Loading...
CONTRACT 3983 Public Works Contract CLOSED3983. :I ORIGINAL PUBLIC WORKS CONTRACT BETWEEN THE CITY OF EL SEGUNDO AND PAVEMENT COATINGS COMPANY This CONTRACT is entered into this 1st day of September, 2009, by and between the CITY OF EL SEGUNDO, a general law city and municipal corporation ( "the City ") and Pavement Coatings Company ( "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 NINETY NINE THOUSAND, NINE HUNDRED EIGHTY SEVEN DOLLARS AND ZERO CENTS ($199,987.00) 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 FORTY FIVE (45) calendar days (the "Contract Time. ") am 3.983.. "i 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: i. 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. I -D -2 3983 . 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 St., El Segundo, CA 9024 (310) 524 -2361 The Contractor Doug Ford President Pavement Coatings Company 10240 San Sevaine Way Mira Loma, CA 91752 (714) 826 -3011 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 3983 . • 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 3983 . IN WITNESS WHEREOF the parties hereto have executed this contract the day and year first hereinabove written. ATTEST: Uta Lb-),-A� �� — Cindy Mort sen, City Clerk APPRfflHS MARK By: Karl H. Berger, Assistant City I -D -5 PAVEMENT COATINGS CO. —� � President Taxpayer ID No. 15'- 29 ILdo *70 Business License No.:. �8Z0 1 39 83 - J LABOR AND MATERIALS BOND Bond No. 6663968 Bond Fee: Included in Performance Bond PAVEMENT COATINGS COMPANY , as principal ( "PRINCIPAL ") and First National Insurance Company of America , a corporation incorporated under the laws of the State of Washington 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 NINETY NINE THOUSAND, NINE HUNDRED EIGHTY SEVEN DOLLARS AND ZERO CENTS ($199,987.00) 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 2008 -2009 FURNISHING AND APPLICATION OF SLURRY SEAL ON VARIOUS STREETS, SPECIFICATIONS NO. PW 09 -10 ( "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- 10,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. ), 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. 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 -10, 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. SpeWcOws— Pro,.ch1PW Labor Malai.le Bond ( 1103) I —F -1 3983 , 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 AN SEALED this 8th day of September . 2009 "JI/ vll)�,Iry T PRIN L's PRESIDE SURETY'S PRESIDEN PRINCIP C TAR PRINCIPAL's MAILING ADDRESS: 10240 San Sevaine Way Mira Loma, CA 9 752 Richard L. Wells, Attorney;In -Fact SURETY's SECRETARY SURETY's MAILING ADDRESS: 120 Vantis, 1st Floor Aliso Viejo, CA 92656 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 (0687102) I_F-2 POWER .e OF ATTORNEY KNOW ALL BY THESE PRESENTS: No. 10053 3983 First National Insurance Company of America 1001 4th Avenue Suite 1700 Seattle, WA 98154 That FIRST NATIONAL INSURANCE COMPANY OF AMERICA, a Washington corporation, does hereby appoint * * * * * * * * * * * * *SUZANNE ADAMS; TED ADAMSON; LYNN A. BEIMER; RICHARD L. WELLS; Brea, CA * * * * * * * * * * * * * * ** its true and lawful attorney(s) -in -fact, with full authority to execute on behalf of the company fidelity and surety bonds or undertakings and other documents of a similar character issued by the company in the course of its business, and to bind FIRST NATIONAL INSURANCE COMPANY OF AMERICA thereby as fully as if such instruments had been duly executed by its regularly elected officers at its home office. IN WITNESS WHEREOF, FIRST NATIONAL INSURANCE COMPANY OF AMERICA has executed and attested these presents this 15th day of January 2009 Dexter R. Legg, Secretary Timothy A. Mikolajewski, Vice President CERTIFICATE Extract from the By -Laws of FIRST NATIONAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys -in -Fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of FIRST NATIONAL INSURANCE COMPANY OF AMERICA adopted July 28,1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of- attorney appointment, executed pursuant thereto, and (iii) Certifying that said power -of- attomey appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, Dexter R. Legg , Secretary of FIRST NATIONAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of this corporation, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this 8th SEAL 1928 .ter f Of WASO S- 1049/13F 1/09 day of September , 2009 �X* Rr kj j Dexter R. Legg, Secretary Safeco® and the Safeco logo are registered trademarks of Safeco Corporation. WEB PDF s . CALIFORNIA ALL - PURPOSE ACKNOWLEDGEMENT State of California County of Orange On 9/8/09 before me, Lynn A. Beimer, Notary Public Date Here Insert Name and Title of the Officer personally appeared Richard L. Wells Name(s) of Signers) LYNN A. BEIMER Commission # 1781026 Notary Public - California Orange County �.�.� my Orange Dec 16,2 11 Place Notary Seal Above 3983•,., who proved to me on the basis of Aptisfactory evidence to be the person* whose name i ;are subscribed to the within instrument and acknowledged to me that(gAhe /they executed the ame in is/ er /their authorized capacity0eaj; and that by is/ er / their signature on the instrument the person , personX or a entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. A Signature XAll11)711,n �;, &10 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 Top of thumb her ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact Top of thumb her ❑ Trustee L3 Guardian or Conservator ❑ Other: Signer is Representing: 3983 . FAITHFUL PERFORMANCE BOND Bond No. 6663968 Bond Fee: $1224.00 PAVEMENT COATINGS COMPANY ( "PRINCIPAL ") and First National Insurance Company of America , a corporation incorporated under the laws of the State of Washington 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 NINETY NINE THOUSAND, NINE HUNDRED EIGHTY SEVEN DOLLARS AND ZERO CENTS ($199,987.00) 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 -10, 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 -10, 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. ) 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 -10 or of the obligation to be performed will in any Sp,oloetlon,- Projous%PW FMhlul Pvtormenoe Bond (1103) -E -1 3983 . 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, O EALED this 8th day of September 00 t PRIN AL's PRESIDENT SURETY's PRESIDENT v - Richard L. Wells, Attorney -In -Fact PRINCI L's SEC TAR SURETY's SECRETARY PRINCIPAL's MAILING ADDRESS: 10240 San Sevaine Way Mira Loma CA 91252 SURETY's MAILING ADDRESS: 120 Vantis, 1st Floor Aliso Viejo, CA 92656 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. Spectlketlone - PfoJocU%PW FeHA1ul Pedormence SOnO ( / 103) I -E -2 KNOW ALL BY THESE PRESENTS: POWER OF ATTORNEY No. 10053 3983 First National Insurance Company of America 1001 4th Avenue Suite 1700 Seattle, WA 98154 That FIRST NATIONAL INSURANCE COMPANY OF AMERICA, a Washington corporation, does hereby appoint * * * * * * * * * * * * *SUZANNE ADAMS; TED ADAMSON; LYNN A. BEIMER; RICHARD L. WELLS; Brea, CA * * * * * * * * * * * * * * ** its true and lawful attorney(s) -in -fact, with full authority to execute on behalf of the company fidelity and surety bonds or undertakings and other documents of a similar character issued by the company in the course of its business, and to bind FIRST NATIONAL INSURANCE COMPANY OF AMERICA thereby as fully as if such instruments had been duly executed by its regularly elected officers at its home office. IN WITNESS WHEREOF, FIRST NATIONAL INSURANCE COMPANY OF AMERICA has executed and attested these presents this 15th �X* R'kjj day of January Dexter R. Legg, Secretary Timothy A. Mikolajewski, Vice President CERTIFICATE Extract from the By -Laws of FIRST NATIONAL INSURANCE COMPANY OF AMERICA: 2009 "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys -in -Fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of FIRST NATIONAL INSURANCE COMPANY OF AMERICA adopted July 28,1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of- attorney appointment, executed pursuant thereto, and (iii) Certifying that said power -of- attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, Dexter R. Legg , Secretary of FIRST NATIONAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of this corporation, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this 8th a SEAL Y Y� i9Z84 fdj� ! Cf WAS�'�•. S- 1049/0F 1/09 •� dayof September , 2009 �X* Prk, I Dexter R. Legg, Secretary Safeco® and the Safeco logo are registered trademarks of Safeco Corporation. WEB PDF CALIFORNIA ALL - PURPOSE ACKNOWLEDGEMENT State of California County of Orange On 9/8/09 before me, Lynn A. Beimer, Notary Public Date Here Insert Name and Title of the Officer personally appeared Richard L. Wells Name(s) of Signer(s) LYNN A. BEIMER commission # 1781026 Notary Public - California z Z Orange County Comm. =Z41.6 2011 Place Notary Seal Above 3983 who proved to me on the basis of satisfactory evidence to be the personfdwhose name(,*Oare subscribed to the within instrument and acknowledge to me that�shhe/they executed the same in Is/ er /their authorized capacity(k*, and that by " is signature* on the instrument the person; ' or he entity upon behalf of which the persol�w acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature L� 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 ❑ 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: TOM DALY CLERK - RECORDER 3983 • .': PROPERTY RECORDS BIRTH AND DEATH RECORDS MARRIAGE LICENSES /RECORDS PASSPORTS FICTITIOUS BUSINESS NAMES NOTARY REGISTRATION ORANGE COUNTY ARCHIVES CERTIFICATION OF NO RECORD SURRENDERED REVOKED, CANCELLED, ANNULLED OR SUSPENDEDOF ADMITTED SURETY INSURER I, Tom Daly, County Clerk- Recorder in and for said County, do hereby certify that based on the statewide database that First National Insurance Company of America has been issued a Certificate of Authority as an Admitted Surety by the Insurance Commissioner who authorized the Insurer to transact Surety Insurance in the State of California, OR, that authority has not been surrendered revoked cancelled annulled or suspended. In Witness Whereof, I have hereunto set my hand and affixed the seal of said County this 27th day of October, 2009. Tom Daly, Orange County Clerk- Recorder (Seal) ,tea By: puty Cl EBE IN C 9 NORTH COUNTY BRANCH OFFICE ORANGE COUNTY SOUTH COUNTY BRANCH OFFICE HISTORIC DOWNTOWN FULLERTON HALL OF FINANCE AND RECORDS LAGUNA HILLS CIVIC CENTER 201 N. HARBOR BOULEVARD 12 CIVIC CENTER PLAZA, ROOM 101 24031 EL TORO ROAD FULLERTON, CALIFORNIA 92832 SANTA ANA, CALIFORNIA 92701 LAGUNA HILLS, CALIFORNIA 92653 (714) 834.2500 ♦ FAX (714) 834.2675 • WWW.00RECORDER.COM ♦ WWW.00ARCHIVES.COM 10/30/2009 18:39 Remote ID Imprint ID 3983 0 2/6 ACORDrN CERTIFICATE OF LIABILITY INSURANCE D roDIYYYVI 100 /30/30 /09 PRODUCER LIC #OD10299 1 -949- 297 -4900 Venture Pacific Insurance Services, Inc. 26487 Rancho Parkway South Lake Forest, CA 92630 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURED Pavement Coatings Company 10240 San Sevaine In Mira Loma, CA 91752 INSURERA:INTERSTATE FIRE & CAS CO 22829 INSURERB:EMPLOYSRS NUT CAB CO 21415 INSURERC INSURERD: SGL1002053 I NSURER E: 10 /01 /10 1r%JVII VGI THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R DD'L TYPEOFINSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY SGL1002053 10/01/09 10 /01 /10 EACH OCCURRENCE $1,000,000 PREMISES aoccurence $50,000 X COMMERCIAL GENERAL LAB ILITY MED EXP (Anyone person) $ CLAIMS MADE 7 OCCUR PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE L IMIT APPLI ES P ER: PRODUCTS - COMPIOPAGG $2,000,000 POLICY PRO LOC JECT 6 AUTOMOBILE LIABILITY OX81588 10/01/09 10 /01 /10 COMBINED SINGLE LIMIT $1,000,000 (Eaacddenl) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Par person) X SCHEDULEDAUTOS BODILY INJURY $ X HIREDAUTOS X (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Par accident) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBKELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR FI CLAIMSMADE $ DEDUCTIBLE $ RETENTION $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBEREXCLUDED? E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ Ifyes, describe under SPECIAL PROVISIONS below B OTHER Equipment Floater OX81588 10/01/09 10 /01 /10 Contractors Equip 1,180,017 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 10 Day Notice of Cancellation for Non Payment of Premium. Project: 2008 -2009 Furnishing and Application of Slurry Seal on Various Streets Project # PW09 -10 The City,its officers ,officials,employees,agents, and volunteers will be named as Additional Insureds as required by written contract as per attached endorsement. L,nR t IrIl-At n nvi wcm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL 0081YA Y5 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ffJA4& xf bXM*X Maryam Jonas88pgpy77MgK�plpg�lliW (i{IfX 350 Main Street XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX E1 Segundo, CA 902 AUTHORIZED REPRESENTATIVE USA ACORD 25120011081 cmckinley 0 ACORD CORPORATION 1988 13511142 OCT -30 -2009 14:26 94% P.02 10/30/2009 18:39 Remote ID Imprint ID IMPORTANT 6983 , D 3/6 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 The Certificate of Insurance on the reverse side of this form 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. 25 (2001108) OCT -30 -2009 14:26 94% P.03 10/30/2009 18:39 Remote ID Imprint ID ❑ 4/6 , 3983..,E POLICY NUMBER: SGL1002053 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS E (FORM ) This endorsement modifies insurance provided under the follow g. COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or organization: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that Insured by or for you. CG 20 10 11 86 OCT -30 -2009 14:26 Copyright, Insurance Services Office, Inc., 1964 Page 1 of 1 0 94% P.04 10/30/2009 16:39 Remote ID Imprint ID POLICY NUMBER: SGL1002053 D 5/6 3983 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization; Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement,) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard" This waiver applies only to the person or organization shown in the Schedule above. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ OCT -30 -2009 14:27 94% P.05 10/30/2009 18:39 Remote ID Imprint ID D 6/6 3983. , AMENDMENT OF OTHER INSURANCE CONDITION - PRIMARY INSURANCE FOR AUTOMATIC STATUS ADDITIONAL INSURED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART if required under a written "insured contract" with you, paragraph a. Primary Insurance in SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance Is amended by adding the following paragraph: Not withstanding the foregoing, the insurance afforded to any person or organization who has been added to this policy by an Automatic Status Additional Insured Endorsement is primary and non- contributory insurance, but only as respects "bodily injury" or "property damage" liability arising out of your sole negligence in performance of "your work" after the effective date of this policy under a written contract between you and such person or organization that requires you to maintain primary and non- contributory insurance and to include such person or organization as an additional insured thereunder. All other terms and conditions of this policy remain unchanged, ICB -8016 06 -05 OCT -30 -2009 14:27 94% P.06 70% .. ACORO� CERTIFICATE OF LIABILITY INSURANCE Date (qm /d / /yy� 10/5/2009 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Bolton & Company )245 S. Los Robles Ave., Suite 105 Pasadena, CA 91102 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER Arch Insurance Company (626) 799 -7000 0008309 www.boltonco.com INSURER Insured INSURER Pavement Coatings Company 10240 San Sevaine Way Mira Loma CA 91752 INSURER INSURER E .> Ct S/E1 A E$ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIAB CLAIMS MADE DOCCUR FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGG LIMIT APPLIES PER PRODUCTS- COMP /OP AGG $ POLICY FlPROJECT Loc $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ .` �` HIRED AUTOS a BODILY INJURY NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE ri (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS LIABILITY OCCUR F� CLAIMS MADE EACH OCCURRENCE $ AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS' COMPENSATION & EMPLOYERS' LIABILITY ZAWC19174900 10/1/2009 10/1/2010 STATUTORY LIMIT I lOTHER,�'.1,1",'�1-1— EL EACH ACCIDENT $ 1000 000 EL DISEASE - EA EMPLOYEE $ 1,000,00 EL DISEASE - POLICY LIMIT $ IDES 'RIPTION OF OP E RATIO A I E H I C LES/EXCLUSIO N ALP N Job: Project #PW 09 -10, 2008 -2009 Furnishing and Application of Slurry Seal on Various Streets. *10 Days notice of cancellation for non - payment of premium by registered or certified mail. CERTIFICATE HOLDER CANCELLATION Project #PW 09 -10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL KU *)M)% MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE City of El Segundo 350 Main Street LEFT,c�►xii�rx#a El Segundo, CA 9024 b?f1(x ' 10 Days for Non - Payment of Premium. AUTHORIZED REPRESENTATIVE William A. Lewis ACORD 25 -S (7/97) O ACORD CORPORATION 1988 CERT NO.: 5940977 CLIENT CODE: PAVEM -1 Bolton Certificate Processing 10/5/2009 5:37:21 AM Page 1 of 2 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 The Certificate of Insurance on the reverse side of this form 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 -S (7/97) created at www.e CertsONLINE.com CERT NO.: 5940977 CLIENT CODE: PAVEM -1 Bolton Certificate Processing 10/5/2009 5:37:21 AM Page 2 of 2 10/30/2009 16:29 FAX 310 543 9175 ABD CONSTRUCTION PAVESYSTE 398 3 002 ACORD.M CERTIFICATE OF LIABILITY INSURANCE • , THE POLICIES OF INSURAM';E L.STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RROUIREMENT, TERM' )R; CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TA WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURA.4CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL Tr.IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE L14 TN. SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DATE 0129/2" "TY' 10/29/2009 PRODUCER Commercial Line,.; ;"10) 533 -9995 Wells Fargo of 0 lifarnis Insurance Services Inc. 21250 Hawthorn: Bowleverd, Suite 600 Torrance, CA 901 ~034519 THIS C R IFICA �E 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORIOING COVERAGE NAIC INSURED Pavement Recyr: ins Systems, Inc, II 10240 San Sevai•le I Mira Loma, CA 617:32 jNSVARA A; Insurance Company of the State of Pennsylvania 19426 INSURER BI GENERA. LIABILITY COMMERCIAL OIPNEF.AL LINBII.ITY INSURER C: AUTHORIZED RePRE6BWN ATM ^, `�• INSURER D: EACH OCCURRENCE INSURER E; RENTED DAMAGE TO IPA wMrftI • , THE POLICIES OF INSURAM';E L.STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RROUIREMENT, TERM' )R; CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TA WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURA.4CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL Tr.IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE L14 TN. SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TTPE Of IIA111411 �E POLICY NUMBER DATE THEREOF, THE ISSWNO INSURER WILL BI IN)VC MAIL 70 DAYS WRRTBN TiON LIMBS 1100 E, Ore ngethorpe Avi., Swe. 200 lmmoso m GENERA. LIABILITY COMMERCIAL OIPNEF.AL LINBII.ITY ABPRBYRMVRt117( AUTHORIZED RePRE6BWN ATM ^, `�• EACH OCCURRENCE f RENTED DAMAGE TO IPA wMrftI 6 MED E:XP (MY dna Mnm CLAIMS MAVE 0 OCCUR PERSONAL 6 ADV INJURY 6 GENERAL AWIGAT6 S GEN'L AGGREGATE L: AIT .APPLIES PER; PRODUCTS - comPIOP AGG 6 POLICY A (�• LOC AUTOMOBILE UABILF T COMBINED SINOLE LIMIT (Ea "cant) 6 ANY AUTO ALL OWNED AUTO$ POOILY INJURY (Par Parson) S ACHEOULECnu' :15 HIRED AUTOS BODILY INJURY (Par wddant) 6 NON.OWNED AUt 09 PROPERTY DAMAGE (Per sadden) _ GARAGE LIABILITY — AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO 6 ANY AUTO S A EXCE&MMARP.LLAIY,ABMLRY X OCCUR C. J CLAIMS MADE 7518522 10101/2009 110/0142010 EACH OCCURRENCE s 1.000.000 AGGREGATE 6 1.000.000 S _ DEDUCTIBLE WC STATU• O 6 RETENTION J — WORKERS COMPENSATNONANP E.L. EACH ACCIDENT 6 EMPLOYERS' LIABILITY E.L. DISEASE - EA EMPLOYEE 6 ANY pROPNt1ETORIPARTNE6aEft�CUTIVE OFFICER/MEMBER EXCLUD:: D7 E.L. DISEASE - POLICY LIMIT 6 M. . d611CM6 under OTHER DESCRIPTION OF OPERATIONS 16 )CM,TIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Job Number. 29858U Job )daMia: Carson Street FOR EVIDENCE OF COVI :RAGE CERTIFIGAIh MVLUtK SHOULD ANY OF TYRE ABOVE mCR19ED POUC1 W BE CANCELLED BEFORE TNB EXMRATION DATE THEREOF, THE ISSWNO INSURER WILL BI IN)VC MAIL 70 DAYS WRRTBN Sully Miller Contracting NOTICE TO THE CIRTIFICiTE HOLDER NAMED TO THE LEFT, K 1100 E, Ore ngethorpe Avi., Swe. 200 lmmoso m Anaheim, CA 82801 -1146• ABPRBYRMVRt117( AUTHORIZED RePRE6BWN ATM ^, `�• RD CORPORATr ^u ,oaa ACORD 25 (2001108) 1 of 1 925805 (This 3srUcate replaces cartHlcate# 925582 Issued on 10/29/2009) OCT -30 -2009 15:28 310 543 9175 96% ® M. P.02 10/30/2009 16:29 FAX 310 549 9175 ABD CONSTRUCTION IMPORTANT � 39 003 �� . If the <- ertiticate holder is an ADDITIONAL INSURED, the policy(ies) Fnust be endorsed. A statement on this, certificate does not confer rights to the certificate holder In Ilet, of such andorsement(a). If SUBRCGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require, ar+ endorsement. A statement on this certificate does not confer rights to the certificate holder n weu of such endorsement(s). DISCLAIMER The Ce 0c. to of Insurance on the reverse side of this form does nol constitute a contract between the Issi Inli Insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmaiiveiy or negatively amend, extend or alter the coverage afforlled by the policies listed thereon. ACORO 25.5 (2001108) +, �f 2 #S9152601101915043 OCT -30 -2009 15:28 310 643 9175 96% P.03 3983. , PROPOSAL FOR THE 2008 -2009 FURNISHING AND APPLICATION OF SLURRY SEAL ON VARIOUS STREETS IN THE CITY OF EL SEGUNDO SPECIFICATIONS NO.: PW 09 -10 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 39 8 3 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. I -C -2 CITY OF EL SEGUNDO - BID SHEET 3 9 8 3 - fl 04 2008 -2009 FURNISHING AND APPLICATION OF SLURRY SEAL ON VARIOUS STREETS PROJECT NO. PW 09 -10 ITEM NO. ESTIMATED QUANTITIES UNIT PRICE WRITTEN IN WORDS UNIT PRICE IN FIGURES AMOUNT Furnish and apply slurry seal, CATIONIC 1 665 Type I, complete and in place as shown on accompanying map, for Monday $ -7 $ I N AOS,7 Extra Long Tons through Friday work @ 61)eA jerd S Vat Pic urJo l«s �- Q VIA. '75- ce4 +s per ton Furnish and apply slurry seal, CATIONIC 2 187 Extra Long Type I, complete and in place as shown on accompanying map, for Saturday and Sunday work @ $ L7 7 $ -79 ' Tons �hda )y4nL e-A Sevee& ty Fa(A r &pia per ton 3 LS Street stripping per specifications for Ne t v On e p o.; S;g hd 6 4 e )-1,4j✓�ed _ $ S J l o 1)4 V/ s lump sum ALL WORK ON STREETS ADJACENT TO SCHOOL PROPERTIES SHALL BE DONE ON SATURDAYS OR SUNDAYS TOTAL BID = $ % 9 q % p D TOTAL BID WRITTEN IN WORDS ah e A r ej /V,`, z `i- ,, Alto '- CJ E 1,, -E'/ 5c VeeL dd lla/'S a70A 7ev"d C I -C -3 (page 1 of 1) 39 83 . ,} , J BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder's Name Pavement Coatings Co. Form of Legal Entity (i.e., individual, partnership, corporation, etc.) Corporation If corporation, State of Incorporation (i.e., California) California Business Pavement Coatings CO. Address 10240 San Sevaine Way Mira Loma, CA 91752 Telephone No. 714/826 -3011 Facsimile No. 714/826 -3129 State Contractor's License No. and Class 303609 A C -32 Original Date Issued 03 -03 -1975 Expiration Date 09 -30 -10 The following are the names, titles, addresses, and phone numbers of all individuals, firm members, partners, joint venturers, and /or corporate officers having principal interest in this proposal: Doug Ford, President, 10240 San Sevaine Way, Mira Loma, CA 91752 , 714/713 -7978 Richard Gove, Secretary, 10240 San Sevaine Way, Mira Loma, CA 91752 951/682 -1091 The date of any voluntary or involuntary bankruptcy judgments against any principal having an interest in this proposal is as follows: None All current and prior DBA's, aliases, and /or fictitious business names for any principal having an interest in this proposal are as follows: None I -C -4 39 8 3 . , IN WITNESS WHEREOF, BIDDER executes and submits this proposal with the names, titles, hands, and seals of all aforenamed principals this 17th day of August -220 09. BIDDER Pavement Coatings Co. / Doug Ford 10240 San Sevaine Way Subscribed and sworn to this I '-? day of AufruST, 2005 NOTARY PUBLIC L t 4411*## oeeollooeeemeeoeeeeee ♦eeee44eee4eee •�� VAN P. DUNCAN o COMM. #1689434 NOTARY PUBLIC - CALIFORNIA 0 ' ORANGE COUNTY —► �oe0000 0000eiioiMMIioie oiiooiioieoioiie� I -C -5 3983. , ,w PROPOSAL GUARANTEE 810 BOND 2008 -2009 FURNISHING AND APPLICATION OF SLURRY SEAL ON VARIOUS STREETS IN THE CITY OF EL SEGUNDO SPECIFICATIONS NO.: PW 09.10 KNOW ALL MEN BY THESE PRESENTS that, Pavement Coatings Co, , as BIDDER, and First National Insurance Company of America , as SURETY, are held and firmly bound unto the City of El Segundo, In the penal sum of Ten Per�ccent o idDOLLARS ($ 10% of), which is ten (10%) percent of the total amount bid by BipDER'Co`} ierCi y of El Segundo fd419§'kbA'6ated project, for the payment of which sum, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE S UCH that, whereas BIDDER is about to submit a -laid 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 time specified, then this obligation shall be null and void, otherwise it shall remain In full force and effect in favor of the City of EI Segundo, IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seals this 7th day of August 2009 BIDDER" Pavement Coatings Co. DOUG FORD President SURETY* First National Insurance Company of America Ted A amson, Attorney -in- act Subscribed and swom to this day of 20 NOTARY PUBLIC Provide BIDOERISURETY name, address and telephone number and the name, title, address and telephone number for authorized representative. I -C -6 3983 - CALIFORNIA -• ACKNOWLEDGMENT State of California County of l2l VC- ✓15f ✓l+5-- On Val tr ics,— i'Z�tevo .7 before me, V fit-1 iP ' 0 O , Dae Here Insert me Te 2tl /fH �° personally appeared w 2 �Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his /her /their authorized ♦+++++++ e+ +++++ +e+ee+a + + +++e++ ++�+ +++ ++ +� capacity(ies), and that by his /her /their signature(s) on the "u instrument VAN P. DUNCAN instrument the person(s), or the entity upon behalf of p COMM. #1689434 g which the person(s) acted, executed the instrument. NOTARY PUBLIC - CALIFORNIA p O ORANGE COUNTY + MyComm4sionExpiraa SEPTEMBER 21 ,nio + 1 certify under PENALTY OF PERJURY under the laws i�+ ++++♦ ♦ +++ ++o++ +ei+++++ai of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Place Notary Seal Above Signature ��` 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: P21 t9 66N12 f) Document Date: 4 u: & u -7 i -7, 2 m o 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 of thumb here 02007 National Notary Association- 9350 De Soto Ave., P.O. Box 2402 - Chatsworth, CA 91313 -2402- www.NationalNotary.org Item #5907 Reorder: Call Toll -Free 1.800. 876 -6827 POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: No. 10053 39 83 First National Insurance Company of America 1001 4th Avenue Suite 1700 Seattle, WA 98154 That FIRST NATIONAL INSURANCE COMPANY OF AMERICA, a Washington corporation, does hereby appoint * * * * * * * * * * * * *SUZANNE ADAMS; TED ADAMSON; LYNN A. BEIMER; RICHARD L. WELLS; Brea, CA * * * * * * * * * * * * * * ** its true and lawful attorney(s) -in -fact, with full authority to execute on behalf of the company fidelity and surety bonds or undertakings and other documents of a similar character issued by the company in the course of its business, and to bind FIRST NATIONAL INSURANCE COMPANY OF AMERICA thereby as fully as if such instruments had been duly executed by its regularly elected officers at its home office. IN WITNESS WHEREOF, FIRST NATIONAL INSURANCE COMPANY OF AMERICA has executed and attested these presents this 15th day of January , 2009 Dexter R. Legg, Secretary Timothy A. Mikolajewski, Vice President CERTIFICATE Extract from the By -Laws of FIRST NATIONAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys -in -fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of FIRST NATIONAL INSURANCE COMPANY OF AMERICA adopted July 28,1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (i) The provisions of Article V, Section 13 of the By -Laws, and (ii) A copy of the power -of- attorney appointment, executed pursuant thereto, and (iii) Certifying that said power -of- attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, Dexter R. Legg , Secretary of FIRST NATIONAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By -Laws and of a Resolution of the Board of Directors of this corporation, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By -Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this 7th day of August 2009 \�S�RANCF,,^0 =P� `Op P o g"4 f�> a SEAL N %1928 `os3 e1P wAS� ��b� Dexter R. Legg, Secretary S- 1049/13F 1/09 • • r SafecoO and the Safeco logo are registered trademarks of Safeco Corporation. WEe POF CALIFORNIA ALL ACKNOWLEDGEMENT 3983 , e .. State of California County of Orange On August 7, 2009 betore me, Lynn A. Beimer, Notary Public Date Here Insert Name and Ttle of the Officer personally appeared Ted Adamson Name(s) of Signers) who proved to me on the basis of satisfactory evidence to be the persono�' whose named I /are subscribed to the within instrument and ac owledge to me that(gshe /they executed the same in Is/ r /their authorized capacity(-ieo, LYNN A. BEIMER and that by " is signatures on the instrument the Commission # 1781026 person or a entity upon behalf of which the personK Notary Public - California z acted, executed the instrument. ' Orange County comet. esoec16,2o11 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 official seal. Signatureo 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 Signer is Representing: Number of Pages: Signer's Name: • Individual • Corporate Officer — Title(s): ❑ Partner ❑ Limited ❑ General • Attorney in Fact Top of thumb here • Trustee • Guardian or Conservator • Other: Signer is Representing: ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee • Guardian or Conservator • Other: Signer is Representing: Number of Pages: Signer's Name: • Individual • Corporate Officer — Title(s): ❑ Partner ❑ Limited ❑ General • Attorney in Fact Top of thumb here • Trustee • Guardian or Conservator • Other: Signer is Representing: CONTRACTOR'S LICENSE DECLARATION Business and Professions Code Section 7028 15) BIDDER'S Contractor's License Number is: 303609 Class No.: A ; C -32 2. The expiration date of BIDDER'S Contractor License is: 09 -30 2009 3983•.._ 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 on 08 -17 , 20 09 , at Mira Loma, CA (insert City and State where Declaration is signed). _1� 7� Signature Doug Ford Typed Name: President Title: Pavement Coatings Co. Name of Bidder: I -C -7 State of California ss. County of Ri vers i de Doug Ford 3983,.. NON - COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID being first duly sworn, deposes and say tha he r she is President of Pavement Coatings Co. 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 Doua Ford Typed Name President Title I -C -8 Pavement Coatings Co. Name of Bidder Date 3983•... 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: President Business Name: Pavement Coatings Co. Business Address: 10240 San Sevai ne flay Mira Loma, CA 91752 Telephone Number: ( 714 ) 826 -3011 Dated this 17th day of August , 2009 I-C' -9 3983•. BIDDER'S CERTIFICATION OF SUBCONTRACTORS As detailed in Section 2 -3.1 (Page II -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 SUBCONTRACTORS a� o Sa�.4' i�C �¢v, o35-6 SUBCONTRACTED WORK �f r ► a ��;,� , (Make copies of this page if additional space is needed) 08 -17 -09 Signature of Bidder Date DOUG FORD President I -C -10 3983 . , , 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: 1. Project Title: Slurry Seal & Microsurfacing FY 06 -07 Location: Various City Streets in the City of Orange City of Orange, 300 E. Chapman Ave., Orange, CA 92866 Name and address of owner Alan Trounq 714/744 -5544 Name and telephone number of person familiar with project Type of Work: Application of Slurry Seal Contract amount: $ 151,251. Date completed: 06 -25 -07 Amount of work done by my /our firm under contract $ 129,580. Did your firm have any financial interest in Project? No 2. Project Title: 2006 -07 Slurry Seal Project ( #8340) Location: Various City Streets in the Town of Yucca Valley Town of Yucca Valley, 57090 Twentynine Palms Hwy, Yucca Valley, CA 92284 Name and address of owner Duane Gassaway 760/369 -7207 Name and telephone number of person familiar with project Type of Work: Application of Slurry Seal Contract amount: $ 223,645. Date completed: 08 -09 -07 Amount of work done by my /our firm under contract $ 216,952. Did your firm have any financial interest in Project? No 3. Project Title: P1 acement of S1 urry Seal in Zone 4, Cash Contract #2007 -02 Location: Various City Streets in The City of La Mirada City of La Mirada, 13700 La. Mirada Blvd., La Mirada, CA 90638 Name and address of owner Steve Froster 562/902 -2385 Name and telephone number of person familiar with project Type of Work: Application of Slurry Seal Contract amount: $ 375,842. Date completed: 04 -28 -08 Amount of work done by my /our firm under contract $ 244,570. Did your firm have any financial interest in Project? No. I -C -11 (Page 1 of 2) 3983 . 4. Project Title: Slurry Seal & Cape Seal Phase I I I Location: Various City Streets in the City of Duarte City of Duarte, 1600 Huntington Dr, Duarte, CA 91010 Name and address of owner Steve Esbenshade 626/357 -7931 Name and telephone number of person familiar with project Type of Work: Application of • S1 urry Seal Contract amount: $ 395,741. Date completed: 05 -22 -08 Amount of work done by my /our firm under contract, 334,905. Did your firm have any financial interest in Project? no 5. Project Title: 2007 -08 Slurry Seal Project Location: Various City Streets in the City of Aliso Viejo City of Aliso Viejo, 12 Journey, Ste. 100, Aliso Viejo, CA 92656 Name and address of owner Angel P Fuertes 949/425 -2533 Name and telephone number of. person familiar with project Type of Work: Application of Slurry Seal Contract amount: $ 490,971. Date completed: 06 -19 -08 Amount of work done by my /our firm under contract $ 361,202. Did your firm have any financial interest in Project? Z The following are the names, addresses, and telephone numbers for all brokers and sureties from whom BIDDER intends to procure insurance bonds: First Natt6nal Insurance Company of America, 949/860 -6612 120 Vantis #130, Aliso- Viejo, CA 92650 1800 Lambert Road #215 Smith Newman & Adamson Insurance Agency, Brea, CA 92821 714/257 -9644 Rancho Parkway South Ventura Pacific Insurance Services, Inc. Lake Forest, CA 92630 949/297 -4900 I -C -11 (Page 2 of 2) 10/30/2009 18:39 Remote ID Imprint ID 'f J,3 2/6 ACORDI. CERTIFICATE OF LIABILITY INSURANCE 1 DATE 10/ 330/09 0 /09IYVYY) PRODUCER LIC #OD10299 1- 949- 297 -4900 Venture Pacific Insurance Services, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26487 Rancho Parkway South ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICYEFFECTIVE DATE(MMIDDfYYI POLICY EXPIRATION -J- Lake Forest, CA 92630 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA INTERSTATE FIRE & CAS CO 22829 Pavement Coatings Company INSURERe:EMPL0YER5 MIIT CAS CO 21415 INSURERC: $ 50,000 10240 San Sevaine Ln NSURERD: _ X COMMERCIAL GENERAL LLABILITY Mira Loma, CA 91752 INSURER E: MED EXP (Any ore person) rn%iCOAr -Cc THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CON IRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN R =DJCED BY PAID CLAIMS. INSR LTR DOL POLICY NUMBER POLICYEFFECTIVE DATE(MMIDDfYYI POLICY EXPIRATION -J- LIMITS A AUTHORIZED REPRESENTATIVE GENERAL LIABILITY SGL1002053 10/01/09 10 /01 /10 EACH OCCURRENCE $1,000,000 PREMISES Eaoccurence $ 50,000 X COMMERCIAL GENERAL LLABILITY MED EXP (Any ore person) $ CLAIMSMADE Fx-1 OCCUR PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGO $2,000,000 POLICY 7 PRO- LOC B AUTOMOBILELIABILITY ANY AUTO 0X81588 10/01/09 10 /01 /10 COMBINED SINGLE LIMIT I $1,000,000 (Ea a or. idenq X ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY (Per person) $ _ X HIREDAUTOS 1 BODILY INJURY X NON -OWNED AUTOS (Par accident) $ -- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ $ OCCUR El CLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ _ �- $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER $ -- EMPLOYERS' LIABILITY ' E.L. EACH ACCIDENT ANY PROPRIETORrPARTNERIEXECUTIVE -- $ OFFICERIMEMBER EXCLUDED? E,L. DISEASE - EA EMPLOYEE Ifyes, describe under SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ B OTHER Equipment Floater 0X81588 10/01/09 10 /01 /10 Contractors Equip 1,180,017 Leased /Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 10 Day Notice of Cancellation for Non Payment of Premium. Project: 2008 -2009 Furnishing and Application of Slurry Seal on Various Streets Project # PW09 -10 The City,its officers ,o£ficials,employees,agents, and volunteers will be named as Additional Insureds as required by written contract as per attached endorsement. COWTIFIr ATF un1 IIFR I'ANr Fl I ATInm ACORD 25 (2001108) cmckinley 13511142 OCT -30 -2009 14:26 UAU,UKUI.UKrUMA1IUIV Iy00 94% P.02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL L XW*9 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ffuMyA %FS'oVWdUJMX'X Maryam Jonas ��pffilypyph} ItNyr7gjp( g�L ItYX1�XA$ 14�IAa> d�i XAbffili7p1087fnX9UpRX�f�SBKi�giOlX 350 Main Street XXONENKA%kN)V"XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX AUTHORIZED REPRESENTATIVE El Segundo, CA 902 USA ACORD 25 (2001108) cmckinley 13511142 OCT -30 -2009 14:26 UAU,UKUI.UKrUMA1IUIV Iy00 94% P.02 10/30/2009 18:39 Remote ID Imprint ID 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 The Certificate of Insurance on the reverse side of this form 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 (2001 /08) D 3/6 OCT -30 -2009 14:26 94% P.03 10/30/2009 18:39 Remote ID Imprint ID 3983 1 D 4/6 t. It POLICY NUMBER: SGLI002053 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (FORM B) This endorsement modifies insurance provided under the follow' g. COMMERCIAL GENERAL LIABILITY COVERAGE PART... SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that Insured by or for you. CG 20 10 11 85 OCT -30 -2009 14:26 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 0 94% P.04 T rint 1D 10/30/2009 18:39 Remote ID mp COMMERCIAL GENERAL 4IABILITY `10 93 POLICY NUMBER: SGL1002053 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRANSFER OF RIGHTS OF RECOVERY AGAINST WAIVER OF TRAN OTHERS TO US s1� &'p-: This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1 ' person or organization for whom you are performing Name of Person or Organization; Any p reed in writing m a contract or operations when y ou and such person or organization have agreed our policy. such person or organization be added as an additional own area Declarations as agreement that P ears above, information required to complete this endorsement will be (If no entry app. applicable to this endorsement.) � S of the following: F RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMM e The TRANSFER OF RIGHTS O our work" done ainst the person or organization shown in the Schedule ' done CIAL GENERAL LIABILITY CONDITIONS) is ag mended by the a ongoing operations or ions hazard" This right of recovery we may arising out of your ong g p Brat We waive any ig or damage ,products- completed op because of payments we make for organization and included in the p under a conttr only ittotihe eon or org waiv er app person or organization shown in the Schedule a ove. CG 24 04 10 93 nrT -q0 -2009 14:27 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 13 P.05 94% 10/30/2009 18:39 Remote ID Imprint ID AMENDMENT OF OTHER INSURANCE CONDITION - PRIMARY INSURANCE FOR AUTOMATIC STATUS ADDITIONAL INSURED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART [) 6/6 If required under a written "insured contract" with you, paragraph a. Primary Insurance in SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended by adding the following paragraph: Not withstanding the foregoing, the insurance afforded to any person or organization who has been added to this policy by an Automatic Status Additional Insured Endorsement is primary and non- contributory insurance, but only as respects "bodily injury" or "property damage' liability arising out of your sole negligence in performance of "your work' after the effective date of this policy under a written contract between you and such person or organization that requires you to maintain primary and non- contributory insurance and to include such person or organization as an additional insured thereunder. All other terms and conditions of this policy remain unchanged. icB -8016 06 -05 OCT -30 -2009 14:27 94% P.06 Aco or F (r�1m /dJ /yy� ' CERTIFICATE OF LIABILITY INSURANCE Date 10/5/2009 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Bolton & Company 245 S. Los Robles Ave., Suite 105 Pasadena, CA 91102 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER Arch Insurance Company A INSURER (626) 799 -7000 0008309 www.boltonco.com Insured INSURER Pavement Coatings Company C INSURER 10240 San Sevaine Way Mira Loma CA 91752 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICY POLICY INSR LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE M DATE Y EXPIRATION M ATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ COMMERCIAL GENERAL LIAB CLAIMS MADE OCCUR MED EXP (Any one person) _ $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN' L AGG LIMIT APPLIES PER PRODUCTS- COMP /OP AGG $ $ POLICY PROJECT F LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON -OWNED AUTOS t; BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY _ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ S $ DEDUCTIBLE $ RETENTION $ A WORKERS' COMPENSATION & EMPLOYERS' LIABILITY ZAWC19174900 10/1/2009 10/1/2010 STATUTORY LIMIT THE " EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS /LO ATIONS V HICLES EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Job: Project #PW 09 -10, 2008 -2009 Furnishing and Application of Slurry Seal on Various Streets. '10 Days notice of cancellation for non - payment of premium by registered or certified mail. CERTIFICATE HOLDER CANCELLATION Project #PW 09 -10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL i 0010 2 U MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE City of El Segundo 350 Main Street El Segundo, CA 90241st LEFT,Ifo2(fXIL�4i�i?Ob}��(d4Afl 10 Days for Non - Payment of Premium. AUTHORIZED REPRESENTATIVE William A. Lewis ��������Vy� • `�������V �// ACORD 25 -S (7/97) O ACORD CORPORATION 1988 CERT NO.: 594097'/ CLIENT CODE: PAVEM -1 Bolton 1 -ezt i.ficate Pi ocessi ng 10/5/20119 5.37 21 AM Page 1 of 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 The Certificate of Insurance on the reverse side of this form 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 -S (7/97) created at www.e CertsONLINE.com CEPT NO.: 5940977 CILIENT CODE: PAVEM -I Bolton Certificate Pror_escing 10/5/2009 5 37:7.] AM Page ^ of 7 10/30/2009 16:29 FAX 310 549 9175 ABD CONSTRUCTION 1& 002 J PAVEBYeTE ACURD.M CICERTIFICATE OF LIABILITY INSURANCE 1 oar10 2009 T1 LTp THIS CERTIFICA IS ISSUED AS A MATTER OF INFORMATION PRODUCER Commercial Line-.: ',: TO) 533 -9995 .E ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EACH OCCURRENCE 5 HOLDER. THIS COTIFICATE DOES NOT AMEND, EXTEND OR Wells Fargo of 0ilifornia Insurance Services Inc. GENERAL LIABILITY ALTER THE COVEERAGE AFFORDED BY THE POLICIES BELOW. 21250 Hawthorn, Bowleverd, Suite 600 DAMAGE TO RENTED S Torrance, CA 90r'034S519 INSURERS AFFOR14ING COVERAGE NAIC 0 INSURER A: Insurance Company of the State of Pennsylvania 19428 INSURED pavement Recyc: ng w:yslems, Inc, 6 GENERALAOORSQATE S 10240 San Seva; )e I 0"Iay INSURER a: PRODUCTS - COMPIOP AGG S INSURER c: — INSURER D: Mira Loma. CA k 1T ?;:: COVERAGES _ THE POLICIES OF INSURAN;E LSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RIEOUIREMENT, TERM' )K ONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURR•4CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL Tr.IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE 1-1141 TV$HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, — Tit UMITS LTp TYPE OF INGS RAW9 POLICY NUMBER EACH OCCURRENCE 5 GENERAL LIABILITY DAMAGE TO RENTED S COMMERCIAL GI: NENAL LIABILITY CLAIMS MAI'E D OCCUR MED EXP (MY 0014 Perean ) S PERSONAL 6 ADV INJURY 6 GENERALAOORSQATE S ' PRODUCTS - COMPIOP AGG S — OEN'L AGGREGATE L: AIT .APPLIES PER: POLICY JIEZ I LOC AUTOMOBILE UABILF T COMBINED SINGLE LIMIT (go ac4l0enl) 5 ANY AUTO ALL OWNED AUT IS BODILY INJURY (Per perc401) 3 eCHEOU6EDAU' 75 HIRED AUTOS BODILY INJURY (Per a0deen1) S NON -OWNED ALh OS PROPERTY DAMAGE (Per B0d0erel S —' AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER EA ACC AUTO ONLY; A00 $ 3 q ExcESSnIMeReLU N. AeaurY X OCCUR C CI -AIMS MADE 7518522 10101J2009 10/0'12010 EACH OCCURRENCE S t,00�,000 AGGREGATE f t,00n,000 S S DEDUCTIBLE a RETENTION b - WC STATU- 0 WORKERS COMPENSATIOWANI" EMPLOYERS' LIABILITY ESL, EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE i ANY PROPRIETORIPARTNEV9XEr1UTIVE OFFICEWMEMBER EXCLUDI; D7 If ee, dmWft IMOer E.L. DISEASE - POLICY LIMIT 3 R V �. OTHER DESCRIPTION OF OPERATIONS 16 )CA+TIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Job Number: 299580 Job Wawa! Carson Street FOR EVIDENCE OF COWRAGE Sully Miller Contracting 1100 E. Orangethorpe &0., She. 200 Anaheim, CA 92801 -1146, ACOR13 25 12001/0811 of SHOULD ANY OF THE A9eiVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSk "1140 INSURER WILL 901091MR11111IMMAIL 30 DAYS WRITTEN NOTICE TO THE CERTIPIC4TE HOLDER NAMED TO THE LEFT, X AUTHORIZED (This:ergicate replaces certificate# 925582 lesued on TUwJ19vuu) OCT -30 -2009 15:28 310 543 9175 ® ACORD CORPORATION 199E 96% P.02 10/00/2009 16:29 FAX 310 540 9175 ABD CONSTRUCTION IMPORTANT If the s-ertifiaats holder is an ADDITIONAL INSURED, the policy(iss) f'nust be endorsed. A statement on this. certificate does not confer rights to the certificate holder In IleL of such endorsement(s). If SUB ICC' ATION IS WAIVED, subject to the terms and conditions or the policy, certain policies may require arr endorsement. A statement on this certificate" does not confer rights to the certificate holder n weu of such endorsement(s). DISCLAIMER The Ctirtltiaate of Insurance on the reverse side of this form does nol constitute a contract between the Issi Ini.I Insurer(s), authorized representative or producer, and the certificate holder, nor does it effirmaNvely or negatively amend, extend or alter the coverage afforlied by the policies listed thereon. ACORD 25.3 (2001108) if 2 #S91526011iA915043 OCT -30 -2009 15:28 310 643 9176 96% [A 003 P.03