CONTRACT 5008 Public Works Contract CLOSEDAgreement No. 5008
PUBLIC WORKS CONTRACT
BETWEEN
THE CITY OF EL SEGUNDO AND
AMERICAN ASPHALT SOUTH, INC.
FY 15/16 SLURRY SEAL RESURFACING PROJECT
PROJECT NO. PW 16 -09
This CONTRACT is entered into this 18th day of April, 2016, by and between the CITY
OF EL SEGUNDO, a general law city and municipal corporation ( "the City ") and A Ml ICI AN
ASPIIAI "l" SO11TI- INC,, a California Corporation ( "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 THREE
HUNDRED SEVEN THOUSAND, FOUR HUNDRED EIGHTY -FIVE DOLLARS
AND SEVENTY CENTS
($307,48.5.7q) 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.
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Agreement No. 5008
A. The Contractor will fully complete the Work within twenty -five (25) working
days (the "Contract Time. ")
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.
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Agreement No. 5008
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
Stephanie Katsouleas
Public Works Director
City of El Segundo
350 Main Street,
El Segundo, CA 90245
(310) 524 -2356
The Contractor
Jeff Petty
Vice President
American Asphalt South, Inc.
14436 Santa Ana Avenue
Fontana, CA 92337
(909) 427 -8276
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Agreement No. 5008
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.
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.
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Agreement No. 5008
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.
IN '4 ITN SS WHEREOF the parties hereto have executed this contract the day and
year first lic/L.i na ove written.
CITY II ' )NIX)
/
��e a nm_....
Or ;� � e� ter Jeff Pett�
City t alter Vice President
ATTEST:
Iva.a Wcav Npmm
Cit Cterlc'
APPROVED AS TO FORM:
MARK D. HENSLI`EY, City Attorney
?'
David H. King,
Assistant City Attorney
Insurance Reviewed by:
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Taxpayer ID No. 7 7 -A y/p
Contractor State
nQ r n
License No.: _/ O
Contractor City Business
License No.:
Agreement No. 5008
PROPOSAL
FOR THE
2015 -2016 FURNISHING AND APPLICATION
OF SLURRY SEAL ON VARIOUS STREETS
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 affect 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.
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Agreement No. 5008
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 DECLARATION
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.
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Company Name:
BASE BID ITEMS
Agreement No. 5008
BID SCHEDULE
2015 -2016 FURNISHING AND APPLICATION
OF SLURRY SEAL ON VARIOUS STREETS
PROJECT NO.: PW 16 -09
// "GO 141,
Item
No.
Estimated
Quantities
Description
Unit Price
M
Item Total
M
1
143,105 SY
Slurry Seal Type II application
/,
/.
(Monday through Friday) — Area 1
,A
2
6,154 SY
Slurry Seal Type II application
Area 1
a
(Saturday and Sunday) —
3
6,446 SY
Slurry Seal Type II application
' w
(Monday through Friday) — Area 2
4
1 LS
Sandblast, restore and replace all
"
street markings and striping
a
5
2,000 SF
2 -inch deep asphalt repairs
a
/ .
TOTAL BID = $
TOTAL BID WRITTEN IN WORDS: e &r� olrAl 9 V ,-, :?
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'0,-/
Agreement No. 5008
BID SCHEDULE
2015 -2016 FURNISHING AND APPLICATION
OF SLURRY SEAL ON VARIOUS STREETS
PROJECT NO.: PW 16 -09
Company Name: I
ALTERNATIVE BID ITEMS
Item Estimated Unit Price Item Total
No. Ouantities Description
............... ........................ ...
Al 17,553 SY Slurry Seal Type II application for `®
Mondays through Fridays —Area 3
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Agreement No. 5008
Company Name:
BIDDER'S INFORMATION
// l,
BIDDER certifies that the following information is true and correct:
Form of Legal [:Intity (i.e., individual, partnership, corporation, etc.)
If corporation, State of Incorporation (i.e., California)'Irrdi�i
Business
Address
Telephone No........OmO ... ......................._.._..._ _..ww w._
Facsimile No. ( D9� RIM
State Contractor's License No. and Class -�7JP
Original Date Issued l- Expiration Date l
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:
A
The date of any voluntary or involuntary bankruptcy judgments against any principal having an
interest in this proposal is as follows:
dwe
All current and prior DBA's, aliases, and /or fictitious business names for any principal having
an interest in this proposal are as follows:
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Agreement No. 5008
BIDDER'S INFORMATION (CONTINUED)
Company Name:"` �.
Bidder shall list the name of the person who attended the mandatory pre -bid job walk:
Name:
Title
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Agreement No. 5008
IN WITNESS WHEREOF, BIDDER executes and submits this proposal with the names,
titles, hands, /
and seals of all a forenamed principals this eday of �h , 2016 / .
BIDDER
/4
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Agreement No. 5008
PROPOSAL GUARANTEE
BID BOND
2015 -2016 FURNISHING AND APPLICATION
OF SLURRY SEAL ON VAR10U5 STREETS
PROJECT NO.:.PW 16 -09
KNOW ALL MEN BY THESE PRESENTS that,
American Asphalt South, Inc. as BIDDER, and
The Guarantee Company of
North America USA , as SURETY, are held and firmly bound unto the
City of El Segundo, in the penal sum of Teri percent of amt bid- DOLLARS (S1_o°!a), which is
ten (10 %) percent of the total amount bid by BIM E, R to the City of l;l Segundo for the above
stated 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 SUCH that. whereas BIAIIER is
about to submit a bid to the City of EI 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 El Segundo,
IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seals this
29 day of February 20 16
BIDDER*
SURETY*
halt South, Inc. P.O. Box 310036, Fontana, CA 92331 (909) 427 -8276
The Guarantee Company of North America USA One Towne Sauare, Suite 1470
Subscribed and sworn) to this day of , 20
NOTARY PUBLIC -See Attached —California all Purpose Acknowledgment Complies with Civil Code 1189.
*Provide BIDDERISURETY name; title, address and telephone number and the name, title,
address and telephone number for authorized representative.
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ACKNOWLEDGMENT
A notary public or other officer completing this ........__
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of San Bernardino
On�wwwmm_IT� before me,
personally appeared Jeff Petty
Agreement No. 5008
Richard Entrikin - Notary
(insert name and title of the officer)
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 /st;tea4eyexecuted the same in
his /b -&FW;& authorized capacity(ies), and that by his /deaf signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validitv of that document.
State of California
County of Butte
On February 29, 2016
Agreement No. 5008
before me, Sara Walliser, Notary Public
(insert name and title of the officer)
personally appeared Elizabeth Collodi
ro
who proved to me on the basis of satisfactory evidence to be the person(&) whose name(s) is/me
subscribed to the within instrument and acknowledged to me that he/she/tfw, executed the same in
)s/her /ttNadxauthorized capacity(" ), and that by Idsiher/RxAx signature(s) on the instrument the
person(s), or the entity upon behalf of which the person() acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
nz
+'a �,� g or r n �w°.;�.re,� �r„•x".�u vmrw ram :��
SARA WAN A 0:: R
WITNESS my hand and official seal, OMM # 2118503
a
{{ Y 6C11 "CWY Y6 IJG N ..li G"AN_WF�R11 A
i COUY1S Y OF BUTTk
Cominn, Expires W1 Y 2019
._
�wPav�
SlgnatUr� (5 @81)
Agreement No. 5008
Barbara Midstokke, Renee Ramsey, Richard W. Pratt, John Hopkins, Elizabeth Collodi, Bobbie Beeny, Nancy Luttenbacher
Phillip O. Watkins, Keith T. Schuler, Melissa D. Diaz, Shawna Johnson, Patricia M. Simas
Interwest Insurance Services, Inc.
its true and lawful attorney(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract
or otherwise.
The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA
USA 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 the
principal office.
The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws
adopted by the hoard of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31st day of December, 2003.
The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority:
1, To appoint Attorney(s) -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto,
bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and
2. To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below
3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact includes any and all consents for the release of retained percentages and /or final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of
Florida Department of Transportation making payment of the final estimate to the Contractor and /or its assignee, shall not relieve this surety
company of any of its obligations under its bond.
4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to
the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner —
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting
duly called and held on the 6th day of December 2011, of which the following is a true excerpt:
RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification
thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and
such signature and seal when so used shall have the same force and effect as though manually affixed.
agar IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and
its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012.
r �a? THE GUARANTEE COMPANY OF NORTH AMERICA USA
�tA
STATE OF MICHIGAN Stephen C. Ruschak, President & Chief Operating Officer Randall Musselman, Secretary
County of Oakland
On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me
duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said
instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of
Cynthia A, Takai
i Notary Public, State of Michigan
�� County of Oakland
*r c
My Commission Expires February 27, 2018
Z Acting in Oakland County
IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee
Company of North America USA offices the day and year above written.
I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true
and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect.
aws IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 29 day of February 2016
r
""" Randall Musselman, Secretary
Agreement No. 5008
CONTRACTOR'S LICENSE DECLARATION
(Business and Professions Code Section 7028.15)
BIDDER'S Contractor's License Number is:
gyW? Class No,:
2. The expiration date of BIDDER'S Contractor License is:
„ 20 .
3. BIDDER 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 Q� �� , 20/ , at
(insert City and State where Declaration signed).
Si ture
Typed Name
ice Ai-;aA Jr
Title� ............. ��_...... ��.............. ��.................. ...............................
Company Name
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Agreement No. 5008
NON - COLLUSION DECLARATION
TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID
(pursuant to Cal. Pub. Contract Code § 7106)
The undersigned declares:
I am the I' /CP l�''li lnol of A00mm / /a' , the party
making the foregoing bid.
The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership,
company, association, organization, or corporation. The bid is genuine and not collusive or
sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in
a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or
agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. 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. All statements
contained in the bid are true. 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, to any corporation, partnership, company, association, organization, bid depository, or
to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and
will not pay, any person or entity for such purpose.
Any person executing this declaration on behalf of a bidder that is a corporation, partnership,
joint venture, limited liability company, limited liability partnership, or any other entity, hereby
represents that he or she has ful l power to execute, and does execute, this declaration on behalf
of the bidder.
1 declare under penalty of perjury under the laws of the State rrl C rlil r °r1ia that the foregoing
is true an correct and that this declaration is executed on ����dtte], at
ON [city], 6,1 [state]."
m
Dated this d y of ," 2016 .
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Agreement No. 5008
WORKER'S COMPENSATION 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:
J
Title:
Business Name: 4 Z
141 C,
Business Address: T7�O i l "t1e
Telephone Number: ( per/ w
Dated this day of /T4r4` 20
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Agreement No. 5008
DESIGNATION OF SUBCONTRACTORS
2015 -2016 FURNISHING AND APPLICATION
OF SLURRY SEAL ON VARIOUS STREETS
PROJECT NO.: PW 16 -09
C: Company Name: ...m..m.w ...._ _...._...__. I_Mkl_11�
__._.._....._� ..._..__
BIDDER will perform the majority of the work and proposes to subcontract certain portions of
the work which are in excess of one -half of one percent (1/2 of 1 %) of the bid and to procure
materials and equipment from suppliers and vendors as follows:
Description of
Subcontractor's Portion of
Name of Contractor Work Estimated
Subcontractor Address License No. Subcontracted $ Amount
(Number and Street)
(City, Zip Code)
'n
4
.. ....... w . .............................
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Company Name;
REFERENCES
l7Z
Agreement No. 5008
The following are the names, addresses, and telephone numbers for public agencies for which
BIDDER has performed similar work as the prime contractor or major subcontractor within
the past five (5) years: /� �.1/�_ �%
1. Project Title: I(Q1,4 51 yel 114i4owce and We, *; ` AVcl
Location: Alliv 1r
Namdand address of owner
i&hld Ampme
Name and current telephone number of person familiar with project
Type of Work: 51ay)v JM /-; "' Sw Zl �
Contract amount $ mmmm,�m mmmmmm�m��wwwwwwwwwwwwww„ Date completed:C.
Amount of work done by my /our firm under contract $ lgvdep. O�
Did your firm have any financial interest in Project? _.._.._._
2. Project Title: i;14440 )� eow iX4"
Location: lloyk af' eel
Contract amount: $ � � d OY, b Date completed: Ac- ,
��- - leted: � ....... ...............................
Amount of work done by my /our firm under contract $ � •
Did your firm have any financial interest in Project?
I -C -12
Agreement No. 5008
3. Project Title: j/%I%Gtl� S /l%y)?/ / ' ",%CCT
J
Location: MaI ocy 114'el
Name ehd address of owner
Name and current telephone number of person familiar with project
Type of Work:
Contract amount: $
dY Date completed:
....
Amount of work done by my /our firm under contract $
Did your firm have any financial interest in Project? .....................__......
4. Project Title: ���.7 �,✓ �r C'''"'
Type of Work:
Contract amount: $ AJ9,--�r4VI
Date completed: Je,�%l �ol
Amount of work done by my /our firm under contract $ ,-7W4V, 0U
Did your firm have any financial interest in Project? /f/O✓
5. Project Title:
Location: Mrtaf fj 1 '�zf
Name I'nd address of owner � A
z,OW,qPr1 ✓,l,%1'`�" [ice% %%� %O�°�'
Name and current telephone number of person familiar with project:
I -C -13
Agreement No. 5008
Type of Work: "g ✓ -
-
�.. mm Contract amount: $ ��A4 Date com p
Amount of work done by my/our firm under contract
Did your firm have any financial interest in Project?
Bidder may attach additional reference pages if necessary.
The following are the names, addresses, and telephone numbers for all brokers and sureties
from whom BIDDER intends to procure insurance bonds:
gee Acid
I -C -14
Agreement No. 5008
BROKERS & SURETIES FROM WHOM THE BIDDER INTENDS
TO PROCURE INSURANCE AND BONDS
BONDING AGENT: INTERWEST INSURANCE SERVICES, INC.
1357 E. LASSEN AVENUE
CHICO, CA 95973
(530)897 -3154
SURETY COMPANY: GUARANTEE COMPANY OF NORTH AMERIC, USA
ONE TIME SQUARE, SUITE 1470
SOUTHFIELD, MI 48076
(248)281 -0281
INSURANCE AGENT: INTERWEST INSURANCE SERVICES, INC.
368 E. YOSEMITE AVENUE, SUITE 100
MERCED, CA 95340
(209)724 -2324
Company Name:
Agreement No. 5008
BIDDER'S STATEMENT OF
PAST CONTRACT DISQUALIFICATIONS
2015 -2016 FURNISHING AND APPLICATION
OF SLURRY SEAL ON VARIOUS STREETS
PROJECT NO.: PW 16 -09
Please state all instances of being disqualified, removed, or otherwise prevented from bidding
on, or completing, a federal, state, or local government project due to a violation of a law or
safety regulation.
1. Have you ever been disqualified from any government contract?
Yes ❑ No X
2. If yes, explain the circumstances:
3. Are you registered in accordance with Labor Code § 1725.5 [Note: failure to register
requires the City to reject your bid as nonresponsive]?
Yes A No ❑
Big ��e�sSi� �natt��..
g ire
Te4r P i . Xice Aer;dervz-
7
Name (Please rint)
I -C -15
Agreement No. 5008
INSURANCE REQUIREMENTS
[MUST BE SUBMITTED WITH PROJECT PROPOSAL]
2015 -2016 FURNISHING AND APPLICATION OF SLURRY SEAL
ON VARIOUS STREETS, PROJECT
PROJECT NO.: PW 16 -09
Company Name:
To be awarded this contract, the successful bidder must procure and maintain the following types of
insurance with coverage limits complying, at a minimum, with the limits set forth below:
Type of Insurance Limits
Commercial general liability: $2,000,000
Business automobile liability: $1,000,000
Workers compensation: Statutory requirement
Commercial general liability insurance must meet or exceed the requirements of ISO -CGL Form No.
CG 00 01 11 85 or 88. The amount of insurance set forth above must be a combined single limit per
occurrence for bodily injury, personal injury, and property damage for the policy coverage. Liability
policies must be endorsed to name the City, its officials, and employees as "additional insureds" under
said insurance coverage and to state that such insurance will be deemed "primary" such that any other
insurance that may be carried by the City will be excess thereto. Such endorsement must be reflected
on ISO Form No. CG 20 10 11 85 or 88, or equivalent. Such insurance must be on an "occurrence,"
not a "claims made," basis and will not be cancelable or subject to reduction except upon thirty (30)
days prior written notice to the City.
Insurer will agree in writing to waive all rights of subrogation against the City, its officers, officials,
employees and volunteers for losses arising from work performed by Contractor for the City.
Automobile coverage must be written on ISO Business Auto Coverage Form CA 00 01 06 92, including
symbol 1 (Any Auto).
The Consultant must furnish to the City duly authenticated Certificates of Insurance evidencing
maintenance of the insurance required under this Agreement, endorsements as required herein, and such
other evidence of insurance or copies of policies as may be reasonably required by the City from time
to time. Insurance must be placed with admitted insurers with a current A.M. Best Company Rating
equivalent to at least a Rating of "A:VII." Certificate(s) must reflect that the insurer will provide thirty
(30) day notice of any cancellation of coverage. The Consultant will require its insurer to modify such
certificates to delete any exculpatory wording stating that failure of the insurer to mail written notice
of cancellation imposes no obligation, and to delete the word "endeavor" with regard to any notice
provisions.
The City requires California Worker's Compensation Coverage with the associated Waiver. Out -of-
state coverage will not be accepted in lieu of the California coverage, because the work is being
performed in the State of California.
By signing this form, the bidder certifies that it has read, understands, and will comply with these
insurance requirements if it is selected as the City's consultant. Failure to provide this insurance will
render the bidder's proposal "nonresponsive."
If,�D /�
. der' s �� w._. ...........�.....
1
Date �1mr
I -C -16
Agreement No. 5008
END PROPOSAL SECTION
I -C -17
ACKNOWLEDGMENT
A notary Wpublic mmormmother officer completing this ...... _..
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of µm Ww mmmmmmmmmITITSan Bernardino
On A ._ R� "" I C, ITITIT� before me,
personally appeared Jeff Petty
Agreement No. 5008
Richard Entrikin - Notary
(insert name and title of the officer)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /ar-e-
subscribed to the within instrument and acknowledged to me that he /skteaAeTexecuted the same in
his /b.&FaUeif authorized capacity(ies), and that by his /ba*ab*k signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) 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.
Agreement No. 5008
Premium is included in the performance bond subject to adjustments based on final contract price.
LABOR AND MATERIALS BOND
FY l 5/16 SLURRY SEAL RESURFACING PROJEcr
PROJEC'r NO.. PW 16-09
Bond No, 12132563
Bond Fee: Included in Performance Bond
BOND CONDITIONS
2. PRINCIPAL will pay all contractors, subcontractors, and persons renting
equipment.
Agreement No. 5008
3. PRINCIPAL will pay for all materials and wher Supplies, for equipment
used in, on, for or about the performance ofthe Public Project, and will pay four al I 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 ("'ESNIC"),
5. SURETY, for value received, agrees that ino changes, extensions of time,
alteration or modification of SPECIFICATIONS NO. PW 1.6-09, or of the obligation to be
performed will in any way affect its obligation on this bond, and it waives not-ice of any such
change, extension of time, alteration Or modification of the contract documents or of the
obligation to be perfonned.
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, 1power 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 SUIkETY's certificate of authority has not been
surrenidered, revoked, cancelled, annulled, or suspended, or in the event that
it has, that renewed authority has been granted.
7. Should PRINCIPAL perform its DbflVAi0nS widilin the time allowed,
PRINCIPAL's obligation will be void upon the acceptance of the performance by CITY;
otherwise this oNigation will remain in full force and eflect,
m1i EMMUM
Agreement No. 5008
SIGNED AND SEALED this 20th day ofAnal 2016
PRINCIPA'-s PRESIDENT
('1PAL's SECRETARY
P11[11NC'1PA111[..,'s IVIA11,11ING ADDRESS,
14436 Santa Ana Avenue
Po ',' C" A 9-2-3- -3-7— - - - - - , , -
The Guarantee Company of North America USA
SURETY
=f Melissa D. Diaz
SURETY's Attorney-In-Fact
SURETY's MARANG ADDRESS:
One'Fowne,Square, Ste, #1470
Southfield, MI 4-8-6-7, 6
NOTE: (1) ALL signatures must be acknowledged by a notary public. ,
Return one (1) original to City Clerk's Office.
(2) Bond shall be effective for one (1) year ufle4r acceptance of the j&
I-F-3
Agreement No. 5008
S)% j
IIIi°tjfjcate pi,irsuant to 995.640(il) e of Civil Princedum
w DE� +� ttor �ejt ( "je of le oiuuot�
.
of . '., .�' "° " �w. p "fie , o IS
tnts of����a forma, in n )dr said o� o�,,
�, .. -. DO HEREBY CER1IFY THAT
te (if z�Ohouuwi as 00 1UMV k mil b tbf�i CaRfiw ni
AG�wN � R.��w�� a.�� u' ��;orru °u�� o ruu�uu °per eau orloflui If ie hrsorer to transact surety ioourmim in
�w�%j Staw of elf rnw� and that bmx ouiir the recordsclihown qtr dw Depailment of
gK ur(jn(�* wofttel, uw eutuiorlt �ieo not oeeo surrendered, revok4 can . M �,,
;jwwwu &od' UNWJpr"o4ow
I esduirm, I � Nivunto ex.A a' horrwi aril affixed IMB kd of
BY-
Dep"counlycledf
L. MURGUTA
Agreement No. 5008
ACKNOWLEDGMENT
A
—notary public or other officer �.. s
ry p er this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of San Bernardino
®
On _ � � �' before me, .m R ichard Entrikin -Notary
_�.. -._.
(insert name and title of the officer)
personally appeared - Lyle Stone and Jeff Petty
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) j6 /are
subscribed to the within instrument and acknowledged to me that be/s4e /they executed the same in
>,,;�lbe/their authorized capacity(ies), and that by lass /het /their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Signature _ w_ (Seal)
Agreement No. 5008
ACKNOWLEDGMENT
........... ... ..............
_..
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that-document.
State of California
County of Sacramento )
On April 20, 2016 before me, Renee Ramsey - Martin, Notary Public
(insert name and title of the officer)
personally appeared Melissa D. Diaz
who proved to me on the basis of satisfactory evidence to be the person(s} whose name(s4 is /afe
subscribed to the within instrument and acknowledged to me that #e /she /##eye executed the same in
#is /her /t#e# authorized capacity(ies} and that by #is /her /t e+f signature(s} on the instrument the
person(s , or the entity upon behalf of which the person(s} 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
(Seal)
A
RENEE RAMSEY- MARTIN
NOTARY PUBLIC - CALIFORNIA
My Comm. Exp. May 3, 2018 �
Agreement No. 5008
Renee Ramsey, Richard W. Pratt, John Hopkins, Elizabeth Collodi, Bobbie Beeny, Nancy Luttenbacher
Phillip O. Watkins, Keith T. Schuler, Melissa D. Diaz, Shawna Johnson, Mindy Whitehouse, Jennifer Stone, Sara Walliser, John J. Weber
Interwest Insurance Services, Inc.
its true and lawful attorney(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract
or otherwise.
The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA
USA 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 the
principal office.
The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws
adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31s` day of December, 2003.
The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority:
1. To appoint Attorney(s) -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto,
bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and
2. To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below
3, In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact includes any and all consents for the release of retained percentages and /or final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of
Florida Department of Transportation making payment of the final estimate to the Contractor and /or its assignee, shall not relieve this surety
company of any of its obligations under its bond.
4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to
the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner —
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting
duly called and held on the 6th day of December 2011, of which the following is a true excerpt:
RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification
thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and
such signature and seal when so used shall have the same force and effect as though manually affixed,
IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and
its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012.
THE GUARANTEE COMPANY OF NORTH AMERICA USA
r
STATE OF MICHIGAN Stephen C. Ruschak, President & Chief Operating Officer
County of Oakland
.� f
Randall Musselman, Secretary
On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me
duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said
instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of
Cynthia A. Takai
Notary Public, State of Michigan
County of Oakland
Y My Commission Expires February 27, 2018
Acting in Oakland County
IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee
Company of North America USA offices the day and year above written.
I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true
and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect.
arrr IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 20th day of April 2016
3,
"* Randall Musselman, Secretary
Agreement No. 5008
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE N9 08305
SAN FRANCISCO
Amended
Certificate of Authority
THIS IS TO CERTIFY THAT, Pursuant to the Insurance Code of the State of California,
The Guarantee Company of North America USA
Of Michigan , organized under the
laws of Michigan subject to its Articles of Incorporation or
otherfundamental organizational documents, is hereby authorized to transact within the State, subject to
all provisions of this Certificate, the following classes of insurance:
Surety
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
fill 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 —? 0 th ,
day of ___ December 2006 I have hereunto
set my hand and caused my official seal to be affixed this
day of __.._ ....._, ... 6
th December 200
John Garamendi
Insurance Commissioner
Patricia By
K Stagga
for Richard 1:a. Baum ,4„r'
Chief Deputy
NOTICE:
Qualification with the Secretary of State must be accomplished as required by the California Corporations Code promptly
after issuance of this Certificate of Authority. Failure to do so will be a violation of Insurance Code Section 701 and will be
grounds for revoking this Certificate of Authority pursuant to the convenants made in the application therefor and the
conditions contained herein.
F01M faJ
,,,p�4 OSP00 39391
Agreement No. 5008
Premium is for contract term and is subject to adjustments based on final contract price,
FAIT UI, PERFORMANCE BOND
FY 15116 SLURRY SEAL KESUIIt FACING PROJECT
PROJECT NO.., PW 16-09
Bond No. 12132563
Bond Fee: $2,152.00
)hd 1 =1=11 t 5—tb. frzlc as w principal ("PRINCIPAL")
and The Guarantee Company of North America USA
a corporation
BOND CONDITIONS
2. PRINCIPAL's work on the Public Project will be done in accordance with
CITY's plains and specifications and with any permit issued by CITY. Should PRINCIPAL fail
to coryiplete all required work, within the time allowed, CITY inay, at its sole discretion, cause all
required work to be done and the parties executing the bond will be firmly bound for tine
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 or one (1) year fbHovving the Public Project's
MW
Agreement No. 5008
completion and acceptance by CITY,
4, This bond is conditioned upon avid guarantees due compliance with app applicable
law including, wkhout firnitation, the El Segundo Municipal Code ("ESMU),
A, A culified copy of the appointment, power of attorney, bylaws or
other instrument enti0fing, or authorizing the persons executing
this bond to do so;
7. Should PRINCIPAL perform its obligations within the firne allowed,
PIUNCIPAI-'s obligation will be void Upon the acceptance of' the performance by CITY;
otherwise this obligation will rernain in full force and effect.
[SIGNATURES ON FOLLOWING PAGE]
M
Agreement No. 5008
SIGNED AND SEALED this 20th day of, April . ......... 120 16
The Guarantee Cornpany of North America USA
PRINCH"Al 's PRE'S , I DENT
Vie "'
lI PAL's SECRETARY
PRINCIPAL's MAILING ADDRESS:
14436 Santa Ana Avenue
.... .. ....... ...... . ......... . .............
Fontana, CA 92337
SURETY
elissa D. Diaz
SLIRETY's Attorney -In -Fact
SURETY's MA. .IN ADDRESS:
Smithfield- MT 48076
NOTE: (1) A LL signatures must be acknowledged by a notary public.
Return one (1) original to City Clerk's Office.
(2) Bond shall be effective for one (1) year after acceptance of the job.
I -E, -3
Agreement No. 5008
s)k,)
`icate pursuaii"it t 99 ( Code o °t Civil Procedure
N n � i�,� ITV 9 4. h �kr� � g r AYNYd'reA� W�.4�tt�64 i�S WSW 'M�X �.MbdW�II�U
S
rr,, yap ht and for saki Count)
r
Gird
unr &D4, " "e 41
lti a Otd I l s b Lika.v4 „(„ i"if t a ht"� ,,,x d li "r sricnvn kn I Depa OTne lnt of
weIhme �'rw au"1pI &'la$1'101 been sui nd r'rd, Vevukecl, ancc,Afml,,
Xfk,rjti,j I7MGa hereunto set, my hand and 'affixt"d t q'�) ,seal of
COUNTY CLERK
-° �.. �. �....
Deputy County Cleo*
L. MURGUTA
ACKNOWLEDGMENT
�A notary public or other officer compl eting this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
�. t
validity o document.
that .. -... __ — �..
State of California
County of San Bernardino
On -)S. before me,
Agreement No. 5008
Richard Entrikin -Notary
(insert name and title of the officer)
personally appeared Lyle Stone and Jeff Petty
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) js /are
subscribed to the within instrument and acknowledged to me that he/she /they executed the same in
hie/be/their authorized capacity(ies), and that by leis /ref /their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) 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,
Agreement No. 5008
ACKNOWLEDGMENT
AWnotary WWpublic or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Sacramento )
On April 20, 2016 before me, Renee Ramsey- Martin, Notary Public
(insert name and title of the officer)
personally appeared Melissa D. Diaz
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /afe
subscribed to the within instrument and acknowledged to me that 14e /she /" executed the same in
4is /her /t#e4 authorized capacity(+es, and that by #+s /her /the# signature(s) on the instrument the
person(s�, or the entity upon behalf of which the person(s) 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.
Signature
(Seal)
� r ,o �
RENEE RAMSEY- MARTIN
WITNESS my hand and official seal„
NOTARY PUBLIC - CALIFORNIA
M-w
SACRAMENTO COUNTY
k'�����
-°
My Comm. Exp. May 3, 2018
��.-
Signature
(Seal)
Agreement No. 5008
Renee Ramsey, Richard W. Pratt, John Hopkins, Elizabeth Collodi, Bobbie Beeny, Nancy Luttenbacher
Phillip O. Watkins, Keith T. Schuler, Melissa D. Diaz, Shawna Johnson, Mindy Whitehouse, Jennifer Stone, Sara Walliser, John J. Weber
Interwest Insurance Services, Inc.
its true and lawful attomey(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract
or otherwise.
The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA
USA 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 the
principal office.
The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws
adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31s` day of December, 2003.
The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority:
1. To appoint Attorney(s) -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto,
bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and
2. To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below
3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact includes any and all consents for the release of retained percentages and /or final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of
Florida Department of Transportation making payment of the final estimate to the Contractor and /or its assignee, shall not relieve this surety
company of any of its obligations under its bond.
4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to
the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner —
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting
duly called and held on the 6th day of December 2011, of which the following is a true excerpt:
RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification
thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and
such signature and seal when so used shall have the same force and effect as though manually affixed.
IN 'WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and
its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012.
THE GUARANTEE COMPANY OF NORTH AMERICA USA
STATE OF MICHIGAN Stephen C. Ruschak, President & Chief Operating Officer
County of Oakland
Randall Musselman, Secretary
On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me
duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said
instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of
Cynthia A. Takai
"" Notary Public, State of Michigan
r ��� - County of Oakland
�" 41 My Commission Expires February 27, 2018
Acting in Oakland County
IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee
Company of North America USA offices the day and year above written.
I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true
and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect.
rer IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said Company this 20th day of April 2016
- .....wm Randall Musselman, Secretary
Agreement No. 5008
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE NQ 08305
SAN FRANCISCO
Amended
Certificate of Authority
THIS IS TO CERTIFY THAT, Pursuant to the Insurance Code of the State of California,
The Guarantee Company of North America USA
Of Michigan , organized under the
laws of Michigan subject to its Articles of Incorporation or
otherftmdamental organizational docutnents, is hereby authorized to transact within the State, subject to
all provisions of this Certificate, the following classes of insurance:
Surety
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 20th
day of December 2006 , I have hereunto
set my hand and caused my official seal to be affixed this
20th 2006
day o f D .._._..� ecember .. � � __._. ,
John Garamendi
Insurance Commissioner
B)^
e� �.r°'
Patricia K taggs
for Richard D. Baum D,)Pxq
Chief Deputy
NOTICE:
Qualification with the Secretary of State must be accomplished as required by the California Corporations Code promptly
after issuance of this Certificate of Authority. Failure to do so will be a violation of Insurance Code Section 701 and will be
grounds for revoking this Certificate of Authority pursuant to the convenants made in the application therefor and the
conditions contained herein.
FORM G9J
OSP 00 39391