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HomeMy WebLinkAboutAGMT - Ruiz Engineering Co. (Annual Paving Rehab) i I. P*EASE•;OMPLcTE THIS INFORMATION. RECORDING REQUESTED BY: Recorded in Official Records, Orange County• Tom Daly, Clerk-Recorder IllillilllllliIIMIIlIIIIDlll IIIIIIIIIIIIIIIIIIIIIIIIIU ItIIINO FEE AND WHEN RECORDED MAIL TO: 2004000796421 03:48pm 09/01/04 i (� , 't , 6 k - ' 213 110 R28 3 �/�/`^�� 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 C asa � � ' ec `-DiY0 THIS SPACE FOR RECORDERS USE ONLY (Please fill in document title(s)on this line) ,.r<2 . w' $J Pncn...v;;;,..;:-.-;;;;,...n i :IC.i.V i .ul"dl::[....afu1L:....... • THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) Rec Rec.Form#R25 b A iP: RESOLUTION NUMBER 5 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEAL BEACH DECLARING WORK TO BE COMPLETED AS TO PLANS AND SPECIFICATIONS FOR PROJECT #50172 THE ANNUAL PAVING REHABILITATION ENTERED INTO BETWEEN CITY OF SEAL BEACH AND RUIZ ENGINEERING COMPANY WHEREAS, on March 8, 2004, City of Seal Beach entered into a contract with Ruiz Engineering Company. WHEREAS, the City Engineer has determined that the work has been substantially completed in accordance with the contract documents. NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF SEAL BEACH DOES HEREBY RESOLVE, DECLARE, DETERMINE AND ORDER AS FOLLOWS: Section 1. That the work required to be performed by said Contractor has been completed. Section 2. That the total cost of said work is in the amount of$135,544.99. Section 3: That the work is hereby accepted and approved. Section 4. It is further ordered that a "Notice of Completion", Exhibit A, be filed on behalf of the City in the Office of the Orange County Recorder within 10 days of the date of this resolution. PASSED, APPROVED AND 9 DOPTED by the City Council of/tyh e City of Seal Beach at a meeting thereof held on the - day of lLd/�l � , 2004 by the following vote: �� AYES: Councilmembers (/}y y A/A/J/17,1�i��" '"" i NOES: Councilmembers c\tOitp. ABSENT: Councilmembers �,,/ PC/P Mayor ATTEST: 101.4167,1 City Clerk STATE OF CALIFORNIA. ) COUNTY OF ORANGE ) SS CITY OF SEAL BEACH ) I, Joanne M. Yeo, City Clerk of the City of Seal Beach, California, do hereby certify that the foregoing resolution is an original copy of Resolution Number 52(o a— on file in the Office ofthe City Clerk, passed, approved and adopted by th City Council of the City of Seal Beach at a meeting thereof held on the 9 day of 2004. 40.44,u. I- AIli. City Ilerk • • • • RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO 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 **** 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: City of Seal Beach,211 8`h Street,Seal Beach, CA 90740 _ __ 4. The nature of tile interest or estate of the owner is; In fee. The City of Seal Beach. 5. A work of improvement on the property hereinafter describe as completed on July 16,2004.The work was: Annual Paving Rehabilitation FY 03/04 Project No. 50172. 6. The name of the contractor,if any,for such of improvement was Ruiz Engineeing Company,The date of the Contract was: March 8,2004. 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: Annual Paving Rehabilitation FY 03/04 Project No. 50172. � Date: Y 12,0e7 Signatu e of owner or corporate officer of owner named in paragraph 2 or his agent. DEPUTY CITY ENGINEER • 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 1/4 2 ,20 CA at Seal := ch, Cali orn.. (Date of Signature) Director of Public Works Exhibit A • , -, PUBLIC WORKS CONTRACT Annual Paving Rehabilitation, FY 2003/ 004 For the following project named /1 /001 ./ di g /c. / ] j¢r)Qij ,in the City of Seal Beach. . - THIS AGREEMENT, made and entered into this U — day of 20, by and between the City of 1 Beach, Cal' ornia, hereinafter referred to s the "CITY," Party of the First Part, and d/Z � /e. 11.ekd.0 �'JC l (� hereinafter designate as the "CONTRACTOR," Party of Second P J 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 bome 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. 3 • • • - IN WITNESS WHEREOF: The Parties hereto have caused ' .4 contract to be executi, e day and year first above written. !/ CITY OF : ACH, CA 0: A Parry of - F art j - - BY - Alt City Mana l r T: / l lerk 03Y CON � F ' - Part of the Secon Part f9 • B.42/011 f Far he Title 13 mile Ave - Lori / ea4 ci -goecy Address 4 . • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No.5907 1 State of CA 1.- FOR ti t- lR Al $ County of I._06 �t6S-i t,� /1 \ 1 On 4 —/ 9-o V . before me, MAR-1 A KAvci NOr�LP06ttc., DATE NA/AE.TmE OFOFFCER-E "JANE DOE.NOT PUBLIC personally appeared / a �)Z 1 NANIQS)OF salxslpT O O personally known to me - OR - IflIcoved to me on the basis of satisfactory evidence Nto be the persi ds) whose name(s) is/are ti subscribed to the within instrument and ac- S knowledged to me that he/she/they executed \ the same in his/her/their authorized �,,,.>..,, MARIAKANLILAR capacity(ies), and that by his/her/their p ,t,.; COMM.#1324276 0 signature(s) on the instrument the person(s), :,7 NOTAR APNt IC-CALIFORNIA 1 DBANGELESCDUNTY or the entity upon behalf of which the PA comm.Fxpires Oct.7,2005 person(s) acted, executed the instrument. \ WITNESS my hand and official seal. . o ti 41.47.A-4--t-r-7 \ TORE OF NOTARY 1 OPTIONAL i Though the data below Is not required by law,it may prove valuable to persons relying on the document and could prevent Nfraudulent reattachment of this form. \ tiCAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT D INDIVIDUAL \ El CORPORATE OFFICER TITLE OR TYPE OF DOCUMENT 1 �PARINER(S) Q GENERAL 0 0 ATTORNEY-IN-FACT NUMBER OF PAGES \I $ D TRUSTEES) S ❑ GUARDIAN/CONSERVATOR D OTHER: \ DATE OF DOCUMENT A • NAME OnF FP�P� OR \ W/ / z /����%/� SIGNER(S)OTHER THAN NAMED ABOVE l 01993 NATIONAL NOTARY ASSOCIATION•9238 Ramat Ave.,P.O.Sox 7184•Canoga Park CA 91309-7184 04Y13/2004 11 : 36 FROM RUIZ ENGINEERING CO TO 19497163247 P. 66 IFd • • EXECUTED IN TRIPLICATE Bond No. 08591194 Bond Premium $1,755.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that WHEREAS the City of Seal Beach,has awarded RUIZ ENGINEERING COMPANY 1344 TEMPLE AVENUE LONG BEACH.CA 90804 (Name and address of Contractor) . ("Principal"),a contact(the"Contract)for the work described as follows: "ANNUAL PAVING REHABILITATION CLIPPER WAY, CARAVEL- WAY, AND CORSAIR WAY, FY 2003/2004" PROJECT NO. 50172 WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful . performance of the Contract • NOW,THEREFORE,we,the undersigned Principal and FIDELITY -AND DEPOSIT COMPANY OF MARYLAND 801 N. BRAND BLVD. CLENDALE.CA 91203 (Name and address of Surety) ("Surety)a duly admitted surety insurer under the laws of the State of California, as Surety, are held and • firmly bound unto the Public Agency in the penal sum of *ONE HUNDRED TWENTY—NINE THOUSAND NINE HUNDRED NINETY—FIVE` AND b0/100* Dollars ($ 129,995.60 ), this amount being not less than the total contract price, in lawful money of the United States of America for ihr payment of which sans well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns,jointly and severally,firmly bY these presents. 1 tit CONDTf'ION OF THIS OBLIGATION IS SUCH THAT,if the hereby bounded Principal,his,her or its hefts. 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 maul= 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,Suucty 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, .lutl 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 Contact or to the work or to the specifications themmde-. Surety hereby waives the provisions of. California Civil Code §§ 2245 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 purp:rses be deemed an original haeot; have been duly executed by Principal and • 5 . 04'!13/2004 11 : 37 FROM RUI?ENGINEERING CO TO 19493247 P. 07 Surety, on Inc date set forth beim., the nacre of each wtpvtatc party being hereto affixed and the.c presents duly sieutd by its undersigned represcntative(s)pursuant to autbority of its gover i-ng body. Dated: APRIL 13, 2004 "Principal° "Surety" RUIZ ENGINEERING COMPANY, FIDELITY jji,EPOSI'r COMPANY OF MARYLAND ad Or t- BY: �� . lt• A$rTrY-IN-FACTS ALOO 6° ie4-44 4 M HAEL A. QUIGLEY By: --- B}: Its Its r -- (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as- attorney-in-fact must be attached. • • 6 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND.a corporation of the State of Maryland. by PAUL C. ROGERS, Vice President. and T. E.SMITH,Assistant Secretary, in pursuance of authority granted by Article VI. Section 2.of the By-Laws of said Company, whickart set forth on the reverse side hereof and are hereby certified to he in full force and effect on the date hereof, deed1 Nty igi4nate,constitute and appoint Michael A.Quigley,of Aliso Viejo, California, its true and lalwfuhrF �t�hnAi�;bittBerne AB et, to slake.execute, seal and deliver, for. and on its behalf as surety, and as its act an a C. d l I cry'un 4 l.takings and the 4 execution of such bonds or undertakings in pursuanctea44�e±sc'•pr'e�rH's, st7a11-t¢�xst�i���ln�g on said Company, as fully and amply. to all intents and purposes, as if the lid btert luty-txct Wud'piril`i ae(aiotvletlged by the regularly elected officers of the Company at its office in B rltmpi�e.�1i1 sn-then own-pr ire persons'. This power of attorney revokes that issued on behalf of Michael Ai uL7 4datul&tobei The said Assistant$ec?etvry_docs'Ii'ry to-My-that the extract set forth on the reverse side hereof is a true copy of Article VI. Section 2,of the By- c ,u4\Cdritpany,and is now in force. IN WITNESS WHEREOF. the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND. this 26th day of June. A.D. 2003. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND /f By: 11 E. Smith Assistant Secretary Paul C. Rogers Vice President State of Maryland ss: City of Baltimore On this 26th day of June, A.D. 2003. before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came PAUL C. ROGERS. Vice President, and T. E. SMITH. Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. to me personally known to be the individuals and officers described in and who executed the preceding instrument. and they each acknowledged the execution of the same. and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF. I have hereunto set my hand and affixed my Official Seal the day and year first above written. 004 mmoserry lame Dennis R. Hayden Notary Public My Commission Expires: February 1, 2005 POA-F 012-0626 EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI. Section 2. The Chairman of the Board, or the President, or any Executive Vice-President, or any of the Senior Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee. shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice-Presidents. Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts. agreements. deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages....and to affix the seal of the Company thereto." CERTIFICATE I. the undersigned. Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice-President who executed the said Power of Attorney was one of the additional Vice-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in Article VI. Section 2. of the By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May. 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President. Secretary. or Assistant Secretary of the Company, whether made heretofore or hereafter. wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF. I have hereunto subscribed my name and affixed the corporate seal of the said Company, this 19th day of Apri 1 , 7004 Ofd.d,deltCALACI Assistant Secretary - CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT r-.- M c.,-scccr.<-cccmcmce .c..cc..cr ces .c ,c^- .c c.-c �a�rc�cc�-.n-c�.c-at 19 State of California County of CI ORANGE ss. c i. On April 13, 2004 , before me, MEG QUIGLEY, NOTARY PUBLIC Date Name and Title of Officer(e.g.,"Jane Doe,Notary Public") ug personally appeared MICHAEL A. QUIGLEY Name(s)of Signer(s) • It personally known to me ❑ proved to me on the basis of satisfactory ✓S 1i evidence MEG QUIGLEY e in :' ev: = COMM. #1461771 a 1 iy ¢ „ ..�° Notary Public California to be the person(x) whose names) is/fit .i } ORANGECOUNTV °' subscribed to the within instrument and I- IMyComm.ExpiraJanuary 10,2008 acknowledged to me that he/xbEtthext executed 9 the same in hisiberithmi( authorized r,` capacity(i ), and that by his/XxXibethr A signature(x) on the instrument the person(), or I the entity upon behalf of which the person(g) . acted, executed the instrument. WIT' ES a aftdfBcial seal. Agi Place Notary Seal Above (�l r blic 4 OPTIONA4% 1 Though the information below is not required by law, it may prove : . .: - to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: ' _ pl 1. Document Date: • Number of Pages: • Z • le Signer(s) Other Than Named Above: 3 2 0 Capacity(ies) Claimed by Signer s Signer's Name: RIGHT THUMBPRINT '' ❑ Individual OF SIGNER ` • Top of thumb here ❑ Corporate Officer—Title(s): n I It ❑ Partner—❑ Limited ❑ General I¢ ❑ 'Attorney in Fact ❑ Trustee ❑ Guardian or Conservator It ❑ Other:It x Signer Is Representing: ti 01999 National Notary Association•9.350 De Soto Aee..P0.f3oa 2402•Chatmonh,CA 91313-2402•wmv.nabonalnotary.org Prod No.5907 Reorder Call Toll-Free 1-800-876-6827 • • • ZURICH THIS IMPORTANT DISCLOSURE NOTICE IS PART OF YOUR BOND We are making the following informational disclosures in compliance with The Terrorism Risk Insurance Act of 2002. No action is required on your part. Disclosure of Terrorism Premium The premium charge for risk of loss resulting from acts of terrorism (as defined in the Act) under this bond is $_waivedi This amount is reflected in the total premium for this bond. Disclosure of Availability of Coverage for Terrorism Losses As required by the Terrorism Risk Insurance Act of 2002, we have made available to you coverage for losses resulting from acts of terrorism (as defined in the Act) with terms, amounts, and limitations that do not differ materially as those for losses arising from events other than acts of terrorism. Disclosure of Federal Share of Insurance Company's Terrorism Losses The Terrorism Risk Insurance Act of 2002 establishes a mechanism by which the United States government will share in insurance company losses resulting from acts of terrorism (as defined in the Act) after a insurance company has paid losses in excess of an annual aggregate deductible. For 2002, the insurance company deductible is 1% of direct earned premium in the prior year; for 2003, 7% of direct earned premium in the prior year; for 2004, 10% of direct earned premium in the prior year; and for 2005, 15% of direct earned premium in the prior year. The federal share of an insurance company's losses above its deductible is 90%. In the event the United States government participates in losses, the United States government may direct insurance companies to collect a terrorism surcharge from policyholders. The Act does not currently provide for insurance industry or United States government participation in terrorism losses that exceed $100 billion in any one calendar year. Definition of Act of Terrorism The Terrorism Risk hnsurance Act defines "act of terrorism" as any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State and the Attorney General of the United States: 1. to be an act of terrorism; • 2. to be a violent act or an act that is dangerous to human life,property or infrastructure; 3. to have resulted in damage within the United States, or outside of the United States in the case of an air carrier(as defined in section 40102 of title 49, United 17 States Code) or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States), or the premises of a United States mission; and 4. to have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. But, no act shall be certified by the Secretary as an act of terrorism if the act is committed as part of the course of a war declared by Congress (except for workers' compensation) or property and casualty insurance losses resulting from the act, in the aggregate, do not exceed $5,000,000. These disclosures are informational only and do not modify your bond or affect your rights under the bond. Copyright Zurich American Insurance Company 2003 surety terrorism disclosure notice • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No.5907 State of GAL i t=oll NIA 1 County of L 06 /9746 S 1 On 1-/-/q-��� before me, MART (C i; )/p v /Posurt , k it DATE '�1 Ruiz NAME.TrLE OF OFFICER ..-JANE DOE.NOTARY PUBLIC �1 personally appeared 1) d I� • `�1 a NAMES)OF SIGNERIS) \1 1 ❑ personally known to me - OR - L''I proved to me on the basis of satisfactory evidence l 1 to be the persQn(s) whose name(s) is/are 1 subscribed to the within instrument and ac- 1 ,. MARIA KANLILAR 1 knowledged to me that he/she/they executed p ... /` t,, NOTARY COMM.#1 24 76NIA 0 the same in his/her/their authorized `\ 0 ' - LOS ANGELES COUNTY n capacity(ies), and that by his/her/their j �. My Comm.Expires Oct.7,2005 ( signature(s) on the instrument the person(s), \\1 or the entity upon behalf of which the person(s) acted, executed the instrument. ■ WITNESS my hand and official seal. �//{// tip \ / SI EOF NOTARY 1 L ti 1 OPTIONAL QThough 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 El CORPORATE OFFICER 1 mss) TITLE OR TYPE OF DOCUMENT 1 U PARTNERS) CI LIMITED S SI GENERAL S ATTORNEY-IN-FACT NUMBER OF PAGES ❑ TRUSTEE(S) a ❑ GUARDIAN/CONSERVATOR ❑ OTHER: N DATE OF DOCUMENT S SIGNER E OPPE�(P�REE�LNG: S /W/ 6M/ ftuiv SIGNER(S)OTHER THAN NAMED ABOVE S !J/Il!/l!-/lll�!/.11 01993 NATIONAL NOTARY ASSOCIATION•8236 Remmet Ave.,P.O.Box 7184•Canoga Park,CA 91309-7164 04%13/2004 11 : 37 FROM RUI ENGINEERING CO TO 19497163247 P. 08 • EXECUTED IN TRIPLICATE Premium for this tend included in charge for Performance Bond. Bond No. 08591194 Bond Premium • PAYMENT BOND (LABOR AND MATERIALS) • KNOW AI,T.PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded to • RUIZ ENGINEERING COMPANY • 1344 TEMPLE AVENUE LONG BEACH,CA 90804 (Name and address of Contractor) ("Principal"),a contract(the"Contract")for the work described as follows: • "ANNUAL PAVING REHABILITATION CLIPPER WAY, CARAVEL WAY, AND CORSAIR WAY, FY 2003/2004" • PROJECT NO. 50172 • • W EREAS,Principal is required under the terms of the Contract and the California Civil Code to secure • the payment of claims of laborers,mechanics,materialnten,and other persons as provided by law. • NOW THEREFORE,we,the undersigned Principal,and FIDELITY AND DEPOSIT COMPANY Ob MARYLAND 801 N. BRAND BLVD. GLENDALE,CA 91203 (Name and address of Surety) ("Surety") a duly admired surety insurer under the laws of the State of California,as Surety.are held and firmly bound unto the Public Agency in the penal sum of *ONE HUNDRED TWENTY—NINE THOUSAND NINE HUNDRED NINETY—FIVE AND 60/100* • Dollars(S 129,995.60 this amount being not less than fifty patent (50%)of the total contract price,in lawful money of the United States of America,far 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- • I Ilk CONDrITON OF ZEUS 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 I3020 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 chill become mill 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, • attention,addition or modification to the terms of the Contract,or of the work to be performed thereunder, ... • or the specifications for the same,till 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 7 04'11312004 11 : 38 FROM RUI ENGINEERING CO TO 194971•63247 P. 09 • Contact or to the work of ea the spvJ,ifications thereunder. Surety hereby waives the provisions of California Civil Code§§2845 and 2849. ES WITNESS WKEREOF, 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 futth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned rcprescn'ative(s)pursuant to authority of its governing body. Dated: APRIL 13, 2004 "Principal" "Surety" RUIZ ENGINEERING COMPANY FIDELITY AND EPOSIT COMPANY OF MARYLAND A Pr" I . s .•TTORNEY- r • ALDO 8 . n1 GLEY Its It+ : - - -. (Seal) (Seal) • . Note: This bond must be dated, all signatures must be notarized, and • evidence of the authority of any person siguiug as attorney-in-fact must be attached. . 8 en—n,r—o n o • • Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland. by PAUL C. ROGERS. Vice President. and T. E. SMITH. Assistant Secretary. in pursuance of authority granted by Article VI. Section 2.of the By-Laws of said Company, wh' k-rxrh set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof.dees(fie-4 Yukritinate. constitute and appoint Michael A. Quigley,of Aliso Viejo, California, its true and lawfulAg hn�l tarneyitl.�'ct, to make, execute, n seal and deliver, for, and on its behalf as surety. and as its act a.RdS}zeit Cant'afi alL.be� i iii14 takings and the } �n execution of such bonds or undertakings in pursumrGe-e(�sc\p�,eSetxs, sl -fF rt�, on said Company, as fully and ita„„t ; s_ tr , nmplr,to all intents and purposes, as if they-I�fid b'4'etLtliY}ytxecutedyitEi)hekrios�lcdged by the regularly elected officers of t : ei t tic . the Company at its office in Bal�tnpre; sn-then awn-lli�vpei pyrstatts'. This power of attorney revokes that issued on behalf of Michael P Qni�k� 5 cdatetl O(tobe � n, G�•The said Assistant Seciefa .doess"f ' 3t certify-that the extinct set forth on the reverse side hereof is a true copy of Article VI. Section 2,of the By-L,a}s -fiu+kCart1tkIny.and is now in force. IN WITNESS WHEREDF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND. this 26th day of June. A.D. 2003. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND ��� OEV Os ti ♦‘° °.4 f(i y.n.n,"t j �( 11\A �/ . By: 7: E. Smith Assistant Secretary Paul C. Rogers Vice President State of Maryland ss: City of Baltimore On this 26th day of June, A.D. 2003, before the subscriber, a Notary Public of the State of Maryland. duly commissioned and qualified, came PAUL C. ROGERS. Vice President. and T. E. SMITH. Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND- to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. co�aN�sm0.H�y m � icJd4 Dennis R. Hayden Notary Public My Commission Expires: February 1, 2005 POA-F 012-0626 • • EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President. or any Executive Vice-President, or any of the Senior Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee. shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice-Presidents, Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require. or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations. policies. contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,...and to affix the seal of the Company thereto." CERTIFICATE I,the undersigned. Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND.do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate: and I do further certify that the Vice-President who executed the said Power of Attorney was one of the additional Vice-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in Article VI. Section 2. of the By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May. 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF. I have hereunto subscribed my name and affixed the corporate seal of the said Company, this 13th day of April • _9004 • Assistun!Seri-clan' • • . CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT _ _ of State of California _ • y ORANGE ss. County of I I. It On April 13, 2004 before me, MEG QUIGLEY, NOTARY PUBLIC It Date Name and Title of Officer(e.g.,'Jane Doe,Notary Public") ,y' e yp A personally appeared MICHAEL A. QUIGLEY j I. Name(s)of Signer(s) .ii KI personally known to me ❑ proved to me on the basis of satisfactory evidence ) c MEG QUIGLEY' COMM. 1461771 D �rn-s to be the person (x)Notary Public California p (x) whose names) is/;lE 'S a '- ORANGE COUNTY subscribed to the within instrument and .etp'- My Comm.ExpretJanuary 10,2008 acknowledged to me that he/ /executed A the same in hisittaX,Xitt authorized I I. capacity(i ), and that by his/Imp/Veto( § signature(s) on the instrument the person(, or r - the entity upon behalf of which the person(g) . acted, executed the instrument. it I aS,rn •h. d and official seal. IE Place Notary Seal Above a'blic �t OPTIONA Though the information below is not required by law, it may prove va uable to persrg on the document K j, and could prevent fraudulent removal and reattachment of this form to another document. FDescription of Attached Document Title or Type of Document: 1' Document Date: Number of Pages: I I¢ 1 Signer(s) Other Than Named Above: ti r, Capacity(ies) Claimed by Signer • I' Signer's Name: - RIGHT THUMBPRINT E!; ❑ Individual. Top of thumb here g ❑ Corporate Officer—Title(s): 10 ❑ Partner—❑ Limited ❑ General I' ❑ Attorney in Fact ❑ Trustee 1.- ❑ Guardian or Conservator e ❑ Other: ly ; A Signer Is Representing: 11 0 1999 Na5onal Notary Association•9350 De Solo Ave.,P.O.Box 2402•Chatsworth.CA 91313-2402•e w.natlonalnotary.org Prod.No.5907 Reorder.Call Toll-Free I-800-8760827 • • • ZURICH THIS IMPORTANT DISCLOSURE NOTICE IS PART OF YOUR BOND • We are making the following informational disclosures in compliance with The Terrorism Risk Insurance Act of 2002. No action is required on your part. Disclosure of Terrorism Premium The premium charge for risk of loss resulting from acts of terrorism (as defined in the Act) under this bond is $_waived . This amount is reflected in the total premium for this bond. Disclosure of Availability of Coverage for Terrorism Losses As required by the Terrorism Risk Insurance Act of 2002, we have made available to you coverage for losses resulting from acts of terrorism (as defined in the Act) with terms, amounts, and limitations that do not differ materially as those for losses arising from events other than acts of terrorism. Disclosure of Federal Share of Insurance Company's Terrorism Losses The Terrorism Risk Insurance Act of 2002 establishes a mechanism by which the United States government will share in insurance company losses resulting from acts of terrorism (as defined in the Act) after a insurance company has paid losses in excess of an annual aggregate deductible. For 2002, the insurance company deductible is 1% of direct earned premium in the prior year; for 2003, 7% of direct earned premium in the prior year; for 2004, 10%of direct earned premium in the prior year; and for 2005, 15%of direct earned premium in the prior year. The federal share of an insurance company's losses above its deductible is 90%. In the event the United States government participates in losses, the United States government may direct insurance companies to collect a terrorism surcharge from policyholders. The Act does not currently provide for insurance industry or United States government participation in terrorism losses that exceed $100 billion in any one calendar year. Definition of Act of Terrorism The Terrorism Risk Insurance Act defines "act of terrorism" as any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State and the Attorney General of the United States: 1. to be an act of terrorism; 2. to be a violent act or an act that is dangerous to human life,property or infrastructure; 3. to have resulted in damage within the United States, or outside of the United States in the case of an air carrier(as defined in section 40102 of title 49, United 17 States Code) or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States), or the premises of a United States mission; and 4. to have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. But, no act shall be certified by the Secretary as an act of terrorism if the act is committed as part of the course of a war declared by Congress (except for workers' compensation) or property and casualty insurance losses resulting from the act, in the aggregate, do not exceed $5,000,000. These disclosures are informational only and do not modify your bond or affect your rights under the bond. Copyright Zurich American Insurance Company 2003 surety terrorism disclosure notice • • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT NO.5907 rez- State of CA L /L L F0NIA S N County of L06 /9NU 1 " On L1—i ct--o ct before me, M132t A K,wta/-1�L )UoTiRcpogu�, 1 t DATE - do NAME 7,1EE OF OFFICER-EL. JANE 00E.NOT PUBLIC 1 personally appeared 6 • 12 t 1 I 1 \ ❑ personally known to me - OR - LI proved to me on the basis of satisfactory evidence to be the persgn_(s) whose name(s) is/are subscribed to the within instrument and ac- knowledged to me that he/she/they executed $ 1 the same in his/her/their authorized 5 capaci(r(ies), and that by his/her/their ti signature(s) on the instrument the person(s), 1 or the entity upon behalf of which the N ,_ v''O4ja' MARIA KANLILAR person(s) acted, executed the instrument. 11 O a r1' ` COMM.#1324276 0 O �_ ., . NOTARY PUBLIC-CALIFORNIA _ 1111 I' . i Los ANGELES COUNN I *: My Comm.Expires Oct.7,2005 1 WITNESS my hand and official seal. //�.`l` ll /7—ft / SKaNATIAE� 1G�•'n�_-w.IA�'n', tlll \ // ^l'�' `,1111 1 ` OPTIONAL. I , kThough the data below is not required by law,it may prove valuable to persons relying on the document and could prevent Sfraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER 6 V 8 TITLE OR TYPE OF DOCUMENT ` k PARTAIER(S) ❑ LIMITED 11j ��ENERAL 1 8 ❑ ATTORNEY-IN-FACT NUMBER OF PAGES ❑ TRUSTEE(S) S ❑ GUARDIANJCANSERVATOR 1 ❑ OTHER: ■ DATE OF DOCUMENT 6 1 1 t SIGNER IS REPRESENTING: 1 NAME OF MEOW;OR 91TOY1E5) /20 Z / 6/.11e-a--fr/N G7 Co. SIGNER(S)OTHER THAN NAMED ABOVE S S 01993 NATIONAL NOTARY ASSOCIATION•9236 Rennet Ave.,P.O.Box 7184-Canoga Park CA 91309.7184 • • • AGREEMENT TO COMPLY WITIICALIFORNIA 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 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 (I) 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 permined 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 I,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 .:rformancc of the work of this"convact." Date II—I -Oy Signaturser AIr 7 e 2u)z, par Mar 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 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 therefor, except in any of the following cases: (I) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104 [now § 20103.5] of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section, the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months, or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract' for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the hid 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 fonn 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.: 35238g Class: 4- Expiration date: 1.--/-00-05 Date —/9—eq Signature / '444 a e g s /2u.iz, pa-yhte r 12 . . INSURANCE REQUIREMENTS • • FOR CITY OF SEAL BEACH PUBLIC WORKS CONTRACT LIABILITY LNSURANCE 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 eeneral liability insurance in which the City, alone 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 sinele 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 • • Page Intentionally Left Blank 14 • • WORKER'S COMPENSATION CERTIFICATE OF INSURANCE Aria dt 4) WHEREAS, the CITY OF SEAL BEACH has required certain insurance to be provided by NOW THEREFORE, the undersigned insurance company does hereby certify that it has issued the policy or policies described below to the following named insureds and that the same are in force at this time. I. This certificate is issued to: CITY OF SEAL BEACH, City Hall,211 EIGHTH STREET, SEAL BEACH,CA 90740-6379. 2. The insureds under such policy or policies are: 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. By: Its Authorized Representative Is • c*e Atriad) • ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): OFFICIAL TITLE OF PROJECT: 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-party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except after written notice to 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: Director of Public Works City of Seal Beach 211 8th Street Seal Beach CA 90740 16 • • 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 THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: ❑ Contractual Liability ❑ Explosion Hazard O Owners/Landlords/Tenants ❑ Collapse Hazard ❑ Manufacturers/Contractors ❑ Underground Property Damage • Products/Completed Operations ❑ Pollution Liability ❑ Broad Form Property Damage ❑ Liquor Liability O Extended Bodily injury ❑ ❑ Broad Form Comprehensive ❑ ❑ General Liability Endorsement 12. A ❑ deductible or ❑ self-insured retention (check one) of S 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 0 occurrence or ❑ claims made policy(check one). 14. This endorsement is effective on at 12:01 A.M. and forms a part of Policy Number (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. Executed ,20 Signature of Authorized Representative (Original signature only; no .facsimile signature or initialed signature accepted) Phone No.: ( 17 • • ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY (yPF ktniCupd) Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): OFFFICAL TITLE OF PROJECT: 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 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 and/or hold harmless provision(s) contained or executed in conjunction with the written agreement(s)or pennit(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 211 8th 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 • • • TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY • Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: ❑ Any Automobiles ❑ Truckers Coverage ❑ All Owned Automobiles ❑ Motor Carrier Act ❑ Non-owned Automobiles ❑ Bus Regulatory Refonn Act ❑ Hired Automobiles ❑ Public Livery Coverage ❑ Scheduled Automobiles ❑ ❑ Garage Coverage ❑ 11. -A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s) except: (if none, so state). The deductible is applicable ❑ per claim or ❑ per occurrence(check one). 12. This is an ❑ occurrence or ❑ claims made policy(check one). 13. This endorsement is effective on at 12:01 A.M. and forms a part of Policy Number I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. Executed ,20 Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) Phone No.: ( ) _ • 19 • • • ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): OFFICL&L TITLE OF PROJECT: 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 he 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 and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s)or permit(s) designated above,between the Named Insured arid 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. 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: Director of Public Works City of Seal Beach 211 8th Street 20 • • • 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 THIS ENDORSEMENT ATTACHES FROMTIO LIABILITY n Following Form 0 Umbrella Liability 0 10. Applicable underlying coverages: INSURANCE COMPANY POLICY NO. • AMOUNT 11. The following inclusions, exclusions, extensions or specific provisions relate to the above coverages: 12. A 0 deductible or 0 self-insured retention (check one) of $ applies to all coverage(s)except: (if none, so state). The deductible is applicable 0 per claim or 0 per occurrence(check one). • 13. This is an 0 occurrence or 0 claims made policy(check one). • 14. This endorsement is effective on - at 12:01 A.M. and forms a part of Policy Number - • I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. • • Executed , 20 • Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) • Phone No.: ( ) • • • • 21 04/27/2004 14:39 BACCARELLA INSURANCE 4 15624346350 NO.357 D03• . � !. 44'27.2094 12e49 PROM 40.8 .8444;0418H Pe . . , TO 14994944844 . ... P.92 ,,., • • ADDITIONAL INSURED RNDOILISKINT COMPIIBiitid8IVE OV4EAAL LIABIId7Y Ruiz Engineering Company .....,, Nomeandaddlaaofinawdbleared(Namedte m"):` • • Western Heritage Insurance Company _ Nemaaidadder of wvaw.Comfyr '? opfnc7Al,Tymg op maim Annual Paving Rehabititatioan,Clipper Way,Caravel Way, Corsair Way,FY 2003-04 Natwithgoadles lay ieoontiatoat staament In the policy to which tine a edmeemmt is adadssd (to'policy')orinon andoreemett now er hawfcsaoWadthta alo,itis agreed asMows: t I. The City of seal Desch,is abated otriplets,o>Tmms,attorney,.moms,employees,and volumes tare ae.diticeal iaswsds (dm above rimed additiorel Wends nos hoenaha referred to as the"Addielocal tasmods9 under the Policy in Salim to seen eodvWs. described ga eeally.bona with mad to apetatioas pafiumed by or on behalf gf the Named lwmad. me Addldepal loatweds have ea{Reify tars payment of ony emulate or Pssmements under the Polar. 1. Ths tosmecc coverdp nffatded the Additional lemu s under the policy shell los Flamm taws r, . H . sad as other insurance malifatal by the Additional hlaemdo obeli be called upaa re eanttibow din Swan=cavemen by the Policy. I. Each inseam oovorgy) u>>der the Polley shall apply avant* to east Additional lasses whom vireos is mode or suit Is beeaght crept with respect le the limits of the Compbmy'e&shinty. • 4. NntlSg in this convict of mamas=shall be construed to praolede eovayge of•elderly ens Stied • under Sc policy a*eat another Shred ender dm policy. Ali suet claims shall tarred is tialcirey CO,l ia. ie the we msmtsr ere if sepetsle polioics had heed hawed to ach hapmed, •Neiht* conm>pd in this provision shall opeam to bureau or replicate the Company411mb of&obi*es pavidod water the policy. . 5. The ajwsnoo styonl d hi Yen policy Per eomtmemat liability • Ry instlreera (abject to the mime, voadibem mad exclusions applicable in such bunswoa) iscbedca liability assumed by the Named ]moved alder the indmmni8cstlon ad/or hold hamless pnwitiou(A) enatated Is of noteited in aosatmedaa with the wee=aereeaxat(s)or pee his)designated above,Ineween the Named Durand a. dad the Addltlswi IwwF+ls • 6. The policy to which this codaaesmeas io attached shell our be gabfest to aafeellulom, chngp9 la Y' txverape,soduaion of limits(@ape as the moult of the peptone of&alma),or nownsum sl go* area wriato notice to Public Agaray,by eadfied m)sil,sedan resofpi re4uesgsd,sat legs than gsiop (30)days prior to the effective date tbmeot in the we pf Componsi Uwe to aanply with h sh under!revision,the policy an hddolly drafted Will continue in full flew and OW vuW oomplimcv ' withtsia twice requirement 7• Cempsay ha*wave on:ighU•of gabmgatioa and Pan ibt l= the Addh$adid Immeds. • whale tads within the rave of their duties, fmm aft claims,laws aid liebilil m rinses out of er incident to the panne hoard spat bn relation to than olivine* deserted ggenwjy abase with mad to opoutiese perfermal by or on behalf of the Hamad tamed npardlon of airy prier, cwa aunt,or subacqueat active WPesdve tteglimc by the Additional hanreds. a, It in haaby wed that the laws of the See of California ghnll apply to and sovera the validlg4 comment%imarynmdbn,and enforcement of this ennead of insmsnca 9, •Idle endaamient and all sedan given heommda shell be son la Public Agtamy et • Mow ofPublic Works • Chy of Sal Beach 211 6th Sao . Seal!leach CA 90740 • • ' 16 f 04272004 14:39 BACCAREL. INSURANCE 4 15624346350 • NO.357 D04 41i2r'2091 17119 PROM 0U12 5NBINEERINO 00 10 10494944300 r,03 i . i0. $Camps a wad above ad dar in eatfiS with dde wldoaamsaau,nothing oodtagpd bat Sit bi. • bald a err ves deer or ad toy of the lima,admas4a1,or aaahuiaai of pm policy 14 etikb the • aahramem is abated. TYPEc covimosa TOW11CI p02JCY'17uIOD 5128/03-04 • L1btyi5of $3,000,0001 Ima upOtindita A.T11CIII8 titatsitTO T AB(tT1Y $1,000,000 . •• • •• 11. 9obodukd Puma r Waist pro to be'Mafia an an eaabed stoat. The fblldmabig btabasmaa tikaotothe Oat comma bol i C Codracta d lair Saploeioa Hamad 0 Ovanit,mdlm vreo sas . 0 Prepay Damage • B�Nap Lbws Lii4ili41 • 0.fhdaadsd Bodily inia7 0 Brad TannCampnLmri9n C Conant(dab_itr Endorsed . 12. A B dedoodblo ar d asd6iamrad rtaudum(cheat err) of$ e2 Sp o i cgs toail cowsomo m um Of Dora,so soda Tta dsdtatbto is D ie 0 par cam Or 0 per eappmsal(tooth i opt). 13, m a m a s' ono). a 1 34 Thin usdampont isteama5128103.04 st 1241ATd andformesport oflaw yt onScP0 72034 . lcStlerri L.Title �-t^�• -can%b.,. 1 dmiso 9adrPmdd of ymjmy Brdlr thti lava retie (Apibtat.,teat I have vmwaagaar*atdod 9 tb0oanpaytathie codossontat sad tbdby soy scat=b a ;I doos bind AACampay. •• . gam!Apra 27th v 20 04. • 1 I 0I 11 • - � e SilaaaeoorAVdbaiad , 71,17,75 , (t7i poi ttiir® oaib; no Jassio loo siguiture or totg nova • • • 17 • 04/27/2004 14:39 BRCCRRELLA INSURANCE 4 15624346350 NO.357 905 ,...SLUILIIMIPS 12149 FRep RUIZ ENeHIEERINQ CO rD 15094944388 . P.04 • • 1 171•DEMND•7CATION ANA SOLD HARMLESS AGEISEMLNTAJW WAIVER OF • SUBROGATION AND CONTRT8UTiON c Trier OF PROJECT OR WORK:ANNUAL PAVING REHABILITATION,CLIPPER indosiuiamiel pin an nano[): • WAY,CARAVEL WAY,CORSAIR WAY,FY 2003-04 • • • To the Mn nucm persatitted by low,ittdwmitm haoby ofcca.10 is ado°M OM Weans,to-sited, . Prof,indotpo ,and bold bestlan the ay of Soil Reach end III elected palish,officers,Wameys, adeana erapieyaa0.valuator..aueaaaame,and atelgRa(aollecilnly'R+NLe!»aiaaa")from told against my • sad td1 da grain coma, Rena, NUM e, claims, denims, men or aelam, pttueodinp,opts, jadOmoda,remelt*,Han,and lents of any mute whataoeva,including(1�w,��,,o�f ar�caRmnann,aaots>sya, . or mho pnafadoneh and.11 Ptah tlmni0ad therewith(eofaWvely"ldobil1iaa").imam or domed b anao,ditwdy or indinaLy,out of,iu cometction with malting hum,or mimed to any act,Whim to apt, Incur, en patience' of Tedeomitot or my of its of inn, amuses, screams, m*voce, atwitter" . rostalehom,MOM or Ibefr etBetia,agent611avarm at aupluimp,aiming is claimed ro>ie1a0.directly or indinway, at of, in cosmevUat with, nwulGng from, or related to the ebovc-tcfctmmal ettoboo, s eomment, Noonan, or permit (Om "Aptexonnti or the pcNbrmann or allum to pmrfotp try,tat i provision,comet, Or outdid=elite Agreement, Iogttg this twiernagy provIelos. :rids Waft , provision ie effective recordists of sty Prior,coneu rar,or anhsoqumit active a panty,ragtilaaw by • Indepmior m mod dull apaato to folly indium*Imlruwitw whist any such oviligenco, this}comely prongliO tape survive the tesmiwtion of the Avernus ltd is in addition tc new other da)te ug mega which Tadanrtioca may nave under ME kw. Feyment is not requirred es a anaiigmn maid=to Ire ttlommitwb tight to recover smite tins indemnity ptevhimr, tad m WO of iu4n t shiner ee • Iademnitee shell be coneh>aiva in flavor of Ms kdemrltads rigid a r000vnr ader ibis indemnity provitlpp, b*m M m r stall pay k f e sag estomsyp fees and coat lug ire entrain traits • matins p'evieloa Nom the foregoing,nothing in*Is In.mo*sbaH bo on to (a)bionedtace solo amgligpmao or willful misamduct to the limited nctcat that the ucdatiyirg A,gramens is object to Civil C04127112®ar(b)the cuntteotimg public agency's nedve neglipmm to the • limiter stmt gat the tmdalyigg Agmmtatt is sultana to Civil Coda 1 276208 This (ndmmi4r b oSacdva without rat m to to the existence or applicalnlitr of any mslnance covaga WS*may hNa hoed again- under gm Agreanwt or an additional kneed tmdmammenta white may amts! to Indemnities. Tmdemmiroe,on behalf of ivalf sad ttU parties obaiming attain'or through it,bemby mama di • linked VRIMPOrto and contribution*rut thhe indagaitue,while Wog S the scope tlidadt limn on data,kiln end IiabWS exiting out of or Maidens to owtivldet or,pat ions piefon red ba er tin . behalf cite IademNun regaeUe s of tnem Prior,OOUO+rmett ar=hems*salvo ea salve meal.=by • Arts indemnities is Me event them is more prom ono person or entity named ire dm Ase area 4 na Indonmitor,then ell obligations, ItabiaUC,omens and conditions under this mettumeni ehai beNdae and savant Indammae Name Western Heritage Insurance Company Nam • 44kozi wt 014 si Thy; • t3 U Its • • • g 04/27.t/2004 14:3'1 — BPCCRRELLA INSURANCE 4 '1562434635 t'B 3r�6 062 • POLICY NUMBER: SCP0472034 COMMERCIAL GENERAL LIABILITY CO 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION this endorsement modifies irsuronce prof;ded under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE jName of flamer' tit'="7:"- itYllc t;C.ty of S_a' coach, its elected offic'ale others. moneys, .� agents emoloyees,volLrnteerb, successors and assigns Of no a.zi ' ru polite ti,EFtnGSIt1R raqu:'?d to nr'Flursugient viir choym In Inc Declaration a applicb'� o ells endorsement.) '.. Sootier, tt,i insured is a'nendeo to (1) Ali work, .nr'u4Inc meieriais, parts or include e0 an imn rFq Lie person or organization equipmonf furnished in cnnnestlon with shown in ine ::zhaOL.:c, Dui or'y witi; respeci ',i ouch work, an The project (other than Uab;;ity aeste,. cut of your ongoing opardhgns service, maintons:1ee or repairs) to be performed for;eel Insured, pelt-merl by or on behalf of the add' t°. With respect o ,he insurr.r,cs nrforiad to ;'rasa tiorsi insured(s) at fns s to of the cov- addniora! ins.ircds. foe following exclus'on Is wad aerations has beer completed: added. or x. Excluuion.s (2) Thet portion of "your r.ork" out of T Is !nsurs^c3 does no: &Filly to `o�d,'y fn• which ihb injury or damage arses has jury 'nr. ,Dry oes nc f:ply to r o�t bees put to its fronded uss by any person or otganizatioh other then an- other contractor or subcontractor er'- ageci ' occurring operations for a principal as a Dart of tna same project CO 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 D r I\ III II, 04/27/2004 14:17 CSI, LA PALMA 4 915624346350 04/27/2024 13:59 15629429M4 NO.511 P001 PALit UY 04/27/2004 08:41 CS!. LA PL MP 4 g191396731311 1`10,491. pan 04/26.2004 68:52 wvOM PU1Z eN6INSRIN5 cc 10 6:d8752 1...e2 ' 'WORKER'S COMPENSATION CERTIFICATE OF INSURANCE wilnuess,thearY OF SEAL SEAC11 1=3v:tweed Certain inguraecc to be provided by -*:,..,...,,•._.,. • "Ow ticultr,Fon.,the undersigned insurance company dues hereby certify that Ii has issued the policy • r-ri:;•.•• • cr pock:*described below to Me following waned insureds and that the same ate in force at this time. • 1. This certificate ig issuoi to: CITY OF SEAL SLAM City Hall.211 RIOSTM STREET,SEAL REACH.CA 913/40-6379. . r•-.'l-- . 2. The insureds under such policy or policies are: Ruiz En• on.is - I or •rytpah •• 4 n , wcirkees caupensation Policy Or reitCies in a form approved by the Ins Commissioner of . • California covcring all opesations of the named ireuroda as follow roucy stayszER EFFECITVE DATE EXPIRATION DATE • . . . - . tii-K1 P 0 13971,121_93.---6H- NI- 04r_ • t941 - 0 I - CS) ,. . . • . . . . . ______,._________________ ___—• , . _ .J..,,....., . ,0.2.,• 4. Said policy or policies slain Dot be canceled, voided or twanged in coverage or twain of liability, •'5.14.' •• unless sad ..min thirty days advance written mike thereof has been served apes) the City Clerk of the CifY • SEAL SEACII. - . ...... . , . • . . ..-- Its • J7,-. - Representative . . -i3•:;::-...'‘ ' .- 0-"..' .. . . . . . . . . . .. . . : . . . . • • • . . Pittr"fikC ' . '