CONTRACT 7087 - PERM One Page Service Agreement CLOSEDAgreement No. 7087
ervices Agreement
CONTRACTOR: VOLLIAMS PIPELINE CONTRACTORS INDATE: August 2024
Below you will find a checklist relating to Insurance and other requirements that are required for doing business with the City of El
Segundo. Only those items checked -off are MANDATORY, however if your standard policies exceed the minimum requirements please
include, Commercial general liability insurance must meet or exceed the requirements of ISO-CGL Form No. CG 20 10 1185 or
equivalent. The amount of insurance set forth below will be a combined single limit per occurrence for bodily injury, personal injury, and
property damage for the policy coverage. Liability policies will be endorsed to name the City, its, officials, and employees as
"additional insureds" under said insurance coverage and to state that such insurance will be deemed "primary" such that any
other Insurance that may be carried by the City wail be excess thereto. Such Insurance must be on an "occurrence," not a
"claims made," basis and Will not be cancelable or subject to reduction except upon thirty (30) days prior written notice to the
City. Please find additional Terms and Conditions on the reverse side of this Services Agreement, This is not a purchase order or
an authorization to begin work.
Com2rehlosive General _LLbLillty, including coverage for premises, products and completed operations, independent contractors,
personal injury and contractual obligations with combined single limits of coverage of at least ELOO 0.00 per occurrence.
Auto Liability, including owned, non -owned and hired vehicles with at least:
0 $1,000,000 per occurrence.
El El OU00 - 300,00,01 per occurrence.
El As required by State Statutes. A copy of your current policy must be submitted naming yourself and or your company.
Workers, ComiDensation Insurance: as required by State Statutes with Waiver of Subroation (Not needed if Self-employed with
no employees and CONTRACTOR signs statement to this effect.)
Business License: The CONTRACTOR shall agree to have a current City of El Segundo license on file at City Hall or purchase
said license (at no cost to the City).
❑ Eermfts: Plans must be approved and permit(s) issued (no fee) by the Planning and Building Safety if appropriate. Call the
Planning Manager @ (310) 524-2340 if you have questions.
El 032yof valid to re LID. (Drivers license etc.)
PLEASE NOTE: ALL APPLICABLE INFORMATION LISTED ABOVE MUST BE OBTAINED AND ON FILE, PRIOR TO THE ISSUANCE OF A CITY
PURCHASE ORDER BEING SENT TO YOU (VIA FAX OR HARD COPY) BY THE PURCHASING AGENT, THUS AUTHORIZING COMMENCEMENT OF
WORK FOR THE CITY.
Submitted by (coMgleLe all blank C01. OR COPY REWRED IBACIK 7`0 THE CITY
Company Name: By (Print name & tide):
WILLIAMS PIPELINE CONTRACTORS, INC. VICTOR HERNANDEZ, PRESIDENT 8 LOYE BARTQN4 lWAMS, SECRETARY/
Company Street Address: V91 is A on ed Signature required. TRESURER
10200 SEPULVEDA BLVD,, #255 ► yp-�
City, State, Zip: Datd'signed: L�l
MISSION HILLS, CA 91345 8/22/24
Phone: FAX:
805-386-2393
Vendor's Email address: Vendor's Web site:
VICTOR@WILLIAMSPIPE.COM
Vendor's Web �sfte.
Originator/Department Contact: AR AtrNE BCOLA 8EN1tR ENtINEERASSOCNAT Date initiated:
Department Head Approval:I..
ELGAS 8AS80N ItrBLIC wCiRS DItECTOR Date Approved: Z 2
lnsuranGeMat Dateknrove&
City Attorney V City Manager City Clerk
PW 24-11 Contract Revised 4/4124
Agreement No. 7087
1.GENERALLY. The materials, supplies, or services (collectively,
"Purchase") covered by this services agreement and purchase order
("order") must be furnished by Seller subject to all the terms and
conditions contained in this order which Seller, in accepting this order,
agrees to be bound by and comply with in all particulars. No other terms
or conditions are binding upon the parties unless subsequently agreed to
in writing. Written acceptance or shipment of all or any portion of the
Purchase covered by this order constitutes unqualified acceptance of all
terms and conditions in this order. The terms of any proposal referred to
in this order are included and made a part of the order only to the extent
it specified the Purchase ordered, the price, and the delivery, and then
only to the extent that such terms are consistent with the terms and
conditions of this order.
2.INSPECTION. The Purchase furnished must be exactly as specified in
this order, free from all defects in Seller's performance, design,
workmanship, and materials, and, except as otherwise provided, is
subject to inspection and test by City at all times and places. If, before
final acceptance, any Purchase is found to be incomplete, or not as
specified, City may reject it, require Seller to correct it without charge, or
require delivery of such Purchase at a reduction in price that is equitable
under the circumstances. If seller is unable or refuses to correct such
items within a time deemed reasonable by City, City may terminate the
order in whole or in part. Seller bears all risks as to rejected Purchases
and, in addition to any costs for which Seller may become liable to City
under other provisions of this order, must reimburse City for all
transportation costs, other related costs incurred, or payments to Seller
in accordance with the terms of this order for unaccepted Purchases.
Notwithstanding City's acceptance of any Purchase, Seller is liable for
latent defects, fraud, or such gross mistakes as constitute fraud.
&CHANGES. City may make changes within the general scope of this
order in drawings and specifications for specially manufactured supplies,
place of delivery, method of shipment or packing of the order by giving
notice to Seller and subsequently confirming such changes in writing. If
such changes affect the cost of or the time required for performance of
this order, an equitable adjustment in the price or delivery or both must
be made. No change by Seller is allowed without City's written approval.
Any claim by Seller for an adjustment under this section must be made
in writing within thirty (30) days from the date of receipt by Seller of
notification of such change unless City waives this condition in writing.
Nothing in this section excuses Seller from proceeding with performance
of the order as changed.
4. TERMINATION. City may terminate this order at any time, either
verbally or in writing, with or without cause. Should termination occur,
City will pay Seller as full performance until such termination the unit or
pro rata order price for the performed and accepted portion of the
Purchase. City may provide written notice of termination for Seller's
default if Seller refuses or fails to comply with this order. If Seller does
not cure such failure within a reasonable time period, or fails to perform
the Purchase within the time specified (or allowed by extension), Seller
will be liable to City for any excess costs incurred by City.
5.TERM 1 TIME EXTENSION. This Agreement's term will be from
AUGUST 26, 2024 to JUNE 30, 2025 City may extend the time for
completion if, in City's sole determination, Seller was delayed because of
causes beyond Seller's control and without Seller's fault or negligence.
In the event delay was caused by City, Seller's sole remedy is limited to
recovering money actually and necessarily expended by Seller because
of the delay; there is no right to recover anticipated profit.
&REMEDIES CUMULATIVE. City's rights and remedies under this order
are not exclusive and are in addition to any legal rights and remedies.
7.TITLE. Title to materials and supplies purchased under this order
pass directly from Seller to City upon City's written acceptance following
an actual inspection and Cii 'S o portunity to reject.
&PAYMENT. City will pay Seller after receiving acceptable invoices for
materials and supplies delivered and accepted or services rendered and
accepted. City will not pay cartage, shipping, packaging or boxing
expenses unless specified in this order. Drafts will not be honored.
9.INDEMNIFICATION. Seller agrees to indemnify and hold City
harmless from and against any claim, action, damages, costs (including,
without limitation, attorney's fees), injuries, or liability, arising out of the
Purchase or the order, or their performance. Should City be named in
any suit, or should any claim be brought against it by suit or otherwise,
whether the same be groundless or not, arising out of the Purchase or
order, or their performance, Seller will defend City (at City's request and
with counsel satisfactory to City) and indemnify City for any judgment
rendered against it or any sums paid out in settlement or otherwise. For
purposes of this section "City" includes City's officers, elected officials,
and employees. It is expressly understood and agreed that the
foregoing provisions will survive termination of this order. The
requirements as to the types and limits of insurance coverage to be
maintained by Seller, and any approval of such insurance by City, are
not intended to and will not in any manner limit or qualify the liabilities
and obligations otherwise assumed by Seller pursuant to this order,
including, without limitation, to the provisions concerning indemnification.
10.WARRANTY. Seller agrees that the Purchase is covered by the
most favorable commercial warranties the Seller gives to any customer
for the same or substantially similar supplies or services, or such other
more favorable warranties as is specified in this order. Warranties will
be effective notwithstanding any inspection or acceptance of the
Purchase by City.
11.ASSIGNMENT. City may assign this order. Except as to any
payment due under this order, Seller may not assign or subcontract the
order without City's written approval. Should City give consent, it will not
relieve Seller from any obligations under this order and any transferee or
subcontractor will be considered Seller's agent.
12.INSURANCE. Seller must provide the insurance indicated on the
face sheet of this Services Agreement.
13.PERMITS. Seller must procure all necessary permits and licenses,
and abide by all federal, state, and local laws, for performing this order.
%INDEPENDENT CONTRACTOR. City and Seller agree that Seller
will act as an independent contractor and will have control of all work
and the manner in which is it performed. Seller will be free to contract
for similar service to be performed for other employers while under
contract with City. Seller is not an agent or employee of City and is not
entitled to participate in any pension plan, insurance, bonus or similar
benefits City provides for its employees. Any provision in this order that
may appear to give City the right to direct Seller as to the details of doing
the work or to exercise a measure of control over the work means that
Seller will follow the direction of the City as to end results of the work
only.
15.WAIVER. City's review or acceptance of, or payment for, work
product prepared by Seller under this order will not be construed to
operate as a waiver of any rights City may have under this Agreement or
of any cause of action arising from Seller's performance. A waiver by
City of any breach of any term, covenant, or condition contained in this
order will not be deemed to be a waiver of any subsequent breach of the
same or any other term, covenant, or condition contained in this order,
whether of the same or different character.
16.INTERPRETATION. This Agreement was drafted in, and will be
construed in accordance with the laws of the State of California, and
exclusive venue for any action involving this agreement will be in Los
Angeles County.
17. PREVAILING WAGES. If required by applicable state law including,
without limitation Labor Code §§ 1720 (as amended by AB 975 (2001)),
1771, 1774, 1775, and 1776, Seller must pay its workers rev�
PW 24-11 Contract
Agreement No. 7087
wage. It is Seller's responsibility to interpret and implement any
prevailing wage requirements and Seller agrees to pay any penalty or
civil damage resulting from a violation of the prevailing wage laws. In
accordance with Labor Code § 1773.2, copies of the prevailing rate of
per diem wages are available upon request from City's Engineering
Division or the website for State of California Prevailing wage
determination at hitp:/lwww.dir.ca. ov/DLSRJP' D. A copy of the
prevailing rate of per diem wages must be posted at the job site.
18. ARTIFICIAL INTELLIGENCE. Seller must not utilize, employ, or
incorporate any form artificial intelligence, machine learning, or other
similar technologies (collectively, "Al") in the provision of professional
services in this Agreement without City's express written consent. The Al
prohibition set forth directly above will not apply to general business
tools and software that may have Al components but are not directly
involved in the execution or delivery of professional services that this
Agreement covers, provided that such tools and software do not
significantly impact the quality or nature of such services. Seller must
promptly notify City, in writing, of any proposal to employ Al in
connection its provision of services to the City under this Agreement.
City will have the sole discretion to grant or deny such proposal.
19. ELECTRONIC SIGNATURES; SIGNATURE AUTHORITY. In
accordance with Government Code §16.5, the parties agree that this
Amendment will be considered signed when the signature of a party is
delivered by electronic transmission. Such electronic signature will be
treated in all respects as having the same effect as an original signature.
Seller warrants that its signatory (or signatories, as applicable) to this
Agreement has the legal authority to enter this Agreement and bind
Licensor accordingly.
20. CONSISTENCY. In interpreting this Agreement and resolving any
ambiguities, this Agreement takes precedence over any attached exhibit
with conflicting provisions.
21. CONSIDERATION. As consideration, City agrees to pay Seller for
Seller's services not to exceed a total of $90,000 for the work. City will
pay for work as specified in the attached Exhibit "A," which is
incorporated by reference.
22. EXHIBITS. Refer to attached Exhibit "A"
PW 24-11 Contract
Agreement No. 7087
EXHIBIT A
CONTRACTORS LICENSE 353528
P.O Box 951031
Mission Hills, CA 91395
P:805-386-2393
F:805-386-3047
Item Description
I EMERGENCY CALL OUT TO INVESTIGATE SINKHOLE;
BROKEN 18" RCP STORM DRAIN AT A JOINT.
2 TRAFFIC CONTROL SET UP 24HRS.
REPAIR 18" RCP STORM DRAIN LATERAL AT A DEPTH
3 OF 24± FEET; REQUIRED SHORING ENGINEER PLAN;
LJSE OF SHORING E UIPMENT PER PLAN.
REPAIR WILL REQUIRED TO EXPOSE THE ENTIRE
4 SECTION OF BROKEN PIPE AND RESET PIPE WITH A
NEW CONCRETE COLLAR AT JOINT
PROPOSAL INCLUDES; LABOR, MATERIALS,
' EQUIPMENT
I
Estimate #: 2024783
Estimate 8/22/2024
Work Order
Grand Ave / Indiana St 18" RCP
Job: SD Repair
Company: City of El Segundo
Name: Arianne Bola
Address: 350 Main Street
City/State/Zip: El Segundo, CA 90245
Unit I QTY Unit Price Item Total
LS 1 $90,000.00
TOTAL (TIME
AND
MATERIAL' $90,000.00
NOT TO
Agreement No. 7087
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08/28/24 AT 12:36PM
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TAXES:
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PAID: 47.00
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Agreement No. 7087
RECORDING REQUESTED BY Cl'! of C:! --lei
WHEN RECORDED MAIL TO: //�� / ¢
NAME °dIIQ{Ms 1 ipe-6 a W�-j4tVcty,-j, .1.i"G-
MAILING ADDRESS I0-200 SeplVeda r &J; "-AI ` `yr
CRY, STATE and ZIP CODE
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08128/2024
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SPACE ABOVE THIS LINE RESERVED FOR RECORDER'S USE
TITLE(S)
9015re, 20 i'1228
Agreement No. 7087
LABOR AND MATERIALS BOND
EMERGENCY STORM DRAIN REPAIR AT GRAND AVE. AND INDIANA ST.
PROJECT NO.: PW 24-11
Bond No. 2353183
Bond Fee: $1,231.00
Williams Pipeline Contractors Inc. . as principal
("PRINCIPAL") and Swiss Re Corporate Solutions America Insurance Corporation x a
corporation
incorporated under the laws of the State of Missouri and licensed by the State
of California to execute bonds and undertakings as sole surety, as surety ("SURETY"), are held
and firmly bound unto the CITY OF EL SEGUNDO ("CITY") in the sum of Ninety Thousand
Doll rs ($90 00.00), lawful money of the United States, which may be increased or decreased
by a rider hereto executed in the same manner as this bond, for the payment of which sum
PRINCIPAL and SURETY bind themselves, their successors, and assigns, jointly and severally,
by this instrument.
This bond is conditioned upon and guarantees payment by PRINCIPAL to contractors,
subcontractors, and persons renting equipment; payment by PRINCIPAL and all PRINCIPAL'S
subcontractors for all materials, provisions, provender, or other supplies, and equipment used in,
upon, for or about the performance of the work contemplated in EMERGENCY STORM
DRAIN REPAIR AT GRAND AVE. AND INDIANA ST. PROJECT, SPECIFICATIONS
NO. PW 24-11 ("Public Project"), the public works contract executed for such Public Project,
and for all work or labor of any kind performed for the Public Project. In the case of any default
in the performance of the conditions and stipulations of this undertaking, it is agreed that
PRINCIPAL or SURETY will apply the bond or any portion thereof, to the satisfaction of any
damages, reclamation, assessments, penalties, or deficiencies arising by reason of such default.
BOND CONDITIONS
1. PRINCIPAL will construct the public improvements identified in
SPECIFICATIONS NO. PW 24-11, and the public works contract executed for such
Specifications, copies of which is on file with CITY's Engineering Division ("Public Project").
Such performance will be in accordance with CITY's plans and profiles (CITY DRAWING
FILE NO. PW 24-11), which are made a part of this bond when said plans and profiles are
approved by the City Council and filed with CITY's Engineering Division.
2. PRINCIPAL will pay all contractors, subcontractors, and persons renting
equipment.
3. PRINCIPAL will pay for all materials and other supplies, for equipment used in,
on, for or about the performance of the Public Project, and will pay for all work and labor
I-F-1
Agreement No. 7087
thereon.
4. This bond is conditioned upon and guarantees due compliance with all applicable
law including, without limitation, the El Segundo Municipal Code ("ESMC").
5. SURETY, for value received, agrees that no changes, extensions of time,
alteration or modification of SPECIFICATIONS NO. PW 24-11, or of the obligation to be
performed will in any way affect its obligation on this bond, and it waives notice of any such
change, extension of time, alteration or modification of the contract documents or of the
obligation to be performed.
6. This bond consists of this instrument; the plans and specifications identified
above; and the following TWO (2) attached exhibits all of which are incorporated herein by
reference:
A. A certified copy of the appointment, power of attorney, bylaws or other
instrument entitling or authorizing the persons executing this bond to do so;
and
B. A certificate issued by the county clerk for the county in which SURETY's
representative is located conforming with California Code of Civil Procedure
§ 995.640 and stating that SURETY's certificate of authority has not been
surrendered, revoked, cancelled, annulled, or suspended, or in the event that
it has, that renewed authority has been granted.
7. Should PRINCIPAL perform its obligations within the time allowed,
PRINCIPAL's obligation will be void upon the acceptance of the performance by CITY;
otherwise this obligation will remain in full force and effect.
[SIGNATURES ON FOLLOWING PAGE]
30G So4ca►%61 5f-
El S{ga.nJo CA Cj 02-4
I-F-2
Agreement No. 7087
SIGNED AND SEALED this 23rd day of August _ 20 2
;�Iil�:aens !?pe-t;^e- e,0A+,`Ar-t4rs, bLA)iES L* Cviporckfe 5c,4++,,cAS
ve�' ZA4,� X. i
PRINCIPAL's P lDl :NT, victor Hernandez SURETY's P"WAFYW
\ 1-51, IV X Cheryl L. Thomas, Attorney -in -Fact
---Wes---
P l�.IPAL's SECRETARY, Loye Barton -Williams SURETY's SECRETARY
PRINCIPAL's MAILING ADDRESS: SURETY's MAILING ADDRESS:
10200 Sepulveda Blvd., Suite 255 777 S. Figueroa St., Suite 3700
Mission Hills, CA 91345 Los Angeles, CA 90017
NOTE: (1) ALL signatures must be acknowledged by a notary public.
Return one (1) original to City Clerk's Office.
(2) Bond shall be effective for one (1) year after acceptance of the job
I-F-3
Agreement No. 7087
ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange }
On AG 3 before me, Beata A. Sensi, Notary Public
ere nnerd iname affd fifle of the o cer
personally appeared Loye Barton -Williams
who proved to me on the basis of satisfactory evidence to be the person* whose
names) is/a-e subscribed to the within instrument and acknowledged to me that
i•rte/she/threy executed the same in Hs/her/# teif authorized capacity0es), and that by
fits/herMtei signature* on the instrument the person*, or the entity upon behalf of
which the person* acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
SEATA A. SENSE M
W SS my hand d officii . 39401
LU
NOTARY PUBLIC CAI.IFf71�W 0 ORANGE COUNTY
M'Y CC MM, its Fphnmry 15,
Notary tt 1p tgrtature (Notary Public Sea[)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
etcL Ja3- ...........................
..._.
(Title or description of attached document)
Williams Pipeline Contractors, Inc.
(title or descrip bon of attached document continued)
Number of Pages Document Date a
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
21 Corporate Officer
Secretarv/T reasurer
(Title)
❑ Partner(s)
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
if needed, should be completed and attached to the document. Acknolwedgents from
other states may be completed for documents being sent to that state so long as the
wording does not require the California notary to violate California notary law.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization,
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/theme is /ate ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document with a staple.
Agreement No. 7087
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of orange
On August 23, 2024 before me, Susan E, Morales„ Notary Public
CI"C` tl9SATMP {YaPA'L� �d1�1 dptl&�' � gMYb CIA I�t
personally appeared Victor Hernandez ,
who proved to me on the basis of satisfactory evidence to be the persons} whose
names) isiefe subscribed to the within instrument and acknowledged to me that
he/she hey executed the same in hisAier/their authorized capacity6esj, and that by
his heFAheR signature(s) on the instrument the person(s), or the entity upon behalf of
which the personW acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
SUSAN E. MORALES m
WITNESS my hand and official seal. Q COMM. #2444309 _J
1-- NOTARY PUBLIC- CALIFORNIA 0
W ORANGE COUNTY
MY COMM. Expires April 14, 2027
Notary Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Bond #2353183
(Title or description of attached document)
Williams Pipeline Contractors, Inc.
(Title or description__of attached document continued)
Number of Pages Document Date 8/23/24
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
0 Corporate Officer
President
(Title)
171 Partner(s)
0 Attorney -in -Fact
❑ Trustee(s)
❑ Other
2015 `.version vd�,vw.NotaiyClasses corn 800-8'3-9865
INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
if needed, should be completed and attached to the document. Acknolwedgents from
other states may be completed for documents being sent to that state so long as the
wording does not require the California notary to violate California notary law.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/they,— is /are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
4. Indicate title or type of attached document, number of pages and date.
. Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document with a staple.
Agreement No. 7087
ALL,- PURPOSE I
CERTIFICATE OF ACKNOWLEDGMENA
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Orange }
Public
i e�ee��pr
On August 23, 2024 ,before me, Susan E. Morales, No�tae� title ot the onicer)
personally appeared Cheryl L. Thomas
who proved to me on the basis of satisfactory evidence to be the person{sj whose
named is/afe subscribed to the within instrument and acknowledged to me that
h%_-/she/tom executed the same in iffs/her/#vei-r authorized capacity{iesj, and that by
iris/herttheif signature* on the instrument the person*, or the entity upon behalf of
which the personal acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
SUSAN E. MORALES m
WITNESS my hand and official seal. U #2444309 �
F— NOTARY PUBLIC- CALIFORNIA 0
W ORANGE COUNTY
comm.MY COMM. Expires April 14, 2027
Notary Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
Bond #2353183
(Title or description of attached document)
Swiss Re Corporate Solutions America Ins. Corp.
p �.�_..,-�.�............ ......... �............_.......� �...........
itle or descri ion of attached document continued)
Number of Pages Document Date
8232
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
(Title)
❑ Partner(s)
0 Attorney -in -Fact
❑ Trustee(s)
❑ Other
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if needed, should be completed and attached to the document. Acknolwedgents from
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Agreement No. 7087
Swiss Re Corporate Solutions America Insurance Corporation
Electronic Corporate Seal
Please read through the below Usage Guidelines for our Electronic Corporate Seal:
1) This Electronic Corporate Seal has been provided for convenience. Swiss Re Corso cannot
provide assurance that specific obligees will, or will not, accept an Electronic Corporate Seal. The
preferred method remains a physically affixed seal. The Electronic Corporate Seal is used at the
discretion of your Agency or Brokerage, and Swiss Re Corso disclaims any liability if the use of the
Electronic Corporate Seal results in any instrument being rejected or challenged,
2) The Electronic Corporate Seal can only be used for electronically affixing a seal to a surety
bond, or related instrument, that has been authorized by Swiss Re Corso and is being executed
on behalf of Swiss Re Corso by your Agency or Brokerage pursuant to a valid Power of Attorney;
3) Your Agency or Brokerage may not transfer an Electronic Corporate Seal to any other entity or
person without the written consent of Swiss Re Corso,
4) Swiss Re Corso may revoke permission to use the Electronic Corporate Seal at any given time;
and
5) Any use of the Electronic Corporate Seal outside of the above described guidelines is not
authorized
Agreement No. 7087
No. 3208-6
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE
OAKLAND
Amended
Certificate of Authority
THIS IS TO CERTIFY that, pursuant to the Insurance Code of the State of California,
Swiss Re Corporate Solutions America Insurance Corporation
of Missouri, organized under the laws of Missouri, subject to its Articles of Incorporation or other
fundamental organizational documents, is hereby authorized to transact within this State, subject to all
provisions of this Certificate, the following classes of insurance:
Fire, Marine, Surety, Disability, Plate Glass, Liability, Workers' Compensation,
Boiler and Machinery, Burglary, Sprinkler, Automobile and Aircraft
as such classes are now or may hereafter be defined in the Insurance Laws of the State of California.
THIS CERTIFICATE is expressly conditioned upon the holder hereof now and hereafter being in
full compliance with all, and not in violation of any, of the applicable laws and lawful requirements made
under authority of the laws of the State of California as long as such laws or requirements are in effect
and applicable, and as such laws and requirements now are, or may hereafter be changed or amended.
IN WITNESS WHEREOF, effective as ofthe 7' day of June, 2022,
1 have set my hand and caused my official seal to be affixed this
7'h day of June, 2022.
Ricardo Lara
Insurance Commissioner
-V�L, 4"gE-
By Valerie J. Sarfaty
for Catalina Hayes -Bautista
Insurance Chief Depuly
NOTICE:
Qualification with the Secretary of State must be accomplished as required by the California Corporations Code promptly after
issuance of this Certificate of Authority. Failure to do so will be a violation of Insurance Code section 701 and will be grounds
for revoking this Certificate of Authority pursuant to the covenants made in the application therefor and the conditions
contained herein.
Agreement No. 7087
SWISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC")
WESTPORT INSURANCE CORPORATION ("WIC")
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint:
TODD M. ROHM, CATHY S. KENNEDY, BEATA A. SENSI, CHERYL L. THOMAS, WRENETTA WALKER, and SHANE WOLF
JOINTLY OR SEVERALLY
Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of:
FIFTY MILLION ($50,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its
Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant
Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of
Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to
attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to
any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
bindlnu upon the Corporation when so affixed and in the future with reeard to anv bond, undertaking or contract of surety to which it is attached."
Ms ray tie
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BY
Erik Janssens, Senior Vice President of SRCSAIC &Senior Vice President , L
M .' orSRCSPIC & Semor Vice President of WIC
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drr Gerald Jagrowski, Vice President orSRCSAIC &Vice President of SRCSPIC
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IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this 10 day of NOVEMBmmER... , 20 22
Swiss Re Corporate Solutions America Insurance Corporation
Skate of Illinois; Swiss Re Corporate Solutions Premier Insurance Corporation
County of Cook ss Westport Insurance Corporation
On this 10 day of- NOVEMBE1 _, 20 22 before me, a Notary Public personally appeared tiri nti-°ns , Senior Vice President of SRCSAIC
and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Oeratd Jagwwvsk, , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of WIC, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney
as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies.
I, Jr ttrt y%'oldlscr ,, the duly elected Senior Vice PresidentandAssistant Secrete of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and
foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 23rd day of AUGUST 2024
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC