRESENTING:
and that by his/h-cr/their IName of Person's)or Entitylieel
signature(.8') on the R.J. NOBLE COMPANY
instrument the person(sl,
or the entity upon behalf
of which the person's')
" PAMELA KITCHENS acted, executed the
�� RIGHT THUMBPRINT(Optional)
$' 3 COMM. #1285317 o instrument.
0°` .', % NOTARY PURUC-CAUfORWA g
C7 `°mom ORINGECOUNTI' Witness my hand and official seal. `
77 My Commission Expires November 24,2004
`a
(SEAL( o
I \rCrrnijeL ?
(SIGNATU E OF NOTARY)
CAPACITY CLAIMED BY SIGNERIS) 1
DINDIVIDUALIS)
DCORPORATE
ATTENTION NOTARY
II OFFICERISI
The information requested below and in the column to the right is OPTIONAL. umi,,
II Recording of this document is not required by law and is also optional. 'l
1 It could, however, prevent fraudulent attachment of this certificate to any DPARTN,ERISI EJLIMITED
ERAL
II •
unauthorized document. ❑GEN .
DATTORNEV IN FACT
li
I I THIS CERTIFICATE Title or Type of Document ❑TRUSTEEISI
I MUST BE ATTACHED !:'GUARDIAN/CONSERVA TOP. •
1 TO THE DOCUMENT Number of Pages Date of Document OTHER: ___ ____ -
I: DESCRIBED AT RIGHT:
I Signerlsl Other Than Named Above '' '—
S I G N E R IS REPRESENTING: I
11 IName of Person(s)or Emir/heir
•
1
WOLCOTTS FORM 83240 Rev.3.94 Twice class 6-2AI 01994 WOLCOTTS FORMS.INC. II
ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATION/TWO FINGERPRINTS II
III 1
7 67775 63240 8
•
AGREEMENT TO COMPLY WITHCALIFORNIA 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 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 June 1, 2001 Signaturec
Mi ael arver, President
10
•
STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE
CONTRACTORS' LICENSING LAWS
[Business &Professions Code§ 7028.15]
[Public Contract Code § 20103.5]
I,
the undersigned, certify that I am aware of the following provisions of California law and that I, or the
entity on whose behalf this certification is given,hold a currently valid California contractor's license as set
forth below(required at time of award) :
Business& Professions Code§7028.15:
(a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage
in the business or act in the capacity of a contractor within this state without having a license therefor,
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 famish materials
and labor on an hourly basis, "the price of the contract" for the purposes of this subdivision means the
aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be
performed.
(c) This section shall not apply to a joint venture license, as required by Section 7029.1.
However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to
this section with respect to his or her individual licensure.
(d) This section shall not affect the right or ability of a licensed architect, land surveyor, or
registered professional engineer to form joint ventures with licensed contractors to render services within
the scope of their respective practices.
(e) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a
contractor who is not licensed in accordance with this chapter shall be considered non-responsive and shall
be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency
shall, before awarding a contract or issuing a purchase order, verify that the'contractor was properly
licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of
the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a
public entity who knowingly awards a contract or issues a purchase order to a contractor who is not
licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall
be subject to Sections 7028.7 to 7028.13, inclusive. Any contract awarded to, or any purchase order issued
to,a contractor who is not licensed pursuant to this chapter is void.
(f) Any compliance or noncompliance with subdivision (e) of this section, as added by
Chapter 863 of the Statutes of 1989, shall not invalidate any contract or bid awarded by a public agency
during which time that subdivision was in effect.
(g) A public employee or officer shall not be subject to a citation pursuant to this section if
the public employee, officer, or employing agency made an inquiry to the board for the purposes of
verifying the license status of any person or contractor and the board failed to respond to the inquiry within
11
• •
three business days. For purposes of this section, a telephone response by the board shall be deemed
sufficient.
Public Contract Code § 20103.5:
In all contracts subject to this part where federal funds are involved, no bid submitted shall be
invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However, at
the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of
this state. The first payment for work or material under any contract shall not be made unless and until the
Registrar of Contractors verifies to the agency that the records of the Contractors' State License Board
indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or
contractor not so licensed shall be subject to all legal penalties imposed by law, including, but not limited
to, any appropriate disciplinary action by the Contractors' State License Board. The agency shall include a
statement to that effect in the standard form of pre-qualification questionnaire and financial statement.
Failure of the bidder to obtain proper and adequate licensing for an
award of a contract shall constitute a failure to execute the contract and
shall result in the forfeiture of the security of the bidder.
License no.: A-782908 Class: A Expiration date: August 31 , 2B02
Date June 1, 2001 Signature
Mi - .el Jo/Carver, President
12
S •
INSURANCE REQUIREMENTS
FOR CITY OF SEAL BEACH
PUBLIC WORKS CONTRACT
LIABILITY INSURANCE
The Contractor shall at all times during the terms of the Contract carry,maintain, and keep in full 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 II.
13
f • •
Page Intentionally Left Blank
14
WORKER'S COMPENSATION CERTIFICATE OF INSURANCE
WHEREAS,the CITY OF SEAL BEACH has required certain insurance to be provided by
R.J. NOBLE COMPANY
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:
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
4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability,
unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the
CITY OF SEAL BEACH.
Its Auth razed Representative
Michael J. Carver, President
15
•
III City of Seal Beach •
.Certificate issued to City of Seal Beach 06/01/2001
Millennium Risk Management & Insurance Services
06/01/2001
Policy #GL11107004
Additional Insured:
The City of Seal Beach, its elected officials, officers, attorney, agents, employees and volunteers
•
ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY
R.J. NOBLE COMPANY, 15505 LINCOLN AVENUE, ORANGE, CA 92865
Name and address of named insured("Named Insured"):
INTERSTATE FIRE & CASUALTY, 525 MARKET ST. #2700, SAN FRANCISCO CA
Name and address of Insurance Company("Company"): 9 41 0 5
OFFICIAL TITLE OF PROJECT: ANNUAL PAVING REHABILITATION FY 2000-2001
PROJECT #49673
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:
I. 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-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/ ) contained in or executed in
conjunction with the written agreement(s) or permit(s) designated above,between the Named Insured
and the Additional Insureds.
6. The policy to which this endorsement is attached shall not be subject to cancellation, change in
coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except
after written notice to 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 MI 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:
Director of Public Works
City of Seal Beach
• 211 8th Street
•
Seal Beach CA 90 740 •
16
£0'd LS:LT T0, 12 52W TL£9L29VIL:Xed 31110N18
• •
•
10. Except as staled 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 07/01 /00 LIMITS OF $2, 000, 000 GEN AG(
THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY
Ip y 07/01 /01 $1 , 000, 000 EA OCC
TI. Sc eduledBitems or locations are to be identified on an attached sheet The following inclusions
relate to then above coverages. Includes:
Xi Contractual Liability k Explosion Hazard
7L Owners/Landlords/Tenants K Collapse Hazard
){; Manufacturers/Contractors XI Underground Property Damage
i Products/Completed Operations S Pollution Liability — HOSTILE FIRE ONLY
Ai Broad Farm Property Damage Li Liquor Liability — HOST LIQUOR ONLY
Extended Bodily Injury 0
Xi Broad Form Comprehensive 0
General Liability Endorsement 0
12. A deductible or 0 self-insured retention (check one) of $ 1 0, 000
applies to all coverage(s)except:
(if none, so state). The deductible is applicable 0 per claim or per occurrence(check
one).
•
13. This is an (%occurrence or 0 claims made policy(check one).
14. This endorsement is effective on JUNE 1 , 2001 at 12:01 A.M. and forms a part
of Policy Number GL11107004
I, DARLENE OWENS (print name), hereby
declare under penalty of perjury under the laws of the State of California, that I have the authority to bind
the Company to this endorsement and that by my execution hereof, I do so bind the Company.
Executed JUNE 1 , Nit( 2001
./:/dam ati .4)
Signature of Authorized Representative
(Original signature only; no facsim-ile signature or initialed signature
accepted)
Phone No.: ( 94ij R97-4500
•
•
17
b0 'd ZS:ZT TO, 12 New TL£9L£9bIL:X23 MEONf21
I 1
ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY
R, . J. NOBLE COMPANY, 15505 LINCOLN AVENUE, ORANGE, CA 92865
Name and address of named insured("Named Insured"):
SAFECO INSURANCE CO. OF AMERICA, 17570 BROOKHURST ST. , FOUNTAIN VALLEY
Name and address of Insurance Company("Company"): CA 92704
OFFFICALTITLEOFPROJECT: ANNUAL PAVING REHABILITATION FY 2000-2001
PROJECT • 49673
Notwithstanding any inconsistent statement in t e 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 arc 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 liebilityrror the payment of any premiums or assessments
under the Policy.
I. 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 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
exclusions applicable to such insurance) includes liability assumed by the Named Insured under the
indemnification andL-- `&4 "-r'--- pro -- -' contained or executed in conjunction with the wrinen
agreements)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:
Director of Public Works
City of Seal Beach
2118th Street
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.
18
SO'd 8S:LT TO 12 FeW 1Z29L29bTL:xed 31EONf?J
i
•
•
TYPE OF COVERAGES TO WHICH
LIMITS OF
THIS ENDORSEMENT ATTACHES POLICY PERIOD
07/01 /00
LIABILITY — AUTO FROM/TO
07/01 /01
Scheduled. Includes;
d locations are to be identified on an attached sheet. The following
the above coverages.dsi Includes:
inclusions relate to
a Any Automobiles
❑ All Owned Automobiles 0 Truckers Coverage
X Non-owned Automobiles 0 Motor Carrier Act
Hired Automobiles ❑ Rus Regulatory Reform Act
❑ Scheduled Automobiles ❑ Public Livery Coverage
0 Garage Coverage ❑
0
11. A C deductible or 0 self-insured retention (check one) of $ N/A
coverage(s)except
cr claim
(if none, so state). 71te deductible is applicable "p applies to all
or ❑ per occurrence(check one).
12. This is am occurrence or 0 clabns made policy(check one).
13- This endorsement is effective on
1 a
Number RAR1F0406 TIINF 1 7 t 12:01 A.M. and forms a
00
Part of Policy
DARLENE OWENS
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 (pint name), hereby
Y my execution hereof,I do so bind the Company.
Executed JUNE 1
AIX 2001
•
Signature of Authorized Representative
(Original signature only; no facsimile signature or initialed sib
accepted)
bnature
Phone No.: (949 ) 857-4500
•
19
90'd 8S:LI T0, 12 fief ___
ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY
R.J. NOBLE COMPANY, 15505 LINCOLN AVENUE, ORANGE, CA 92865
Name and address of named insured("Named Insured"k
INSURANCE CO. OF THE STATE OF PA, PO BOX 44532,. SAN FRANCISCO,CA 94114
Name and address of Insurance Company("Company"):
OFFICIAL TITLE OF PROJECT: ANNUAL PAVING REHABILITATION FY 2000-2001
PROJECT 49673
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:
I. 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 gcncmtty above with regard to operauars 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-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
indemnifica-tion an"t°` `old °^-a-btorp r- :ci°r') contained in or executed in conjunction with the written
agreement(s)or permit(s)designated above,between the Named Insured and the Additional Insureds.
6. The policy to which this endorsement is attached shall not be subject to cancellation, change in
coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except after written
notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the
effective date thereto. hi 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:
Director of Public Works
City of Seal Beach
211 8th Street
20
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•
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 07/01 /00
LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO 07/01 /01
LIABILITY _ UMBRELLA
0 Following Form
Umbrella Liability
0
10. Applicable underlying coverages:
INSURANCE COMPANY POLICY NO.
AMOUNT
INTERSTATE FIRE & CASUALTY $2, 0002900? GEN AGG GL11107004
SAFECii INSte tonowtn Oincluusions, txF'ciuss11Cdri, extension orr speccnc provisions relate is fill 6e0ov+e6
coveragess: CALIFORNIA ENDORSEMENT FOR CONTINUING OR PROGRESSIVELY DET. DAM
EXCLUDE PUNITIVE DAMAGES, CALIFORNIA AMENDATORY ENDORSEMENT FOR CANCELLA-
TION &NON—RENEWAL MARGIN CLAUSE, CONTACTORS LIMITATION ENDORSEMET *
12. A ❑ deductible or 0 self-insured retention (check one) of $ N/A
applies to all coverage(s)except: (if none,
so state). The deductible is applicable ❑per claim or ❑ per occurrence(check one).
13. This is an y3 occurrence or 0 claims made policy(check one).
14. This endorsement is effective on JUNE 1 , 2001 at 12:01 A.M. and forms a part of
Policy Number 42007417
I DARLENE OWENS (print name), hereby declare under
penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this
endorsement and that by my execution hereof.I do so bind the Company.
Executed JUNE 1 79X 2001
/ r `
Signature of Authorized Representative
(Original signature only; no facsimile signature or initialed signature
accepted)
PhoneNo.: ( 949) 857-4500
*EXCSS/UMBRELLA DATE RECONITION, EXCLUDE LEAD
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