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CONTRACT 3970 Public Works Contract CLOSED0ARA-L' PUBLIC WORKS CONTRACT BETWEEN THE CITY OF EL SEGUNDO AND INTERNATIONAL PAVEMENT SOLUTIONS, INC. This CONTRACT is entered into this 6th day of Aug, 2009, by and between the CITY OF EL SEGUNDO, a general law city and municipal corporation ( "the City ") and International Pavement Solutions, Inc. ( "the Contractor"). 1. WORK. A. The Contractor will provide all work required by the Contract Documents (the "Work "). The Contractor agrees to do additional work arising from changes ordered by the City in accordance with the Contract Documents. B. The Contractor and the City agree to abide by the terms and conditions contained in the Contract Documents; C. The Contractor will furnish all of the labor; supplies and materials; equipment; printing; vehicles; transportation; office space and facilities; all tests, testing and analyses; and all matters whatsoever (except as otherwise expressly specified to be furnished by the City) needed to perform and complete the Work and provide the services required of the Contractor by the Contract Documents. D. "Contract Documents" means the Notice Inviting Bids; Instructions to Bidders; Supplementary Instructions to Bidders; Proposal; this Contract; Standard Specifications; Supplementary Conditions; Exhibits; Technical Specifications; List of Drawings; Drawings; Addenda; Notice to Proceed; Change Orders; Notice of Completion; and all other documents identified in the Contract Documents which together form the contract between the City and the Contractor for the Work. The Contract Documents constitute the complete agreement between the City and the Contractor and supersede any previous agreements or understandings. 2. CONTRACT SUM. The City agrees to pay the Contractor a sum not to exceed ONE HUNDRED SIX THOUSAND, SIX DOLLARS AND ZERO CENTS ($106,006.00) for the Work in the manner set forth in the Contract Documents. The City may adjust this amount as set forth in the Contract Documents. 3. TIME FOR PERFORMANCE. A. The Contractor will fully complete the Work within FIFTY (50) working days (the "Contract Time. ") I -D -1 3970•.:..4 B. The Contract Time will commence when the City issues a notice to proceed. The Contract Documents will supersede any conflicting provisions included on the notice to proceed issued pursuant to this Contract. C. The Contractor may not perform any Work until: The Contractor furnishes proof of insurance as required by the Contract Documents; and ii. The City gives the Contractor a written, signed, and numbered purchase order and notice to proceed. D. By signing this Contract, the Contractor represents to the City that the Contract Time is reasonable for completion of the Work and that the Contractor will complete the Work within the Contract Time. E. Should the Contractor begin the Work before receiving written authorization to proceed, any such Work is at the Contractor's own cost and risk. 4. DISPUTES. Disputes arising from this contract will be determined in accordance with the Contract Documents and Public Contracts Code §§ 10240 - 10240.13. 5. THIRD PARTY CLAIMS. In accordance with Public Contracts Code § 9201, the City will promptly inform the Contractor regarding third -party claims against the Contractor, but in no event later than ten (10) business days after the City receives such claims. Such notification will be in writing and forwarded in accordance with the "Notice" section of the Contract Documents. As more specifically detailed in the Contract Documents, the Contractor agrees to indemnify and defend the City against any third - party claim. 6. TAXPAYER IDENTIFICATION NUMBER. The Contractor will provide the City with a Taxpayer Identification Number. 7. PERMITS AND LICENSES. Unless otherwise provided, the Contractor, at its sole expense, will obtain and maintain during the Contract Time, all necessary permits, licenses, and certificates that may be required in connection with the Work. 8. OWNERSHIP OF DOCUMENTS. All documents, data, studies, drawings, maps, models, photographs and reports prepared by the Contractor under the Contract Documents are the City's property. The Contractor may retain copies of said documents and materials as desired, but will deliver all original materials to the City upon the City's written notice. PM 3970 - ,, "A 9. INDEMNIFICATION. The Contractor agrees to indemnify, defend, and hold the City harmless as set forth in the Contract Documents. The requirements as to the types and limits of insurance coverage to be maintained by the Contractor as required by the Contract Documents, and any approval of such insurance by the City, are not intended to and will not in any manner limit or qualify the liabilities and obligations otherwise assumed by the Contractor pursuant to the Contract Documents, including, without limitation, to the provisions concerning indemnification. 10. INDEPENDENT CONTRACTOR. The City and the Contractor agree that the Contractor will act as an independent contractor and will have control of all work and the manner in which is it performed. The Contractor will be free to contract for similar service to be performed for other employers while under contract with the City. The Contractor is not an agent or employee of the City and is not entitled to participate in any pension plan, insurance, bonus or similar benefits the City provides for its employees. Any provision in this Contract that may appear to give the City the right to direct the Contractor as to the details of doing the work or to exercise a measure of control over the work means that the Contractor will follow the direction of the City as to end results of the work only. 11. AUDIT OF RECORDS. The Contractor will maintain full and accurate records with respect to all services and matters covered under this Contract. The City will have free access at all reasonable times to such records, and the right to examine and audit the same and to make transcript therefrom, and to inspect all program data, documents, proceedings and activities. The Contractor will retain such financial and program service records for at least three (3) years after termination or final payment under the Contract Documents. 12. NOTICES. All communications to either party by the other party will be deemed made when received by such party at its respective name and address as follows: The City Maryam M. Jonas Principal Engineer City of El Segundo 350 Main Street, El Segundo, CA 90245 (310) 524 -2361 The Contractor William Max Fisher Vice President International Pavement Solutions, Inc. P.O. Box 10458 San Bernardino, CA 92423 (909) 794 -2101 Any such written communications by mail will be conclusively deemed to have been received by the addressee three (3) days after deposit thereof in the United States Mail, postage prepaid and properly addressed as noted above. In all other instances, notices will be deemed given at the time of actual delivery. Changes may be made in the names or addresses of persons to whom notices are to be given by giving notice in the manner prescribed in this paragraph. I -D -3 3970 • „O -A 13. NO THIRD PARTY BENEFICIARY. This Contract and every provision herein is for the exclusive benefit of the Contractor and the City and not for the benefit of any other party. There will be no incidental or other beneficiaries of any of the Contractor's or the City's obligations under this Contract. 14. INTERPRETATION. This Contract 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 Contract will be in Los Angeles County. 15. EFFECT OF CONFLICT. In the event of any conflict, inconsistency, or incongruity between any provision of the Contract Documents, precedence will be as follows: A. This Contract; B. The Standard Specifications; and C. Precedence of documents as determined in the Standard Specifications. 16. SEVERABILITY. If any portion of the Contract Documents are declared by a court of competent jurisdiction to be invalid or unenforceable, then such portion will be deemed modified to the extent necessary in the opinion of the court to render such portion enforceable and, as so modified, such portion and the balance of this Contract will continue in full force and effect. 17.AUTHORITY /MODIFICATION. The Parties represent and warrant that all necessary action has been taken by the Parties to authorize the undersigned to execute this Contract and to engage in the actions described herein. This Contract may be modified by written amendment. The City's city manager, or designee, may execute any such amendment on the City's behalf. 18.ACCEPTANCE OF FACSIMILE SIGNATURES. The Parties agree that this Contract, agreements ancillary to this Contract, and related documents to be entered into in connection with this Contract will be considered signed when the signature of a party is delivered by facsimile transmission. Such facsimile signature will be treated in all respects as having the same effect as an original signature. 19. COVENANTS AND CONDITIONS. The parties agree that all of the provisions hereof will be construed as both covenants and conditions, the same as if the words importing such covenants and conditions had been used in each separate paragraph. 20. CAPTIONS. The captions of the paragraphs of this Contract are for convenience of reference only and will not affect the interpretation of this Contract. 21. TIME IS OF ESSENCE. Time is of the essence for each and every provision of the Contract Documents. I -D -4 3970•.,614 IN WITNESS WHEREOF the parties hereto have executed this contract the day and year first hereinabove written. CITY OF EL SEGUNDO Ja ayt, City Manag ATTEST: Cindy Mo sen, City Clerk APPROVED A 9, MARK D. HE C' , A By: 'Berger, Assistant City A orr I -D -5 W. Max Fisher, Moe President Taxpayer ID No. 3-1 — U 7/ � S 4� 7 Business License No.: ,Zq 133 3970 - J FAITHFUL PERFORMANCE BOND Bond No. Bond Fee: INTERNATIONAL PAVEMENT SOLUTIONS, INC. ( "PRINCIPAL ") and _ , a corporation incorporated under the laws of the State of 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 ONE HUNDRED SIX THOUSAND, SIX DOLLARS AND ZERO CENTS ($106.006.00) dollars, which is a minimum one hundred percent (100 %) of the contract amount, 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. PRINCIPAL or SURETY will apply this bond for the faithful performance of any and all of the conditions and stipulations set forth in this bond, SPECIFICATIONS NO. PW 09 -07, and the public works contract executed with such Specifications. 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 09 -07, a copy 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. L -1759) 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's work on the Public Project will be done in accordance with CITY's plans and specifications and with any permit issued by CITY. Should PRINCIPAL fail to complete all required work within the time allowed, CITY may, at its sole discretion, cause all required work to be done and the parties executing the bond will be firmly bound for the payment of all necessary costs therefor. 3. PRINCIPAL will guarantee its work against any defective work, labor, or materials on the Public Project for a period of one (1) year following the Public Project's completion and acceptance by CITY. 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 09 -07 or of the obligation to be performed will in any SpecMcabons — ProjectOPW FaMful Performance Bond ( I 103) I -E -1 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; 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; and 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. SIGNED AND SEALED this day of , 20 PRINCIPAL's PRESIDENT SURETY's PRESIDENT PRINCIPAL's SECRETARY PRINCIPAL's MAILING ADDRESS: SURETY's SECRETARY SURETY's MAILING ADDRESS: NOTE: (1) ALL signatures must be acknowledged by a notary public. Return two (2) originals to City Clerk's Office. (2) Bond shall be effective for one (1) year after acceptance of the job. Specifications — Projects %PW Fehhful Performance Bond (I /03) I -E -2 -39 7 0 •1 LABOR AND MATERIALS BOND Bond No. Bond Fee: INTERNATIONAL PAVEMENT SOLUTIONS, INC. , as principal ( "PRINCIPAL ") and , a corporation incorporated under the laws of the State of 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 ONE HUNDRED SIX THOUSAND, SIX DOLLARS AND ZERO CENTS ($106,006.00) dollars, which is a minimum one hundred percent (100 %) of the contract, 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 REHABILITATION OF SYCAMORE PARK PLAYGROUND, SPECIFICATIONS NO. PW 09 -07 ( "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 09- 07,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. L- 1759), 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 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 09 -07, 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. Specifications — Profects%PW Labor Materials Bond ( 1 103) I —F -1 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. SIGNED AND SEALED this day of PRINCIPAL's PRESIDENT PRINCIPAL's SECRETARY PRINCIPAL's MAILING ADDRESS: 20 SURETY'S PRESIDENT SURETY's SECRETARY SURETY's MAILING ADDRESS: NOTE: (1) ALL signatures must be acknowledged by a notary public. Return two (2) originals to City Clerk's Office. (2) Bond shall be effective for one (1) year after acceptance of the job. LABOR AND MATERIALS BOND I -F -2 (0627 102) I -F_2 J r' 0 • .. • .�i PLEASE NOTE: Bidders are required to submit one (1) original and one (1) copy of the proposal forms. PROPOSAL FOR THE REHABILITATION OF SYCAMORE PARK PLAYGROUND IN THE CITY OF EL SEGUNDO SPECIFICATIONS NO.: PW 09 -07 TO THE CITY OF EL SEGUNDO: In accordance with the City of El Segundo's Notice Inviting Sealed Bids, the undersigned BIDDER hereby proposes to furnish all materials, equipment, tools, labor, and incidentals required for the above stated project as set forth in the Plans, Specifications, and contract documents therefor, and to perform all work in the manner and time prescribed therein. BIDDER declares that this proposal is based upon careful examination of the work site, Plans, Specifications, Instructions to Bidders, and all other contract documents. Submittal of this bid shall be considered evidence that the BIDDER has satisfied himself regarding the contract documents, access and any other field conditions which may effect bid prices. If this proposal is accepted for award, BIDDER agrees to enter into a contract with the City of El Segundo at the unit and /or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to the City of El Segundo of the proposal guarantee accompanying this proposal. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE CITY OF EL SEGUNDO RESERVES THE RIGHT TO INCREASE OR DECREASE THE AMOUNT OF ANY QUANTITY SHOWN AND TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and /or lump sum prices bid include all apparent expenses, taxes, royalties, and fees. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. If awarded the Contract, the undersigned further agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within ten working days after the date of the City of El Segundo's notice of award of contract to the BIDDER, including sending by U.S. Mail a Public Works Contract for signature by the Awardee, the proceeds of the security accompanying this bid shall become the property of the City of El Segundo and this bid and the acceptance hereof may, at the City of El Segundo's option, be considered null and void. I -C -1 3�Jl70.60j EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE BIDDER certifies that in all previous contracts or subcontracts, all reports which may have been due under the requirements of any agency, State, or Federal equal employment opportunity orders have been satisfactorily filed, and that no such reports are currently outstanding. AFFIRMATIVE ACTION CERTIFICATION BIDDER certifies that affirmative action has been taken to seek out and consider minority business enterprises for those portions of the work to be subcontracted, and that such affirmative actions have been fully documented, that said documentation is open to inspection, and that said affirmative action will remain in effect for the life of any contract awarded hereunder. Furthermore, BIDDER certifies that affirmative action will be taken to meet all equal employment opportunity requirements of the contract documents. NONCOLLUSION AFFIDAVIT BIDDER declares that the only persons or parties interested in this proposal as principals are those named herein; that no officer, agent, or employee of the City of El Segundo is personally interested, directly or indirectly, in this proposal; that this proposal is made without connection to any other individual, firm, or corporation making a bid for the same work and that this proposal is in all respects fair and without collusion or fraud. ME CITY OF EL SEGUNDO - BID SHEET 39 70 • , , REHABILITATION OF SYCAMORE PARK PLAYGROUND PROJECT NO. PW 09 -07 ITEM ESTIMATED UNIT PRICE UNIT PRICE AMOUNT NO. QUANTITIES WRITTEN IN WORDS IN FIGURES 1 109 LF Construct variable height retaining walls,;. per APWA std 610 -1 type 1 including $ I DS. tV $) wall caps and skate stoppers 2 LS Construct ADA ramp, including $ a $ excavation and grading preparation Uri U 3 49 LF Install galvanized metal hand railing $ $'� per APWA std 606 -1 high $�' 4 61 LF Install 4' galvanized metal railing $ Remove existing sand, rubber surface, l '] '" �---- 5 4712 SF procure and install new poured -in place $ 6 ` rubber surfacing per specifications including sub -grade preparation 6 286 LF Install 6" curb around the poured -in -place $ $ area per APWA std 120 -1 Remove existing concrete pad (6'x29'), 7 LS picnic tables, benches and barbeque racks and install new concrete pad (10'x34'), new $ .- salLv 6 —.— new tables and benches per plans and specifications. (items listed on page I -C -3 (page 2 of 2)) Relocation of existing equipment, procure- ment and installation of playground equipment i (% 6( 8 LS per plans & specifications (items listed on $ tI_b $� page I -C -3 (page 2 of 2) ti TOTAL BID = $ TOTAL BID VVRITTEN IN WORDS u L,oL( cd 44 'h�v. i-11- .f � � � r� 4 / _i it 4 . I -C -3 (page 1 of 2) CITY OF EL SEGUNDO - List of Materials REHABILITATION OF SYCAMORE PARK PLAYGROUND PROJECT NO. PW 09 -07 Ref. No. Model # Description Quantity 1 SWING -1-18 -4 3-leg Heavy-Duty Swing with 4 belt seats, 8' high 1 2 ZZXX1411 6' Bench with Back, Eco -Armor back and seat, painted frame, inground 3 3 1140 -05 Single Galvanized BBQ Grill with 3 -1/2" OD post 1 4 SG115D 8' ADA Accessible Picnic Table, Signature Series, Diamond Pattern, portable /surface mount 1 5 SG106D 6' Picnic Table, Signature Series, Diamond Pattern, portable/ surface mount 1 I -C -3 (page 2 of 2) BIDDER'S INFORMATION BIDDER certifies that the following informaation is true and corre ct: / n Bidder's Name 64 . Form of Legal Entity (i.e., individual, partnership, corporation, etc.) If corporation, State of Incorporation (i.e., California) Ne vG U Business PC) 13UX /o -15F Address San f ei--n arcc i'1 0 bu 02-1-23 Telephone No. 0 , /Q L _ -)- / r) 1 Facsimile No. `-�1 L`�Q -�w/LJ- lCiC State Contractor's License No. and Class C� 2 z tf Original Date Issued I /- / -Q 1 ( Expiration Date The following are the names, titles, addresses, and phone members, partners, joint venturers, and /or corporate officers proposal: �� �._.1' `'_ C��S , numbers of all individuals, firm having rincipal interest in this 0Z`�'L'� �� 909 3Z-0 -w Q 79 Fi5h -CA, Douz C, Vje-y AEG U2. t �1 cr��r The date of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal is as follows: ... . &/ / a'- All current and prior DBA's, aliases, and /or fictitious business names for any principal having an interest in this proposal are as follows: I -C -4 3 9 7 0 • , ,.,, IN WITNESS WHEREOF, BIDDER executes and its this pro sal with the mes, titles, hands, and seals of all aforenamed principals this day of , 20 BIDDER PFJ6,)y nch ? AJ. A4 4V Rr5 -hfkk 1 //O - FT&� ICEPJT Subscribed and sworn to this da o f ea`hmen �w1R�Je �cn no�'N a or iu�zt NOTARY PUBLIC I -C -5 3� / 0 • •A 4 CALIFORNIA JURAT WITH AFFIANT STATEMENT see Attached Document (Notary to cross out lines 1 -6 below) See Statement Below (Lines 1 -5 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 - -- -- - - -- Signature of Document Signer No 2 (If any) State of cal, �rnia County of _ - _ wk 11411,0 0 Subscribed and sworn to (or affirmed) before me on this ql_ day of _ _ __ „ , 20_ U Date " Month �-- Year -' by (1) ).me �11 f TAMMY L PATTON e proved to me on the basis of satisfactory evidence " Commission # 1818445 z to be the person who appeared before me . i ;..m Notary Public -California v z San Bernardino County My Comm. Expires Oct 19, 2012 t (2) 1. Name of Signer proved to me on the basis of satisfactory evidence to be the perso who appeared before me. Signature Place N Tamn LV"! lie - - otary Seal Ahova OPTIONAL. Notary Public Though the infrnmation below is not required by law, it may prove valuable t,, relying On the document and could prevent traudulent removal and reattachment of this forn-i to another document. Further Description of Any Attached Docu"nt t f/_n i6 Title or Type of Document:- _i� Document Date: �,2e /&) - ° . Number of Pages: Signers) Othei Than Named Above: A'6 )L—� ��2007 NaBonal Notary A soclation -11111. Soto Ave., P.O. Box 2402 •Chatsworth, CA 9131&2402 • vaww.NationalNotary.o19 Item 451 10 Reorder �C.11T.11-Free 1- 800 - 878 -6817 39 70 - .:. CONTRACTOR'S LICENSE DECLARATION (Business and Professions Code Section 7028.15) 1. BIDDER'S Contractor's License Number is: w lZ q2 2te Class No.: All?? 2. The exxpiration date of BIDDER'S Contractor License is: Il -Un 20 1C) 3. BIDDER'S acknowledges that Section 7028.15(e) of the Business and Professions Code provides as follows: "A licensed contractor shall not submit a bid to a public agency unless his or her contractor's license number appears clearly on the bid, the license expiration date is stated, and the bid contains a statement that representations herein are made under penalty of perjury. Any bid not containing this information, or a bid containing information which is subsequently proven false, shall be considered non - responsive and shall be rejected by the public agency." The undersigned declares, under penalty of perjury, that the representations made by the undersigned in this bid proposal are true and correct. Executed oi 1� 20_Q.9, at (]jjA� (insert City and State where Declaration is signed). Signature W Max Fisher Typed Name: V A LZ PE � 11D'1 Title: Name of Bidder: 1 -C -7 NON - COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ) ) ss. County of RWL ) being first duly sworn, deposes and say t at he or she is (� of d_,� T MC-. the party making the foregoing bid that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Signature W Max Fisher Typed Name Title MMI Na o i er Date 3970 • 61 .�; CERTIFICATION Section 1861 OF THE LABOR CODE (Workers' Compensation) Pursuant to Section 1861 of the Labor Code, the BIDDER, in submitting his /her PROPOSAL, shall sign the following certification: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' 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." Signature of Bidder: Title: Business Name: pot i- emP1.:111 �?�11 � f � r�'2 � // }c� . Business Address: PV l 04 1z Telephone Number: (q. or /) /"/ 1 /— :) / 0 / Dated this �7 day of , 20 ("1 C11 -C -9 Poured-in-Place Playground UI4ADng . Playground / Recreational Surfacing Quotation Proposal 4530 Brazil St. #2, Los Angeles Calif. 90039 Ph 818 - 502 -2111/ Fx 818 -502 -3331 California Contractors License #:873908 Date: June 29, 2009 Proposal No: 1 Customer: Sq Ft. Estimator Project Name: Project Location: Sycamore Park El Segundo, CA Scope of Work Total" Furnish and install poured rubber surfacing • 2,673/SF at 1.75" (3'cfh) • 676/SF at 3" (6'cfh) • 1,363/SF at 4" (8'cfh) Security: Provided by Owner 50150 Standard Color Mix�'� PrAVailinn wanes I Y s Sales Tax Included 1,633 ]Used Tires Recycled For: Sycamore Park Total $38,152 152 Qualifications • ProDek does not provide base preparation unless noted in the scope of work. • Acceptance of this proposal allows ProDek to provide the client with an installation agreement or retain from the client a purchase order or contract for the scope of work on this proposal. • Accuracy of the information provided is the responsibility of the client or sales representative. • Customer is responsible for project dimensions and quantities projected to ProDek. • Price quoted above includes all Freight, Material, Installation, and Warranty (unless otherwise noted). • Any changes in colors, square footage or depth will cause changes to the price. • Bond not included unless noted above. • All colors amber to a certain extent, some more than others. • This quote expires 60 days from quoted date. Post Installation Head Impact Criteria test not included. Acceptance of Proposal: The above prices, specifications, and conditions are satisfactory and are hereby accepted. Plesae sign and fax back to (8 18) 502.3331 Signature: Date: 90:OT NOW 6009 /6Z /9 T00 /T00' 3 9 7 0 - "A BIDDER'S CERTIFICATION OF SUBCONTRACTORS As detailed in Section 2 -3.1 (Page 11 -B -3) of the City Standard Specifications, Bidder certifies that he has listed below all subcontractors who will perform work in excess of one -half of one percent (1/2 %) of the total bid price or certifies that the bidder is fully qualified to perform and will perform that portion of the work himself. NAME, ADDRESS AND PHONE NUMBER OF SUB1414TRACTORS SUBCONTACTED WORK .P 0. ro txxl Gcr So f^ta_ ( V n t 8h► ! �S'�7x �, ( pbwrfld Lf £30 r-a z- ! ST- -4 Z CSLL�e-� ► -t,Llo b-Gr Sw+r-�� c � lns eAe-S,C:,* q 0 0 e3 0 (Make copies of this page if a ' ' nal space is needed) Signature of adder Date I -C -10 3970•.+. REFERENCES The following are the names, addresses, and telephone numbers for three (3) public agencies for which BIDDER has performed similar work as the prime contractor or major subcontractor within the past two (2) years: tom; j 1. Project Title: 1 d I Lttk� Location: ` me n -h L4 i✓ CM fn aAt4 3Ch00% Name and ddress (6f owner ocll 47LPC L/ / 619 LP / l--19 Name and telephone number of person familiar with project. Type of Work:` Contract amount: $ ��; q° Date completed: Amount of work done by my /our firm under contract $ 9 ,3// 09 Did your firm have any financial interest in Project? 2. Project Title: AA-: Location: PM -& -() Zro �) -a00 i alww"Bwlz � Name antl telephone number of person familiar with project Type of Work: Contract amount: $ aq --� 0 Date completed. Amount of work done by my /our firm under contract $ /30 Did your firm have any financial interest in Project? 3. Project Title: k4a"Ln. k L;10i d1 )uY (?"O e% OA- Location: )FOld a- kJtle'� AL o'b� s1 Name and address of ow er Name and telephone number of person familiar with project a Type of Work: (IZCX- k..e Contract amount: $-9-7c7 OJ3 . `� � Date cc pI ted: Amount of work done by my /our firm under contract $ c "�L Did your firm have any financial interest in Project? I -C -11 (Page 1 of 2) �JJi elz) A0 0 6%2 4 3970 • .I ..,J 4. Project Title: r''or fl- � ` 15M c-G a-1 Location:'G�(? V L =l���a ��TGG`Z�, Name and address of owner If"f4e 02� 1 5146 1 Name and t lephon number of person familiar with project Twe of Work: O &L, 0 "U-t' O-ft ft l a:)M-61- -+ Contract amount: $ -7-Z L4V. 00 Date completed: Amount of work done by my /our firm under contract $ Did your firm have any financial interest in Project? 5. Project Title: 41C, CVf% -10,L, PJt,.1' q-.)14 k' Q..1' a, l / I �C tc Location: V% VV MISI %c?� AltW.S % , _P f V NarrtO and address of owrvefr OJYAAn II.0A- q5/ (--122'- J1 0 Name and telephone number of person familiar with project,,�� r ������� � Type of Work: : (2- JV� / C� "--( 'rJA Pal too Contract amount: $10 7, 021' • C I Date completed: U Amount of work done by my /our firm under contract $ 6 f-5 -71 02 L9 Did your firm have any financial interest in Project? The following are the names, addresses, and telephone numbers for all brokers and sureties from whom BIDDER intends to procure insurance bonds: /1 r r A , l��i /A 4 P/) � o q r� 30 I -C -11 (Page 2 of 2) Owner: Palm Springs Unified School District 980 East Tahquitz Canyon Way, Palm Springs, CA 92262 Project: Playground and Parking Lot Improvements at Katherine Finchy Elementary School Contact: Joel Sorensen (760) 416 -6112 fax (760) 416 -6114 Contract Amount: $231,094.00 Date of Completion: 4/6/2009 Owner: County of San Bernardino 825 East 3rd Street, San Bernardino, CA 92415 Project: Wesley Avenue Rehabilitation Project HB0017 Contact: Sundaramoorthy Srirajon (909) 387 -7932 fax (909) 387 -7927 Contract Amount: $130,448.60 Date of Completion: 3/16/2009 Owner: City of Riverside 3900 Main Street, Riverside, CA 92522 Project: Mount Rubidoux Road Repair Project Contact: Alisa Sramala (951) 351 -6039 fax (951) 351 -6069 Contract Amount: $279,933.00 Date of Completion: 3/13/2009 Owner: San Gabriel Unified School District 408 Junipero Serra Drive, San Gabriel, CA 91776 Project: Roosevelt Elementary School Play Area Development Contact: Irene Yin (626) 451 -5464 fax (626) 451 -5494 Contract Amount: $78,480.00 Date of Completion: 3/10/2009 Owner: City of Banning - Public Works PO Box 998, Banning, CA 92220 , 99 E. Ramsey St.,Banning, CA 92220 Project: A.C. Overlay, Pavement Rehabilitation and Sidewalk Improvements Contact: Arturo Vela (951) 922 -3130 fax (951) 922 -3141 Contract Amount: $657,026.09 Date of Completion: 10/21/2008 Owner: County of San Bernardino - Architecture & Engineering 385 N Arrowhead Ave, San Bernardino, CA 92415 Project: Lake Gregory Regional Park South Beach Parking Lot Renovation Contact: Levi Oveson (909)387 -5000 Contract Amount: $74,000.00 Date of Completion: 10/14/2008 3970 ' s� .: Owner: City of Colton - 655 N. La Cadena Drive, Colton, CA 92324 Project: Roger Elementary School Bus Drop -Off Zone Project Contact: John Jefferson (909) 514 -4213 fax (909) 370 -5072 Contract Amount: $81,027.23 Date of Completion: 9/30/2008 Owner: Lanterman Development Center - 3530 West Pomona Blvd, Pomona, CA 91769 Project: Repair Roads - Facility Wide Contact: Yolanda Munoz (909) 979 -8837 fax (909) 839 -1309 Contract Amount: $148,800.00 Date of Completion: 9/18/2008 Owner: City of Ridgecrest - 100 West California Ave, Ridgecrest, CA 92355 Project: Downs Landscape Median Project Contact: Jeremy Bowman - Helt Engineering (661) 323 -6045 Contract Amount: $393,189.00 Date of Completion: 9/10/2008 Owner: Redlands Unified School District - PO Box 3008, Redlands, CA 92373 Project: Asphalt Work at Cram Elementary, Orangewood High School Contact: Antonette Llamas (909) 307 -5300 Contract Amount: $128,467.00 Date of Completion: 8/22/2008 Owner: City of West Covina - 1444 West Garvey Ave South, West Covina, CA 91793 Project: Curb and Gutter Repair and Construction of Wheel Chair Ramps at Various Locations Citywide Contact: Oscar Caplin (626) 939 -8425 Contract Amount: $213,092.00 Date of Completion: 8/15/2008 Owner: County of San Bernardino, Public Works Department - 825 East 3rd Street, San Bernardino, CA 92415 Project: Pinewood Drive and Others Contact: Oscar Salazar Bueno (909) 387 -7920 Contract Amount: $79,125.20 Date of Completion: 8/13/2008 39 70 • 64 .,I Owner: City of Gardena - 1717 West 162nd Street, Gardena, CA 90247 Project: Local Street Improvements Project 2008 - Various Locations Contact: John Felix (310) 217 -9643 Contract Amount: $302,455.00 Date of Completion: 7/8/2008 Owner: City of Temecula - 43200 Buisness Park Drive, Temecula, CA 92589 Project: Citywide Concrete Repairs Contact: Rodney Tidwell (951) 694 -6444 Contract Amount: $103,702.00 Date of Completion: 6/17/2008 Owner: County of San Bernardino, Public Works Department - 825 East Third Street, San Bernardino, CA 92415 Project: Opal Avenue, 5th Avenue to Independence Avenue Contact: Franklin Luna (909) 387 -7920 Contract Amount: $341,688.70 Date of Completion: 6/6/2008 Owner: City of Lynwood - 11330 Bullis Road, Lynwood, CA 90262 Project: Ernestine Ave and Fourth Street Improvements Contact: Jorge Roque (310) 603 -0220 Contract Amount: $349,385.61 Date of Completion: 5/13/2008 Owner: City of Placentia - 401 East Chapman Ave, Placentia, CA 92870 Project: Richfield /Miraloma Widening Improvements Contact: Andrew Muth (714) 993 -8245 Contract Amount: $411,439.03 Date of Completion: 4/14/2008 Owner: City of Anaheim - 200 South Anaheim Blvd # 276, Anaheim, CA 92805 Project: Brookhurst Street Improvements, Niobe Ave to Orange Ave Contact: Mike Wood (714) 231 -8372 Contract Amount: $199,156.78 Date of Completion: 2/26/2008 JUN -29 -2009 10:16 June 9, 2009 THE CO ATTENTION CITY OF EL SEGUNDO PW &BL 310 640 0489 39 7 0 . 491 i Public Works Department Dana Greenwood, Director ADDENDUM NO. 1 to �T DOCUMENTS, SPECIFICATIONS AND PLANS for ATION OF SYCAMORE PARK PLAYGROUND PROJECT NO.: PW 09 -07 The following addit ons, modifications, and clarifications to the specifications shall be included in, and be ome a part of any contract which may be executed for the above project in the City o El Segundo: 1. The City hal accepted "Pro -Tect Turf' as an Equal Product for the Poured - In -Place Rubber Surface. As evidence that the BIDDER has read this Addendum, the BIDDER must acknowledge same in the space provided below and submit this Addendum with the Bid Proposal. Failure to acknowledge this Addendum may cause rejection of bid. signs e) (date) Page 1 of 1 Main Street, El Segundo, CA 90245 -3895 — Fax A JUN -29 -2009 10:16 June 15, 2009 THE CO ATTENTION BID The following adi included in, and 1 project in the City 1. Replace API item 1 on B Retaining W CITY OF EL SEGUNDO PW &BL 310 640 0489 397U - „ WWY 49// Public Works Department Dana Greenwood, Director ADDENDUM NO.2 to CT DOCUMENTS, SPECIFICATIONS AND PLANS for CATION OF SYCAMORE PARK PLAYGROUND PROJECT NO.: PW 09 -07 modifications, and clarifications to the specifications shall be .e a part of any contract which may be executed for the above Segundo: A Std 610 -1 (Reinforced Concrete Retaining Wall Type 1) of I sheet I -C-3 (page I of 1) with APWA Std 618 -1 (Masonry ll). As evidence that the IDDER has read this Addendum, the BIDDER must acknowledge same in the space p ovided below and submit this Addendum with the Bid Proposal. Failure to acknowled e this Addendum may cause rejection of bid. (si afar (date) Page 1 of 1 Main Street, El Segundo, CA 90245 -3895 — Fax A JUN -29 -2009 10:17 CITY OF EL SEGUNDO PW &BL 310 640 0489 P.06i06 June 16, 2009 THE 39'U.,,J Public Works.. Department Dana Greenwood, Director ADDENDUM NO.3 to CT DOCUMENTS, SPECIFICATIONS AND PLANS for CATION OF SYCAMORE PARK PLAYGROUND PROJECT NO.: PW 09 -07 ATTENTION BIDDERS: The following add' ions, modifications, and clarifications to the specifications shall be included in, and be -,ome a part of any contract which may be executed for the above project in the City o El Segundo: 1. Use APWA Ptd. 606 -1 type "B" for hand rails. Adjust spacing accordingly to match 4' height requested. As evidence that th BIDDER has read this Addendum, the BIDDER must acknowledge same in the space rovided below and submit this Addendum with the Bid Proposal. Failure to acknowle ge this Addendum may rau P. r i -ctinn of bid. 4- L Page 1 of l 150 Main Street, El Segundo, CA 90245 -3895 — Fax (date) 39/0 • J d Bond Number: SU 5013231 PROPOSAL. GUARANTEE dw BOND RENABIXAMON OP SYCAMORE PARK PLAYOROUNO IN THE CITY OF EL SEGUNDO SPECIPIICATIONS NO.: PW 09-07 KNOW ALL MEN BY THESE PRESEWS that, International Pavement Solutions, Inc. , as SIDD1111% and Arch Insurance Company , ao SURETY] are held and 0rmtybound urit0 the City of El Segundo, In the penal aura of * * * * * * * * * * DOLLMS (; * *)t which Is ten (10%) pamOnt Of the 20taI amount bid by BIDDER to the City of El Segundo for the above stated project, for the payment of which sum, BIDDER and SURETY agree for be bound, jointly and ewers", firmly by those prosrsnts:. *10% percent of bid amount not to exceed Fifteen thousand and 00 /100 *($15,000.00) THR CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER Is about to $ubrntt a bid to the City of El Segundo for the above stated project, If said bid Is rejected, or if said bid is accepted and a contract is awarded and entered Into by BIDDER In the manner and dms specified, Own this obitgat on shall be null and void, o#wfwhw ft shall remain In full force and effect in favor of the Clay of EI Segundo. IN WITNESS WHEREOF the parties hereto have set their names, Was, hands, and seal$ this 29thplayof J,�une —,,_, O09_. InteKi -i BIDDER* `— Arch Insurance Comp: SURETY* > "�. G�" Solutions, Inc. -1199 Opal Avenue:Mentone, CA 92355 (909)794 -210: -135 N. Los Robles Ave., Ste 825:Pasadena, CA 9110: (626) 639 -5201 Raymond E. Gail, `Attorney in Fact Subscribed and sworn to this _ day of , 20_. [NOTARY PUBLIC Provide BIDDOWSURETY nano, address and telephone number and the name, tide, address and telephone number for authorized representative. *PleaaCVnoWedgement I-C-e notary or jurat State of California County of San Bernardino 39 i % • 6i ,6A , >; 4' On JUN 2 9 2009 before me, Stacia C. Baker, Notary Public , Date Here Insert Name and Title of the Officer personally appeared Raymond E. Gail Name(s) of Signer(s) N/A who proved to me on the basis of satisfactory evidence to be the person(a) whose name(G) is /at:e subscribed to the within instrument and acknowledged to me that he /sJ @Ahey executed the same in his /her, hak authorized _� capacity(aes), and that by his / iew signature( on the STACIA C. BAKE instrument the person(, or the entity upon behalf of Commission # 1776731 which the person(G) acted, executed the instrument. +s Notary Public - California p San Bernardino County Cornet. oct29,2o11 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and offi ial sea . r Signature Place Notary Seal Above Signature of Notary Public " OPTIONAL Though the information below is not required by law, it may prove valuable 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: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact - • ❑ Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHTTHUMBPRINT OF SIGNER POWER OF ATTORNEY 3 9 0 „..Add Know All Men By These Presents: That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal office in Kansas City, Missouri (hereinafter referred to as the "Company ") does hereby appoint Raymond E. Gail and William J. Shupper of Rancho Cucamonga, CA (EACH) its true and lawful Aftorney(s)-in -Fact, to make, execute, seal, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed: Any and all bonds and undertakings EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver bonds or undertakings that guarantee the payment or collection of any promissory note, check, draft or letter of credit. This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond Within the dollar limit of authority as set forth herein. The Company may revoke this appointment at any time. The execution of such bonds and undertakings in pursuance of these. presents shall be as binding upon the said Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal office in Kansas City, Missouri. This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on March 3, 2003, true and accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being In full force and effect: "VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attomeys -in -fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings, obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process." This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of Directors of the Company on March 3, 2003: VOTED, That the signature of the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on March 3, 2003, and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company. OOML0013 00 03 03 Page 1 of 2 Printed in U.S.A. 0 • . CALIFORNIA . ACKNOWLEDGMENT S:a vSc�S � �:..':'�� S.: � !"� ate!; Goa C!.�•� S 2� 5�� _��!��.!?$$;.'+�.� i;:'�S`�i.��!�C�R.'�i.'�5����. �$�S]a �.'u..�v�'.�v,�...7:t�i�a'.�i �S.� \C,��,s�• State of California County of &,I A--' WIU.IZ ,14-4r,� On U` "% before me, Dale — personally appeared Tammy L. Patton, Notary Public and Name(s) of signers) who proved to me on the basis of satisfactory evidence to be the person 8e whose named is /aye subscribed to the within instrument and acknowledged to me that he /slae twy executed the same in his /herM4eir authorized capacity(ies ' and that by his /lyer/tlaeir"signatur*s) on the TAMMY L. PATTON instrument the person(sj or the entity upon behalf of ' ' Commission # 1818445 Z which the persof� acted, executed the instrument. .�; Notary Public - California A 1 � San Bernardino County My Comm. Expires Oct 19, 2012 certify under PENALTY OF PERJURY under the laws J I Y of the State of California that the foregoing paragraph is true and correct. WITNESS my hhjind and official seal. re Place Notary Seal Above Signatu / Si re of Notary Public Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document ( � )x—'40 Title or Type of Document: // �'1 Document Date: % Number of Pages: / Signer(s) Other Than Named Above: /rJiJt� Capacity(ies) Claimed by Signers) Signer's Name: L�C�+�+fTti[ iGf� Signer's Name: r.l Individual 1 Individual ?' ,'_Corporate Officer — Title(srY _ &4L L: ll Corporate Officer — Title(s): CJ Partner — ❑ Limited r 1 General _ ❑ Partner — Ll Limited D Gen _ u Attorney in Fact • D Attorney in Fact • - -- L Trustee Top of thumb here ❑ Trustee Top of thumb here Li Guardian or Conservator ❑ Guardian or Cons ator Other: L Other: Signer _ Signer Is presenting: JX!TT ©2007 National Notary Association- 9350 De Soto Ave.. P.O. Box 2402 -Chatsworth, CA 91313-2402- www.NationalNotary.org Item #5907 Reorder Cali Toll -Free 1- 800 - 876 -6827 0•J Executed In Duplicate LABOR AND MATERIALS BOND Band No. SU 1102528 Bond Fee:Premium Included In Performance Bond INTERNATIONAL PAVEMENT SOLUTIONS, INC. , as principal ( "PRINCIPAL") and Arch Insurance Company 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 ONE HUNDRED SIX THOUSAND, SIX DOLLARS AND ZERO CENTS ($106 006.00 dollars, which is a minimum one hundred percent (100 %) of the contract, lawful money of the United States, which maybe 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 REHABILITATION OF SYCAMORE PARK PLAYGROUND, SPECIFICATIONS NO. PW 09 -07 VPublic 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 09- 07,and the public works contract executed for such Specifications, copies of which is on file with CITY's Engineering Division CPublic Project "). Such performance will be in accordance with CITY's plans and profiles (CITY DRAWING FILE NO. L- 1759), 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 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 N0, PW 09 -07, 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. 8►„e„�o„•. FI*C V W LAW raa.a" eon. 10 m» I —F -1 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 § 955.640 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. SIGNED AND SEALED this 20th day of August , 20 09 International Pavement Solutions, Inc. Arch Insurance Company SURETY's PRESIDENT Brent C. R(eger, President Raymond E. Gail, Attorney in Fact PRINCIPAL's SECRETARY PRINCIPAL's MAILING ADDRESS: International Pavement Solutions, Inc. 1199 Opal Avenue Mentone, CA 92359 SURETY's SECRETARY SURETY's MAILING ADDRESS: Arch Insurance Company 135 N. Los Robles Avenue, Suite 825 Pasadena, CA 91101 NOTE: (1) ALL signatures must be acknowledged by a notary public. Return two (2) originals to City Clerk's Office. (2) Bond shall be effective for one (1) year after acceptance of the job. LAWAND4M OWLiWN04104?" I -F -2 State of California County of San Bernardino On Al IG 2 n before me, Stacia C. Baker, Notary Public , Here Insert Name and Title of the officer Date Raymond E. Gail personally appeared Names) of Signer(s) N/A ' who proved to me on the basis of satisfactory evidence to be the person(s) whose name(e) is /are subscribed to the within instrument and acknowledged to me that he /W;@A#ey executed the same in his/499th& authorized STACIA C. BAKER capacity(4es), and that by his /heFAhei+' signatures) on the instrument the person(, or the entity upon behalf of Commission # 1776731 which the persons) acted, executed the instrument. -r S Notary Public - California San Bernardino County Oct29,20tt t certify under PENALTY OF PERJURY under the laws Comm. of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and officials I. Signature Sign ure of Notary Pu lic Place Notary Seal Above OPTIONAL to persons reling on Though the of th sl form to anotherydocument. document t. yfraudulent and could prevent remo al and reattachment Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): El Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General [I Attorney in Fact • '. ❑Attorney in Fact Top of thumb here El Trustee Top of thumb here ❑ Trustee El or Conservator El Guardian or Conservator El Other: El Other: Signer Is Representing: Signer Is Representing: POWER OF ATTORNEY Know All Men By These Presents: the St ate That the Arch Insurance Company, a corporation organized and existing under the laws of hereby appo ntMissouri, having its principal office in Kansas City, Missouri (hereinafter referred to as the "Comp y ) Raymond E. Gail and William J. Shupper of Rancho Cucamonga, CA (EACH) al, and deliver from the date of issuance of this power for and its true and lawful Attomey(s) -in -Fact, to make, execute, se on its behalf as surety, and as its act and deed: Any and all bonds and undertakings EXCEPTION: NO AUTHORITY is granted to make, d execute, seal c and edltliver bonds or undertakings that guarantee the payment or collection of any promissory note, check, This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond Within the dollar limit of authority as set forth. herein. The Company may revoke this appointment at any time. se The execution of such bonds and undertakings in pursuance of the had p e been duly executed and acknowledged by its Company as fully and amply to all intents and purposes, as if the same regularly elected officers at its principal office in Kansas City, Missouri. This Power of Attorney is executed by authority of resolutions adopted by unanimous et consent of the Board of Directors Of forth and are hereby certified to by the Company on March 3, 2003, true and accurate copies of which are hereinafter s the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the Board, the President, or any Vice President, r heir appointees agents andignated in nriting, and filed with the Secretary, or the Secretary shall have the power and authority PP and to authorize them to execute on behalf of the Company, and anw writings, obligatory in the nature athereofeand any such undertakings, rncognizances, contracts agents for acceptance of process" officers of the Company may appoint This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of Directors of the Company on March 3, 2003: VOTED, That the signature of the Chairman of the Board, the President, or any Vice President, or their appointees designated ary, the seal of the and designated in writing and flied with the Secretary, and the signature Secret or bond executed pursuant to the certifications by the Secretary, may be affixed by facsimile on any p ower of y resolution adopted by the Board of Directors on Marcttached Oshall continue to be valid and binding upon the Company. certified with respect to any bond or undertaking to which it is attached, OOML0013 00 03 03 page 1 of 2 Printed in U.S.A. 39 % U In Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their j authorized officers, this 1st day of May 20 08 . Attested and Certified Arch Insurance Company once COREOMTE TEAL Jul ` Nlstout9 AMartin J. Nil , 4Secretary r 4icesiidte�_ J. Mi hael et STATE OF PENNSYLVANIA SS COUNTY OF PHILADELPHIA SS I, Brian C. Kuhn, a Notary Public, do hereby certify that Martin J. Nilsen and J. Michael Pete personally known to me to be the same persons whose names are respectively as Secretary and Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri, subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes therein set 0010 O OP PSNISIMV AL SEAL , Notary Public Brian C. Kuhn, Notary Public CERTIFICATION Philadelphia County My commission expires 12 -06 -2011 as December 06, 2011 I, Martin J. Nilsen, Secretary of the Arch Insurance Company; do hereby certify that the attached Power of Attorney dated May 1, 2008 on behalf of the persbn(s) as listed above is a true and correct copy and that the same has been. in full force and effect since the date thereof and is in full force and effect on the date of this certificate; and I do further certify that the said J. Michael Pete, who executed the Power of Attorney as Vice President, was on the date of execution of the attached Power of Attorney the duly elected Vice President of the Arch Insurance Company. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and a ed the corpor s I of the Arch Insurance Company on this day of QU 2 0 �q 20 Martin J. NII , Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company except in the manner and to the extent herein stated. PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: Arch Contractors & Developers Group 135 N. Robles Ave., Ste. 625 Pasadena, CA 91101 OOMLOO13 00 03 03 Page 2 of 2 o Printed in U.S.A. 3 9 7 0 • .� ACKNOWLEDGMENT State of California County of San Bernardino } ss. On August 20, 2009 before me, Tammy L Patton — Notary Public, personally appeared Brent C. Rigger who proved to me on the basis of satisfactory evidence to be the personk*) —whose nam4,3}-is /oe- subscribed to the within instrument and acknowledged to me that he /5he/tbt,-rexecuted the same in his /lor/tjboir authorized capacity, and that by his/heTAjwk signatures on the instrument the person,; or the entity upon behalf of which the persons) - cted, 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. WITNESS my hand and official seal. Signature Tammy L. Patton, Notary Public 50— TAMMY L. PATTON Commission # 1818445 i Notary Public • California i Z a� San Bernardino County My Comm. Expires Oct 19, 2012 Date of Document Type or Title of Document Number of Pages in Document Document in a Foreign Language Type of Satisfactory Evidence: OPTIONAL INFORMATION August 20, 2009 Labor and Material Bond ,Pages Not Applicable _X_ Personally Known with Paper Identification Paper Identification Credible Witness(es) Capacity of Signer: Trustee Power of Attorney CEO /CFO /COO X President / Vice - President / Secretary / Treasurer Other: Other Information Brent C. Rigger - President Thumb print of Signer P-15eck here if no thumbprint or fingerprint is available. 39 7 0 • G.1.4A No. 08157 STATE OF CALIFORNIA DEPARTMENT OF INSURANCE SAN FRANCISCO Amended Certificate of Authority THIS IS TO CERTIFY, That, pursuant to the Insurance Code of the State of California, Arch Insurance Company 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, Liability, Workers' Compensation, Common Carrier Liability, Boiler and Machinery, Burglary, Team and Vehicle, 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 of the 15th day of December, 2005, I have hereunto set my hand and caused my official seal to be affixed Fee $117.00 Rec. No. Filed 12/15/2005 this 15th day of December, 2005. John Garamendi Insurance Commissioner BY Patricia K. Staggs for Richard D. Baum Chief Deputy Certification I, the undersigned Insurance Commissioner of the State of California, do hereby certify that I have compared the above copy of Certificate of Authority with the duplicate of original now on file in my office, and that the same is p f <ll, true, and correct transcript thereof, and of the whole of said duplicate, and said Certificate of Authority is now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and caused my official seal to be affixed this 1st day of November, 2007. Steve Poizner Insurance Commissioner By a""" a Ak,jue. Pauline D'Andrea .1t Executed In Duplicate 3970 - j Premium Based On Final Contract Amount FAITHFUL PERFORMANCE BOND Bond No. SU 1102528 Bond Fee: $ 2, 12 0.0 0 (Premium) INTERNATIONAL PAVEMENT SOLUTIONS. INC. ( "PRINCIPAL ") and Arch Insurance Company , 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 ONE HUNDRED SIX THOUSAND, SIX DOLLARS AND ZERO CENTS ($106.006.00 J dollars, which is a minimum one hundred percent (100°x) of the contract amount, 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. PRINCIPAL or SURETY will apply this bond for the faithful performance of any and all of the conditions and stipulations set forth in this bond, SPECIFICATIONS NO. PW 09 -07, and the public works contract executed with such Specifications. 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 09-07, a copy 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. L -1759) 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's work on the Public Project will be done in accordance with CITY's plans and specifications and with any permit issued by CITY. Should PRINCIPAL fail to complete all required work within the time allowed, CITY may, at its sole discretion, cause all required work to be done and the parties executing the bond will be firmly bound for the payment of all necessary costs therefor. 3. PRINCIPAL will guarantee its work against any defective work, labor, or materials on the Public Project for a period of one (1) year following the Public Project's completion and acceptance by CI'T'Y. 4. This bond is conditioned upon and guarantees due compliance with all applicable law including, without limitation, the El Segundo Municipal Code ("SSMC "). 5. SURETY, for value received, agrees that no changes, extensions of time, alteration or modification of SPECIFICATIONS NO. PW 09 -07 or of the obligation to be performed will in any gp..r,mrn.- r.WKrww /M.MIM.MrwMre%at (r,w) I -E -1 { 0,0 �0,41111 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; 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; and 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 lull force and effect. SIGNED AND SEALED this 2 0th day of August , 20 09 International Pavement. Solutions, Inc. Arch Insu)rraance Company SURETY' PRESIDENT PRINCIPAL'S Raymon! E. Gall, Attorney in Fact Brent C. R�Qnar President PRINCIPAL's SECRETARY SURETY's SECRETARY PRINCIPAL's MAILING ADDRESS: SURETY'S MAILING ADDRESS: International Pavement Arch Insurance Company Solutions, Inc. - ------ - - - -- 1199 Opal Avenue 135 N. Los Robles Avenue, Suite Me tone CA 9235 Pasadena, CA 91101 NOTE: (1) ALL signatures must be acknowledged by a notary public. Return two (2) originals to City Clerk's Office. (2) Bond shall be effective for one (1) year after acceptance of the job. 9poktient- P,*CUVW F&"u VwMam. lwd (IW) ( -E -2 J / V 111114 111 C-1 State of California County of San Bernardino 2 2��9 Stacia C. Baker, Notary Public , On AU before me, — Here Insert Name and Title of the Officer Date Raymond E. Gail personally appeared Names) of Signer(s) N/A ' who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /a*e subscribed to the within instrument and acknowledged to me that he /stae/00ey executed the same in his /4e4th& authorized capacity(ee), and that by his /he 4heir signature(s) on the - - - - - instrument the person(a), or the entity upon behalf of STACIA C. BAKE which the persons) acted, executed the instrument. Commission # 1776731 -d Notary Public - California San Bernardino County I certify under PENALTY OF PERJURY under the laws WComm. Iresoct29,2o11 of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signs ure of ry Public Place Notary Seal Above OPTIONAL Though the information below is not required by law, it ma.1v prove valuable to persons reiying on the document of this form to another document. nt fraudulent removal and could prevent and reattachment Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact 77 ❑ Attorney in Fact Top of thumb here ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: POWER OF ATTORNEY 3 9 7 0 • , Know All Men By These Presents: That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal office in Kansas City, Missouri (hereinafter referred to as the "Company") does hereby appoint Raymond E. Gail and William J. Shupper of Rancho Cucamonga, CA (EACH) its true and lawful Attorney(s)=in -Fact, to make, execute, seal, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed: Any and all bonds and undertakings EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver bonds or undertakings that guarantee the payment or collection of any promissory note, check, draft or letter of credit. This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond Within the dollar limit of authority as set forth. herein. The Company may revoke this appointment at any time. The execution of such bonds and undertakings in pursuance of these. presents shall be as binding upon the said Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal office in Kansas City, Missouri. This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on March 3, 2003, true and accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attomeys -in -fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings, obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process." This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of Directors of the Company on March 3, 2003: VOTED, That the signature of the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on March 3, 2003, and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company. OOMLOO13 00 03 03 Page 1 of 2 Printed in U.S.A. 3970 In Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their authorized officers, this 1 st day of May , 20 OS . Attested and Certified dance c o CORPORATE SEAL 2 1971 NIit0Y11 Martin J. Nil , Secretary STATE OF PENNSYLVANIA SS COUNTY OF PHILADELPHIA SS Arch Insurance Company wdjht J. Mi hael ete, Vice siden I, Brian C. Kuhn, a Notary Public, do hereby certify that Martin J. Nilsen and J. Michael Pete personally known to me to be the same persons whose names are respectively as Secretary and Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri, subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes therein set (AbIINOIdWBAL1ii OP PBNNBYLVANGI NOTARIAL SEAL Brian C. Kuhn, Notary Public �Brlan. Kuhn; Notary �Public City of Philadelphia, Philadelphia County My commission expires 12 -06 -2011 CERTIFICATION M commission expires-December 06, 2011 I, Martin J. Nilsen, Secretary of the Arch Insurance Company; do hereby certify that the attached Power of Attorney dated May 1, 2008 on behalf of the person(s) as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this certificate; and I do further certify that the said J. Michael Pete, who executed the Power of Attorney as Vice President, was on the date of execution of the attached Power of Attorney the duly elected Vice President of the Arch Insurance Company. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and aff ed the corpor s I of the Arch Insurance Company on this day of Al 16 2 0 20�9?0 Martin J. Nil , Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company except In the manner and to the extent herein stated. PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: Arch Contractors & Developers Group 135 N. Robles Ave., Ste. 825 Pasadena, CA 91101 OOMLOO13 00 03 03 Page 2of2 yyonce 0 CORPORATE RUl 1971 Nb000d Printed in U.S.A. 1970 . ACKNOWLEDGMENT State of California County of San Bernardino } ss. On August 20, 2009 before me, Tammy L Patton — Notary Public, personally appeared Brent C. Rigger who proved to me on the basis of satisfactory evidence to be the person,Kwhose name�Wis /a'g'subscribed to the within instrument and acknowledged to me that he /sju -4tbay -executed the same in his /hO authorized capacity(jes and that by his /kertt signatures on the instrument the persoty(g',"or, the entity upon behalf of which the person>�-Scted, 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. WITNESS my hand and official seal , � " 4�" z . '(' �Z' # '/ - Signature Tammy L. Patton, Notary Public TAMMY L. PATTON Commission # 18184 45 A z :.m Notary Public - California Z San Bernardino County My Comm. Expires Oct 19, 2012 Date of Document Type or Title of Document Number of Pages in Document Document in a Foreign Language Type of Satisfactory Evidence: OPTIONAL INFORMATION August 20, 2009 Performance Bond PageS Not Applicable _X_ Personally Known with Paper Identification Paper Identification Credible Witness(es) Capacity of Signer: Trustee Power of Attorney CEO /CFO /COO X President / Vice - President / Secretary / Treasurer Other: Other Information Brent C. Rigger - President Thumb print of Signer ,2r__C_heck here if no thumbprint or fingerprint is available. SV I `l - s' -eJdd Farm w -9 Request for Taxpayer Give form to the (Rev. January 2002) requester. Do not Identification Number and Certification send to the IRS. Department of the Treasury Internal Revenue Service r; Name m m International Pavement Solutions, Inc. o Business name, if different from above c 0 C..0 c _ �� Individual/ Exempt from backup ❑ � Corporation Partnership Other ► ____ _____________ ❑withholding _ Check appropriate box: Sole proprietor o Address (number, street, and apt. or suite no.) Requester's name and address (optional) ., . c — P.O. Box 10458 V != City, state, and ZIP code u San Bernardino, CA 92423 CL yList account number(s) here (optional) V) F7M Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security number However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on or page 2. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 2. is in one name, see the chart on page 2 for guidelines on whose number ��OA7 ation number Note: If the account more than 1 16 15 1 6 4 to enter. F71M Certific ation Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 2.) Sign Signature of /11tery Here U.S. person ► — Date ► Purpose of Form A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W -9 only if you are a U.S. person (including a resident alien), to give your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If you are a foreign person, use the appropriate Form W -8. See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. Note: If a requester gives you a form other than Form W -9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W -9. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 30% of such payments after December 31, 2001 (29% after December 31, 2003). This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part II instructions on page 2 for details), or 3, The IRS tells the requester that you furnished an incorrect TIN, or 4. The IRS tells you that you are subject to backup withholding because you did not report ail your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions on page 2 and the separate Instructions for the Requester of Form W9. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a 8500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and /or imprisonment. Misuse of TINS. If the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No. 10231X Form W -9 (Rev, 1 -2002) 3 9 y U . ,i , *4A State Of California CONTRACTORS STATE LICENSE BOARD � °r"' ACTIVE LICENSE ONUxm A1fn: 729226 CORP prom. INTERNATIONAL PAVEMENT SOLUTIONS INC e A g ` -- D- 11/30/2010 1 �yf0• ' DATE (MM/DD/YYYY) .ACORD. CERTIFICATE OF LIABILITY INSURANCE 08/19/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IRODUCER (909)792 -2345 FAX (909)792 -0159 I D CONFERS NO RIGHTS UPON THE CERTIFICATE Beall Insurance Services 130 W. Vine Street Redlands, CA 92373 INSURED INTEKNA11UNAL rAvCI'ICI9, ww1.Luna, -, - INTERNATIONAL PAVEMENT SERVICES, INC. P. 0. BOX 10458 SAN BERNARDINO, CA 92423 ONLY AN HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURERA: Travelers Prop & Casualty Co of 25674 INSURERS: Alaska National Insurance Co 38733 INSURER C: INSURER D: INSURER E: COVERAGES — --- —.1 __ ,nv 000inn 10.1n1r'ATFn AI(1TVUITHATANDING r.��.• -• • • • - • -•- - -- - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I55UtU I U I rtc INOUMCu 1.4mviw E MAY ISSUED OR CERTIFICAT ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE MM /DD/YYYY DATE MM/DD/YYYY NSR DTEC0365K9614TIL09 08/13/2009 08/13/2010 EACH OCCURRENCE $ 1,000,000 GENERAL LIABILITY $ 300,0001 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ S,00 rA CLAIMS MADE � OCCUR MED EXP (Any one person) PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP /OP AGG $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JE 0 LOC DT810365K9614TIL09 08/13/2009 08/13/2010 COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ A SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) $ X NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EA ACC $ ANY AUTO OTHER THAN AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY DTSMCUP365K9614TIL09 08/13/2009 08/13/2010 EACH OCCURRENCE $ 1,000,00 X OCCUR � CLAIMS MADE AGGREGATE $ 1,000,000 $ A $ DEDUCTIBLE $ X RETENTION $ 10,00 WORKERS COMPENSATION 09HW540057 08/13/2009 08/13/2010 Y LIMITS ER 7E.L.EACH ACCIDENT $ 1, 000, 00 AND EMPLOYERS' LIABILITY Y I❑N B ANY OFFICER/MEMBER EXCLUDED? ECUTIVE ASE - EA EMPLOYEE $ 1,000,00_ (Mandatory In NH) describe under E.L. DISEASE - POLICY LIMIT $ 11000,00 Syes, SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS PW 09 -07 REHABILITATION OF SYCAMORE PARK PLAYGROUND E: PROJECT NO. OB DESCRIPTION: EXCAVATION AND GRADING, CONCRETE, LANDSCAPING AS ADDITIONAL INSURED TO THE GENERAL ITY OF EL SEGUNDO, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED IBILITY AND COVERAGE IS CONSIDERED PRIMARY PER ENDORSEMENT CG D2 46 08 05. °10 DAY NOTICE OF CANCELLATION FOR NON- PAYMENT OF PREMIUM CERTIFICATE HOLDER " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL N)lfiXlM)i MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF EL SEGUNDO ���i41�( XdCNXi(xXa14X1G4K)tX�ExXxiH(dfX PUBLIC WORKS DEPARTME KD4', Kdldi&] tXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 350 MAIN STREET AUTHORIZED REPRESENTATIVE k I EL SEGUNDO, CA 90245 Richard Beall ;I, . J - & ACORD 25 (2009/01) FAX: 310.640. 04)89 ©1988 -2009 ACCFRD'CORPORATION. Ali rights reserved. he ACORD name and logo are registered marks of ACORD 39 / 0 s .fie IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009101) 39 7 O s' • COMMERCIAL GENERAL LIABILITY THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section 11) Is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section Ill — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: t. The preparing, approving, or failing to prepare or approve, maps, stop draw - ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional In- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional Insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of Sme for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other Insurance ", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis. this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance ". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional Insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim, To the extent possible, such notice should include: CG 02 46 08 05 C) 2005 The St. Paul Travelers Companies, Inc. Page t of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "Docurrenee" or offense. b) If a claim is made or "suit" is brought against the additional Insured, the additional insured must: 1. Immediately record the specifics of the claim or "suit" and the date received; and Ii. Notify us as soon as practicable, The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. C) The additional insured must snore Via8►e'n send us copies of all legal paper connection with the claim or "suit ", cooperate with us In the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all policy conditions, d) fenseand Indemnity eodf an claim or the to 3970 -,. any provider of "other Insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. fi Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 06 05