HomeMy WebLinkAboutAGMT - Top Design Builders (City Hall & Pier Restrooms) .;
ly-' . y , PLEASE COMPLETE THIS INOMATION •
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RECORDING REQUESTED BY:
•
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Recorded in the County of Orange, California
Gary L. Granville,• 1IIIIIIIIIIIIIIII1111 JIIIIIIIIIIIIIIJ JillIIIIIIIIllIIIIIIII Clerk/Recorder
AND WHEN RECORDED MAIL TO:
1999
0584454 04;30P1 08/10/99
005 16002 15 as Sec ram R28 4 6.00 9.00
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au IC' THIS SPACE FOR RECORO/F,f'S USE ONLY
TITLE OF 000UMENT: Peso ILui-i on / oz 3
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THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION
(Additional recording fee applies)
° 059 Tt n E PACE 187/151
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WHEN RECORDED RETURN TO: RECORDING REQUESTED PURSUANT TO
CITY OF SEAL BEACH GOVERNMENT CODE SECTION 6103
211 8TH STREET
SEAL BEACH, CALIFORNIA 90740
7
RESOLUTION NUMBER 27jZ 3
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEAL
BEACH DECLARING WORK TO BE COMPLETED AS TO PLANS
AND SPECIFICATIONS FOR PROJECT #825 CITY HALL AND PIER
RESTROOM PROJECT 1998/99, CONTRACT ENTERED INTO BETWEEN
TOP DESIGN BUILD AND THE CITY OF SEAL BEACH.
THE CITY COUNCIL OF THE CITY OF SEAL BEACH DOES HEREBY RESOLVE:
WHEREAS, on October 26, 1998, the City of Seal Beach entered into a contract with Top
Design Build for City Hall and Pier Restroom Project.
WHEREAS, the City Engineer has determined that the work has been substantially completed in
accordance with the contract documents. -
NOW, THEREFORE BE IT RESOLVED by the City Council of the City of Seal Beach 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$ 264,466.57.
Section 3. That the work is hereby accepted and approved.
'Section 4. It is further ordered that a "Noti ce of Completion", Exhibit "A", be filed on behalf
of the City is in the Office of the County of Orange within 10 days of the date of
this resolution.
PASSED, APPROVED AND ADOPTED by i+ Council of the City of Seal Beach at a
meeting thereof held on the / day of _ ir,_ ` , 1999 byj- folio g vote:
AYES: Councilmen,yr� ///
NOES: Councilmembers
ABSENT: Councilmembers ails
Mayor rid
A 7TreT:
IA
qty Clerk
'P: ' , • ••
STATE OF CALIFORNIA)
COUNTY OF ORANGE )SS
CITY OF SEAL BEACH)
'/7Z-3
I, Joanne M. Yeo, City Clerk of Seal Beach, California, do hereby certify that the
foregoing resolution is the original copy of Resolution Numbe> on file in the
office of the City Clerk, passed, approved, and adopted by the City . .r-. • of the
City of Seal Beach, at a regular meeting thereof held on thee' day o` _
ILIIA
air Clerk
' RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO typos-
+V
C'S
OF SEAL BEACH �i.;Pl�f ,,,
Ann: City Clerk =_
211 8th Street 31 f
Seal Beach, CA 90740 r '
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Space 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:
I. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the
property hereniafter 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 8th Street. Seal Beach 90740
4. The nature of the:merest or estate of the owner is; In fee. The City of Sea! I:each..
5. A work of improvement on the properly hereinafter describe as completed on May 31. 1998.The work
was: City Hall and Pier Restroom Project, #825.
6. The name of the contractor, if any. for such of improvement was: Top Design Builders.The dale of the
Contract was: October 26, 1999.
7. The property on which said work of improvement was completed in the City of Seat Beach. County of
Orange, State of California,and is descrihed as follows: Block B, Tract 1009 and Lotl7 and 19, Block
107, Bay City Tract
8. The street address or addresses of said property ' : : 0 Oce t Av-..nfslf t S°■Street.
Date: / (2,2- c:.
� I
Signature of owe r or crporate ofh • of owner
named in paragraph 2 or his agent.
r^-cST. 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 taste and correct.
I,
Executed on -7 2J/o /p? . 19 , at Seal Beach, California.
late .f Signature) �i ,
_/ /��
�ircctor of Public Works
EXHIBIT "A"
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. Public Works Contract
MAIN STREET IMPROVEMENT PLAN, •
•
• ' . CITY HALL & PIER RESTROOMS
-.For. MAIN STREET IMPROVEMENT PLAN, CITY HALL PIER RESTROOMS in the City of Seal Beach.
; AGREEMENT, made and entered intoithi ' day 19 , by and between,the City
of Seal Beach, California,.hereinaft r r eferred to as the "CITY," Party of the First Part, and
`, • _ • Top ' s r
l, 1[,c i 1c� er ,
-, hereinafter designated as a "CONTRACTOR," Party of the Second Part. -•
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•
.; WITNESSETH; That the_P_arties do hereto mu tually agree as follows:
ARTICLE I. .For and in''consideration of the payments and agreements hereinafter mentioned to be made .
•' and performed,by said,yCITY, the_CONTRACTOR.agrees with said CITY to MAIN STREET IMPROVEMENT
- --: :- i PLAN, CITY HALL PIER RESTROOMS and to perform and complete in a good and workmanlike manner
''t ' all the work pertaining:. thereto shown on the drawings and described in the Specifications and Contract
,. Documents;, therefore . ,to fumish•at his own proper -cost and expense all tools, equipment, labor and materials
'• , : necessary therefore :(except those materials expressly noted as to be fumished by the CITY), and to do
everything.. required. by this and the said Specifications, Drawings; and Contract Documents. _
- ARTICLE 11 For furnishing all said materials and labor, fumishing and removing all plant, temporary works or
'stru toots�and equipment and doing all the:work contemplated and embraced in this Agreement, also
for all loss 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 :orin consequence of the suspension or discontinuance of work;. except such as in the said -
- Specifications are expressly 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 sliall receive in full compensation, therefore, the unit prices and the lump sum prices named .
In the Schedule of Work items 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'contairied 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. : ,: ';;;. -:: <
VI
ORTOSUBMIT UPON AWARD: a
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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 SEAL BEACH, CALIFORNIA
Party of the First Part • • .
City Manager. .. r J . -..
Clerk
• -:BY .x.
CONTRACTOR - Party of t • Second Part, -
:..._ Title r•.:. -''. . , r a:n: ;` ..
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SUBMIT UPON AWARD: D•3
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CONTRACTOR TO B T '
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Bond No. 3 97 28 67
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the CIty of Seal Beach, has awarded TOP DESIGN /BUILDER
2140 W. OLYMPIC BLVD., #324, LOS ANGELES. CA 90006
(Name and address of Contractor)
('Prindpar), a contract (the 'Contract') for the work described as follows: MAIN STREET IMPROVEMENT
PLAN CITY HALL AND PIER RESTROOM RENOVATTONS 11875
WHEREAS, Prindpal is required under the temrs of the Contract to furnish a bond for the faithful
performance of the Contract.
1 ' AMERICAN ALLIANCE INSURANCE COMPANY
NOW, THEREFORE; we, the undersigned Prindpal. and
541 N. PALMETTO PLACE, SANFORD, FL 32771
(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 IIUNDRED TWENTY EIGHT THOUSAND
NINE HUNDRED - -- -AND 00 /100
Dollars ($ 228.900.00 ), this amount being not less than the total contract
price, in lawful money of.the United States of America, for the payment of which sum well and truly to be
made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and
severally, fimily 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 attomeys'
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 ft 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 Califomia
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 Prindpal and Surety, on the date set
CONTRACTOR TO SUBMIT UPON AWARD: D - d
FY 97.98 MAIN STREET IMPROVEMENT PLAN, RESTROOM PROJECTS ' ' '
• •
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: NOVEMBER 9, 1998
Prindpar 'Surety
TOP DESIGN /BUILDER AMERICAN ALLIANCE INSURANCE COMPANY
By: By:
Its yeo H� Q, o tooeo its PETER L. CARR, ATTORNEY -IN -FACT
By: By:
Its Its
(Seal) (Seal)
Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any
person signing as attomey -tn -fact must be attached.
CONTRACTOR TO SUBMIT UPON AWARD: D.S
FY 97.98 MAIN STREET IMPROVEMENT PLAN, RESTROOM PROJECTS
• •
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
..,: e.' !`< ey;<x <; , :k.x ,; r;(. 4; t:.;.x. .- e.••c,•r.;e.•• <;c;es..‹ ;Cc-t •.,l`.., <`, i•.- ( •.•r. (•' •, i,. e''r- ;
',••.('' '.;r, ( i•
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c:, State of CALIFORNIA
tJ .I County of ORANGE -
I.t DFI3ORAll LT ' I
6 On Novvmt r 9, 1998 before me, - -_- (n
I Date Name and Tale of (Arm r -' .'
11, PETER L. CARR 1 1 • 'Jana on e, Ilnlary m'orl lrr, )
I personally appeared _ r
if : r
' ._ Nmm�(v) of Signor(a)
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g :• IXIXpersonally known to me
1 'l 1.1 proved to me on the basis of satisfactory evidence :
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to be the person(s) whose name(s) is /are subscribed to the r'
: 1 within instrument and acknowledged to nie that he /she /They
{ DEBORAH 1,tpSCUMt3 executed the same in his/her/their authorized capacily(ie.$), `)'
Ar
COM ft 1174869 >
and that by his /her /their signature(s) on the instrument the '
:1. W -•u; t 4 ;� NOTARYPUBLIC- CALIFORNIA person(s), or the entity upon behalf of which the person(s)
.r; Q • 4.j ; • I ORANGE COUN acted, executed the instrument. •
.1.'i t My Comm Expires March 27.2002 }
0 , ' i WITN SS my hand and official seal.
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Ii OPTIONAL
� 1. Though the information below Is not required by law, if may prove valuable to person relying on the document and could prevent
l i fraudulent removal and reattachment of this form to another document. i
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Description of Attached Document ; ';•
' Title or Type of Document: SIJR T?'TY BOND ;
., r:
D Date: Number of Pages: __. - ______ I''
g - - J.
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i.' Signer(s) Other Than Named Above: _ _____ _` -` -_ - �''
7. PETER L. CARR r'
r Signer's Name: Signer's Name: 1
4. 1 1';
l_) Individual 1 Individual f r
1': 1.1 Corporate Officer 1 I Corporate Officer i
Title(s): Title(s): __ -_ -- __ - _ -____ l
LJ Partner - I.1 Limited LI General 1 1 Partner -1 I Limited 1 I General .'∎
'• Attorney -in -Fact 1 I Attorney -in -Fact 1.1.
■ • 1.1 Trustee 1 I Trustee t
11 Guardian or C onservator RIGHT THUMBPRINT
l;
or SIGNER I 1 Guardian or Conservator RIGHT THUMBPRINT
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• Li Other: I1 a nt7 hr're
• er: nv o n,i I 1 Other: _. -_ --- Inlr i Ihrnnl• barn 'r
AMERICAN ATLIANCE •
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Signer Is Representing: Signer Is Representing:
AMERICAN ALLIANCE
•
INSURANCE COMPANY •
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a,1 1498 liannnal Nnlnry M' oc:auon • 8'30 nnmmnl Ave . r o Hoy 71111 • Cmxrpn rook CA n1;10n 7I ni trod Nn 5907 feordnr Call loll roan 14100 1176-61127
•
•
BOND NO. 3 97 28 67
•
PAYMENT BOND
(LABOR AND MATERIALS)
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Seal Beach, has awarded to TOP DESIGN /BUILDER
2140 E. OLYMPIC BLVD., #324
LOS ANGELES. CA 90006
(Name and address of Contractor) MAIN STREET IMPROVEMENT
Principar), a contract (the "Contract) for the work described as follows:
PLAN CITY HALL AND PIER RESTROOM RENOVATIONS #825
WHEREAS, Principal is required under the terms of the Contract and the Califomia Civil Code to secure the
payment of claims of laborers, mechanics, materialmen, and other persons as provided by law.
NOW, THEREFORE, we, the undersigned Prindpal, and AMERICAN ALLIANCE INSURANCE COMPANY
D41 N. YALMt'11'U PL.
SANFORD, FL 32172
(Name and address of Surety)
("Surety) a duly admitted surety insurer under the laws ilentAS G ip, f I�`Ii'reVH! l and
finely bound unto the Public Agency in the penal sum of
NINE HUNDRED - - -AND 00 /100
Dollars ($ 77R onn nn ), this amount being not Tess than fifty percent (50 %) of the
total contract price, in lawful money of the United States of America, for the payment of which sum well and
truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly
and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT, If the hereby bounded Prindpal, 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 Califomia 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 inure to the benefit of any of the persons named in Section 3181 of the Califomia Civil Code
so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case
suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in
an amount fixed by the court.
FURTHER, the Surety, for value received, hereby stipulates and agrees that no change, extension of time,
alteration, addition or modification to the terms of the Contract, or of the work to be performed thereunder, or
the specifications for the same, shall in any way affect Its obligations under this bond, and it does hereby
waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the
Contrail or to the work or to the specifications thereunder. Surety hereby waives the provisions of Califomia
Civil Code §§ 2845 and 2849.
CONTRACTOR TO SUBMIT UPON AWARD: D•6
• FY 97.98 MAIN STREET IMPROVEMENT PLAN, RESTROOM PROJECTS • •
•
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 Prindpal 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: NOVEMBER 9, 1998
'Princlpar 'Surety
TOP DESIGN /BUILDER AMERICAN ALLIANCE INSURANCE COMPANY
BY� By:. /61iL
Its � g yh Owu. is i✓nxK, nt tuKrvr,Y -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-fad must be attached.
CONTRACTOR TO SUBMIT UPON AWARD: D•7
FY 9T -98 MAIN STREET IMPROVEMENT PLAN, RESTROOM PROJECTS
• •
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of CALIFORNIA
r,.1 County of ORANGE
<a
P• On Nnvn-mb .S, 1998 before me, _ DEfiORAlI LII'SCONB
` Dnla Nam.noA 1'nle at NPrn "On ,nn,, _—._._,
�I
tcn_', I Xnnry Prrhlir'I
ii personally appeared — PETER L. CARR "
/- -- Nnrn$s)nl CinnndS)
IXIXpersonally known to me
.
I_I proved to me on the basis of satisfactory evidence
to he the person(s) whose name(s) is/are subscribed to the
22 within instrument and acknowledged to me that he/she/they
,` } ••■• ••• •••DLi30RA1911i SCOMIIY executed the same in his/her/their authorized capacity(ies), ::
•• COMM H 117A869 > and that by his/her/their signature(s) on the instrument the •
It �y NOTARY PUBLIC-CAIIFRRNI� fft person(s), or the entity upon behalf of which the person(s)
' ORANGE COUNTY 1 acted, executed the instrument.
UJ'• .♦My CnmmisslPn&puts Match 27,2002f
S WITNESS my hand and official seal.
,, dit-h,4_ Oh • ' . ----- )
•1 DEB() P. COMB
l; OPTIONAL
Though the information below is not required by law, if may prove valuable to persons relying on the document and could prevent
Lj fraudulent removal and reattnchnrenl of this form to another docunre,!. Ci
cr
'! Description of Attached Document
et Title or Type of Document: SIMETY 80N1)
t Document Date: _..__Number of Pages: __.._---.-----_ '.
t.
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Signer(s) Other Than Named Above:
I
I,
Capacity(ies) Claimed by Signer(s)
t PETER L. CARR
Signer's Name: - _ Signer's Name'. __-______ _
• IL Individual I:.I Individual
L.: LI Corporate Officer I:1 Corporate Officer i;
is Tille(s): ( ):
linos ;I
-- ---- -------------------------------
Li Partner—I I Limited LI General I I Partner—I I Limited I I General
il K Attorney-in-Fact I I Attorney-in-Fact
CI Trustee I.I Trustee rl
i LI Guardian or Conservator RIGHT THUMBPRINT Guardian or Conservator RIGHT THUMB•RINT
OR SIGNER k SIGNE&
Cl Other: hop of Ihnmb barn, I I Other: lap nI Il,,lrra,I,,,rn�
•
AMERICAN ALLIANCE
Signer Is Representing: Signer Is Representing:
AMERICAN ALLIANCE
t' INSURANCE COMPANY — —
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S 11510(4 98, AMERICAN ALLIANCE INSURANCE COMPANY
• • • • •
AMERICAN ALLIANCE INSURANCE COMPANY® NO. 13301
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:That the AMERICAN ALLIANCE INSURANCE COMPANY,a corporation organized
and existing under and by virtue of the laws of the State of Arizona, does hereby nominate, constitute and appoint the person or
persons named below its true and lawful attorney-in-fact, for it and in its name, place and stead to execute in behalf of the said
Company, as surety, any and all bonds, undertakings and contracts of suretyship or other written obligations in the nature thereof;
provided that the liability of the said Company on any such bond, undertaking or contract of suretyship executed under this authority
shall not exceed the limit stated below.
NAME ADDRESS LIMIT OF POWER
PETER L. CARR ALL OF ALL
DEBORAH E. CARR LOS ANGELES, CALIFORNIA UNLIMITED
This Power of Attorney revokes all previous powers issued in behalf of the attorney(s)-in-fact named above.
IN WITNESS WHEREOF the AMERICAN ALLIANCE INSURANCE COMPANY has caused these presents to be sign 9edd$nd
attested by its appropriate officers and its corporate seal hereunto affixed this 20th day of May , 1998
.
Attest: AMERICAN ALLIANCE INSURANCE COMPANY
$11:[,qq4
Or , C._ - -Th
•45:11 Assistant.Secmtars i Vice President
STATE OF OHIO,COUNTY OF HAMILTON —ss:
On this 20th day of May, 1998 , before me personally appeared DOUGLAS R. BOWEN, to me known,
being duly sworn,deposes and says that he resides in Cincinnati, Ohio that he is the Vice President of the Bond Division of American
Alliance Insurance Company,the Company described in and which executed the above instrument;that he knows the seal;that it was
so affixed by authority of his office under the By-Laws of said Company, and that he signed his name thereto by like authority.
�
MAUREEN DOUGhf Ohio �/ $
? ' Notary Public, State of OhioQC1/a&0rL CLt�(J(J
�' ,,- ,` My Commission Expires Aug. 12, 2001
This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of American
Alliance Insurance Company by unanimous written consent dated July 12. 1995.
RESOLVED:That the Divisional President,the several Divisional Vice Presidents and Assistant Vice Presidents,or anyone of
them,be and hereby is authorized,from time to time,to appoint one or more Attorneys-In-Fact to execute in behalf of the Company,as
surety,any and all bonds,undertakings and contracts of suretyship,or other written obligations in the nature thereof;to prescribe their
respective duties and the respective limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER:That the Company seal and the signature of any of the aforesaid officers may be affixed by facsimile to
any power of attorney or certificate of either given for the execution of any bond, undertaking,contract or suretyship,or other written
obligation in the nature thereof,such signature and seal when so used being hereby adopted by the Company as the original signature
of such officer and the original seal of the Company,to be valid and binding upon the Company with the same force and effect as though
manually affixed. •
CERTIFICATION
I,RONALD C.HAYES,Secretary of the American Alliance Insurance Company,do hereby certify that the foregoing Power of
Attorney and the Resolutions of the Board of Directors of July 12, 1995 have not been revoked and are now in full force and effect.
Signed and sealed this 9th day of November '1998
tEI CJ,rn1,
V
at
Assistant Secretary
5 1151F(11/97)
• S
INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
AND WAIVER.OF SUBROGATION AND CONTRIBUTION
MAIN STREET IMPROVEMENT PLAN, CITY HALL& PIER RESTROOMS
s
In'demnitor(sy(list all names):
Ycon,f Si k-- Kim clt�t •
- c� 13r, Bui' Id�er
•
„To the fullest extent permitted by Indemnitorhereby agrees, at its sole-.cost and expense, to defend,--
protect,
indemnify,and hold harmless the City of Seal Beach_ and its elected officials„officers,-attomeys;'
agents, employees, volunteers, successors, and assigns (collectively 9ndemnitees') from and against
any,.and;all.damages,lcosts, expenses liabilities;, claims,:demands,_ causes of action; =proceedings,
expenses„ judgmentspenalties liens,.:and_;losses; of,;:any :nature,whatsoever, including.:fees;of
:acc'ountants'attorneye,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,acti error, or omission of indemnitor or any of its officers,agents,'servants,-,employees,
—:subcontractors;materialmen, suppliers or their,officers„agents,:servants or employees, arisingtor claimed
to arise,directly or indirectly, out of, in connection with, resulting from, or related to the above-referenced
e contract, agreement,license, or,permit (the e Agreement),or the performance or,failure-to perform any.t
term; provision covenant or condition"of.:th e•Agreement,: including this indemnity provision. •This
indemnity provision is effective regardles of any
prior,„concurrent, or subsequent active or passive ;
negligence by Indemnitees and shall operate!to;fully indemnify lndemnitees against any,such negligence:
• This indemnity provision shall survive the termination of the Agreement and is in addition:to.any other.r
rights or remedies which Indemnitees may have under the law. Payment is not required as a.condition
- .precedent-to•an Indemnitees,right1to recover under,this indemnity provision; and,an entry.of judgment
against.art Iniiemni teeshall,berconclusive;,in favor, of the •Indemnitee's. right to.recover under this.%
indemnity provision Indemnitor shall;pay;Indemnitees for.,any attorneys fees,and;costs incurred in
enforcing this indemnification provision.-Notwithstanding the foregoing, nothing in this instrument shall be
. construed te.encompass„(a)Jndemnitees' 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 tothe existence or.applicability of any insurance,coverages which
may have been required under the Agreement or anyadditional insured endorsements which may extend
to Indemnitees.lndemnitor, 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
-byor on behalf of theindemnitor;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, liablilities, covenants and conditions under this
instrument shall be joint and several-
'Indemnitor'.. . •
Name TCf-D SI �IYm
0LIIG�er Name:
•
By: c ; `J By:
Its Its
CONTRACTOR TO SUBMIT UPON AWARD:68
.FY 97.98 MAIN STREET IMPROVEMENT PLAN,RESTROOM PROJECTS r 5
•
• •
;.,;AGREEM ENT TO;COMPLYWITH ;
. CALIFORNIA LABOR LAW REQUIREMENTS
.•:[Labor Code §§ 1720 1773.8, 1775 1776, 1777.5, 1813, 1860, 1861, 3700]
"The,undersigned Contractor.certifies that it is aware of and hereby agrees to fullyrcomply with the
• following provisions of California,law:
R
1. Contractor acknow _ledges that this contract is subject.to'the provisions of.Division.2, 'Part 7
Chapter t (commencing.with.Section.1720) 61-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 .-
forthinfull herein ..
2. • Contractor agrees to comply with the provisions of Caldomra Labor,Cede Section 1773.ft which
requires the payment of travel and subsistence payments to each worker needed to execute the work to
the extent required bylaw ` ,. - `
'1�J <it F i �'el y s � � s x�: 1� R .` F I e1�.:, � u 3 t Yx
pi's ent-fit r }it'+RJ?: Ii. 't 3t 8,f .i e5 lia.-.9
3. tip,Contractoragrees to'comply-with=the provisions of•Califomia tabor Code Sections 1774 and
1775 concerning•the payment oPprevailing rates of wagesito workers and the penaltie`s`forfailure to pay
prevailing'wages .11-he%Contractorshatl as a',:penaltyto the Agency forfeit n`ot more',thansfiftyfidollars
'($50) for;each'calendar{day'orpeition`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 rs emplo`ye`d for
• any public work done under the contract by-Contractor or"by any`subcontractor. ` I i',' C `°5 •
-}.yt t t � 4 t \ { C \
� �. + oti} t 'h iN rr, i.�r:ils d r-.I. `iYJ 1.�... s ? � Sb t i r r ': ?"� a .1 I
4 r z;'€ Gontractoragrees to comply with the provisions'of California Labor-Dada•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- ar d'(3j igform'the'Agencyrof
• location of.the tecords-The Contractor is responsible for compliance with`Section 1776 by dself and all of
its subcontractors z h fi •a, twit; ?neriY it .
a.li ztn r,A 't2 LW? t 'U !irC�n-i I. f r * 1 b a i .?fP P'i i1 'C.- `fit+! 7 urE"T a i1 tie:aFa' .
5 mcri,ContraCtor.:agrees to comply with'th'eiprovisions`af'California' LaborzCode, Sectiong17775t
concerning the'employnient of apprentices'`on public works•projects'and fuither agrees that Contractor is '
responsibleifor compliance with Section 1777.5'by itself and all of its subcontractors rx- �' t" if "' '" •
511 p'11p1ri',i rsit°yu'i0'- r3ar"i"� t.�: ,L, tl:cn-. + � Irr(1*l"�r r�•t9t�, fli f[?.:.
• 6 16' Contractor ag iee l.itoteoaily; vAth'5 treVit h ieibli's5OF California L'abor'•Code"Sectiori '1813x ' ,
concemingfpenalties lfor;workers'twho°work`==excess:houra. The'Contractor shall as'a paneItyto`the5ift.
.Agency,.forfeittwenty five"dollars($25) foreach worker employed in the execution ofthe contract iby the '
Contractor or by any subcontractor for each•calendar-day during which °such worker is required,or ':'
permitted to work more-thanv8tioursin"any one calendar day and.40 hours'in any one;calendar week
' violation of the•provisions,of Division 2, Part•7 "Chapter 1,Article 3 of the Caldomia Labor
• t, 1 S ' r- x f' -r-1r � ta3, si t'7 5+s` .
7 *yn Califoia' abor"Code!Secon1860'and 3700 1° vide'thet eery contractor- rn p
secuethe-payment of:compensation to itS employees In accordance with will be required to
the prowsionsrof California
Labor Code Section 1861, Contractor•hereby certifies asfollows
41 T Y +r %=S z i t i S.,S .7 G i.,.§2 Y . ;af_l ri,c ty{.l t i.{pS.
"I am aware of the-provisions'of'Section.3700 of the L'atior`Code'which9r quire'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"'-'t
the performance of the work of this contract.' : • - • •
Date illi�/617.Signature u I) 1 •
•
li
e j,\a ut r L Jl. YZ' °k:74 se ti CONTRACTOR TO SUBMIT UPON AWARD D-9
Y T�� r < "` n t :' FY 97 98 MAN STREET IMPROVEMENT PLAN,RESTR0OM PROJECTS' _ Utz'
tJi y e !"S ltf' \ !\< a k 2 $y 1 4
p.4'{5{A!<'�}?.u, yi '�h`zl��c y✓}.{s iL. "`xaF�w' 5�,_f."r ^"t i i+>^f,"d' y t f: t . `1r _ S 1�` Gy (xM-2
mk � t�`i"ar#ai � t*h t - a Lk�X'�"L r+'ih f; 1$iy•-(, 5 s tin FG 7 - w I
` tt>. lisp K\ b .Y. ,.. t 1 01.?F'i ' .u° : .,h s 1:: ' .. s s: I i {_ { 2 }i
rr.
•
• � .
STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES
—''':',CONCERNING THE CONTRACTORS' LICENSING LAWS
[Business 8 Professions Code§7028.15]
[Public Contract Code§20103.5]
I,the undersigned, certify that I am aware of the following provisions ofCalifomia 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 x r; _
s + "
Business 8 Professions Code§702815
(a); ; It is a misdemeanor for any person to submit a bid to a public agency in order to engage in
the business`or ad in,the capacity of a contractor within this state without having a license therefor, except in
- . any of the following cases s <
{
(1) The person is particularly exempted from this chapter. r c
(2) The bid is submitted on a state project governed by Section 10164 of the Public
Contract Code or on any local agency project govemed 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 fumished 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
CONTRACTOR TO SUBMIT UPON AWARD 6111
Z.FY 97-98 MAIN STREET IMPROVEMENT PLAN,RESTROOM PROJECTS.
k p
411 •
. •
license status of any person or contractor and the board failed to respond to the inquiry within three business
days: For purposes of this section,itelephene response by the board shall be deemed Sufficient
ii;:iiii‘i:c :,±,-;.?,::::':t.;;,...•. 2. .r,,i.4%i'-'
. . .
Public Coirt—act Code§20103.5:
?r-,P3c1rit'all contracts subject to?-this part Where-.tide:Lel'filicdi,iiii invol■fddE;ne:tiid submitted shall be -...
imralidatedftY.the-failike of the bidder to be licensed in lacOriiinceivith the laws of this atet6.-1-loWever;oty
7 - the time the contract is awarded,the contraCtOtahall be properly licensed in accordance with the laws of thia'A
. -• state. The first payment for work material under:any contract-shall not be made. unless and until the,
Registrar of Contractors verifies to the agency that the records of the'dOntraqtars'- tatarlicenae'Bgards
• indicate that the contractor was properly. licensed at the time the contract was awarded.-; Any bidder or
Contractor 661'So-licensed shall be.iubjecito ali'lebal'pehaltieS iMpOilci by law not limited to,„
--• any';aripropicatevdiscipliriary action by lidenie(Bbaia?,Tte'6gen 61siallnaude-at i
statement to that effect in the standard form of prequalification questionnaire and financial'statemgii.sFailure;
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 retiiit in'theiorfeitUi.inf the Sianitinf the bidder.
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License no.: 3 53 q Class: --D- • Expiration date: 7 SI/ // ..2)37, ticr-,•,..,cti
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WORKER'S COMPENSATION
CERTIFICATE OF INSURANCE
WHEREAS;the CITY OF SEAL BEACH has required certain insurance to be provided by
STATE COMPENSATION INSURANCE FUND
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:
TOP DESIGN BUILDER
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
1473129-98 12/01 /98 12/01 /99
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 Cleric of the
CITY OF SEAL BEACH.
I 6rized Representative
� rt >� CONTRACTOR TO SUBMIT UPON AWARD 615
FY 97:48 MAIN STREET IMPROVEMENT PLAN,RESTROOM PROJECTS ^'
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ADDITIONAL INSURED ENDORSEMENT
COMPREHENSIVE GENERAL LIABILITY.
•
TOP DESIGN BUILDER
Name and address of named insured('Named Insured:
CREDIT GENERAL INSURANCE COMPANY
Name and address of Insurance Company('Company)
MAIN STREET IMPROVEMENT PLAN, CITY HALL &PIER RESTROOMS
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 limit's 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 contrail 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
10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to
waive, atter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached.
a CONTRACTOR TO SUBMIT UPON AWARD:0.16
b4": G ,, , , FY 97-98 MAIN STREET IMPROVEMENT PLAN,RESTROOM PROJECTS
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TYPE OF COVERAGES TO WHICH POLICY PERIOD ' LIMITS OF '
THIS ENDORSEMENT ATTACHES FROM/TO? ' ' • " LIABILITY •
•
. 11 /17/98 — 11 /17/99 $1000 , 000
. .
11. ,Scheduled Items or locations are to be identified on an attached sheet The following Inclusions relate to the -
above coverages. Includes:
O Contractual Liability 0 Explosion Hazard
O Owners/Landlords/Tenants •, :Collapse Hazard ,
O Manufacturers/Contractors 0 Underground Property Damage
O Products/Completed Operations 0 Pollutien Liability r
• Broad Form Property Damage „ 0 Liquor
O Extended Badilyfnjury' . , _ 0
O Broad Form Comprehensive '
0/
General Liability Endorsement
12. Arldeductible or 0 self-insured retention(check one)of$
-NONE. 1 , 000 applies to •all
coverage(s)except .
(if none so state) The deductible is applicable ET per claim or o.per occurrence(check one)
13. This is an El occurrence or 0 claims made poli y(check one).
141 Thia'enderaiment is eurcilve.en at 12:01AM.and forms a part of Policy,
Number
YOUNG HOON JUNE
(pant 1 hereby deClate under'penalty of perjury under.the laws of the State of California; thatil.,have,the.authority to;bind the
Conipany to this endorsement and that by my axeeirtiOn heleirt.I do so bind the CoMpany.
E&:-'aLifaii,. c, NOVEMBER 17 g8
,./frgria re of Authorized Representative " . , .
(Original signature only no facsimile'signature Aoi signature accepted)
Phone No.: ( 213) 368-5200
: ' . . COPffRAOR TO SUBMIT UPON AWARD: 17
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•:-.1,.::: 13f4t:17,1.001;4.Z.4)tfCir:-;:.-•-:61.97-S8 MAJN*STREET IMPFtOVEMENT PLAN,RESTROOM PROJECTS 7.:;;;;<::;-:;j.
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.. ADDITIONAL INSURED ENDORSEMENT
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EXCESS LIABILITY
TOP DESIGN BUILDER
Name and address of named insured('Named Insured:
UNITED .NATIONAL INSURANCE COMPANY
Name and address of Insurance Company('Company):
MAIN STREET IMPROVEMENT PLAN, CITY HALL & PIER RESTROOMS
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'naintained 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 provisions)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. 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 8t Street
Seal Beach CA 90740
9. 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.
. .. -`. :; CONTRACTOR TO SUBMIT UPON AWARD:D-20": '.
:S FY 97-98 MAIN STREET IMPROVEMENT PLAN,RESTROOM PROJECTS s" p
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TYPE OF COVERAGES TO WHICH_: POLICY PERIOD
LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO
LIABILITY
11 /16/98 - 11 /12/99
❑ Following Form
❑ Umbrella Uabifrty
Q EXCESS COVERAGE
10. Applicable underlying coverages:
INSURANCE COMPANY POLICY NO.
AMOUNT
UNITED NATIONAL INSURANCE COMPANY XTP 59139'
$1 , 000, 000
11. The following inclusions, exclusions, extensions or specific provisions relate to the above
coverages:
12. A❑deductible or❑self-insured retention(check one)of$ applies
to all coverage(s)except
NONE (if none so state). ,The deductible is applicable❑per claim or❑per.occurrence(check one).
13. This is an® occurrence or❑ claims made policy(check one).,.
14. This endorsement is effective on 1 1 /17/9%)12:01 AM.and forms a pert of Policy Number
YOUNG f BOON 'JUNE
(pent 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 Nov. 17 19 98
Signatur: of Aut orized Representative
(Original signature only,no facsimile signature or initialed signature accepted) ,
PhoneNo.: ( 213 ) 368-5200
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CONTRACTOR TO SUBMIT UPON AWARD:D-21
FY 97.98 MAIN STREET IMPROVEMENT PLAN,RESTROOM PROJECTS_1' c
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