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R J Noble Company - 2009-01-20
.its'^7-.�..-yur.;=-,.sn.�,g,,.r:,..,�Yi, ;mow^.-:-rxr- < ✓+.`v-.' :-,�'y�,..yv:.-. ...�..,,.Ns....ti;,-..n.- ^'i - .-"" v �:�'. ��iNw� ,.a„-",a;;b' ,., RECEIVED BY: CITY CLERK RECEIPT COPY r p Return DUPLICATE to i� City Clerk's Office (Name) f} after signing/dating GJ L4 I a® (Date) t x �. CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: Shari Freiden�rich, City Treasurer FROM: DATE: T f 0 SUBJECT: Bond Acceptance I have received the bonds for lJo -� i (Company Name) Faithful Performance Bond No. Labor and Material Bond No. Monument Bond No. ! �s Maintenance Bond No. / .� ✓ C t�-.3 Guarantee and Warranty Bond No. Re: Tract No. � ) d CC No. MSC No. f Approved l / � I� Agenda Item No. (Coun'cil Approval Date') ( �r City Clerk Vault No. ' -'1 �• #27 g:/followup/bondletter.doc City of Huntington LDINTER-DEPARTMENT COMMMUNICATION HUNTINGTON BEACH TO: THOSE LISTED HEREON FROM: Robert A. Martiner, Constructi oodinator DATE: April 27, 2010 SUBJECT: Retention Release Payment Company Name: R. J. Noble Co Address: 15505 E. Lincoln Aveune City, State and Zip Code: Orange, CA 92856-6620 Phone Number: (714) 637-1550 Business License Number:A 005420 Local Address: N/A Notice of Completion Date:July 2, 2009 Contract Purpose: Retention Release for MSC-454, Various Residential Street Overlays The conformed copy of the Notice of Completion for the above contract has been filed. The thirty-five (35) day waiting period has elapsed or will elapse before payment is made. Processing of the retention payment is recommended so long as no stop notices or outstanding invoices are on file with the City. I certify that no stop notices are on file on the subjec at is time. ' ( Bond unety Company D to ravis K. Ho kips Rating S Frei City Treasurer I certify that there are no outstanding invoices on file and that t and Surety Company is approved as to Credit / Financial Rating. Date hari Fr 'denrich, City Treasurer I certify that no stop notices are on file on the subject contract, and that a guaranty bond has been filed with this office. 1� - Dbid oaK Flynn, Clerk Retention 3 Signature Memo.doc 4/27/2010 11:21:00 AM Certification of Compliance with Prevailing Wage Laws To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Prevailing Wage Laws Contract: Various Residential Street Overlay Project: Various Residential Street Overlay The undersigned contractor on the above-referenced project ("Project") hereby certifies that all laborers, mechanics, apprentices, trainees, watchmen and guards employed by him or by any subcontractor performing work tinder the contract for the Project have been paid pursuant to the minimum wage and bona fide fringe benefit requirements specified for each particular classification of work, as set forth in the wage-rate determinations of the State of California, Department of Industrial Relations, and/or the United States Department of Labor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 15505 E. Lincoln Ave Executed this 26th day of April , 20 _L0 at Orange ,California. R.J. Noble Company (Type Contractor Name) By: 4aA4- po'-'5� Name: [Type N ] Craig Porter,Vice President Title: [Type Title] ffF' MRNkF,4Y a'�t?S�CI'i X i 6 ` CY a3 tTlp f E . 1 247542.1 t 1 CONTRACTOR'S CERTIFICATE 1, Craig Porter , state and certify that: (Name of Declarant) 1. R.J.Noble Company is the general contractor to the City of Huntington Beach ("City") on Contract No. Various Residential Street (the "Contract") for the construction of the public work of improvement entitled: Various Residential Street Overlay (the"Project"). 2. All work to be performed pursuant to the Contract has been completed in accordance with the Contract Documents (as such term is defined in the Contract). 3. Except for the claims listed.below and the disputed claims listed in paragraph five(5). all persons supplying labor, services, materials and equipment to the Project, including all claims against the Contractor arising from the performance of the Contract, have been paid and satisfied(list unpaid debts and claims; if none, write"NONE"): NONE 4. .Attached hereto are the lien waivers required by the Contract Documents, which lien waivers have been executed by all persons who performed work on or supplied labor, services,materials, and/or equipment for use at the Project. 5. Set forth below is a list of disputed claims or claims that are the subject of a Notice to Withhold filed. pursuant to the Civil Code of the State of California (list all disputed claims; if none,write"NONE'): NONE 1 declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed at 15505 E. Lincoln Ave, Orange,Ca on this 26th day of April ,2010 . x (Si e of Declarant) APPROVED AS TO FORM Craig Porter, Vice President s�1��� -1lJ 3• Zo•oCp Name: [Type Name] Title: [Type Title] 1 245914.1 Certification of Compliance with'Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 Contract: Various Residential Street Overlay Project: Various Residential Street Overlay The undersigned contractor on the above-referenced project ("Project") hereby certifies that it has complied with Title VII of the Civil Rights Act, the Equal Opportunity Act of 1972 and Executive Order 11246, and has not discriminated against any employee or applicant for employment because of race, creed, color, sex, national origin, age or disability. The undersigned contractor also certifies that it has not maintained any segregated facilities at its establishments on the basis of race, creed, color, sex, national origin, age or disability(with the exception of access for the disabled). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. . 15505 E. Lincoln Ave Executed this 26th day of Auril ,20_Lo , at Orange,Ca , California. R.J.Noble Company (Type Contractor Name) By: Name: [Type N Title: [Type Title] R c� A ©RNEX � n Craig Porter, Vice President { ti 1 I t Z4S411.1 1 CONSENT OF SURETY TO FINAL PAYMENT C 0'N'1 F,A fC',' 1 A I A, .0o r,id e i ('*f Z 0-7 BOND NUMBER 105210283 CITY OF HUNTINGTON BEACH A Jh('I J'j'j- RO... 2000 MAIN STREET HUNTINGTON BEACH, CA 92648 CONTRACT FOR. MSC-454, VARIOUS RESIDENTIAL STREET ASPHALT OVERLAY PROJECT: MSC-454 VARIOUS RESIDENTIAL STREET CONTRACT DATED:FEBRUARY 4, 2009 ASPHALT OVERLAY In accord'ance with the provj.5iorls of the Contract heivvccil the 0"mrier and the Conn-actor as Indicated ahovt, the (1?7SC11-/W4121C'and OddrVSI(f.VUMIJI) TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA 21688 GATEWAY CENTER DR. DIAMOND BAR CA 91765 SURFTY, on bond of flnseri name and address o[Cowivc1or) R.J. NOBLE COMPANY 15505 E. LINCOLN AVE. ORANGE, CA 92856 CONTRACTOR, hereby approves of[he finai 1-aymen, to, the Contractor, and ogees chat final 1)2vnwi-,t to the Con Lractor shall not relieve the Surewof any of its obligations to (laser/none and efeldry soj oww") CITY OF HUNTINGTON BEACH 2000 MAIN STREET HUNTINGTON BEACH, CA 92648 OWNER, as set Forth in said Surety's bond IN WITNESS WTfEREOF,the Surety has hereunto set its hand on this(12(e: APRIL 14, 2010 TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA "g wme(�'Ialflhol ... .....' """' ' ""z Aucst MI EL D. STONG, ATTORNEY—IN—FACT (PI i'ww jlni'w(old tile; CAUTION: You should sign an original AIA document that has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. See instruction Sheet for Limited License for Reproduction of this document. AIA DOC LIMEN1 G70i , CONISFK: 0 !!1�;JYTG FAA' t AAA/,;� 99-1 EWTION- 'A f. a (01994 - T]iJ--AMFRWAN IN it!I,: -AR0ij'fF(.1 S.! 1 Nt-.WYORK AVFNiJz-Nr%,V/ASH "NGTON. !-C, WARNjN(,: UfjhCeTlSF.d 1010tDCOpyifig VIOJDICS US, Coj)y- righl taw and v411,-;A&jcc1 the viol,-tot lu Jpa<,!prosecution. G707---1994 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On q'_ ! '7"/ 0 before me, R. NAPPI "NOTARY PUBLIC" (Here insert name and title of the officer) personally appeared MICHAEL D. STONG who proved to me on the basis of satisfactory evidence to be the person,(.a'jwhose name(s'fis/amsubscribed to the within instrument and acknowledged to me that he/sheAhey executed the same in his/#erf*reir authorized capacitykic4 and that by hisAwTAh#,k signature(<on the instrument the person,(. ,or the entity upon behalf of which the persongacted,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. R. NAPPI N COMM.#1796916 NOTARY PUBLIC•CALIFORNIA , l RIVERSIDE COUNTY (Notary Seal) M COMM.Expires June 7,2012 Signature of Notary P�ilie y ADDITIONAIL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT aPPears above in the mnary section or a separate acknowledgment form mart be properly completed and attached to that document. 77te only exception is if a document is to be recorded outside of California.In such instances,any alternative (Title or description of attached document) acbursviedgment verbiage as nrpv be printed on such a document so long as the rerbiage does not require the notary to do something thin!s Illegal for a notary in California(ive. certifying lire aut$od ed capacity of the signer).Please check rite (Title or description of attached document continued) document carefully for proper notarial wording and attach this farm fjrequlred. Number of Pages Document Date o State and County information must be the State and County where the document signer(s)personally appeared,before the notary public for acknowledgment. Date of notarization must be the date that the signer(s)personally appeared which must also be the same date the acknowlcdgnwA is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public), Print the name(s)of document signers)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER a Indicate.the correct singular or plural forts by crossing off incorrect forms(i.e. El Individual(s} he/she/Iltey-is/are)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. Cl Corporate Officer a The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to different document. ❑ Other • Indicate title or type of attached document;number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.c.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v 12.10.07 800-873-9865 w%vw.NotarvClasses.eom WARNING:THIS POWER OF ATTORNEY 1S INVALID WITHOUT THE RED BORDER TRAVELERS J POWER OF ATTORNEY Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 222079 Certificate No. 003471268 KNOW ALL MEN BY THESE PRESENTS:That St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company and St.Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota,that Farmington Casualty Company,Travelers Casualty and Surety Company,and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut,that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Michael D.Stong, Rosemary Nappi,and Jeremy Pendergast of the City of Riverside State of California their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in thei�.business of..guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or p in ar# Gtions o �gcecdings allowed bylaw. IN WITNESS WHEREOF,the Companies have caused this instnJrtteft to be sxned ande corporate seals to be hereto affixed,this 1 St day of February 2010 r ,- Farmington Casualty Copany » , r St.Paul Mercury Insurance Company Fidelity and Guaranty'--rsurnctnifipam Travelers Casualty and Surety Company Fidelity and Guaranty Iusurgaice Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company y St.Paul Guardian Insurance Company GASOUn,��j 4V'-�� Jy flAE 6� }*N_�NSG ay{NSV9q`k JPISY A1,06 1'Aa_"'^',l• o.� Y�/(0 �ypp W rp0 f nnarFom. < w�srFrnm,Tt < fAHN• i �W1NG��R w t896 r. t � �w�,�:m�c ls�Aar ,�s.......�d bi • *a+ �v� Alt�� State of Connecticut By: City of Hartford ss. Georg Thompson, nior ice President On this the 1 st day of February 2010 before me personally appeared George W.Thompson,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. G• tAl�" v My Commission expires the 30th day of June,2011. Lt® {t Marie C.Tetreauit,Notary Public 58440-4-09 Printed in U.S.A. WARNING:THIS POWER OF!,UORNEY.j§MVALID WITHO BQUQEE3 RECEIVED BY: CITY CLERK RECEIPT COPY Return DUPLICATE to City Clerk's Office (Name) after signing/dating (Date) ®, CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: Sha i Freidenrich, City Treasurer FROM: DATE: o SUBJECT: Bond Acceptance have received the bonds for - (Company Name) Faithful Performance Bond No. Labor and Material Bond No. Monument Bond No. / pp Maintenance Bond No. / ��d� / D 03 Guarantee and Warranty Bond No. Re: Tract No. CC No. MSC No. Approved /ok lLo Agenda Item No. (Coup i/Approval Datof City Clerk Vault No. 0� #27 g:/followup/bondleffer.doc JvtH+Fv I r-NHNL L: bUNU TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA Hartford,Connecticut 06183 BOND NO, 105210283 PREMIUM INCLUDED IN PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That R.J. NOBLE COMPANY as Principal, hereinafter called Contractor, and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, as Surety, hereinafter called Surety, are held and firmly bound unto CITY OF HUNTINGTON BEACH as Obligee, hereinafter called Owner, in the penal sum of$2,323,568.87 ,for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors, and assigns,jointly and severally, firmly by these presents. WHEREAS, Contractor has by written agreement, dated FEBRUARY 4, 2009 entered into a contract with Owner for MSC-454, VARIOUS RESIDENTIAL STREET ASPHALT OVERLAY in accordance with the General Conditions,the Drawings and Specifications,which contract is by reference incorporated herein, and made a part hereof, and is referred to as the Contract. NOW, THEREFORE, the condition of this obligation is such that, if Contractor shall remedy any defects due to faulty materials or workmanship which shall appear within a period of ONE year(s) from the date of substantial completion of the work provided for in the Contract,then this obligation to be void;otherwise to remain in full force and effect. PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable promptness. SIGNED and sealed this 14th day of APRIL , 20LO IN THE PRESENCE OF : R.J. NOBLE COMPANY (Seat) Principal X Title MICeFJ. ZCARVER, PRESIDENT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA By t JqQJ4�1\1 •� MI EL D. ST04 At V-Fact 5-2326-1 (07-97) CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On 04/16/2010 before me, JENNIFER DE IONGH, NOTARY PUBLIC Date Here Insert Name and Title of the Officer ' personally appeared MICHAEL J. CARVER _ Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the persono whose name4o is/ar.cl-subscribed to the within instrument and acknowledged to me that he/sheAhey executed the same in his/bs4the4r authorized capacity(ies), and that by his/ho;4he4.signatureW on the instrument the personA, or the entity upon behalf of jENNiFER DE ION which the person64 acted, executed the instrument. i commission # 1771186 z �. .` Notary Public -County. California I certify under PENALTY OF PERJURY under the laws 2 '_, Orange County ^-arrnn.Expiresoct28,2o11 of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Place Notary Seal Above Signa>� t of Notary Pu is OPTIONAL Though the information below is not required by law,it may prove valuable to persons rel ' 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:, Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: _ Signer's Name:--- 0 Individual ❑Individual O Corporate Officer—Titie(s): ❑Corporate Officer—Title(s): _ ❑ Partner—❑ Limited 0 General D Partner—CI Limited 0 General ❑ Attorney in Fact ❑Attorney in Fact 0 Trustee Top of thumb here O Trustee Top of thumb here `1 Guardian or Conservator Cl Guardian or Conservator ❑ Other: ❑Other: — Signer Is Representing: Signer Is Representing: ®2007 National Notary Association-9350 De Soto Ave-P.O.Box 2402•Chatsworth,CA 91313-2402•www-NatlonaiNotary.org item#5907 Reorder:Call Toll-Free 1-600-876-6827 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On —��- before me, R. NAPPI "NOTARY PUBLIC" (Here insert name and title of the officer) personally appeared MICHAEL D. STONG , who proved to me on the basis of satisfactory evidence to be the person,(<whose nameWis/arvsubscribed to the within instrument and acknowledged to me that he/sheA4tey executed the same in his/4,�r authorized capacityki=s and that by hisAwrU4 signature(,<on the instrument the person , or the entity upon behalf of which the personKacted, executed the instrument. 1 certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. R. NAPPI WITNESS my hand and official seal. COMM,#1796916 G7^ NOTARY PUBLICIDE-CALIFORNIA RIVERSIDE COUNTY My Comm.Exom June 7,2012 Signature of Notary Puby (Notary Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any oclinowledgmem completed in California uuust contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the normy section or a separate acatowledgntent form mast be properly completed and attached to that document. 77re on13+ exception is if a document is to be recorded otaside of California.In such instances,any alternative (Title or description of attached document) acknowledgment verbiage as may be printed on such.a document so long as the verbiage does nor require the notary to do something that is illegal for a notary in California fie. ceriify ing the authorized capocity of the signer).Please check the (Tilts or description oI attached document continued) docronent carefully for proper notarial wording mid attach thisform if required • State and County information trust be the State and County where the document. Number of Pages Document Date signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signers)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) a The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural roans by crossing off incorrect forms(i.e. ❑ Individual(s) he/she/#ey,is We)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a diMrenl document. ❑ Other Indicate title or type of attached document,number of pages and dale. Indicate the capacity claimed by the signer.If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10,07 800-873-9865 %v%vw.NotaryClasses.eom WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER AW POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 222079 Certificate No. 003471267 KNOW ALL MEN BY THESE PRESENTS:That St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company and St.Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota,that Farmington Casualty Company,Travelers Casualty and Surety Company,and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut,that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Michael D.Stong,Rosemary Nappi,and Jeremy Pendergast of the City of Ri=side State of ( I;fnrp#� their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their.business o£.guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executingor guaranteeing bonds and undertakings required or g g g eq per jL in an¢y" ctonsceedings allowed bylaw. IN WITNESS WHEREOF,the Companies have caused this ins trli eYlt td bg signed and thel poNrate seals to be hereto affixed,this 1st day of February 2010 n . Farmington Casualty Cgs�iprty St.Paul Mercury Insurance Company Fidelity and Guaranty1ms6rnc "(lrripay ." Travelers Casualty and Surety Company Fidelity and Guaranty InsutYce Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company O�,{)G,'pApSpOUp�,��j�j ..qw`•• �y��,.. 'yFtRE6�y o�TN..�NSG9 ♦♦ rSB Ja�.INSVggyt� oJp lY gryo sG Nppyw�, h,y1StY I�._ ar 1951 s, �;SEA1 Iol ALa b + � ti o �•. A b !D Or �y A� .f � �'�.�ryNCE fSN.AN 1s....'..•�r bt � ,,,. + A�j1d' State of Connecticut By: City of Hartford ss. Georg Thompson, nior ice President On this the 1 St day of February 2010 before me personally appeared George W.Thompson,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters, Inc., St.Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. i C • �V� .t�v1 My Commission expires the 30th day of June,2011. pd ath Marie C.Tetreault,Notary Public t�J 58440-4-09 Printed in U.S.A. WARNING:THU POIqER OF A Y I I L T R PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY: Recorded in Official Records, Orange County Tom Daly, Clerk-Recorder IIIIII11111111111111111111111111111l11111IIIII I11111IIIIIIIIIIIIIIIIINO FEE AND WHEN RECORDED MAIL TO: 2009000352805 04:30pm 07102/09 111 200 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 WHEN RECORDED MAIL TO: CITY OF HUNTINGTON BEACH - — Attn: Robert A. Martinez P.O. Box 190—2000 Main Street Huntington Beach, CA 92648 THIS SPACE FOR RECORDER'S USE ONLY TITLE OF DOCUMENT: NOTICE OF COMPLETION N� NOTICE IS HEREBY GIVEN by the City of Huntington Beach, owner in fee, 2000 Main Street, Huntington Beach, CA 92648, that the contract heretofore awarded to R.J. Noble Company who was the company thereon for doing the following work to-wit: VARIOUS RESIDENTIAL STREETS ASPHALT OVERLAYS,_MSC-454 That said work was completed June 25, 2009 by said company according to plans and specifications and to the satisfaction of the City Engineer of the City of Huntington Beach and that said work was accepted by the Director of Public Works on June 25,2009, per City Council Resolution No.2003-70 adopted October 6,2003. That upon said contract Travelers Casualty and Surety Company of America was surety for the bond given by the said company as required by law. This document is solely for the official business of the City of Huntington Beach, as contemplated under Government Code Section 6103 and should be recorded free of charge. Dated at Huntington Beach, California,this June 25,2009. Di for of Vublic Works or City Engineer City of Huntington Beach,California STATE OF CALIFORNIA) County of Orange )ss: City of Huntington Beach ) I, the undersigned, say: I am an Agent of the City of Huntington Beach, owner in fee, in the foregoing NOTICE OF COMPLETION. I have read said NOTICE OF COMPLETION and know the contents thereof; the same is true of my knowledge. I declare under penalty of perjury that the foregoing is true and correct, and that said NOTICE OF COMPLETION was duly and regularly ordered to be recorded in the Office of the County Record r of Orange County. Dated at Huntington Beach, California,this June 25,2009. Di for of PuNic Works or City Engineer City of Hu tington Beach, California THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION (Additional recording fee applies) 610'_059-TITLE PAGE(R7/95) RECEIVED BY: CITY CLERK RECEIPT COPY \ 1 ) Return DUPLICATE toy,"*' City Clerk's Office (Name) �J after signing/datirig (Date) A, CITY OF HUNTINGTON BEACH INTERDEPARTMENTAL COMMUNICATION TO: Shari Freidenrich, City Treasurer FROM: DATE: SUBJECT: Bond Acceptance have received the bonds for 6' \�'�.� � - L L () (company Name) Faithful Performance Bond No. / � Labor and Material Bond No. 0 d� Monument Bond No. Maintenance Bond No. Guarantee and Warranty Bond No. ` Re: Tract No. CC No. MSC No. __ r Approved / r`�'? C.� e Agenda Item No. (Council Approval Date) City Clerk Vault No. #27 g1followuplbondletter.doc { CITY FUNDED CONSTRUCTION CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND FOR C 'jv w.'AoT mot" TABLE OF CONTENTS Page No. 1. STATE OF WORK;ACCEPTANCE OF RISK 1 2. ACCEPTANCE OF CONDITIONS OF WORK;PLANS 2 3. COMPENSATION 4 4. COMMENCEMENT OF PROJECT 4 5. TIME OF THE ESSENCE 4 6. CHANGES 5 7. NOTICE TO PROCEED 6 8. BONDS 6 9. WARRANTIES 6 10. INDEPENDENT CONTRACTOR 7 11. LIQUIDATED DAMAGES/DELAYS 7 12. DIFFERING SITE CONDITIONS 9 13. VARIATIONS IN ESTIMATED QUANTITIES 10 14. PROGRESS PAYMENTS 10 15. WITHHELD CONTRACT FUNDS,SUBSTITUTION OF SECURITIES 11 16. AFFIDAVITS OF SATISFACTION OF CLAIMS 1 11 17. WAIVER OF CLAIMS 12 18. INDEMNIFICATION,DEFENSE,HOLD HARMLESS 12 19. WORKERS' COMPENSATION INSURANCE 13 20. INSURANCE 13 21. CERTIFICATES OF INSURANCE;ADDITIONAL INSURED 14 22. NOTICE OF THIRD PARTY CLAIM 15 23. DEFAULT&TERMINATION 15 24. TERMINATION FOR CONVENIENCE 16 25. DISPOSITION OF PLANS,ESTIMATES AND OTHER 16 26. NON-ASSIGNABILITY 16 27. CITY EMPLOYEES AND OFFICIALS 16 28. STOP NOTICES 17 29. NOTICES 17 30. SECTION HEADINGS 18 31. IMMIGRATION 18 32. LEGAL SERVICES SUBCONTRACTING PROHIBITED 18 33. ATTORNEY'S FEES 18 34 INTERPRETATION OF THIS AGREEMENT 19 35. GOVERNING LAW 19 36. DUPLICATE ORIGINAL 19 37. CONSENT 20 38. SURVIVAL 20 39. MODIFICATION 20 40. SIGNATORIES 20 41. ENTIRETY 20 CITY FUNDED CONSTRUCTION CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND FOR THIS AGREEMENT ("Agreement") made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and - - -��� ( , a California en*?P —R Q�4 hereinafter referred to as "CONTRACTOR." WHEREAS, CITY has solicited bids for a public works project, hereinafter referred to as "PROJECT," more fully described as aj _ in the City of Huntington Beach; and CONTRACTOR has been selected to perform said services, NOW, THEREFORE, in consideration of the promises and agreements hereinafter made and exchanged, the parties covenant and agree as follows: 1. STATEMENT OF WORK, ACCEPTANCE OF RISK CONTRACTOR shall complete and construct the PROJECT pursuant to this Agreement and the Contract Documents (as hereinafter defined) and furnish, at its own cost and expense, all labor, plans, tools, equipment, supplies, transportation, utilities and all other items, services and facilities necessary to complete and construct the PROJECT in a good and workmanlike manner. CONTRACTOR agrees to fully assume the risk of all loss or damage arising out of the nature of the PROJECT, during its progress or prior to acceptance by CITY, from the action of the elements, from any unforeseen difficulties which may arise or g/agree/surfnet/cityconst 12-07 1 be encountered in the prosecution of work, and for all other risks of any description in connection with the work, including, but not limited to, all expenses incurred by or in consequence of the suspension or discontinuance of work, except such as are herein expressly stipulated to be borne by CITY, and for well and faithfully completing the work within the stipulated time and in the manner shown and described in this Agreement, and in accordance with the requirements of CITY for the compensation set forth in the accepted bid proposal. 2. ACCEPTANCE OF CONDITIONS OF WORK; PLANS AND SPECIFICATIONS CONTRACTOR acknowledges that it is fully familiar with all the terms, conditions and obligations of this Agreement and the Contract Documents (as defined below in this Section), the location of the job site, and the conditions under which the work is to be performed, and that it enters into this Agreement based upon its thorough investigation of all such matters and is relying in no way upon any opinions or representations of CITY. It is agreed that the Contract Documents are incorporated into this Agreement by this reference, with the same force and effect as if the same were set forth at length herein, and that CONTRACTOR and its subcontractors, if any, shall be bound by the Contract Documents insofar as they relate in part or in any way, directly or indirectly, to the work covered by this Agreement. "Contract Documents" as defined herein mean and include: A. This Agreement; B. Bonds covering the work herein agreed upon; g/agree/surfnet/cityconst 12-07 2 C. The CITY's standard Plans and Specifications and special contractual provisions, including those on file in the office of the Director of Public Works of CITY and adopted by the City Council, and any revisions, amendments or addenda thereto; D. The current edition of Standard Specifications for Public Works Construction, published by Builders' News, Inc., 10801 National Boulevard, Los Angeles, CA 90064, and all amendments thereto, written and promulgated by the Southern California chapter of the American Public Works Association and the Southern California District Associated General Contractors of the California Joint Cooperative Committee; E. Bid documents including the Notice Inviting Bids, the Special Instructions to Bidders and the CONTRACTOR's proposal, (which is attached hereto as Exhibit "A" and incorporated herein by this reference); F. The particular Plans, Specifications, Special Provisions and Addenda applicable to the PROJECT. Anything mentioned in the Specifications and not indicated in the Plans or indicated in the Plans and not mentioned in the Specifications, shall be of like effect as if indicated and mentioned in both. In case of a discrepancy between any Plans, Specifications, Special provisions, or Addenda, the matter shall be immediately submitted by CONTRACTOR to the Department of Public Works of CITY (hereinafter referred to as g/agree/surfnet/cityconst 12-07 3 "DPW"), and CONTRACTOR shall not attempt to resolve or adjust the discrepancy without the decision of DPW, save only at its own risk and expense. Should there be any conflict between the terms of this Agreement and the bid or proposal of CONTRACTOR, then this Agreement shall control and nothing herein shall be considered as an acceptance of the terms of the bid or proposal which is in conflict herewith. 3. COMPENSATION CITY agrees to pay and CONTRACTOR agrees to accept as full compensation for the faithful performance of this Agreement, subject to any additions or deductions made under the provisions of this Agreement or theContract Documents, a sum 01 not to exceed - Dollars iyp as set forth Nint e ContYacl Documents, to be paid as provided in this Agreement. 4. COMMENCEMENT OF PROJECT CONTRACTOR agrees to commence the PROJECT within ten (10) working days after the Notice To Proceed is issued and diligently prosecute the PROJECT to completion within from the day the Notice to Proceed is issued by DPW, excluding delays provided for in this Agreement. 5. TIME OF THE ESSENCE The parties hereto recognize and agree that time is of the essence in the performance of this Agreement and each and every provision of the Contract Documents. g/agree/surfnet/cityconst 12-07 4 CONTRACTOR shall prepare and obtain approval as required by the Contract Documents for all shop drawings, details and samples, and do all other things necessary and incidental to the prosecution of its work in conformance with the progress schedule set forth in the Contract Documents. CONTRACTOR shall coordinate its work with the work of all other contractors, subcontractors, and CITY forces working on the PROJECT in a manner that will facilitate the efficient completion of the PROJECT and in accordance with the terms and provisions of this Agreement. CITY shall have complete control of the premises on which the work is to be performed and shall have the right to decide the time and order in which the various portions of the work shall be performed and the priority of the work of other contractors, subcontractors and CITY forces and, in general, all matters concerning the timely and orderly conduct of the work of CONTRACTOR on the premises. 6 CHANGES CONTRACTOR shall adhere strictly to the plans and specifications set forth in the Contract Documents unless a change therefrom is authorized in writing by DPW. CONTRACTOR agrees to make any and all changes, furnish materials and perform all work necessary within the scope of the PROJECT as DPW may require in writing. Under no condition shall CONTRACTOR make any changes without the prior written order or acceptance of DPW, and CITY shall not pay any extra charges made by CONTRACTOR that have not been agreed upon in writing by DPW. When directed to change the work, CONTRACTOR shall submit immediately to DPW a written cost proposal reflecting the effect of the change. Should DPW not agree to such cost proposal, the work shall be performed according to the g/agree/surfnet/cityconst 12-07 5 changes ordered in writing by DPW and the proper cost thereof shall be negotiated by the parties upon cost and pricing data submitted by CONTRACTOR; thereupon, CITY will promptly issue an adjusted change order to CONTRACTOR and the contract price will be adjusted upward or downward accordingly. 7. NOTICE TO PROCEED No work, services, material, or equipment shall be performed or furnished under this Agreement unless and until a Notice to Proceed has been given to CONTRACTOR by CITY. CITY does not warrant that the work will be available on the date the Notice to Proceed is issued. In the event of a delay in commencement of the work due to unavailability of the job site, for any reason, relief to CONTRACTOR shall be limited to a time extension equal to the delay due to such unavailability. 8. BONDS Only bonds issued by California admitted sureties will be accepted. CONTRACTOR shall, prior to its performance of this Agreement, furnish the following two (2) bonds approved by the City Attorney: One in the amount of one hundred percent (100%) of the contract price to guarantee the CONTRACTOR's faithful performance of the work, and one in the amount of one hundred percent of the contract price to guarantee payment of all claims for labor and materials furnished. In addition, CONTRACTOR shall submit to CITY a bond in the amount of one hundred percent (100%) of the final contract price, including all change orders, to warrant such performance for a period of one (1) year after CITY's acceptance thereof within ten(10) days of filing of the Notice of Completion. g/agree/surfnet/cityconst 12-07 6 9. WARRANTIES CONTRACTOR unconditionally guarantees all work done under this Agreement including, but not limited to, any workmanship, installation, fabrication, material or structural facilities constructed. CONTRACTOR, within ten (10) days after notice by CITY of any defect in the work, shall have the option to make appropriate repairs or replace the defective item or items. Upon expiration of such ten(10) day period, CITY may then make appropriate repair or replacement at CONTRACTOR's risk and own cost and expense. 10. INDEPENDENT CONTRACTOR It is understood and agreed that CONTRACTOR is, and shall be, acting at all times hereunder as an independent contractor and not an employee of CITY. CONTRACTOR shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONTRACTOR and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services performed hereunder. 11. LIQUIDATED DAMAGES/DELAYS It is agreed by the parties hereto that in case the total work called for hereunder is not in all parts and requirements finished or completed within the number of calendar days as set forth herein, damage will be sustained by CITY; and that it is, and would be, impractical and extremely difficult to ascertain and determine the actual damage which CITY would sustain in the event of and by reason of such delay. It is, therefore, agreed that CONTRACTOR will pay to CITY, as liquidated damages and not as a penalty, g/agree/surfnet/cityconst 12-07 7 the sum of Dollars ($ �.7 , oc::> ) per day for each and every working day's delay in completing the work in excess of the number of working/calendar days set forth herein, which represents a reasonable endeavor by the parties hereto to estimate a fair compensation for the foreseeable damages CITY would sustain in the event of and by reason of such delay; and CONTRACTOR agrees to pay these damages herein provided, and further agrees that CITY may deduct the amount thereof from any monies due or that may become due to CONTRACTOR hereunder. CONTRACTOR will be granted an extension of time and will not be assessed damages for any portion of the delay in the completion of the work due to unforeseeable causes beyond the control and without the fault or negligence of CONTRACTOR, including, but not limited to, acts of God or of the public enemy, fire, floods, epidemics, quarantine restrictions, strikes, unsuitable weather, or delays of subcontractors due to such causes. CONTRACTOR shall, within fifteen (15) days from the beginning of any such delay (unless DPW shall grant a further period of time), notify DPW in writing of the cause of the delay and CITY shall extend the time for completing the work if, in its judgment, the findings of fact thereon justify the delay; and the decision of DPW shall be conclusive on the parties hereto. Should CONTRACTOR be delayed in the prosecution or completion of the work by the act, neglect or default of CITY, or should CONTRACTOR be delayed by waiting for materials required by this Agreement to be furnished by CITY,'or by damage caused by fire or other casualty at the job site for which CONTRACTOR is not responsible, or by the combined action of the workers, in no way caused by or resulting g/agree/surfnet/cityconst 12-07 8 from default or collusion on the part of CONTRACTOR, or in the event of a lockout by CITY, then the time herein fixed for the completion of the work shall be extended by the number of days CONTRACTOR has thus been delayed, but no allowance or extension shall be made unless a claim therefor is presented in writing to CITY within fifteen (15) days of the commencement of such delay. No claims for additional compensation or damages for delays, irrespective of the cause thereof, and including without limitation the furnishing of materials by CITY or delays by other contractors or subcontractors, will be allowed and an extension of time for completion shall be the sole remedy of CONTRACTOR. 12. DIFFERING SITE CONDITIONS A. Notice: CONTRACTOR shall promptly, and before such conditions are disturbed,notify DPW in writing of: (1) Subsurface or latent physical conditions at the job site differing materially from those indicated in this Agreement or the Contract Documents; or (2) Unknown physical conditions at the job site, of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent to work of the character to be performed under this Agreement. DPW shall promptly investigate the conditions and if it finds that such conditions do materially so differ and cause an increase or decrease in the time required for performance of any part of the work under this Agreement,whether or not changed as g/agree/surfnet/cityconst 12-07 9 a result of such conditions, an equitable adjustment shall be made and the agreement modified in writing accordingly. B. Time Extension: No claim of CONTRACTOR under this Section shall be allowed unless CONTRACTOR has given the notice required hereunder provided, however, the time prescribed therefor may be extended by CITY. 13. VARIATIONS IN ESTIMATED QUANTITIES The quantities listed in the bid schedule will not govern final payment. Payment to CONTRACTOR will be made only for the actual quantities of contract items used in construction of the PROJECT, in accordance with the plans and specifications. Upon completion of the PROJECT, if the actual quantities used are either more than or less than the quantities listed in the bid schedule, the bid price shall prevail subject to the provisions of this Section. DPW may, at its sole discretion, when warranted by the facts and circumstances, order an equitable adjustment, upwards or downwards, in payment to CONTRACTOR where the actual quantities used in construction of the PROJECT are in variation to the quantities listed in the bid schedule. No claim by CONTRACTOR for an equitable adjustment in price or time for completion shall be allowed if asserted after final payment under this Agreement. If the quantity variation is such as to cause an increase in the time necessary for completion, DPW shall ascertain the facts and circumstances and make such adjustment for extending the completion date as in its sole judgment the findings warrant. g/agree/surfnet/cityconst 12-07 10 14. PROGRESS PAYMENTS Each month DPW will make an estimate in writing of the work performed by CONTRACTOR and the value thereof. From each progress estimate, ten percent(10%) will be deducted and retained by CITY and the remainder of the progress estimate, less the amount of all previous payments since commencement of the work, will be paid to CONTRACTOR. When CONTRACTOR has, in the judgment of DPW, faithfully executed fifty percent (50%) or more of the value of the work as determined from the bid schedule, and if DPW finds that satisfactory progress has been and is being made, CONTRACTOR may be paid such sum as will bring the payments of each month up to one hundred percent (100%) of the value of the work completed since the commencement of the PROJECT, as determined in its sole discretion by DPW, less all previous payments and less all previous retained amounts. CITY's final payment to CONTRACTOR, if unencumbered, or any part thereof unencumbered, shall be made thirty-five (35) days after the acceptance of the work and the filing of a Notice of Completion by CITY. Payments shall be made on demands drawn in the manner required by law, each payment to be accompanied by a certificate signed by DPW, affirming that the work for which payment is demanded has been performed in accordance with the terms of the Agreement and that the amount stated in the certificate is due under the terms of the Agreement. Partial payments on the contract price shall not be considered as a acceptance of any part of the work. 15. WITHHELD CONTRACT FUNDS, SUBSTITUTION OF SECURITIES At the request and at the sole cost and expense of CONTRACTOR, who shall retain beneficial ownership and receive interest, if any thereon, CITY shall permit the g/agree/surfnet/cityconst 12-07 11 substitution and deposit therewith of securities equivalent to the amount of any monies withheld by CITY to ensure performance under the terms of this Agreement. 16. AFFIDAVITS OF SATISFACTION OF CLAIMS After the completion of the work contemplated by this Agreement, CONTRACTOR shall file with DPW its affidavit stating that all workers and persons employed, all firms supplying materials and all subcontractors working upon the PROJECT have been paid in full and that there are no claims outstanding against the PROJECT for either labor or material, except certain items, if any, to be set forth in CONTRACTOR's affidavit covering disputed claims, or items in connection with Notices to Withhold, which have been filed under the provisions of the statutes of the State of California. 17. WAIVER OF CLAIMS The acceptance by CONTRACTOR of the payment of the final certificate shall constitute a waiver of all claims against CITY under or arising out of this Agreement. 18. INDEMNIFICATION, DEFENSE, HOLD HARMLESS CONTRACTOR hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to CONTRACTOR's employees and damage to CONTRACTOR's property, arising directly or indirectly out of the obligations or operations herein undertaken by CONTRACTOR, caused in whole or in part by any negligent act or omission of the CONTRACTOR, any subcontractors, anyone g/agree/surfneticityconst 12-07 12 directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the CITY. CONTRACTOR will conduct all defense at its sole cost and expense and CITY shall approve selection of CONTRACTOR's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by CONTRACTOR. 19. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE Pursuant to California Labor Code Section 1861, CONTRACTOR acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; CONTRACTOR covenants that it will comply with such provisions prior to commencing performance of the work hereunder. CONTRACTOR shall obtain and furnish to City workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. CONTRACTOR shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. CONTRACTOR shall furnish to CITY a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and CONTRACTOR shall similarly require all subcontractors to waive subrogation. g/agree/surfnet/cityconst 12-07 13 20. INSURANCE In addition to the workers' compensation and employer's liability insurance and CONTRACTOR's covenant to defend, hold harmless and indemnify CITY, CONTRACTOR shall obtain and furnish to CITY, a policy of general public liability insurance, including motor vehicle coverage covering the PROJECT. This policy shall indemnify CONTRACTOR, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out or in connection with the PROJECT, and shall provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for this PROJECT. This policy shall name CITY, its officers, elected or appointed officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the PROJECT shall be deemed excess coverage and that CONTRACTOR's insurance shall be primary. Under no circumstances shall said above-mentioned insurance contain a self- insured retention, or a "deductible" or any other similar form of limitation on the required coverage. 21. CERTIFICATES OF INSURANCE: ADDITIONAL INSURED ENDORSEMENTS Prior to commencing performance of the work hereunder, CONTRACTOR shall furnish to CITY certificates of insurance subject to approval of the City Attorney g/agree/surfnet/cityconst 12-07 14 evidencing the foregoing insurance coverages as required by this Agreement; the certificates shall: 1. provide the name and policy number of each carrier and policy; 2. state that the policy is currently in force; and 3. promise to provide that such policies will not be canceled or modified without thirty(30) days' prior written notice of CITY. CONTRACTOR shall maintain the foregoing insurance coverages in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverages shall not derogate from the CONTRACTOR's defense, hold harmless and indemnification obligations as set forth under this Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of all the policies of insurance. CONTRACTOR shall pay, in a prompt and timely manner, the premiums on all insurance hereinabove required. CONTRACTOR shall provide a separate copy of the additional insured endorsement to each of CONTRACTOR's insurance policies, naming CITY, its officers, elected and appointed officials, employees, agents and volunteers as Additional Insureds, to the City Attorney for approval prior to any payment hereunder. 22. NOTICE OF THIRD PARTY CLAIM Pursuant to Public Contracts Code §9202, CITY shall provide notice to CONTRACTOR of receipt of any claim filed with CITY or a court of competent jurisdiction which arises out of performance of this agreement within ten (10) days of receipt of such claim or claims. g/agree/surfnet/cityconst 12-07 15 23. DEFAULT AND TERMINATION If CONTRACTOR fails or refuses to prosecute the work hereunder with diligence, or fails to complete the work within the time specified, or is adjudged bankrupt or makes an assignment for the benefit of creditors or becomes insolvent, or violates any provision of this Agreement or the Contract Documents, CITY may give CONTRACTOR notice in writing of its intention to terminate this Agreement. Unless the violation is cured within ten (10) days after such Notice of Intention has been served on CONTRACTOR, CITY may, without prejudice to any other remedy it may have, terminate this Agreement upon the expiration of that time. Upon such default by CONTRACTOR, CITY may elect not to terminate this Agreement; in such event CITY may make good the deficiency in which the default consists and deduct the resulting costs from the progress payments then or to become due to CONTRACTOR. If it is subsequently determined by a court of competent jurisdiction that CITY's termination of this Agreement under this Section was wrongful, such termination shall be converted to a termination for convenience under Section 24 and any damages shall be assessed as set forth in Section 24. 24. TERMINATION FOR CONVENIENCE CITY may terminate this Agreement for convenience at any time with or without cause, and whether or not PROJECT is fully complete upon seven (7) calendar days written notice to CONTRACTOR. In the event of termination, under this Section CITY shall pay CONTRACTOR for value of work in place on the PROJECT through the termination period less all such payments already made. In case of such termination for convenience, the CONTRACTOR shall be entitled to receive payment for work executed, g/agree/surfnet/cityconst 12-07 16 and costs incurred by reason of such termination. In no event shall CONTRACTOR be entitled to recover overhead,profit or CONTRACTOR's fee on work not performed. Such payment by CITY shall be CONTRACTOR's sole and exclusive remedy for termination by CITY for its convenience and CITY shall have no further obligation to CONTRACTOR. 25. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS CONTRACTOR agrees that upon completion of the work to be performed hereunder, or upon expiration or earlier termination of this Agreement, all original plans, specifications, drawings, reports, calculations, maps and other documents pertaining to this Agreement shall be delivered to CITY and become its sole property at no further cost. 26. NONASSIGNABILITY CONTRACTOR shall not sell, assign, transfer, convey or encumber this Agreement, or any part hereof, or any right or duty created herein, without the prior written consent of CITY and the surety. 27. CITY EMPLOYEES AND OFFICIALS CONTRACTOR shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any financial interest in this Agreement in violation of the California Government Code. 28. STOP NOTICES: RECOVERY OF ADMINISTRATIVE COSTS CITY shall be entitled to all reasonable administrative costs and necessary disbursements arising out of the processing of Stop Notices, Notices to Withhold, or any similar legal document. This obligation shall be provided for in the labor and materials payment bond required of CONTRACTOR. CITY may charge an administrative fee of g/agree/surfnet/cityconst 12-07 17 One Hundred Dollars ($100) for every Stop Notice filed in excess of two (2), regardless of whether or not CITY is named in an action to enforce such stop notices. CITY may set off any unreimbursed cost or expense so incurred against any sum or sums owed by CITY to CONTRACTOR under this Agreement. 29. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONTRACTOR's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below; provided that CITY and CONTRACTOR may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other party via personal delivery, reputable overnight carrier or U. S. certified mail-return receipt requested: TO CITY: TO CONTRACTOR: City of Huntington Beach JTVr. _�_ • ^ C il. _ � ATTN: T /"�' �� I y i- 2000 Main Street Huntington Beach, CA 92648 �TC�f�VK bat? 30. SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of maters included or excluded from such provisions, and do not interpret, g/agree/surfnet/cityconst 12-07 18 define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 31. IMMIGRATION CONTRACTOR shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of United States Code Section 1324a regarding employment verification. 32. LEGAL SERVICES SUBCONTRACTING PROHIBITED CONTRACTOR and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. CONTRACTOR understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for CITY; and CITY shall not be liable for payment of any legal services expenses incurred by CONTRACTOR. 33. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the non-prevailing party. 34. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent g/agree/surfnet/cityconst 12-07 19 jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 35. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 36. DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. g/agree/surfnet/cityconst 12-07 20 37. CONSENT Where CITY's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be consent/approval to any subsequent occurrence of the same or any other transaction or event. 38. SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement shall so survive. 39. MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 40. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact,held by the signatory or is withdrawn. 41. ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that parry's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, g/agree/surfnet/cityconst 12-07 21 promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. This Agreement, and the attached Exhibit "A", contain the entire agreement between the parties respecting the subject matter of this Agreement,and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. IN WITNESS WHEREOF,the parties hereto have caused this Agreement to be executed by and through their authorized officers on - . -January 20, 2009 CONTRACTOR CITY OF HUNTINGTON BEACH, a R.J. Noble Company municip corporation of the State of California .10&i9Z g /S'k" ayor By: arver - City Clerk 411(0?� print name INITIATED AND APPROVED: ITS: (circle one)Chairma residen ice President AND �.. Director o P blic Works By: /,�11� G REVIEW APPROVED: Steve Mendoza l n e ITS: (circle one Secrefa Ghief Financial Officer/Asst. ity Pininistrator Secretary-Treasurer APPROVED AS TO FORM: City Attorney g/agree/surfnet/cityconst 12-07 22 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On 02/03/0 9 before me, JENNIFER DE IONGH, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared MICHAEL J. CARVER Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to o _ A be the personp' whose name,O is/ars-subscribed to the JENNIFER DE IONGH within instrument and acknowledged to me that Commission # 1:71186 he/gheAh y executed the same in his/hQ#4he4r authorized $ Notary Public -California = capacity(,tes'j, and that by his/f@the+w signature�K on the Orange County instrument the personA, or the entity upon behalf of MVC0mm.Ex0esOct28,2011 which the personV 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 m hand and offi ial seal. Sign ture Place Notary Seal Above SignatE0 f Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persogs re l ing on the document and could prevent fraudulent removal and reattachmenfofl is form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): Partner—❑ Limited ❑General ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact • ❑Attorney in Fact ❑ Trustee Top of thumb here ❑Trustee Top of thumb here Cl Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association-9350De Soto Ave.,P.O.Box 2402-Chatsworth,CA91313-2402-www.NationaiNotaryorg Item45907 Reorder:Call Toll-Free 1-800-876-6827 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On 02/03/09 before me, JENNIFER DE IONGH, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared STEVE MENDOZA Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(/whose name is/are subscribed to the within instrument and acknowledged to me that he/staQ449y executed the same in his/fir authorized capacity(je< and that by his/heaWeir signatureX on the �m JENNIFER DE IONGH instrument the person(; or the entity upon behalf of Commission # 1771186 which the person(4 acted, executed the instrument. Notary Public -California z Z ` ` Orange County I certify under PENALTY OF PERJURY under the laws fVly Comm.Expires Oct 28,2011 of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. -ignatu e Place Notary Seal Above p� ) Sig ture of Notary Public OPTION) l Though the information below is not required bylaw,it may prove valuable to persi ns re�ying 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑ Limited ❑General _ ❑Partner—❑ Limited ❑ General ❑ Attorney in Fact - ❑Attorney in Fact ❑ Trustee Top of thumb here El Trustee Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association-9350 De Soto Ave.,P.0.Box 2402-Chatsworth,CA 91313-2402-www.NationalNotary.orgvItem#5907 Reorder:Call Toll-Free 1-800-876-6827 SECTION C PROPOSAL for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT#454 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work, therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY 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 AGENCY of the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-t Bid Schedule MSC - 454 Cold Plane 1 706,001 S.F. at per S.F. $ _ $ Furnish and Install Petromat 2 2,537,923 S.F. at per S.F: $ -all _ $9.7 171, 5-3 Furnish and Install Asphalt at .12' �� �� od 3 22,841 Ton at per Ton $ t4 $1630x -- Adjust Water Valves to Grade 4 338 EA at per Each $ $ 00 $gq,g�Q OO Adjust Manholes to Grade 5 262 EA at per Each spo oo $a Im. 0® Install Traffic Loops 6 30 EA at per Each $ f 00. $ 5- L(O , ob Prepare Pre & Post Construction Corner Record and File with Appropriate Agencies a 00 7 241 EA at per Each $20(, U, 0 p 14q I Total Bid Amount in Fi ures $ t Z L( ,7 - Total Bid Amount in Words ITWO v1 e lAdr ;X % 0 ,5-in TLip added FVJ- "b Alt 7�OVPP Ad dO NCS S Q veA43 c C-2s If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option,be considered null and void. Accompanying this proposal of bid, find 101; bid bondin the amount of$ which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any; Addenda No. Date Received 4 Bidder's Si nature No. 1 December 1, 08 x Mi ei J. Carver, President C-2 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name and Address of Subcontractor State License Class of'Work Number 66(o s,r Berix,dl` Rd C& ; C-1. ca (Aofdli(A PC0r f_4onq e-n . /07 3�0 04 t C C4se I-Avid Serve , L By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOI.LUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange Michael J. Carver , being first duly sworn, deposes and says that he or she is President of R.J. Noble Company the party making the foregoing bid that the bid is not made in the interest of, or on the 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, or 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 fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. R.J. Noble Company Name of Bidder X ature of Bidder Michael J. Carver President 15505 E. Lincoln Avenue, Orange, Ca Address of Bidder Subscribed and sworn to before me this 18th day of Decembers 20 08 JENNIFER DE IONGH Commission # 1771186 Z ;-a Notary Public -California z ° Orange County My Comm.Expires Oct28,2011 NOTARY PUBLIC Jennil€er De `lIongh NOTARY SEAL I C-4 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT# 454, (1)(we)(it) will employ and utilize only qualified persons, as hereinafter defined,to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code; Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. R.J. Noble Company Contractor By Michael J. Carver President Title Date: December 18 , 2008 C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder,shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? Yes ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. R.J. Noble Company Contractor By Michael J. Carver President Title Date: December 18 , 2008 C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: R.J. Noble Company Contractor B Michael J. Carver President Title Date: December 18, 2008 Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained fi°om the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: R.J. Noble Company Bidder Name 15505 E. Lincoln Avenue Business Address nrangp�1A g7RtiS City, State Zip 714 ) 637-1550 Telephone Number A-782908 Class A State Contractor's License No. and Class August 2000 Original Date Issued August 31, 2010 Expiration Date The work site was inspected by Steve Mendoza of our office on December 9 , 20 08 The following are persons, firms,and corporations having a principal interest in this proposal: R.J. Noble Company C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability; financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. R.J. Noble Company Company Name x Signature Aidder Michael J. Carver, President Printed or Typed Signature Subscribed and sworn to before me this 18 day of December 2008 JENNIFER DE IONGH Commisslon # 1771186 z �ca Notary Public -California r ' Orange County My Comm.ExpiresOct28,2011 NOTARY PUBLIC _ - -- Jenn,Jennifer 1 Iongh NOTARY SEAL iferListed below are theWar a mes addr sand telephone _ phone numbers for three public agencies for which the bidder has performed similar work within the past two years: 1. City of San Clemente, 910 Calle Negocio Ste. 100, Corona, Ca Name and Address of Public Agency Name and Telephone No. of Project Manager: nary Hoborsky 94 9-3 6 1-6 1 1 8 433 , 099 . 30 Street Improvements March 2008 Contract Amount Type of Work Date Completed 2 City of Santa Ana, P.O. Box 1988, Santa Ana, Ca 92702 Name and Address of Public Agency Name and Telephone No. of Project Manager: Ed Torres 714-64 7-54 3 2 1, 035, 915 . 00 Pavement Rehabilitation November 2007 Contract Amount Type of Work Date Completed 3 County of Riverside, P.O Box 1090, Riverside, Ca 92502 Name and Address of Public Agency Name and Telephone No. of Project Manager: Stan Dery 951-955-6742 4, 6281, 247 70 Street Improvements June 2007 Contract Amount Type of Work Date Completed C-1 b TRAVELERS CASUALTY AND SURETY COMPANY O.%AMERICA Hartford, Connecticut 06183 Bond No. N/A KNOW ALL MEN BY THESE PRESENTS, That We, R. J. NOBLE COMPANY as Principal, hereinafter called the Principal, and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA,of Hartford,Connecticut, a corporation duly organized under the laws of the State of Connecticut, as Surety, hereinafter called the Surety,are held and firmly bound unto CITY OF HUNTINGTON BEACH as ONinoa horoinnftPr rattan tho r)hlinaa in tha aim of TEN PERCENT OF THE AMOUNT OF THE BID Dollars($ 10 o OF BID AMA for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for VARIOUS RESIDENTIAL STREET OVERLAY (MSC454) NOW,THEREFORE, if the Obligee shall accept the.bid of the Principal and the Principal shalt enter into a Contract with the Obligee in accordance with the terms of such bid,and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Cuntract and give such bonds or bonds, if the Principal shall d to the Obligee the diffCrence not to exceed tie 9 p-'shall t�-Y'- u penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith co^tract:with another party to-r!orm the!Nor4 covered by said bid, then this obligation shall be null and void,otherwise to remain in full force and effect. Signed and sealed this 8th day of DECEMBER, 2008 R. J. NOBLE COMPANY (`/';i^•f (Principan(Seal) MICIJIKL J. CARVER, PRESIDENT (Tine) TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA (4'viinessj a gVQ _ M HAEL CSTONG (A" �'Tact) Printad in cooperation with the American Institute of Architects(AIA) by Travelers Casualty and Surety Company of America, The language in this document conforms exactly to the language used in AIA Document A310, February 1970 edition. c_I gin r:(n7.9'T CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE hh On Al ) � V� before me, JENNIFER DE IONGH, NOTARY PUBLIC Date - Here Insert Name and Title of the Officer personally appeared MICHAEL J. CARVER Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the personX whose nameW is/axa subscribed to the within instrument and acknowledged to me that _ _ _ _ _ he/sheAhey executed the same in his/t o0heir authorized JENNIFER DE IONGH capacity(les, and that by his/hei;414r.signature�gj on the Commission # 1771186 instrument the personA, or the entity upon behalf of Z -. Notary Public -California Orange County which the person(') acted, executed the instrument. Z MVCornM.EM*esOct28,2011 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m hand and official -eal. Place Notary Seal Above Signature nat e of Notary Public OPTIONAL Though the information below is not required by law, it may prove valua a to persons lyi 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: Number of Pages: Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name:_ ❑ Individual _ Individual Corporate Officer—Title(s): ❑ Corporate Officer—Titie(s): Partner—❑ Limited El General _ ❑ Partner—7 Limited El General _ Attorney in Fact Ej Attorney in Fact • Trustee Top of thumb here u Trustee Top of thumb here Guardian or Conservator ❑Guardian or Conservator Other: ❑Other: Signer Is Representing: Signer Is Representing: I 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 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On ��—$ —�� before me. R. NAPPI "NOTARY PUBLIC" (Here insert name and tide of the officer) personally appeared MICHAEL D. STONG who proved to me on the basis of satisfactory evidence to be the person(,a'jwhose name(s'f is/arc subscribed to the within instrument and acknowledged to me that he/shek4tey executed the same in his/lienk4►ek authorized capacityki=s and that by his/ker4hc4r signature(,<on the instrument the personK, or the entity upon behalf of which the personWacted,executed the instrument. l certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. PI WITNESS my hand and official seal. comm. 16 /Jcc ff., =RNIA rn+!✓ RIVERSIDE Y 2012 Signature of Notary Public (Notary Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM .any acknowledgment completed in California must contain verbiage exacth, as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California.In such instances.arty alternative (Title or description of attached document) acknowledgment verbiage as may be printed on such a doctmtent so long as the verbiage does not require the notary to do something that is illegal for a notar 1,in California(i.e. cert jying the authorised capacio,of the signer). Please check the (Title or description of attached document continued) document carefully for proper notarial m,ording and attach this form if required. Number of Pages Document Date - State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. o Date of notarization must be the dale that the signer(s)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ❑ Individual{S) he/sheMmy,is/are)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) o Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v 12.10.07 800-873-9865 rvivw.NotaryClasses.com WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER a e� POWER OF ATTORNEY .TRAVELERS Farmington Casualty Company St.Paul Guardian Insurance Company Fidelity and Guaranty Insurance Company St.Paul Mercury Insurance Company Fidelity-and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company Seaboard Surety Company Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company a Attorney-In Fact No. 219372 Certificate No. ®0 2 4 0 7 KNOW ALL MEN BY THESE PRESENTS:That Seaboard Surety Company is a corporation duly organized under the laws of the State of New York,that St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company and St.Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota,that Farmington Casualty Company,Travelers Casualty and Surety Company,and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut,that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Michael D.Stong,Shawn Blume,Rosemary Cisneros,and Jeremy Pendergast of the City of Riverside State of California their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their businessof guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or perai'tted'in an actions or proceedings allowed by law. 28th IN WITNF, UU S$WHEREOF,the Comp�t)i�s8hake caused this instrtmtenrto be-signed and_then corporate seals to be hereto affixed,this flu y day of Farmington Casualty Company St.Paul Guardian Insurance Company Fidelity and Guaranty hasurance,Company, St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company Seaboard Surety Company Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company coo ittYt� a...E�0.E�6'�W,.. �*~M�I(S : iNSpaMny " P c t�, G� 'ORAtFQ� 9j9i! com. I1951 tSEALt CONN. �1� ji State of Connecticut gy; City of Hartford ss. Georg Thompson. enior 'ice President 28th July 2008 On this the day of _,before me personally appeared George W.Thompson,kk ho acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc.. Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do•executed the foregoing instrument for the pu1p0ses therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G Ter - In Witness Whereof,I hereunto set my hand and official seal. My Commission expires the 30th day of June,201 I. Marie C.'fetreault.Notary Public 58440-5-07 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1,2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1,dated December 1,2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for 1. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, dated De ember 1, 2008. R.J. Noble Company Company Name By Michael J. Carver, President December 18, 2008 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714)374-1732. tn a 6a.i - `= ENGINEERING CONTRACTORS c=). 15505 E. LINCOLN AVENUE•P.O. BOX 620,ORANGE, CA 92856 (714)637-1550 c�v TO: U1- Y OF t-IUNTINGTON br AC J 2000 MAIN 5TRF.F_-I f-UN-I-INGTON 6E-ACI--I,CA 9z6'1e .RIOUS RESIDENTIAL STREETS FOR A.C. "ERLAY AT .IT MAINTENANCE SERVICE NTRACT #454, HUNTINGTON BEACH DATE: 12/18/08 AT 2:00 PM CONTRACTOR'S SWORN STATEMENT AND WARRANT' REGARDING CONTINUING INSURANCE OBLIGATIONS FROM: R.J. Noble Company PROJECT: Various Residential Streets (Contractor Name) for Asphalt overiay 4454 15505 E. Lincoln Ave — ----- -- - ------ (Street Address) Orange, Ca 92865 (City,State and Zip) TO: CITY OF HUNTINGTON BEACH DECLARATION Attached hereto is a true and correct copy of the current Certificate of Insurance and Additional Insured Endorsement CG 2010 1185, which Certificate complies with the insurance requirements of the Contract by and between the City of Huntington Beach C'City'�and the above-named Contractor("Contractor')for the above-described project("Project'). I declare under penalty of perjury under the laws of the State of California that the above statement is true and correct. Signed on Februa_ry_ 3 20 09at Orange, Ca (Date) (City,State) ignature of Individual Who is Making Declaration) Michael J. Carver, President WARRANTY Contractor hereby warrants and agrees to maintain Products and Completed Operations Insurance in compliance with the insurance requirements of the Contract for the Project. Said insurance shall be maintained through and until the expiration of all Warranties provided by Contractor. Said insurance shall contain Additional Insured Endorsement CG 2010 1185, naming City as an additional insured. Contractor shall supply to City, on at least an annual basis, a Certificate of Insurance and the aforementioned Endorsement evidencing continued coverage which meets the Contract requirements. Signed on February 3 2)9 at Orange, Ca (Date) (City,State) CONTRACTOR: Name: R.J. Noble Company By X Name: Mietlhae J. arver Title: President 277621.2 COM,t CERTIFICATE OF LIABILITY INSURANCE 02/05/20091 PRODUCER (?419)857-4500 FAX (949)857-4800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Millennium Risk Management & Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License # OC13480 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5530 Trabuco Road Irvine, CA 92620 INSURERS AFFORDING COVERAGE NAIC# INSURED R. J. Noble Co. INSURER A: Travelers Indemnity Co. of America #25666 15 505 Lincoln Avenue INSURER B: P. 0. BOX 620 INSURERC: Orange, CA 92856-9020 INSURER D: 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. rA DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY C09322B893TIL08 07/01/2008 07/01/2009 DAMAGE TO RENTED $ 300,000 PREMISE'(Ea occurance) CLAIMS MADE OCCUR MED EXP(Any one person) $ r 5 000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO CAP932ZB42608 07/01/2008 07/01/2009 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ A HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident)qq� �+ AP ED A$� F® ) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY JMN1ff91R WIG 71.4 City y �{/�I AUTO ONLY-EA ACCIDENT $ ANY AUTO 1�d n �� OTHER THAN EA ACC $ `c' 7(_/�/1 AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 51000,000 A CUP93221343808 07/01/2008 07/01/2009 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X WC.RYSTATU- OTH- FIR EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE C2JUB4786C03108 07/01/2008 07/01/2009 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS W Various Residential Streets for Asphalt Overlay @.12;MSC #454, RJN Job #91199 Certificate Holder is named Additional Insured as respects General Liability per endorsements CG20370704 & CG20101001 and Auto Liability per endorsement CA20480299 & CAT3530104 attached. Workers Comp Waiver of Subrogation applies per form WC99037600 attached. °10 days notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Huntington Beach, its agents,offi cers EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL KN)MYOM MAIL and employees *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Departments of Public Works 2000 Main Street p(I� y(p(rVdC 31�6X1�(Xol�3f�fi �()drDG14XXJf�CXX PO Box 190 X XX Huntington Beach, CA 92648 AUTHORIZED REPR A Leonard Zimins ACORD 25(2001/08) @ACORD CORPORATION 1988 4 } 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(2001108) Insured: R. J. Noble Co. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: C09322B893TIL08 ISSUE BATE: 07/01/2008 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWE , LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organizatlon(s): City of Huntington Beach , its agents , officers and employees Location And Description Of Completed Operations Various Residential Streets for Asphalt Overlay @ . 12 MSC #454, RJN Job #91199 Intormation required to complete this Schedule,if not shown above,will be shown in the Declarations, Se*tion It--Who Is An Insured is amended to in- location designated and described in the schedule of clude as an additional Insured the person(s) or or- this endorsement perrormed for that additional in- +, ganizatlon(s) shown in the Schedule, but only with sured and Included:in the"products-completed opera- w respect to Iiablllty for"bodily Injury" or"property dam. Lions hazard". age caused,in whole or In part,by"your work"at the CG 20 37 07 04 0 ISO Properties,Inc.,2004 page 1 of 1 CG20101001 Policy # C09322B893TIL08 Effective 07/01/2008 R. J. Noble Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Huntington Beach,its agents,officers and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II—Who Is An Insured 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 ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds,the following exclusion is added: 2. Exclusions This insurance does not apply to"bodily Injury"or"property damage"occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional Insured(s)at the site of the covered operations has been completed; or (2) That portion of"your work"out of which the Injury or damage arises has been put to Its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG20101001 Privacy I Legal Notices 02008 The Travelers Companies,Inc. POLICY NUMBER! CAP9322B246TIL08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE R5AD IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSiNEBS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modirled by this endorsement. This endorsement Identifles person(s) or organization(s) who are 'Insureds" under the Who Is An Insured Provision of the Coverage Form.This endorsement does not after coverage provided in the Coverage Form. SCHEDULE Name of Personls)or Oraanizati°on(s): City of Huntington Beach , its agents , officers , and employees (If no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to the endorsement.) Each person or organization shown to the Schedule is an "Insured"for Liability Coverage, but only to the extent that person or organization quaiifes as an "Insured"under the Who is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 'rac I Legal Notices 02007 The Travelers Companies,Inc. Policy:" CAP9322B426TIL08 Effective 07/01/2008 R. J. Noble Co.' COMMERCIAL AUTO THIS ENDORSEMENT CHANGEfS THE POLICY.PLEASE REA® IT CAREFULLY. BUSINESS AUTO COVERAGE EXTENSION FORM This endorsement modifies insurance provided under the following: 8USINE$8AUTO COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified Ey the endorsement. A. BROAD FORM NAMED iNSUREiD (4) All reasonable expenses incurred by the "in- SECTION II - LIABILITY COVERAGE, A. 1. sured"at our request,including actual loss of Who Is An insured provislon Is amended by add. earnings up to$500 a day because of time off Ing the following: from work. d. Any business entity newly acquired or formed D. HIRED CAR—WORLDWIDE COVERAGE by you during lire policy period, provided you SECTION It-- LIABILITY COVERAGE,A,2.Cov. own 50% or more of the business entity and erage Extensions is amended by addfng the the business entity Is not separately Insured following extension: for Business Auto Coverage.Coverage is ex- c. Hired Car--Worldwide Coverage tended up to a maximum of 180 days follow- Ing acquisition or formation of the business (1) We will pay all sums an "insured"legally entity. must pay as damages because of"bodily This provision does not apply to an injury"or "property damage"to which this p pp y e person Insurance applies, caused by an "acci- cl organization by a tfon emlbr which coverage is ex- dent" which occurs outside the United eluded by endorsement. States of America, the territories and B. EMPLOYEES AS INWREID possessions of the United States of SECTION Ii LIABILITY COVERAGE,AJ.Who America, Puerto Rico,and Canada result- Is An Insured is amended by adding the follow- Ing from the operation, maintenance, or Ing: use of any covered "auto" of the private passenger type you lease, hire, rent, or a. If you are not a sole proprietor, any "em- borrow without a driver for 30 days or ployee"of yours Is an"Insured"while using,in less the course and scope of your business at the 2 With respect to an claim made or suit" time of an "accident", a covered "auto" you ( ) Y " don't•t;dun,hire or borrow. instituted outside the United States of singg,, In " America,the territories and possessions of yours is an "Insured" twhileu us if you are a sole proprietor,any inn thee the United States of America,Puerto biro, and Canada: course and scope of your business or per- a You shall undertake the Investigation, sonar affafrs at the time of an °accident", a f ) g tion, covered"auto"that you don't own,hire or bon settlement, and •defense. of such row. . claims and "suits" and (reap e s ad- C. COVERAGE EXTENSIONS •- SUPPL.EMEW vised of all proceedings and actions. TARP PAYMENTS (b) You will not make any setilament SECTION If-LIABILITY COVERAGE,A. 2-Cr v- without our consent.. erage F_xtenslorts, a.Supplementary Payments (a) We will reimburse you: subparagraphs (2) and (4) are deleted and re- (1) For the amount of damages be- placed by the rollowing: cause of liability Imposed upon (2) Up to$3,000 for cast of ball bonds (including you by law on account of"bodily ponds for related traffic law violations)required injury" or "property damage" to because of an"accident"we oover-We do not 1 which this policy applies, and have to furnish these bonds. (II) For all reasonable expenses in- curred with our consent in connec- CA T3 53 0104 Copyright, The Travelers indenmsty Company Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc„ with its permission. Com MERCIAL AUTO lion with the lnvestigatlon, settle- you legally must pay to the lessor of a cov-• ment or defense of such claims or ered "auto" which you have leased without a "suits". Reimbursement for ex- driver for 30 days or less for the lessor's loss penses will be part of the Limit of of use of the covered"auto",provided; Insurance for Liability Coverage t, This Insurance provides comprehensive, shown in ITEM TWO of the specified causes of foss or callislon cover- BUSiNESS AUTO COVERAGE age on the covered"auto"; In add lon to s DECLARATIONS,limits. and not 2, The loss of use results from the covered In add}tfon to such tirrrits. (3) The Limit of Insurance for Liability Cover- being damaged In an "accident"Cover- while you are leasing it. age shown In ITEM TWO of tiro BUSINESS AUTO COVERAGE PART We will pay up to $65 per day subject to a DECLARATIONS Is the most we will re- maximum limit of$760 for any one"accident". Imburse you for the sum of all damages F. PHYSICAL DAMAGE — TRAf4SPORTATION Imposed on you, as set forth In c.(2)(c) EXPENSE alloy$, and all expense incurred by you SECTION III PHYSICAL DAMAGE arising out of any single "accident" or COVERAGE, A. h. Coverage Extensions, sub- "lass". paragraph a.Is deleted and replaced by the fol[ow- (4) You must maintain the greater of the to]- Ing; fowing primary auto liability Insurance lim- a, Transportatlon Expenses its! (a) Compulsory admitted Insurance with We will pay up to $50 per day to a maxi- ilmits required to be in-force to satisfy mum of $1,500 for temporary transporta- the legal requirements of the jurlsdic- titan expense incurred by you because of tton where the"accident"occurs;or the total theft of a covered auto of the private passenger type, We will pay only (b) Insurance limits rpqulred by law and for those covered "autos" for which you isstred by a'governmental entity or-by carry either Comprehensive or Specifted an Insurer licensee} or parrnitted by Causes of Loss Coverage.We will pay for law to do business In the jurisdiction temporary transportation expenses In- where the"accident°occurs;or curred during the period beginning 46 (c) Auto liability Insuranou limits of at hours after the (haft and ending, regard- toast $300,000 Combined Single less of the policy's expiration, when the Limit or $400,000 per personl covered "auto" is returned to use or we $300,000 per accident Bodily Injury, pay for Its"lose". '$100,000 Property Damage, if the temporary transportation expanse in- If you fall to comply with the above, this cursor arises from your rental of an"autd' Insurance Is not invalidated, However, in of the private passenger typo,the most we the event of a "loss", we will pay only to will pay is the amount it costs to rent an the extent that we would have been liable "auto° of the private passenger type which is of a like kind and alit as the$(clan had you so compiled. quality (5) The Insurance provided by HIRED GAR— covered"auto". " WORLDWIDE COVERAGE Is excess G. PERSONAL EFFECTS COVERAGE over any other collectible Insurance avall- SECTION III -- PHYSICAL DAMAGE stile to you whether on a primary, excess COVERAGE, A. Coverage, 4. Coverage Exten- - - contingent or any other basis. sions is amended by adding the fallowing., E. HIRED CAR PHYSICAL DAMAGE ----LOSS OF c. Personal Effects Coverage USE We Witt pay to $400 for loss to wearing SECTION III -- LIABILITY COVERAGE, A. 2. apparel and other personal effects which Coverage Extensions Is modified by adding the ere; followi#rg; (1) owned by an insured;and d. Notwithstanding SECTION 11, LIABILITY B. ', (2) In or on your covered"auto". Exclusions 2.and 6,,we w#i pay aunts which Page 2 of 3 Copyright,The Travelers indemnity Company CA T3 53 0104 Includes copyrighted material of Insurance Services Office, Inc„with its permission, COMMERCIAL.AUTO This coverage applies only In the event of 5. Transfer Of Rights Of recovery Against a total theft of your covered"auto". Others To Us No deductibles apply to Personal Effects Cov- We waive any right of recovery we may have erage. against any person or organization to the,ex- H, NOTICE OF AND KNOWLEDGE OF tent required of you by a written contract exe OCCURRENCE cuted prior to any "accident" gr 'toss!', SECTION Ill—BUSINESS AUTO CONDITIONS, provided that the "acaldent" or "loss" arises A. 2. Duties In The Event Of Accident, Claim, out of operations contemplated by such con- sult Or loss,subparagraph a. is deleted and re- tract.The waiver applies only to the person or placed by the following: organization designated in such contract. a. in the event of "accident", claim, "suit" or J. UNINTENTIONAL ERRORS OR OMISSIONS "loss", you must give us or our authorized SECTION IV — BUSINESS AUTO CONDITIONS, representative prompt notice of the"accident" B. General Conditions; 2. Concealment, Mis- or"loss"Including: representation, Or Fraud Is amended by'adding (1) Mow, when grid where the "accident" or the following: °loss"occurred; The unintentional omission of, or unintentional (2) the"Insured's"name and address;and error In, any information given by you shall,,not (3) to the extent passible, the names and ad- prejudice your rights under this insurance. How- (3) a of an Inured ever this provision does not affect our right to col- y„ j persons and wit- loot additional premium or exercise our right of nesses. cancellaflon or non-renewal. Your duty to give us or our authorized repre- K. MENTAL ANGUISH sentative prompt notice of the "accident" or "loss' applies only when the "accldent" or SECTION V — DEFINITIONS, Definition G. Is "loss"Is known to: amended by adding the following: 9. You,if you are an individual; "Bodily Injury" also includes mental anguish but 2, A partner,If you are a partnership;or only when the mental anguish arises from other 3. An executive officer or insurance man- bodily Injury,sickness, or disease. ager,If you are a corporatton. 1. BLANKET WAIVER OF SUBROGATION t SECTION IV—BUSINESS AUTO CONDITIONS, A. Loss Conditions, S. Transfer Of Rights Of Recovery„Against Others To Us is deleted and replaciA bythe following: CA T3 53 0104 Copyright,The Travelers Indemnity Company Page 3 of 3 Includes copyrighted material of insurance Services office,Inc,,with Its permission. ST'PAUL TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 9903 76 (00) - 001 POLICY NUMBER. C2JU134786CO3108 R. T. Noble Co. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described In the Schedule. The additional premium for this endorsement shall be 5 .0 % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHOM TIIE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER w T DATE OF ISSUE: 08-03-06 STASSIGN: AC-OR-Er. CERTIFICATE OF LIABILITY INSURANCE 02/05/2009' PRODUCER (949)857-4500 FAX (949)857-4800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Millennium Risk Management & Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License # OC13480 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5530 Trabuco Road Irvine, CA 92620 INSURERS AFFORDING COVERAGE NAIC# INSURED R. J. Noble Co. INSURERA: Travelers Indemnity Co. of America #25666 15505 Lincoln Avenue INSURER B: P. O. BOX 620 INSURERC: Orange, CA 92856-9020 INSURER D: 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. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE IMM/DDfYY) DATE(MMIDDIYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY C0932213893TIL08 07/01/2008 07/01/2009 DAMAGE TO RENTED $PREMISES(EA occ., 300,000 CLAIMS MADE Fj] OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO CAP9322B42608 07/01/2008 07/01/2009 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY A SCHEDULED AUTOS t1 L A c0 (Per person) $ HIRED AUTOS BODILY INJURY A7�iFL /ro ('��y (Per accident) $ NON-OWNED AUTOS igtM�k�F' ,R c T,�A 9 vi y ll�.lA PROPERTY DAMAGE $ =2 (Per"'cident) GARAGE LIABILITY / AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X OCCUR El CLAIMS MADE AGGREGATE $ 51000,000 A CUP9322B43808 07/01/2008 07/01/2009 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND - X WC STATU- OTH- I FIR EMPLOYERS'LIABILITY C2JUB4786C03108 07/01/2008 07/01/2009 E.L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Various Residential Streets for Asphalt Overlay @.12;MSC #454, RJN Job #91199 Certificate Holder is named Additional Insured as respects General Liability per endorsements CG20370704 & CG20101001 and Auto Liability per endorsement CA20480299 & CAT3530104 attached. Workers Comp Waiver of Subrogation applies per form WC99037600 attached. *10 days notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Huntington Beach, its agents,officers EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL MOUXM MAIL and employees *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Departments of Public Works 2000 Main Street XJba�6DC1I�( XXX�XXX1lS�ItiXXll6XIKIXXXX PO Box 190 KK*Jk)(*D6XAf XK1dxX >f X XXXX Huntington Beach, CA 92648 AUTHORIZED REPR S T Leonard Zi in ACORD 25(2001/08) @A( CORPORATI N 1988 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) Insured: R. J _ Noble Co. COMMERCIAL GENERA.LfA51LITY POLICY NUMBER: C09322B893TIL08 ISSUE DATE: 07/01./2008 THIS ENDORSEMENT CHANGES THE POLICY. PL5ASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 'Phis endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FART SCHEDULE Name Of Additional Insured Persan(s)Or Organization(s), City of Huntington Beach , its agents , officers and employees Location And Description Of Completed Operations Various Residential Streets for Asphalt Overlay @ . 12 MSC #454 , RJN Job #91199 Information required to complete this Schedule,if not shown above,will be shown In the Declarations, Section II --Who Is An Insured Is amended to In- location designated and described in the schedule of clude as an additional Insured the person(s) or or- Ws endorsement performed for that additional in- T ganizalion(s) shown in the Schedule, but only with sured and Included in the"products-completed opera- respeot to Ilabgity for"bodily Injury" or"property dam- dons hazard", age"caused,in whole or In part,by"your work"at the CG 20 37 07 04 ISO Properties,Inc.,2004 Rage 1 of 1 CG 20 10 10 01 Policy # C09322BS93TIL08 Effective 07/01/2008 R. J. Noble Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS ® SCHEDULE® PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Huntington Beach,its agents,officers and employees (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section 11—Who Is An Insured 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 ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds,the following exclusion is added: 2. Exclusions This insurance does not apply to"bodily injury"or"property damage"occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s)at the site of the covered operations has been completed; or (2) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. T CG 20 10 10 01 Privacy I Legal Notices 02008 The Traveler:Companies,Inc. POLICY NVMBBR! CAP9322B245TIL08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE R15AD IT CAREFULLY, DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless. modified by this endorsement, This endorsement identifies person(s) or organization(s) who are 'Insureds" under the Who Is An Insured Provision of the Coverage Form.This endorsement does not after coverage provided in the Coverage Form. SOHEDULE - Name of Person(s)or Oruanization(s): City of Huntington Beach , its agents , officers , and employees (if no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to the endorsement.) Each persol n+r vrg—anon $l vain in the vviipduf is air "Iniur@d"fCr�fa1Fiiiit vQrvlagc�, but Orii to the vntuici that person or organization qualifies as an "insured"under lne Who Is An Insured Provision contained in Section II of the Coverage Form, CA 20 48 02 99 Edv&oy I Legal Notices 'y 02007 The Trauelers Companies,Inc. 1701icy:" CAP9322B426TIL08 Effective 07/01/2008 R. J. NObl e CO.' COMMERCIAL AUTO THIS ENDORSEMENT CHANGlfd THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAQE EXTENSION FORM This endorsement modifies insurance provided under the following: BUSJN5$S AUTO COVERAGrz FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified Fay the endorsement. A. BROAD PORM NAMED iNSURED (4) All reasonable expenses incurred by the "in- SECIION It — LIABILITY COVERAGE, A. 1. sured"at our request, including actual loss of Who Is An Insured provislon is amended by acid. earnings up to $500 a day because of time off ing the foilowing: from work. d. Any business entity newly acquired or formed D. HIRED CAI,—WORI-nWIDE.COVERAGE by you during the policy period, provided you SECTION It-- LIABILITY COVERAGE,A.2.Cov- own 50%or more of the business entity and erage Extensions 1s amended by adding.the the business entity is not Sepatately insured following extension: for Business Auto Coverage. Coverage is ex- m Hired Car—Wortdwids Coverage tended up to a maximum of 180 days follow- Ing acquisition or formation of the business t'I) We will pay all sums an 11insured"legaiiy ,entity. must pay as damages because of"bodily This provision does not apply to any iwS o� injiiry"or "property da,iiii,Lge"to which this or organization for whlo� coverage Is ex- insurance applies, caused by an accl- chided by endorsement. dent' which occurs outside the United B. EMPLOYEES AS 1NStlREID States of America, the territories and possessions of the United States of SECTION Ii LIABILITY COVERAGE,A.I.Who America,Puerto Rica,and Canada result- Is An Insured is amended by adding the follow- ing from the operation, maintenance, or ing: use of any covered "auto" of the private passenger type you lease, hire, rent, or a. If you are not a sole proprietor, any "em- borrow wtthout a driver for 30 days or ployee"of yours is an`Insured"while using,in less. the course and scope of your business at the time of an "accldent", acovered "auto" you (2) With respect to any claim made or"suit" dowt- den,hire or borrow. instituted ou%lde the United States of America,the territories and possesslons of yours is an "Insured" tNh11e ussinging,, I If you are a sole proprietor, any" in the'employee" a the united States of America,Puerto Rico, course and scope of your business or per- and Canada: sonst aflairs at the time of an "acoldent", a (a) You shall undertake the Investigation, covered"auto that you don't own,hire or bor sattleirisnt, and •defense. of such row, claims and "suits" and keep us ad- C. COV9RAGE UTENSIONS — SUPPL.EMEW vised of all proceedings and actions. TA,RY PAYMENTS (b) You will not make any settlement SECTION Il LIABILITY COVERAGE,A. 2.Cov- without our consent.- erage Extensions,a.Sttptaletnentary Payments (c) We will reimburse you: subparagraphs (2) and (4) are deleted and re- (1) For the amount of damages be- placed by the rollowing: cause of liability imposed upon (2) { p to$$,t g for cost of ball bonds (including you by law m► account of"bodily bonds for related traffla law violations)required injury" or "property damage" to bemuse of an"accldent"we oover.We do not 1 which this policy applies,and , have to furnish these bonds. (it) For all reasonable expenses in- curred with our consent fn connec- CA T3 53 0104 Copyright,The Travefers indumnity Company Page 1 of Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CpiV MERCIAL AUTO lion wltb the lnvestigation, settle- you legally must pay to the lessor of a cov- ment or defense of such claims or Bred "auto"which you have leased without a "su€ts". Reimbursement for ex- driver for 30 days or less for Me€essor's loss penses will be part of the Limit of of use of the covered"auto",provided: insurance for Ltablflty Coverage q, This insurance provides comprehensive, shown In ITEM TWO of the spec€deft causes of loss or cbllislan cover- BUSIN SS AUTO COVERAGE age can the covered"auto"; PART DECLARATIONS, and not in additfon to such limits. 2, The loss of use results from the covered (3) The l.(rolt of Insurance for Llablllty Cover "auto" being damaged in an "accident" age shown In ITEM TWO of the while you are leasing it. BUSINESS AUTO COVERAGE PART We wilf pay up to $66 per day subject to a DECLARATiONS is the most we will re- maximum limit of$750 for any one"accident". imburse you for the sum of all damages F. PHYSICAL DAMAGE W-- TRANSPORTATION Imposed an you, as set forth In c.(2)(c) EXPENSE. above, and all expense Incurred by you SECTION III -- PHYSICAL DAMAGE arising out of any single "accident" or COVERAGE, A. 4. Coverage Extensions, sub- "toss", paragraph a.Is deleted and replaced by the follow- (4) You must maintain the greater of the fol- Ing: towing primary auto liability insurance lim. a, Transportation Expenses its, (a) Compulsory admitted insurance with We wilt pay up to $50 per day to a maxi- . limits required to bed force to satisfy mum of$1,500 for temporary transparta- the legal iced to a in o the jrsatisfy Kon expense incurred by you because of Von where the"ec ants o t dia- tha total theft of a covered auto of the """",or private passenger type. We will pay only (b) Insurance limits required by law and for those covered "autos" for which you Isstred by a'governmentst entity or-by curry slther Comprehensive or Spechtied an Insurer licensed or permitted by Causes of Loss Coverage.We vrlll pay for law to do Business In the furisdiotion temporary transportation expanses in- where the"accident°occurs; or curred during the period beginning 48 (c) Auto liability €nsuranoo linttts of at hours after the theft and ending, regard- feast $300,000 Combined Single less of the policy's expiration, when the " Limit or $100,000 per person( covered "auto" Is returned to use or we $300,000 per accident Bodily injury, pay for its"loss". 1 __�$100,000 Property Damage. if the temporary transportation expanse in- If you tall to aornply with the above, this curred atlses from your rental of an haute" Insuranue €s not invalidated, However, in of the private passenger type,the most we the event of a"loss", we will pay only to will pay is the amount It costs to rent an the extent that we would have been liable °auto' of the private passenger type whfch had you so oomptled. is of a like It€nd, and quality as the stolen (6) The Insurance provided by HIRED GAR-- covered"auto". WORLDWIDE COVERAGE Is excess C. PERSONAL EFFECTS COVERAGE over any outer collectible insurance avail- SECTION III — PHYSICAL DAMAGE able to you whether on a primary, excess COVERAGE, A. Coverage, 4. Coverage Exten- contingent or any other basis. sions is amended by adding the fallowing: E. AIRED CAR PHYSICAL DAMAGE LOSS OF c. Personal Effects Coverage USE We will pay to $400 for loss to wearing SECTION 11 — LIABILITY COVERAGE, A. 2. apparel and other personal effects which Coverage Extensions Is madified by adding the are: followifig: (1) owned by an insured;and d. Notwithstanding SECTION 11, LIABILITY B. ', (2) In or on your covered"auto". Exclusions Z and 6,,we will pay sums which Page 2 of 3 Copyright,The Travelers indemnity Company CA T3 53 0104 Includes copyrighted material of Insurance Services Office, Ina.,with Its permission, COMMERCIAL AUTO This coverage applies only In the event of g, Transfer Of Rights Of Recovery Against a total theft of your covered"auto", Others To Us No deductibles apply to Personal E�fFects Cov. We waive any right of recovery we may have erase. against any person or organization to the ex- H. NOTICE OF AND KNOWLEDGE OF tent required of you by a written contract exe-' OCCURRENCE cuted prior to any "accident" pr gloss", SECTION IV—BUSINESS AUTO CONDMIONS, provided that the "accident" or "loss" arises A. 2, Duties in The Event Of Accident, Claim, out of operations contemplated by such con. Suit Or Loss,subparagraph a. is deleted and re- tract.The waiver applies only to the person or placed by the following: organization designated in such contract. a. In the event of "accident", claim, "suit" or J. UNINTENTIONAL ERRORS OR OMT$SiONS "loss", you must give us or our authorized SECTION IV— BUSINESS AUTO CONDITIONS, representaltve prompt notice of the"accident" B. General Conditions, a. Concealment, Mis- or"loss"Including: representation, Or Fraud is amended by'adding (1) How, when artd where the "accident" or the following: "loss"occurred; The unintentional omission of, or unintentional (2) the"Insure&s"name and address;and error In, any information given by you shallrnot (3) to the extent posstbfe, the names and ad- prejudice your rights under this Insurance. How- dressee of any,Injured persons and wit- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. Your duty to give us or our authorized repre- K. MENTAL ANGUISH sentative prompt notice of the "accident" or "ioso applies drily when the "accident" or SECTION V — DEFINITIONS, VeRnillon C. Is "loss"is[mown to, amended by adding the following: 1. You,if you are an Individual; `Bodily Injury" also includes mental anguish but 2, A partner,If you are a partnership;or only when the mental anguish arises from other 3. An executive officer or insurance man- bodily injury,sickness, or disease. ager,If you are a corporatton. 1. BLANKETWAIVER OF SUBROGATION T SECTION tv—SUSII EsS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Lights Of RecovoW_Against Othem To Us is deleted and replaced bythe following: r CA T3 53 0104 Copyright, The Travelers Indemnity Company Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc,,with Its permission. STPAUL TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 9903 76 (00) - 001 POLICY NUMBER: C2JUB4786CO3108 R. J. Noble Co. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described In the Schedule. The additional premium for this endorsement shall be 5 .0 % of the California workers` compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description AN"I PERSON' JR ORGANIIZA.TION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER DATE OF ISSUE: 08-03-06 STASSIGN: RECEIVED BY: CITY CLERK RECEIPT.COPY Return DUPLICATE to City Clerk's Office (Name) after signing/dating (Date) A ., CITY OF HU NTINGTON REACH . INTERDEPARTMENTAL COMMUNICATION NICATION TO: Shari Freidenrich, City Treasurer FROM: �� I C fJ �� , DATE: D SUBJECT: Bond Acceptance have received the bonds for LC _ j (Company ame) � Faithful Performance Bond No. Labor and Material Bond No. Monument Bond No. Maintenance Bond No. Guarantee and Warranty Bond No. Re: Tract No. CC No. MSC No. Approved 46 Agenda Item No. � (Co ncil Appr at Da ) City Clerk Vault No. #27 g:/followup/bondletter.doc Bond No, 105210283 PREMIUM: $11,163.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: WHEREAS, City of Huntington Beach(hereinafter referred to as"City' has,by written agreement dated 02/04 20 09, entered into a contract with R.J. No Company 15505 E. LINCOLN AVE ORANGE, CA 92856 (name and address of Contractor) (hereinafter referred to as "Principal"), for performance of the work described as follows: Various Residential Streets . or -As a v #454 (Project Title) WHEREAS, said contract, and all documents referenced therein(hereinafter collectively "Contract"), are incorporated herein by this reference made a part hereof as though set forth herein in full. WHEREAS, said Principal is required under the terms of the Contract to furnish a bond guaranteeing the prompt, full and faithful performance of said Contract. NOW THEREFORE,we, the undersigned, as Principal, and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA 21688 GATEWAY CENTER DR. DIAMOND BAR CA 91765 (name and address of Surety) (a duly admitted surety insurer under the laws of the State of California and hereinafter referred to as "Surety"), as Surety, are held and firmly bound unto City in the penal sum of TWO MILLION ONE HUNDRED SIXTY-TWO THOUSAND TWO HUNDRED FORTY-NINE Dollars($ 2,162,249.00 ), this amount being not less than one hundred percent of the price set forth in the Contract,in lawful money of the United States,for the payment of which sum,well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT if the Principal shall promptly, fully and faithfully perform each and all of the covenants,obligations and things to be done and performed by the Principal in strict accordance with the terms of the Contract as said contract may be altered, amended or modified from time to time; and if the Principal shall indemnify and save harmless City and all of City's officers, agents and employees(hereinafter collectively referred to as"Obligees")from any and all Josses, liability and damages, claims,judgments, stop notices,fees and costs of every description, whether imposed by law or in equity,which may be incurred by the Obligees by reason of the failure or default on the part of the Principal in the performance of any or all of the terms or the obligations of the Contract, including all alterations, amendments and modifications thereto, and any warranties or guarantees required thereunder; then this obligation shall be void; otherwise, it shall be and shall remain in full force and effect- *PROVIDED FURTHER THAT THE WORK COVERED BY THIS PERFORMANCE SHALL BE GUARANTEED FOR THE PERIOD OF ONE YEAR AFTER ACCEPTANCE BY THE CITY Surety stipulates and agrees,for value received,that no adjustment of the time or price in the Contract or any alteration, change, deletion, addition or other modification to the Contract, or the work to be performed thereunder, shall in any way affect, limit, restrict, impair or release the obligations of the Surety under this Bond. Surety waives notice of any adjustment of contract time or contract price,and 277591 1 PERFORMANCE BOND Page 1 of 2 Bond No.105210283 any other alteration,change,deletion,addition or other modification to the Contract,or the work to be performed thereunder, and agrees to automatically adjust the penal sum of this Bond to reflect such adjustments,alterations,changes,deletions,additions or other modifications. Surety agrees to provide written confirmation of such adjustments in the penal sum to City on not less than a quarterly basis Surety also waives the provisions of Civil Code§§ 2845 and 2849. The obligations of this Bond shall survive the completion of the work described in the Contract as to all obligations and liabilities of the Principal which survive completion.of the work. IN WITNESS WHEREOF, each party represents and warrants that this instrument has been duly executed by Principal and Surety, on the date set forth below,that the name of each corporate party being affixed hereto is such party's proper legal name and that the individuals signing this instrument have been duly authorized pursuant to the authority of its governing body. Surety,by execution of this bond,waives any defense which Surety has or may have by reason of any failure of the Principal to execute or properly execute this bond. Dated: 02/04/09- ATTEST R.J. Noble Company (Corporate Seal) (P cipai Name) By: i Name: ichael J. Carver Title: President ATTEST TRAVELERS CASUALTY AND SURETY COMPANY OF AMERI.CA (Corporate Seal) (Surety Name) B y: Na MICHA STONG (Signature ttorney-in ct for Surety) (Attach Attorney-in-Fact Certificate) (909 612-3000 (Area Code & Telephone Number of Surety) APPROVED AS TO FORM: CITY Of ktUNTINGTON BEACH By ennifer Mc ath 1S44_ 4 Attorney Note: This bond must be executed in duplicate and dated, aft signatures must be notarized,and evidence of the authority of any person signing as attomey-in-fact must be attached. 277S91.1 PERFORMANCE BOND Page 2of2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On 0 2/0 9/0 9 before me, JENNIFER DE IONGH, NOTARY PUBLIC Date Here Insert Name and Title of the Oificer personally appeared MICHAEL J. CARVER _ Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the persona j whose namekg) is/ar.@.subscribed to the within instrument and acknowledged to me that he/sheAhey executed the same in his/W#414eir authorized J NNIFER DE IONGH capacity(ies`J, and that by his/l;wAheit:signature'on the Commission 1 NGH instrument the personA, or the entity upon behalf of Notary PubliC -California which the person(y) acted, executed the instrument. Z Orange County WComm.EXPireSOct28.2011 I certify under PENALTY OF PERJURY under the haws of the State of California that the foregoing paragraph is true and correct. WIT handhand official seal. i -- at Place Notary Seal Above Si ure Signature of Notary Public - OPTIOA! L Though the information below is not required by law,it may prove v e to persUnrelying on the document and could prevent fraudulent removal and reattachment of thisformtoaher document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: 0 Individual - i] Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑ Limited ❑General ❑Partner—❑ Limited El General ❑ Attorney in Fact •"thumbhereEl Attorney in Fact • ❑ Trustee Top El Trustee Top of thumb here ❑ Guardian or Conservator a Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth.CA 91313-2402•www.NationaiNotary.org Item 05907 Reorder:Call Toll-Free 1-800-876-W7 1 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On / before me, R. NAPPI "NOTARY PUBLIC" (Here insert name and title of the officer) personally appeared MICHAEL D. STONG. who proved to me on the basis of satisfactory evidence to be the persoRKwhose name(,a'jis/are•subscribed to the within instrument and acknowledged to me that he/sheAhep executed the same in his/4en4heir authorized capacity(ic4 and that by his/hgd4haok signature(<on the instrument the personX,or the entity upon behalf of which the personoacted,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 m hand and official seal. R. NAPF i Y Zn = COMM. #1796916 cc 710 cc NOTARY PUBLIC-CALIFORNIA / RIVERSIDE COUNTY / (Notary Seal) My Comm.Expires June 7,2012 Signature of Notary Publi AIDIDITIONALr OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exacrly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The onlv exception is if a document is to be recorded outside of California.In such instances,any alternative (Title or description of attached document) acknmvledgrnent verbiage as may be printed on such a documtent so long as the verbiage does not require the notary to do something durr is illegal for a notary in California(i.e.certh•ing lire aulhorlced capacity of the signer). Please cheek the (Title or description of attached document continued) document carefully for proper notarial wording and attach this form if required. Number of Pages Document Date a State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment, • Date of notarization must be the date that the signers)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER a Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. El Individual(s) he/she1d ey;-is/are)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) o Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Cl Other 4e Indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA 02.10.07 800473-9865 cwww.NotarvClasses.eom Bond No 105210283 PREMIUM INCLUDED IN PERFORMANCE BOND PAYMENT BOND (LABOR ARID MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that WHEREAS,the City of Huntington Beach (hereinafter referred to as"City") has awarded to R.J. Nob e Company, inco Grange,--Ca (name and address of Contractor) (hereinafter referred to as"Principal"), a contract("Contract") for the work described as follows Various Residential Streets for .Asphalt Overlay @ . 121 ; MSC #454 (project title) WHEREAS, Principal is required under the terms of the Contract and the California Civil Code"to secure the payment of claims of laborers, mechanics, materiaimen, and other persons as provided by law. NOW THEREFORE, we, the undersigned Principal, and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, 21688 GATEWAY CENTER DR. DIAMOND BAR CA. 91765 (name and address of Surety) (a duly admitted surety insurer under the laws of the State of California and hereinafter referred to as"Surety"), as Surety, are held and firmly bound unto City in the penal sum of TWO MILLION ONE HUNDRED SIXTY—TWO THOUSAND TWO HUNDRED FORTY—NINE dollars, ($2,162,249.00 ), this amount being not less than one hundred percent (100%) of the total price set forth in the Contract, in lawful money of the United States of America, for the payment of which sum, well and truly to be made, we bind ourselves, and each of our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the Principal, his, her, or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the California Civil Code ("Claimants") for all labor, materials or services used or reasonably required for use in performance of the work described in the Contract, or any amounts due under ,the Unemployment Insurance Code with respect to work or labor performed by any such Claimant, or prevailing wages due and penalties incurred pursuant to Sections 1774, 1775, 1813 or 1815 of the Labor Code, or any amounts required to be deducted, withheld and paid over to the Employment Development Department from the wages of employees of the Principal and Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to the work or labor performed under the Contract, Surety will pay for the same, in an amount not exceeding the penal sum specified in this bond; otherwise, this obligation shall be null and void. This bond shall inure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns. In case any action is brought upon this bond, Surety further agrees to pay all court costs and a reasonable attorney's fee in an amount fixed by the court. Surety stipulates and agrees, for value received, that no change, extension of time, alteration, addition or modification to the terms of the Contract, or any contract document or any work to be performed thereunder, whether made after notice or not, shall in any way affect, impair or release the obligations of Surety under this bond. Surety hereby waives notice of any such change, 277589.1 PAYMENT BOND Page I of 2 Bond No 105210283 extension of time, alteration, addition, or modification to the terms of the Contract, the contract documents or the work thereunder. Surety also waives the provisions of California Civil Code §§ 2645 and 2849. IN WITNESS WHEROF, each party represents and warrants that this instrument has been duly executed by Principal and Surety, on the date set forth below, that the name of each corporate party being affixed hereto is such party's proper legal name and that the individuals signing this instrument have been duly authorized pursuant to the authority of its governing body Surety, by execution of this bond, waives any defense which Surety has or may have by reason of any failure of the Principal to execute or properly execute this bond. Dated 02/05/09 ATTEST R. J. Noble Company (Corporate Seal) J _ (Pon ipal Name) By X Name: 17 7 Its: President AT-TEST TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA (Corporate Seal) (Surety Name) By: Na4e. MI 1iA D STONGSignature of A ney-in-Fact f Surety) (�99 612-3000 (Attach Attorney-in-Fact Certificate) (Area Code & Telephone Number of Surety) APPROVED AS TO FORM: CITY OF HUNTINGTON BEACH By 1 C I L ennifer Mc rath ity Attorney Note: This bond must be executed in duplicate and dated, all signatures must be notarized,and evidence of the authority of any person signing as attorney-in-fact must be attached. 277589.1 _ PAYMENT BOND Page 2 of 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On 02/09/09 before me, JENNIFER DE IONGH, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared MICHAEL J. CARVER Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person.0 whose namejg) is/arQ.subscribed to the within instrument and acknowledged to me that he/sHe4hey executed the same in his/4@Al4eir authorized JENNIFER DE IONGH capacityW, and that by his/4&4keif-signaturefK on the Commission # 1771186 instrument the personA, or the entity upon behalf of Notary Public -California which the personV acted, executed the instrument. ' Orange County MyComm.E)q*mOct28,2011 1 certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m h nd and o ficia! seal. Signatu Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law,it may prove valuable to persis) elying on the document and could prevent fraudulent removal and reattachment of this form to a er document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s)Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑Limited ❑General ❑Partner—❑Limited ❑General ❑ Attorney in Fact • - ❑Attorney in Fact • ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationaiNolaryorg Item#5907 Reorder:Call Toll-Free 1-800-876-6827 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On �`I�� � before me, R. NAPPI "NOTARY PUBLIC" (Here insert name and title of the officer) personally appeared MICHAEL D. STONG who proved to me on the basis of satisfactory evidence to be the person_Wwhose name(ois/art-subscribed to the within instrument and acknowledged to me that helsheAhey executed the same in his/4eW+heir authorized capacity(ic4 and that by his/ht rAhrir signatureKon the instrument the personW,or the entity upon behalf of which the persongacted,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. R. NAPPI WITNESS m/y�hand and official seal. COMM.#1796916 33 �r/ cc 4 NOTARY PUBLIC-COUNTY I�� � �`4 RIVERSIDE COUNTY (Notary Seal) My Comm.Expires June 7,2012 Signature of Notary Publi ADDITIONAL,OPTIONAL,INFORMIAT'ION INSTRUCTIONS FOR COMPLETING THIS FORM Aral ackno+rledgment completed in Cal Tornio must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above.in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The omit,exception is if a document is to be recorded outside of California.In such instances,any alternative (Tide or description of attached document) acknowledgment verbiage as may be printed on such a docrmrent so long as the verbiage does not require the notary to do something that is i legal for a notary in California(i.e. certifying the authod:ed capacity of r/re signer). Please check the (Title or description of attached document continued) document carefully,for proper notarial wording and attach this form tf required. Number of Pages Document Date • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. Date of notarization must be the date that the signers)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s)who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ❑ Individual(S) ire/shcAhey,is tare)or circling the correct forms.Failure to correctly indicate this ❑ In Corporate Officer o orate information may lead to rejection of document recording. The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-sea) if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other Indicate title or type oranached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.)0.07 800-873-9865 ww%v.NotaryClasscs.com WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER AW POWER OF ATTORNEY TRAVELERS.1 Farmington Casualty Company St.Paul Guardian Insurance Company Fidelity and Guaranty Insurance Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company Seaboard Surety Company Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company Attorney-In Fact No. 19372 Certificate No. I i •)2 1h 3 KNOW ALL MEN BY THESE PRESENTS:That Seaboard Surety Connpam is a corporation duly organized under the laws of the State of New York,that St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company and St.Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota,that Farmington Casualty Company.Travelers Casualty and Surety Company,and Travelers Casualty and Suret} Company of America are corporations truly organized under the laws of the State of Connecticut.that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters.Inc.is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies")- and that the Companies do hereby make,constitute and appoint Michael D.Stong,Shawn Blume,Rosemary Cisneros,and Jeremy Pendergast of the City of Riverside . State of California their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above.to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of.guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. 28th IN WITNESS WHEREOF,the Comp�,rtitks8have caused this instrumenvto be signed and them corporate seals to be hereto affixed,this July CUUll11 day of Farmington Casualty Companti St.Paul Guardian Insurance Company Fidelity and Guaranty`Insurance Company,'" St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company Seaboard Surety Company Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company GAS UgStYiETf. °FIRE ..,Sp� >p�` vq x Jp� Nn s wawq�y �lYAryp =a€ --- �€ NaAlFoao, �ttasrrrotm,T� 1egp'�c 1951 aO SEAL,io: e O< � a r 3% s �''- r •6 SBALjsf "'Oo `•.....+' �F�N' '"G`;,.�p� �•,1NH AN��� ...........r`'a �61 �+aa; �t • � �1�Atild�`- State of Connecticut By: City of Hartford ss. Georg Thompson. enior ice President 28th July 2008 On this the day of ,before me personally appeared George W.Thompson,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company. Fidelity and Guaranty Insurance Company.Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, Sri Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. ex#uo)�4", My Commission expires the 30th day of June,201I. Marie C.Tetreault,Notary Public CW 58440-5-07 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER Certification of Compliance with Prevailing Wage Laws To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Prevailing Wage Laws Contract: Project: The undersigned contractor on the above-referenced project ("Project") hereby certifies that all laborers, mechanics, apprentices, .trainees, watchmen and guards employed by him or by any subcontractor performing work under the contract for the Project have been paid pursuant to the minimum wage and bona fide fringe benefit requirements specified for each particular classification of work, as set forth in the wage-rate determinations of the State of California, Department of Industrial Relations, and/or the United States Department of Labor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this day of 520 at , California. (Type Contractor Name) By: Name: [Type Name] Title: [Type Title] AIR TO Cn'Y ATTORNEY 1 247542.1 Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 To: City of Huntington Beach Department of Public Works 2000 Main Street/P.O. Box 190 Huntington Beach, CA 92648 Re: Certification of Compliance with Title VII of the Civil Rights Act and Equal Employment Opportunity Act of 1972 Contract: Project: The undersigned contractor on the above-referenced project ("Project") hereby certifies that it has complied with Title VII of the Civil Rights Act, the Equal Opportunity Act of.1972 and Executive Order 11246, and has not discriminated against any employee or applicant for employment because of race, creed, color, sex, national origin, age or disability. The undersigned contractor also certifies that it has not maintained any segregated facilities at its establishments on the basis of race, creed, color, sex, national origin, age or disability (with the exception of access for the disabled). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this day of , 20_, at , California. (Type Contractor Name) By: Name: [Type Name] Title: {Type Title] E IA cGRA g- » c7RNEX JL) up 1 CONTRACTOR'S CERTIFICATE state and certify that: (Name of Declarant) 1• is the general contractor to the City of Huntington Beach ("City") on Contract No. (the "Contract') for the construction of the public work of improvement entitled: (the "Project"). 2. All work to be performed pursuant to the Contract has been completed in accordance with the Contract Documents(as such term is defined in the Contract). 3. Except for the claims listed below and the disputed claims listed in paragraph five (5), all persons supplying labor, services, materials and equipment to the Project, including all claims against the Contractor arising from the performance of the Contract, have been paid and satisfied(list unpaid debts and claims; if none, write "NONE"): 4. Attached hereto are the lien waivers required by the Contract Documents, which lien waivers have been executed by all persons who performed work on or supplied labor, services, materials, and/or equipment for use at the Project. 5. Set forth below is a list of disputed claims or claims that are the subject of a Notice to Withhold filed pursuant to the Civil Code of the State of California (list all disputed claims; if none, write"NONE"): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed at on this day of , 20_ (Signature of Declarant) APPROVED AS TO FORM By: Aj��� - 17/a —RJ 3 Zo MCP Name: [Type Name] Title: [Type Title] 1 245914 1 City of Huntington Beach 2000 Main Street . Huntington Beach, CA 92648 OFFICE OF THE CITY CLERIC JOAN L. FLYNN CITY CLERK February 19, 2009 R. J. Noble Company 15505 E. Lincoln Ave. Orange, CA 92856 Re: Various Residential Streets for Asphalt Overlay @ .12' — MSC-454 The City Council awarded the bid to your company for the above referenced project. Enclosed is.a copy of the executed contract with the City of Huntington Beach. A Declaration of Satisfaction of Claims and a Certificate of Compliance form must be returned to this office after the proiect is completed but prior to the release of retention funds. In addition, the following item must also be on file, with this office before the City can release any retention funds: A warranty bond guaranteeing the final amount of work and materials for six months. If your performance bond does not include specific wording for a six-month warranty, then a rider or separate bond must be submitted. Should you have any questions or concerns regarding the enclosures or items that must be on file in this office prior to release of retention funds, please call the Public Works Department at 536-5432. Sincerely, ht nL. Flynn, M y Clerk JF:pe Enclosures: Copy of Agreement Copies of insurance/bonds Declaration of Satisfaction Certificate of Compliance Bid Bond (original) Sister Cit� ��owj�a 'a`�� r19���rat�`e��� New Zealand (Telephone:714-536-5227) Council/Agency Meeting Held: Q Deferred/Continued to: Appr ved ❑ Conditionally Approved ❑ Denied \ Ai(o )WCit /CI rk's 54gnatur Council Meeting Date: 1/20/2009 Departme Number: PW 09-03 CITY OF HUNTINGTON BEACH REQUEST FOR CITY COUNCIL ACTION SUBMITTED TO: HONORABLE MAYOR AND CITY COUN L MEMBERS SUBMITTED BY: FRED A. WILSON, CITY ADMINISTRA PREPARED BY: TRAVIS K. HOPKINS, PE, DIRECTOR fOF'PIIJW—ORK ��S SUBJECT: Award Contract for Asphalt Overlay of Various Residential Streets -A Fstat of Issue, Funding Source, Recommended Action,Alternative Action(s),Analysis,Environmental Status,Attachment(s) Statement of Issue: On December 18, 2008, bids were received for Asphalt Overlay of Various Residential Streets, MSC 454. Staff is requesting authorization to award contract to the lowest responsive and responsible bidder. Funding Source: Funds in the amount of $2,400,000 are budgeted in the following accounts: Measure M Residential Pavement, Street Improvements Account No. 21390002.82300 ($800,000), Proposition 42 Traffic Congestion Relief Fund Program Account No. 21990417.82300 ($1,600,000). With contingency and supplemental expenses, the full project cost is approximately $2,400,000. Recommended Action: Motion to: 1. Approve the plans and specifications; 2. Accept the lowest responsive and responsible bid submitted by R. J. Noble Company in the amount of$2,162,249.73 for MSC 454; and 3. Authorize the Mayor and City Clerk to execute a construction contract in a form approved by the City Attorney. Alternative Action(s): Do not authorize award of this contract and direct staff on how to proceed. REQUEST FOR CITY COUNCIL ACTION MEETING DATE: 1/20/2009 DEPARTMENT ID NUMBER: PW 09-03 Analysis: The project proposed to resurface 109 residential street segments utilizing an asphalt concrete overlay application. The street segments included in this project were originally identified for our Residential Street Program from 2003 through 2007, but were not completed in the identified year due to funding constraints. The engineer's estimate for this project is $2,600,000. Bids were opened publicly on December 18, 2008 and are listed in ascending order. • • 1 • • • • ' • 1 R. J. Noble Company $2,162,249.73 2 D P. L Wheeler Enterprise $2,256,160.98 3 Silvia Construction, Inc. $2,309,325.92 4 All American Asphalt $2,329,350.75 5 Hardy & Harper, Inc. $2,339,644.62 6 Ruiz Engineering Company $2,366,040.76 7 Imperial Paving Company, Inc. $2,381,539.19 8 Palp, Inc. DBA Excel Paving Company $2,424,972.44 Staff has prior positive experience with R. J. Noble Company on similar city contracts. Staff recommends that City Council accept the bid from R. J. Noble Company, the lowest responsive and responsible bidder. Public Works Commission Action: This project was reviewed by the Public Works Commission on July 16, 2008 and approved 6-0-1 (Spencer absent). Strategic Plan Goal: 1-1 Improve the City's plan for funding and completing infrastructure needs, and develop strategies for resolving crucial infrastructure problems to preserve the physical foundation of the community and enable the community's value to grow. Environmental Status: Categorically exempt pursuant to CEQA Article 19, section 15301(c). Attachment(s): Number NO. Description U Location Map of Districts with Overlay Segments 2. List of Overlay Street Segments -2- 12/31/2008 10:00 AM ATTACHMENT # 1 MSC 454 2008/09 Residential Overlay Districts with Overlay Segments 1 IT- 0, 14� 7 1#4S241 -i4 a r LIn Ek, I-�5�6 =9 1 �2752$j rTf 6 16 26 26,2 .: Or"'iL i iAA1 T 1 ITT 7 �VJF 61 27 2 A _ ,�.-2 Fffl V rr" li- XTU R6 28 2---.-- 283 19 1 199 _2-93 J 11;!� r31-9 P7 74 J329: T 12 4, 1 8 L .8 4UF, [Tr,,E 14A tj r ull z $-54- 7 1XI F 9�: A�A, 61 465 467 474 T475 4 477- FLT ' 485- �aq 6 ATTACHMENT #2 2008/09 Residential Overlay MSC 454 116 Spa Dr. Rancho Rd. Harold Pl. 116 Spa Dr. Harold Pl. Dollar Dr. 117 Chinook Dr. Tropicana Ln. Chinook Ave. 117 Croupier Cir. Calneva Ln. Springdale St. 117 jDollar Dr. Spa Dr. Nevada Dr. 117 Dunes Ln. Hacienda Dr. Chinook Dr. 117 Hammon Ln. Harold Pl. Sands Dr. 117 Hammon Ln. Sands Dr. Spa Dr. 117 Harold Pl. Graham St. Hammon Ln. 117 Sahara Ln. Croupier Cir. Nugget Cir. 117 Spa Dr. Dollar Dr. Hammon Ln. 117 Tangiers Dr. Spa Dr. Nevada Dr. 117 Tropicana Ln. Chinook Dr. Sands Dr. 118 Danes Cir. END Briarcliff Dr. 127 Nugget Cir. Sahara Ln. END 127 Spa Dr. Hammon Ln. Calneva Ln. 128 Larchwood Dr. Sunnycrest Ln. END 128 Penfield Cir. Mar Vista Dr. END 128 Sunnycrest Ln. END Royal Oak Dr. 128 Zane Cir. END Royal Oak Dr. 152 Countess Dr. Edinger Ave. Portofino Cir. 152 Venture Dr. Typhoon Ln. Walrus Ln. 153 Venture Dr. Walrus Ln. Sunclancer Ln. 153 Venture Dr. Sunclancer Ln. END 165 Sell Cir. Heil Ave. END 169 Cod Cir. END Sun Dr. 178 St George Ln. Warner Ave. St Paul Cir. 179 Cobra Ln. Wrenfield Dr. Norino Dr. 179 Cory Dr. END Mayor Ln. 179 Whetmore Ln. Capstone Dr. Spickard Dr. 186 Barwood Dr. Rain glen Ln. Beckwall Ln. 189 Altamirano Ln. Villa Nueva Dr. Cadiz Cir. 189 Galicia Ln. Jardines Dr. Villa Nueva Dr. 189 Villa Nueva Dr. Carranza Ln. Quintana Ln. 189 Villa Nueva Dr. Quintana Ln. END 189 Villa Nueva Dr. Altamirano Ln. Carranza Ln. 253 Stark St. Beach Blvd. Malaga Ln. 349 Fifteenth St. Pecan Ave. Acacia Ave. 349 Fifteenth St. Walnut Ave. Olive Ave. 349 Fifteenth St. Olive Ave. Pecan Ave. 349 Sixteenth St. Acacia Ave. Palm Ave. 349 Sixteenth St. Pecan Ave. Acacia Ave. 349 Sixteenth St. Olive Ave. Pecan Ave. Page 1 of 3 2009/09 Residential Overlay MSC 454 Drstrict Street,Narne From aR ° w i Ta 349 Palm Ave. Goldenwest Seventeenth 423 Hamden Ln. Garfield Ave. Newhaven Ln. 423 Hamden Ln. Harding Ln. Newhaven Ln. 423 Newhaven Ln. Bridgeport Dr. Alley Gilford Cir. 425 Lola Ln. Annik Dr. Yorktown Ave. 425 Willhelm Cir. Randi Ln. END 431 Adams Ave. Main St. Alley Shipley St. 432 Venice Ave. Alabama St. — Huntington St. 433 Compton Dr. Ditmar Ln. Newland Ave. 433 Ditmar Ln. Deepcliff Dr. Hurstwell Dr. 433 Kin sdale Dr. Coldwater Ln. Ed ewood Ln. 435 Hone wood Ln. Yorktown Ave. Veronica Dr. 441 Acacia Ave. Eleventh St. Fourteenth St. 441 Fourteenth St. Acacia Ave. Palm Ave. 441 Palm Ave. Seventh St. Fourteenth St. 442 Georgia St. Indianapolis Ave. Joliet Ave. 442 Joliet Ave. California St. Delaware St. 442 Joliet Ave. Georgia St. Beach Blvd. 442 Knoxville Ave. Huntington St. Delaware St. 443 Londonderry Ln. END Munster Dr. 443 Port Greenwich Ln. Northport Dr. Boothbay Cir. 443 Port Greenwich Ln. Boothbay Cir. Cape Newbury Dr. 443 Seven Seas Ln. END Indianapolis Ave. 444 Bellshire Dr. Mayport Ln. Swansea Ln. 444 Charford Dr. Camfield Ln. Ives Ln. 444 Densmore Ln. Bedel Dr. Bainford Dr. 444 Imperial Cove Ln. Viscount Dr. Masters Dr. 444 Masters Dr. Norcroft Ln. Newby Ln. 444 Page Cir. Crown Reef Ln. END 444 Princess Cir. Crown Reef Ln. END 444 Knights Cir. Crown Reef Ln. END 444 Squires Cir. Crown Reef Ln. END 451 Acacia Ave. Eighth St. Eleventh St. 451 Ninth St. Alley Walnut Walnut Ave. 451 Olive Ave. Sixth St. — Eighth St. 451 Pecan Ave. — Eighth St. Eleventh St. 451 Twelfth St. Olive Ave. Pecan Ave. 452 California St. Detroit Ave. Elmira Ave. 452 Chicago Ave. Huntington St. California St. 452 Chicago Ave. Alabama St. Huntington St. 453 Sunset Cir. Beach Blvd. END 453 Mermaid Cir. Beach Blvd. END Page 2 of 3 2008/09 Residential Overlay MSC 454 District- 8teeet N From 453 Sail Cir. Beach Blvd. END 453 Beach Blvd. Frontage Driftwood Dr. Travelway 453 Ebbticle Cir. Beach Blvd. END 453 Evelyne Cir. END Farnsworth Ln. 453 ISnowbird Dr. Catamaran Ln. Schooner Ln. 453 Snowbird Dr. Bastia Ln. Mission Ln. 453 Snowbird Dr. Schooner Ln. Bastia Ln. 456 Balgair Cir. END Scotstoun Dr. 456 Dumbreck Dr. Paisley Ln. Queens Park Ln. 456 Friarscourt Dr. Glencairn Ln. Hunter Ln. 456 Hunter Ln. Erskine Dr. Scotstoun Dr. 456 Jura Dr. Woodlea Ln. Hunter Ln. 456 Kite Dr. Sparkman Ln. Skimmer Ln. 456 National Ln. Star Dr. Kite Dr. 456 Netherway Dr. Paisley Ln. Iona Ln. 456 Paisley Ln. Caithness Dr. Netherway Dr. 456 Queens Park Ln. Upland Dr. Atlanta Ave. 456 Queens Park Ln. Caithness Dr. Netherway Dr. 456 Scotstoun Dr. Glencairn Ln. Queens Park Ln. 456 Sparkman Ln. END Kite Dr. 456 Star Dr. Reef Ln. Skimmer Ln. 456 Voyager Cir. Horizon Ln. END 1 462 Huntington St. I Pacific View lAtlanta Ave. 1 463 Dr men Dr. IBanff Ln. JAIley Doncaster Dr. Total Street Segments = 109 Page 3 of 3 CA ROUTING SHEET INITIATING DEPARTMENT: Public Works SUBJECT: Award Contract for Asphalt Overlay of Various Residential Streets COUNCIL MEETING DATE: 1/20/09 MCA TTA HMENTS STATUS Ordinance (w/exhibits & legislative draft if applicable) Attached ❑ Not Applicable Resolution (w/exhibits & legislative draft if applicable) Attached ❑ Not Applicable Tract Map, Location Map and/or other Exhibits Attached Not Applicable ❑ Contract/Agreement (w/exhibits if applicable) Attached ❑ (Signed in full by the City Attorney) Not Applicable Subleases, Third Party Agreements, etc. Attached ❑ (Approved as to form by City Attorney) Not Applicable Certificates of Insurance (Approved by the City Attorney) Attached ❑ Not Applicable Fiscal Impact Statement (Unbudgeted, over $5,000) Attached ❑ Not Applicable Bonds (If applicable) Attached ❑ Not Applicable Staff Report (If applicable) Attached ❑ Not Applicable Commission, Board or Committee Report (If applicable) Attached ❑ Not Applicable Findings/Conditions for Approval and/or Denial Attached ❑ Not Applicable EXPLANATION FOR MISSING ATTACHMENTS REVIEWED RETURNED FOR A DED Administrative Staff ( ) ) Deputy City Administrator (Initial) ( ) ( ) City Administrator (Initial) ( ) ( ) City Clerk ( ) EXPLANATION FOR'RETURN OF ITEM: - e RCA Author: Jones/Jubinsky cc- BID DATE: T M C� Engineer's Estimate: $ BLD LIST BIDDER'S NAME -RANK-- TOTAL BID"OLWT 1CAJ $ �. ,3aq a . - 2. $ . , - � 4. 5. AC 8. C6 0 t� 10. $ 11. $ 12. $ 13. $ 14. $ �,S77LZTETS co UL LLJ CD C= 91330 800Z IO-7~/oe- 1z/�6/0d' SECTION A ����� ��� NOTICE INVITING SEALED BIDS for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT #454 in the CITY OF HUNTINGTON BEACH PUBLIC NOTICE IS HEREBY GIVEN that the CITY OF HUNTINGTON BEACH, as AGENCY, invites sealed bids for the above stated projects and will receive such bids in the office of the City Clerk, Second Floor, 2000 Main Street, Huntington Beach, California 92648, up to the hour of 2:00 PM on December 18, 2008. Bids will be publicly open in the Council Chambers unless otherwise posted. Copies of the Plans, Specifications, and contract documents are available from the Office of the Director of Public Works, 2000 Main Street, Huntington Beach, CA 92648, upon payment of a $35.00 nonrefundable fee if picked up, or payment of a $45.00 nonrefundable fee if mailed via U.S. Postal Service, FedEx, UPS or any other delivery service. Any contract entered into pursuant to this notice will incorporate the provisions of the State Labor Code. Pursuant to the provisions of the Labor Code of the State of California, the minimum prevailing rate of per diem wages for each craft, classification or type of workman needed to execute the contract shall be those determined by the Director of Industrial Relations of the State of California, which are on file at the Office of the Director of Public Works, 2000 Main Street, Huntington Beach, CA 92648. The AGENCY will deduct a 10% retention from all progress payments. The Contractor may substitute an escrow holder surety of equal value to the retention in accordance with the provisions of the California Government Code, Section 4590. The Contractor shall be beneficial owner of the surety and shall receive any interest thereon. The AGENCY hereby affirmatively ensures that minority business enterprises will be afforded full opportunity to submit bids in response to this notice and will not be discriminated against on the basis of race, color, national origin, ancestry, sex, or religion in any consideration leading to the award of contract. No bid shall be considered unless it is prepared on the approved Proposal forms in conformance with the Instructions to Bidders. The bid must be accompanied by a certified check, cashier's check, or bidder's bond made payable to the AGENCY for an amount no less than 10% of the amount bid. The successful bidder shall be licensed in accordance with provisions of the Business and Professions Code and shall possess a State Contractor's License Class at the time of the bid opening. The successful Contractor and his subcontractors will be required to possess business licenses from the AGENCY. The AGENCY reserves the right to reject any or all bids, to waive any irregularity and to take all bids under advisement for a maximum period of 60 days. The engineer's estimate for this project is $ 2,600,000. BY ORDER of the CITY COUNCIL of the CITY OF HUNTINGTON BEACH, CALIFORNIA, the 2nd day of September 2008, by Resolution No. 2008-54. CITY OF HUNTINGTON BEACH 2000 Main Street P . O . Box 190 Huntington Beach , CA 92648 LETTER OF TRANSMITTAL Fax (714) 374-1573 Attention: Joan FIVnn Date: November 17, 2008 To: City Clerk's Office Project/C.C.No.: MSC 454 2000 Main Street Regarding: Various Residential Street Overlay Huntington Beach, CA 92648 ® We are sending you: ❑ By Mail ❑ By Fax Mail(Number of pages including this sheet:) ® We are hand delivering: ❑ Attached ❑ Under a separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order ® Other: Notice Inviting Sealed Bids Item# Copies Pages Description 1 1 1 Notice Inviting Sealed Bids 2 3 4 5 These are transmitted as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ® For your use ❑ Approved as noted ❑ Submit copies for distribution ® For your action ❑ Returned for corrections ❑ Return corrected prints ❑ For review/comment ❑ Other: Remarks: On September 17, 2008 the Public Works Commission authorized the advertisement of the Various Residential Streets for Asphalt Overlay; MSC 454 Project. Please find attached the Notice Inviting Sealed Bids for advertisement on 11/26, 12/4, and 12/11. The bid opening is scheduled for 12/18 @ 2:00 PM. Please contact me at extension 1732 with any questions you may have. c: file By: ereck Livermore, Street Crewleader GAMAINTENANCE DIVISION\Cr►y YARD\MSC FiLEs\MSC FRo,IEcrs\400's\MSC 454\NISB TRANsmrrAL To CLERK 454.DOC J, e CITY OF HUNTINGTON BEACH 2000 Main Street P . O . Box 190 Huntington Beach , CA 92648 LETTER OF TRANSMITTAL Fax (714) 374-1573 Attention: Joan Flynn Date: December 1, 2008 To: City Clerk's Office Project/C.C.No.: MSC 454 2000 Main Street Regarding: Various Residential Street Overlay Huntington Beach, CA 92648 ® We are sending you: ❑ By Mail ❑ By Fax Mail(Number of pages including this sheet:) ® We are hand delivering: ❑ Attached ❑ Under a separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change Order ® Other: Addendum 1,MSC 454 Item# Copies Pages Description 1 1 22 Addendum 1 2 3 4 5 These are transmitted as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ® For your use ❑ Approved as noted ❑ Submit copies for distribution ® For your action ❑ Returned for corrections ❑ Return corrected prints ❑ For review/comment ❑ Other: Remarks: Please find attached Addendum 1, Resolution 2008-63 —A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The bid opening is scheduled for 12/18 @ 2:00 PM. Please contact me at extension 1732 with any questions you may have. c: file By: ereck Livermore, Street Crewleader G:\MAINTENANCEDMSION\CrryYARD\MSC£u,Es\MSC PROJECTS\400's\MSC 454\ADDENDUM 1 TRANSMITAL To CLERK 454.DOC City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1, 2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC464 plans and specifications is Addendum No. 1,dated December 1,2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for I. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, dated December 1, 2008. Company Name By Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714) 374-1732. CONTRACTOR'S SWORN STATEMENT AND WARRANTY REGARDING CONTINUING INSURANCE OBLIGATIONS FROM P'ROIECT: (Ctmtractor Name) (Street Address) (City,state ww Zip) TO: CITY OF HUNTINGTON BEACH DECLARATION Attadwd hereto is a true and aerred cwv of the current Certthtate of Insurasve aid AwWrial Rt, pecl€ndmemsnt CG 2010 1185, which QrWaW compiles with the insurance recluirertarts of the±Conbvct by and between Me My of Hunuropm eeach(`City"]and the abo"wned Conlremr("COentracU rp)for the above-desc ibeci pro ("Project"). I declare uncles pwafty of wMy urder the taws of the Stale of Cawon is that the above str ement is he and correct, signed on ._ 20_,at ( ) (cam,state) I (Signature of Individual Wtv Is Making Dedarom) WARRANTY Contractor hereby warrants and&grees to maintain Prodwis,and Comp4Ked OpetaWns Insurance in cormLinze wth the murance reiwowwts of the C**act for the Pried- Said imuranc+e shall be rna mmmd ttatlugh and uW the v0ra0w of all Warranties erected try Contractor. Said it rite#hall MntaM Adder Ir+esrmett BMrsernaflt011 2010 11$5,naming City as an insured. Contractor shall supply to City,on at least an gust basis,a CertIrtate of Insuvw4ce aril the alaretrtefoned &xlwsemenl evidenong continued wverage which meets the Contract reqArwients, Signed on 20_at (OW) (City,stute) CONTRACTOM kame: BY Name: �. This form to be turned in with Payment Bond L-s RESOLUTION NO. 2008-63 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH REVISING AND RESTATING THE CITY'S INSURANCE AND INDEMNITY REQUIREMENTS WHEREAS, there are persons and organizations who are engaged in various activities in the City, thereby subjecting the City to substantial risk of liability for damage to property and injury to persons; and, The City desires to establish insurance and indemnification requirements; and, in appropriate cases,-a procedure for the waiver thereof; and, The City desires to establish internal staff responsibility for the administration of the insurance required by this Resolution and delineate the authority to make adjustments to requirements based upon unique and unusual circumstances. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Huntington Beach that effective on the date of adoption of this Resolution, the insurance coverage and indemnity requirements shall be as follows: SECTION I. DEFINITIONS AND FORMS REQUIRED A. Definitions: 1. "Contractors" are any persons or entities who contract with the City and/or provide services to the City which are readily available and efficiently procured by competitive bidding. 2. "Design Professionals" are professional services contractors who contract with the City and/or provide architectural and/or engineering services to the City. 3. "Licensees/Lessees" are any persons or entities who contract with the City for the use of public property. 4. "Permittees" are any persons or entities who make application to the City for any use of or encroachment upon any public street, waterway, pier, or City property. 5. "Professional Services" are as defined by Huntington Beach Municipal Code section 3.03. 6. "Vendors" are any persons or entities who transfers property or goods to the City which may or may not involve delivery and/or installation. B. Indemnity and Insurance Coverage Requirements Defined 1. General Liability: Combined single limit bodily injury, personal injury and property damage: Minimum limits of$1,000,006 per occurrence. 19723 1 Resolution No. 2008-63 a. Coverage must include completed operations liability and unlimited blanket contractual liability and, where products are furnished, products liability. b. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 or an increased coverage as memorialized in the terms and conditions agreed to by the parties and the policy holder shall submit written notice of any known depletion of limits to City attached to the proof of insurance. C. Claims made policies are not acceptable, except that claims made insurance for pollution liability shall be acceptable. d. All deductibles in excess of $5,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution, The requirement for self-insured retention remains at zero. e. The City, its, officers, elected or appointed officials, employees, agents and volunteers are to be covered as additional insureds by separate attached endorsement(s) approved by the City Attorney as respects liability arising out of action performed by or on behalf of the contractor, products and completed operations of the contractor, premises owned, occupied or used by the contractor; or automobiles owned, leased or borrowed by the contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its agents, officers and employees. f. For any claims related to the project, the contractor's insurance coverage shall be primary insurance as respects the City, its agents, officers, and employees. Any insurance or self-insurance maintained by the City, its agents, officers, and employees shall be excess of the contractor's insurance and shall not contribute with it. g. Any failure to comply with reporting or other provisions of the .policies including breaches of warranties shall not affect coverage provided to the City, its agents, officers and employees. h. The contractor's insurance shall apply separately to each insured against Whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 2. Workers Compensation and-Employers' Liability: In accordance with the applicable state statutes with limits in the case of workers'compensation and employers' liability in amounts not less than the State statutory limits. Alternatively, a signed declaration of non-employee status shall be filed. A certificate or consent to self-insure issued by the California Director of Industrial Relations is also acceptable. 19723 2 Resolution No. 2008-63 3. Professional Liability Insurance: Coverage must be provided at a minimum of $1,000,000 per occurrence and in the aggregate. All deductibles in excess of $10,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. a. Claims made policies are acceptable if the policy further provides that: 1. The policy retroactive date coincides with or precedes the professional services contractor's start of work (including subsequent policies purchased as renewals or replacements). 2. The professional services contractor will make every effort to maintain similar insurance during the required extended period of coverage following project completion, including the requirement of adding all additional insureds. 3. if insurance is terminated for any reason, professional services contractor agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this agreement or permit. 4. The reporting of circumstances or incidents that might give rise to future claims. 4. Automobile Liability Coverage must be provided at a minimum of $1,000,000 per occurrence. a. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 and the policy holder shall submit written notice of any known depletion of limits to City attached to the proof of insurance. b. All deductibles in excess of $1,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. C. The City, its officers, elected or appointed officials, employees, agents and volunteers are to be covered as additional insureds by separate attached endorsement(s). The coverage shall contain no special limitations on the scope of protection afforded to the City, its agents, officers and employees. d. For any claims related to the project, the contractor's insurance coverage shall be primary insurance as respects the City, its agents, officers, and employees. Any insurance or self-insurance maintained by the City, its agents, officers, and employees shall be excess of the contractor's insurance and shall not contribute with it. 19723 3 Resolution No. 2008-63 C. Certificate of Insurance Requirements Defined 1. Form. Evidence of insurance coverage and limits as required by the City shall be furnished to the City as a certificate holder on the "Acord' or similar form approved by the City Attorney. (See samples attached herein as Exhibit "A"). a. The description of work to be performed, the City department involved in the performance, and the City staff contact person must be clearly identified on the "Acord" or similar form evidencing insurance coverage. b. All forms of insurance shall identify the City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers as an additional insured by separate attached endorsement with respect to general liability and automobile liability coverages. C. Contractors shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein. 2. Approval of Certificate Insurance certificates must be approved by the City Attorney prior to commencement of any performance under a contract or issuance of any permit, as authorized by the City Charter. 3. Acceptability of Insurers Insurance must be placed with insurer with a Best's rating of no less than A: VII and insurer must be a California admitted carrier. SECTION II INSURANCE AND INDEMNIFICATION REQUIREMENTS A. INSURANCE 1. Contractors and Permittees must meet the requirements as set forth in Exhibit "B" incorporated by reference and attached herein. Permittees who do not use vehicles or equipment in connection with the permit, shall not be required to provide auto insurance. To be exempt from this requirement, permittees must execute a declaration such as Exhibit I attached hereto and incorporated by this reference. 2. Professional Services providers must meet the requirements as set forth in Exhibit"C" incorporated by reference and attached hereto. 3. Licensees/Lessees must meet the requirements as set forth in Exhibit "D" incorporated by reference and attached hereto. 4. Vendors a. Vendors supplying goods including delivery, service and/or installation must meet the requirements of Exhibit "B". 19723 4 Resolution No. 2008-63 b. Vendors supplying goods only without delivery, service and/or installation are required to provide products liability coverage only. 5. The insurance requirements of persons or organizations not identified herein shall be as designated by the agreement. All certificates of insurance designated must conform to the requirements of this Resolution. 6. Exceptions. a. Public entities are exempt from the requirements of this resolution. Any insurance and indemnity requirements of a public entity shall be pursuant to Section II(A)(5). b. Persons providing judicial or quasi-judicial services as independent contractors, such as judges, arbitrators, hearing officers, expert witnesses, and court reporters shall be exempt from all insurance coverage requirements. Any insurance and indemnity requirements shall be pursuant to Section II(A)(5). C. Each person making application for a permit for private property construction, alteration, improvement, demolition, or repair of any building or structure shall sign a declaration under penalty of perjury verifying workers' compensation coverage or exemption from coverage, as required by Section 19825 of the Health and Safety Code and, at the time of permit issuance, contractors shall show their valid workers' compensation insurance certificate. d. Persons contracting with the City under subdivision agreements are exempt from providing evidence of workers' compensation. e. Oil operators as regulated by Huntington Beach Municipal Code Section 15.16 and pipeline franchises as regulated by Huntington Beach Municipal Code Section 3.44 are exempt from the requirements of this resolution. f. Taxicabs/Vehicles-for-hire as regulated by Huntington Beach Municipal Code Section 5.50 are exempt from the requirements of this resolution. g. Trucking companies, including those regulated under Huntington Beach Municipal Code Section 10.32, are exempt from the minimum insurance requirements of this resolution but must submit proof of workers' compensation insurance and general liability insurance in accordance with the requirements of the Public Utilities Commission (PUC) regulations which include: 1) the general liability insurance requirements are $600,000 combined single limit or $250,000 bodily injury or death of one person and $500,000 protection against total liability for bodily injury or death of more than one person from any one accident. 2) this is subject to the same $250,000 limitation for each person and $100,000 protection for accidental damage or destruction of property other than property being transported. 3) the City of Huntington Beach must be 19723 5 Resolution No. 2008-63 named as certificate holder but does not need to be named as additional insured. 7. Indemnity a. Contractors and Permittees shall be required to indemnify City, pursuant to the indemnity provision attached hereto and incorporated herein by this reference as Exhibit"E". b. All design professionals shall be required to indemnify City pursuant to the indemnity provision attached hereto and incorporated herein by this reference as Exhibit"F". C. All other persons or organizations, including but not limited to professional service providers other than Design Professionals as defined by this Resolution, shall be required to indemnify City, pursuant to the indemnity provision attached hereto and incorporated by reference as Exhibit "G". SECTION III. WAIVER OR MODIFICATION PROCEDURE A. Waivers or Modification Request Form. A department Request for Waiver or Modification, Exhibit "H" attached, shall be completed and forwarded to the Risk Manager for all requests for waiver or modifications of the minimum indemnification and insurance requirements. Claim history, financial statements and scope of work must be submitted as attachments with any request for waiver. B. Waiver or Modification Authority. The Risk Manager and the City Attorney may approve any waiver or modification of the insurance and indemnification requirements, including requests for indemnification of third parties. A denial may be appealed to the City Administrator. C Waiver Criteria. The criteria to evaluate any requests for waiver shall include the following: a. The type of waiver or modification requested; b. The reason for the waiver or modification; C. The nature of the scope of work; d. The cost of the contract; e. The liability exposure of the City; f. The cost and availability of the coverage requested; g. The claim history of the requesting party; h. The past experience of the City with the requesting party; and i. The past experience of the City with other contracting parties of a similar nature. 19723 6 Resolution No. 2008-63 SECTION IV. Resolution 2007-03 and all other resolutions in conflict herewith are hereby repealed. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting held 6th day of October 200 8 An I ND A ir unIgh Resources VIEW PPROVED: ftf A inistrator APPROVED AS TO FORM: �v City Attorney Attachments • ��' Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G Exhibit H Exhibit I 19723 7 Resolution No.2008-63 A 11J®RDiar CERTIFICATE OF LIABILITY INSURANCE OATS(NMtOOKYYYI PRODUCER 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 NAIC 9 INSURED INSIIRERA. DISURERS: INSURER C: INSURER O_ INSURERE. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RECUREMENT.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 SEEN REDUCED BY PAID CLAIMS- IWStt POLICYEFfCt'TIVE POLICYEM"TTON LIMITS GENERALLIAZILM EACH OCp P47EM E f _ COWERGULGENERALUA&LITY ►OSES(Ea S CWMSMADE f--1 OCCUR W1GD8Wftoneperwm) f PERSONAL a AM INJURY S GENERALAGGREGATE S GENL AGGREGATE UWTAPPUESPER PRODUCTS-COMPIOPAGG f POLICY MPRO-ECT AVTOMOBILEUABIUTY ANYAUTO I Ea NEOSUNGLE LIMIT $ ALLOWNEO AUTOS BODILYUNJURY S SCHEDULED AUTOS (Pw Person) HIREOAUTOS BODILY INJURY S NONOWNEDAUTOS /I`J` (Per acadwd) l� PROPERTYDAMAGE f IPeraood" GARAGELlAB&ITY AUTOONLY.EAACCIOENT S ANY AU TO 1 OTHER THAN EAACC S AUTOONLY: AGG S EXCESSNNBREISAUABUTY EACH OCCURRENCE S OCCUR CLAIMSMADE /ice AGGREGATE f ✓) S DEDUCTIBLE S RETENTION $ S WORKERSCOMPENSATIONAND WCSTATU- OTI4 Ef EMPL.OYERS'LIABILM ANY PROPWETORRARTNEWEXECUTIVE ELEACHACCIDENT f OFfTCER EREXCLUDEOT yyeess.,__ EL DISEASE-EA EMPLOYEE $ SPWIL.PRON 0.below E.L DISEASE-POUCYL"T S OTHER OESCRJPTION OF OPERATIONS I LOCATIONS 1VETiIC (EXCLUSIONS ADDED BY ENOORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED I.OUCIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WU L ENOEAVOR TO MAIL Lo DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.OUT FAILURE TO 00 SO SHALL. IMPOSE HO OBLIGATION OR LIABILITY OF ANY(ONO UPON THE INSURER,ITS AGENTS OR REpRE$ENTATTVES. - AUTHORIZED REPRESENTATIVE ACORD 25(2001f08) EXHIBIT A-1 of 4 0 ACORD CORPORATION 1988 Resolution No.2008-63 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(2001108) EXHIBIT A-2 of 4 Resolution No.2008-63 POLICY NUMBER: COMMERCIAL GENERAL.Mtl I Trr THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (Fora B) This endamirnent modifies insurance provided under the following: COMMERCIAL GENERAL llABlLnY SCHEDULE Name of Person or Orgaauatlon. THE CITY OF HUNTI NGTON BEACH 2000 Main Street Huntington Beach, CA 92648 (if no entry appears above,infonnation requited to compteta uhis endorsementwU be shown in the Declarations as applicable to ttus 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 Nyour world for that insured by or for you RE: ALL OPERATIONS OF THE NAMED INSURED FOR THE CERTIFICATE HOLDER. City of Huntington Beach, its elected or appointed officials.agents, officers, employees and volunteers CG 20 10 1185 Copyright.Insurance Services Office,Inc.,1984 EXHIBIT A-3 of 4 Resolution No.2008-63 ATE P.O.BOX 420807.SAN FRANCISCO.CA 94142-0807 COMPENSATION FUNINSURANCE ®=�CERTIFiCgTE-OF WORKERS'COMP>i:NSATtC1N INSURpCE .ia`:r- -�. .;/.p.,•-^.•s•'.`.. y,i+�... - 1 .a;:7' •mow• _ �+••� r,- a?'; _•'L-t.-f:.'-0.. :rY�~Y:•rid �l-• Ji �i t`�ti:.}'�.��/-F•- %'L• j:.i l.• j. ^���•: =1.;:.4: .r ..1- t-�VGfI}^.v.� -TSB � _ 1 > .W,_at-�� �. :, •".:'y'� <� .�.5;.4-;,;.. :� 5,��•' _ x: '^�.- �•: '�' 4isl ••�. �i Nam CITY OF HIN!r1n6 6i F' `• _ ':t ;� �, r• '-� rk� :' RISK NANA 2"s MMN HLNTINGTON BEAGli�; KCA 92648 iW ,,, t ^' L_ This is to Certify that we have issued a valid Workers'Compensation insurance policy in a loam approved by the California Insurance Commissioner to the employer named below for the po&cy period Indicated. This policy is not subject to cancellation by the Fund except upon 30iW0ays'advance wfitten notice to the employer: 30 We will also give you Tky days'advance notice should this policy be cancelled prior to Its normal expiration" This certificate of insurance is not an insurance policy and does not amend.extend or alter the coverage afforded by the policies fisted herein. Notwithstanding any requirement.-:term, or condition of any contract or other document with respect to which this eecate lris7u_once maK:be`issifed:or may pestaui, tt3e insn�raik e' 7ordeby the policies described herein is sU_bjea to ap exclustotis aiict Coridi6oris of such potiags. •r`� �}:.--==,-ram..-'-r'•=•:-.."'fit°�c,c'i;: F tv 00 •r•�.� �� ` sib: -��r�.��%' ` +`' ;• c._5;.::_ Y` ?1(S AUTHORI R y`• -a-,; - c1_xai :�i. 2Ep EPR E TATtV :- `.•:.i:'°'�.,'&. .` - t• - E^yl 'T Vie',:-::rJ '•..-.. -: <.�- .. �...;.• �._:, EMPLOYER'S LIABILI.TY'LIMIT INCLUDINfi.DEFENSE COSTS: $1,'0e0;0ii<0: sOGf RR�10E. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07/01/00 1S ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER t -A- :=x EXHIBIT A-4 of 4 L_ o a Io now Resolution No.2008-63 EXHIBIT B INSURANCE REQUIREMENTS FOR CONTRACTORS, AND PERMITTEES PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance ' City Council Resolution 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M.Best's Rating of no less than A:VII: 1. General Liability: $1,000,000 per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used,either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. `Claims made" designation is only acceptable for professional or pollution liability.insurance. The City of Huntington Beach its officers elected or appointed officials employees agents and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact.) 2. Workers' Compensation and Employer's Liability: State statutory limits of $250,000 bodily injury by disease, policy limit, and $100,000 bodily injury each employee for accident or disease per occurrence. If you have no employees, you must sign a Declaration of Non-employee Status form available from the City. In lieu of a certificate of insurance, a certificate of consent to self-insure issued by the California Director of Industrial Relations is also acceptable. 3. Automobile liability of $1,000,000 per occurrence for bodily injury, personal injury and property damages. The City of Huntington Beach its officers elected or appointed officials employees, agents and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact)_ Deductibles Self-Insured Retentions or Similar Forms of Coverage Limitations or Modifications Any deductibles, self insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Subcontractors Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and -endorsements for each subcontractor. All coverages for subcontractors shalt be subject to all of the requirements stated herein. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. PLEASE FORWARD THIS NOTICE TO YOUR INSURANCE AGENT. FOR ASSISTANCE, PLEASE CONTACT RISK MANAGEMENT. 06-3"/5103 E''XM 1T B Resolution No.2008-63 EXHIBIT C INSURANCE REQUIREMENTS PROFESSIONAL SERVICE CONTRACTORS PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current kM. Best's Rating of no less than A:VII Errors and.©missions liability: $1,000,000..per occurrence. Deductibles. Self-Insured Retentions, or Similar Forms of Coverage Limitations or Modifications Any deductibles, selfAnsured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. 06 399/5104 EXHIBIT C Resolution No.2008-63 EXHIBIT D INSURANCE REQUIREMENTS FOR LESSEESILICENSEES PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance City requires submittal of certificates of insurance pursuant to the form set forth in Resolution No. 2008-63= evidencing the following minimum limits with a California admitted carrier with a current A.M. Besfs Rating of no less than A:VI1: 1. General Liability: $1,000,000 per occurrence for bodily injury, personat injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this projectflocation or the general aggregate limit shall be twice the required occurrence limit. "Claims made" designation is only acceptable for professional or pollution liability insurance. For general liability certificate holder, the City of Huntington Beach, its elected or appointed officials agents officers, employees, and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact). 2. Workers Compensation and Employer's Liability: State statutory -limits of $250,000 bodily injury by disease, policy limit, and $100,000 bodily injury. each employee for accident or disease per occurrence. If you have no employees, you must sign a Declaration of Non-employee Status form available from the City. In lieu of a certificate of insurance, a certificate of consent to self-insure issued by the California Director of Industrial Relations is also acceptable.. 3. Property insurance: Full replacement cost with no coinsurance penalty provision. Deductibles, Self-Insured Retentions or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Description of Work to be Performed The-staff contact and purpose of the evidence of-coverage-must be-identified: PLEASE FORWARD THIS NOTICE TO YOUR INSURANCE AGENT, FOR ASSISTANCE, PLEASE CONTACT RISK MANAGEMENT 06-3996105 EXHIBIT D Resolution No.2008-63 EXHIBIT E TO RESOLUTION NO. 2008-63 CONTRACTOR'S INDEMNIFICATION DEFENSE HOLD HARMLESS Contractor hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Contractor's employees and damage to Contractor's property, arising directly or indirectly out of the obligations or operations herein undertaken by Contractor, caused in whole or in part by any negligent act or omission of the Contractor, any subcontractors, anyone directly or indirectly employed by any of them .or anyone for whose acts any of them may be liable, including but not Limited to concurrent active-or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Contractor will conduct all defense at its sole cost and expense and City shall approve selection of contractor's counsel. City shall be reimbursed for all costs and attorney's fees incurred by City in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Contractor. f 06-39915 LOG EXHI$IT E Resolution No.2008-63 EXHIBIT F TO RESOLUTION NO. 2008-63 INDEMNIFICATION DEFENSE AND HOLD HARMLESS To the fullest extent permitted by law(including, without limitation, California Civil . Code Sections 2782 and 2782.6), CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, demands, and defense costs (including without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANTs (or CONSULTANT's subcontractors, If any) negligence, recklessness or willful misconduct related to performance of this Agreement or its failure to comply with any _of its obligations contained .in _this Agreement .by CONSULTANT, its officers, agents or employees. CITY shall be reimbursed by CONSULTANT for all costs and attorney's fees incurred by CITY in enforcing this obligation_ CONSULTANT will conduct all defense at its sole cost and expense, and the CITY shall approve selection of CONSULTANTs counsel. This indemnity shall apply'to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by the CONSULTANT. 06-399/5 I07 EXIT IT F Resolution No.2008-63 EXHIBIT G TO RESOLUTION NO. 2008-63 INDEMNIFICATION DEFENSE AND HOLD HARMLESS CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. CITY shall be reimbursed by CONSULTANT for all costs and attorneys fees 'incurred by CITY in enforcing this obligation. CONSULTANT will conduct all defense at its sole cost and expense and the CITY shall approve selection of CONSULTANT's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as limitation upon the amount of indemnification to be provided by the CONSULTANT. 0 6-3 9 915 1 08 E'XFU$IT G Resolution No.2008-63 INSURANCE AND INDEMNIFICATION WAIVER MODIFICATION REQUEST 1. Requested by: 2. Date. 3. Name of contractor/permittee: 4. Description of work to be performed: 5. Value and length of contract: 6. Waiver/modification request: 7. Reason for request and why it should be granted- 8. Identify the risks to the City in approving this waiver/modification- Department Head Signature Date: APPROVALS Approvals must be obtained in the order listed on this form. Two approvals are required for a request to be granted_ Approval from the City Administrator's Office is only required if Risk Management and the City Attorney's Office disagree. 1. Risk Management 0 Approved Q Denied Signature Date 2. City Attorney's Office Q Approved ® Denied Signature Date 3. City Administrator's Vice ® Approved Denied Signature Date If approved,the completed waiver/modification request is to be submitted to the City Attomey's Office along with the contract for approval. Once the contract has been approved, this form is to be filed with the Risk Management Division of Administrative Services EXHIBIT H Resolution No.2008-63 S i`l CITY OF HUNTINGTON BEACH Hun. 6 2000 Main Street Huntington Beach, CA 92648 DECLARATION OF PERMITTEE I certify that no vehicle(s) will be used or operated in the performance of the task(s) or event(s) for which this permit is granted. I authorize the City of Huntington Beach to immediately and retroactively revoke the license or permit issued in connection with or in the performance of said task(s) or event(s) if any vehicle(s) is used. Signature of Permittee Print name Company name (if applicable) Date signed 16407 EXHIBIT I Res. No. 2008-63 STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH ) I, JOAN L. FLYNN the duly elected, qualified City Clerk of the City of Huntington Beach, and ex-officio Clerk of the City Council of said City, do hereby certify that the whole number of members of the City Council of the City of Huntington Beach is seven; that the foregoing resolution was passed and adopted by the affirmative vote of at least a majority of all the members of said City Council at a regular meeting thereof held on October 6, 2008 by the following vote: AYES: Hansen, Hardy, Bohr, Cook, Coerper, Carchio NOES: None ABSENT: Green ABSTAIN: None Ci lerk and ex-officio erk of the City Council of the City of Huntington Beach, California Unsuccessful Bids MSC-454 Various Residential Streets Asphalt Overlay ® City ®f Huntington Beach 2000 Main Street • Huntington Beach, C� � )48 OFFICE OF THE CITY CLERK ® JOAN L. FLYNN CITY CLERK April 1, 2009 D& L Wheeler Enterprises Corp. 32389 Dunlap Blvd. Yucaipa, CA 92399 RE: MSC-454 —Various Residential Streets Asphalt Overlay Enclosed please find your original bid bond for MSC-454. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe enclosure Sister Citiyh��N, p/j&& greet,r,Rig&rc%cNew Zealand (Telephone: 714-536-5227) 1 1w, k tj�)N��}a�+,. q i � a�. r,''y�M° K�� �s �'"�^ix",�f • 'n;'�s„�K.'�,"VMS �� ,t� �:�7 t<Sr! � sed^,,,-,r a VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT# 454 ,y .r a - � ...:..; :.: >�, :e ',.,��- .,. � R :.,:; :., 'i.,. „.,3} ;. .,�:.,.�;�,: _,'.c,��rti ,aim .� M,r{.: k. _:•�< SECTION C PROPOSAL for the VARIOUS RESIDENTIAL, STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT#454 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor,�in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY 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 AGENCY of the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 18. Addenda The effect of all addenda to the contract documents'shall be considered in the bid package and said addenda shall be made part of the contract documents and shall be returned with the bid package. Failure to submit any such addenda with the bid package may render the bid irregular ,.' and may result in its rejection by the AGENCY. 19. Bid Protest To be considered timely, a bid protest must be filed within the following time lmi its: (a) Protests based upon alleged defects or improprieties in the bid-documents shall be filed prior to the date of bid opening. (b) All other protests must be filed within five calendar days after the protester knew or should have known the basis of the protest, but-no later than five calendar days after the date of when the Bids were due to the AGENCY. 20. Questions to the Engineer X Questions regarding the bid documents(i.e. plans, specifications, contract documents, bid forms, etc.) will be received by the Engineer up to five working days prior to the bid opening as specified in SECTION A. Questions asked of the Engineer after this time will not be addressed. B-5 If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void.- Accompanying this proposal of bid, find , T in the amount of$ 2 Q JC> which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received Bidder's Signature C-2 Bad Schedule MSC - 454 Cold Plane 1 706,001 S.F. at 5i)crcLrIi g-g,�egr� per S.F. $ Ct W,16 Furnish and Install Petromat 2 2,537,923 S.F. at J7�4 ; kTg CtM+S per S.F. $ ti Furnish and Install Asnhalt at..12 C7CC,�f S 3 22,841 Ton at �_ Oaf DVJJ" 0 fir"MOW,- $ e $ 1 1a q.5, ,, Adjust Water Valves to urade 4 338 EA at` - _ .�, I(N*per Each $ Adjust Manholes to Grade jy�(►G-PtS` 5 262 EA, at7gtZ C-kuncp2F0'Tut&fYAur- per Each $ 32 S; Install Traffic Loops G �� ,j. 6 30 EA f(ZEiv`�!� y �µper Each $ .33 $ C) o 15c) Prepare Pre & Post Construction Corner Record and File with Appropriate Agencies 7 241 EA atTwo guwo !6t%am per Each $ iota! Bid Amount in Figures $ e - btal Bid Amount in WordsTwo tqa-6&z4r , ,_ a _ kuntpn D- Cry f312 �►ai� NJrfT'yJ:—*f"T C.f-N�'S C-2s LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name and Address of Subcontractor State License Class of Work Number Arc 4- e,G�� 0/0 AVAL-OtJ fit. CA C-10 By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDEN AND SUBMITTED WITH BID State of California ss. County of Orange ,Q r , being first duly sworn, deposes and says that he arse is Ps 2d�' A- of ) k o Enter^prises the party making the foregoing bid that the bid is not made in the interest of, or on the 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, or 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 fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. ,kl� OlX�l' Name of Bidder Signature of Bidder Address of Bi der Subscribed and sworn to before me this day of m r , 20C-1 . CYMIA D.AUNWOM Can 16505M NOWY a -cotaft San Benuncono Cour MYcofnm. MW 1Q,201 NOTARY PUBLIC NOTARY SEAL C-4 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion 1Yame and Address;of Subcontractor ' State Licen's e- -Of Work 1Vumber B submission of this proposal, the Bidder certifies: to a;d„will perform the balance of all work which is not covered in the =sits ontraa.ors ASting. Qul N k 51:,:y +nofcii{ "t o r T+hovthnAGE 11 be furnished copies of all subcontracts entered into and bonds A Y stib4 r tractor for this project. C-3 ITTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT#-454, (I)(we)(it)will employ and utilize only qualified persons, as hereinafter defined,to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. m Contractor By Title Date: l� C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury,the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? ❑ Yes XNo If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION-INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with-the provisions.of that,code, and I will comply with such provisions before commencing the performance of the work of this contract. Contractor By Title Date: O C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Contractor By Title Date: Note: This form is required for every Dig Alert Identification Number issued by USA. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: lOr^ sc Bidder Name Business Address City, State Zip (qM 0�00 Telephone Number Li A a State Contractor's License No. and Class o0�1 -,-x Original Date Issued C. Expiration Date The work site was inspected by, r^ of our office on , 20M The following are persons, firms, and corporations having a principal interest in this proposal: C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Company Name ignature of Bidder Printed or Typed Signature Subscribed and sworn to before me this day of AQ�^ , _ cvN>�w ALEMaZIcoUt2 Commission# 1650502 Notary Pubik-C011fornio Son Bernardino County My Comm.Expires Mar 10.201 r NOTARY PUBLIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: I. t c r(Q 30C) SNr4l-� nctrQ 04V GBC)3 Name d Address of Public Agency Name and Telephone No. of Project Manager: (aVMp►1 \ ' 11y 1 0 N Contract Amount Type of Work Dat Completed 2. Q;� Ook A C 21 Nam nd Address of Public Agency Name and Telephone No. of Project Manager:;Avid wn S '30� Contract Amount Type of Work Date Completed '�p -��kjuc(-)A !2��1.0A 91n 9 3. 1 (, t N am and Address of ublic Agency Name and Telephone No. of Project Manager:(��u(� �,©� ©q[7q 7 A �\o C) cc) Contract Amount Type of Work Date Completed C-10 - NT .-)- &L VVHEELER E - S .dba. D&L PAVING a f � ate Of camornia 2&=ff6ACT=,qAT OD 1 c 1 CORP 4 Q&L WHEELER EWERPRiSES CORPORATION DBA Q&L PAVING A C12A - s a � City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1, 2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1,dated December 1,2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for 1. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, dated December 1, 2008. Company Name By Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714) 374-1732. r NORTH AMERICAN SPECIALTY INSURANCE COMPANY BOND NO.: DLWHE-167 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, D & L WHEELER ENTERPRISES CORPORATION, (hereinafter called the Principal), and NORTH AMERICAN SPECIALTY INSURANCE COMPANY, a corporation organized and doing business under and by virtue of the laws of the State of NEW HAMPSHIRE, and duly licensed for the purpose of making, guaranteeing or becoming sole surety upon bonds or undertakings required or authorized by the laws of the State of CALIFORNIA, as Surety, are held and firmly bound unto CITY OF HUNTINGTON BEACH (hereinafter called the obligee) in the sum equal to 10% of the accompanying bid of the Principal, not, however, in excess of TEN PERCENT OF THE TOTAL AMOUNT BID Dollars (10% OF BID AMOUNT), for the payment of which, well and truly to be made, we hereby bind ourselves and our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS, the above bounden Principal as aforesaid, is about to hand in and submit to the obligee a bid for VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' — MAINTENANCE SERVICE CONTRACT #454, in accordance with the plans and specifications filed in the office of the obligee and under the notice inviting proposals therefore. NOW, THEREFORE, if the bid or proposal of said principal shall be accepted, and the contract for such work be awarded to the principal thereupon by the said obligee, and said principal shall enter into a contract and bond for the completion of said work as required by law, then this obligation to be null and void, otherwise to be and remain in full force and effect. IN WITNESS WHEREOF, said principal and said Surety have caused these presents to be duly signed and sealed this 16t" day of DECEMBER, 2008. D & L WHEE S ORPORATION BY: TH AMERICAN-SPECIALTY INSURANCE COMPANY BY: N Y SPOHN, Attorney-in-Fact a NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City®f Itasca,Illinois,each does hereby make,constitute and appoint: RANDY SPOHN and MATTHEW R.DOBYNS JOINTLY OR SEVERALLY Its true and lawful Attorneys)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or maybe required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of TWENTY-FIVE MILLION($25,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 2e of March,2000: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." a\ptya8afftNl4 B .\0Q'•'t)FPpfwlSG s• S E•r]m= Steven P.Aadersoe,President&Chlef P.xecudve Of ccr of Wuhlagtoa lnitreatiunal Ius—Company 07 4 SEALr� $jsT�, 1gT3 �eri O,Q &Samar X.isr P.usldwt.oLA!Iotth! kxn, tptto,'"�s:scnlGow,gaaav ..M: . tR?$ti ... tHnnn+n By Oavid M.Layman,Seolor Vice Pre,ideo of Washingtoo Intrraetional Insuranea Campony &Vice Yratdeni of lhorth American Specialty Imuranee C'ompasy IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 30th day of September ,2008 . North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Du Page ss. On this 30th day of September 20 08,before me,a Notary Public personally appeared Steven P.Anderson ,President and CEO of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M.Layman_, Senior Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective comnanies. ---------------- "OFEIt 7 D.SKI Rntc -4"11 J Notary Public,State urIDmoie Donna D.Sklens,NotaryPublic My flommis9 Expires r0A0 Mll 1, James A.Camenter , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies thisl6tb day of December 2008 , lames A,Carpenter,Vice Prc:id-W&A4istlud Secrotary of Washington Intanelional lws nee Company&. North American Speciatry In:a mma Compyny s CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of CALIFORNIA County of ORANGE On December 16, 2008 before me, Erika Guido, NOTARY PUBLIC-, personally appeared RANDY SPOHN ® 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 capacity (ies), and that by his/her/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 ERKAZZ""1191 California that the foregoing paragraph is true and correct. comm. 16MI33 �� WITNESS my hand and official seal. eocp�es 5,2M J Sigma e.: ,1Nvtavy < Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ LIMITED ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) City of Huntington Beat 2000 Main Street Huntington Beach, CA 92648 ' OFFICE OF THE CITY CLERIC o JOAN L. FLYNN CITY CLERK April 1, 2009 Silvia Construction, Inc. 9007 Center Avenue Rancho Cucamonga, CA 91730-5311 RE: MSC-454 —Various Residential Streets Asphalt Overlay Enclosed please find your original bid bond for MSC-454. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe enclosure Sister Citiq.xoAwop/oj &rttW$;ij rAcNew Zealand (Telephone:714-536-5227) SILVIA CONSTRUCTION, INC. 9007 CENTER AVENUE RANCHO CUCAMONGA , CA 91730-5311 _c J1- f 1 F l.: t J^t I> n x CITY OF HUNTINGTON BEACH CITY CLERKS OFFICE, 2nd FLOOR 2000 MAIN STREET HUNTINGTON BEACH , CA 92648 "SEALED BID FOR: VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT . 12 ' MAINTENANCE SERVICE CONTRACT #454 IN THE CITY OF HUNTINGTON BEACH, DO NOT OPEN WITH REGULAR MAIL" BID DATE : THURSDAY , DECEMBER 18 , 2008 BID TIME: 2 :00 p .m. City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER E For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1,2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1,dated December 1,2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for 1. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate:$2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, da ed December 1 008. SILVIA CONSTRUCTION , INC . Company Name By KURTIS AKABORI , VICE PRESIDENT DECEMBER 18 , 2008 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714)374-1732. r, r y SECTION C � �LL=` PROPOSAL for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .R2' MAINTENANCE SERVICE CONTRACT# 454 f in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL. OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY 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 AGENCY of the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids 4 and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 Bid Schedule MSC -.454 o Cold Plane ce� S 1 706001 S.F: a ha/Yper S.F. $ 0,2 $ �o i�Zl Furnish kd Install Petromat 2 2,537,923 S.F. at�,.,eke Jr) h2k-� er S.F. $ 0,125 $3 t 7. 2816d3 Furnish and Install Asphalt.at .1 ' 3 22,841 Ton at dgIII e Ton $ Adjust Water Valves to G add� 4 338 EA afi�' re 'o ' dp F ach $ _ U $ 915 5 �_ Adjust Manholes to Grade 5 262 EA a t&n �o�kr a c h $-2y pO $ ysa l Install Traffic Loops de,Aa,- 6 30 EA a �,+Jre �' I7� -ei "per Each $ r�� ° $ Prepare Pre & Post Construction Corner Record and File with Appropri ot �A�ncies 7 .241 EA at/ - ee ach $�a _ $ 707 _ NATotal Bid Amount in Figures $ 3 - - otal Bid Amount in Words ;l ion 1 tie H O C-2s ( If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in t' executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option,be considered null and void. TIN PERcm OF BID AMOUNT Accompanying this proposal of bid, find BIDDER'S BOND in the amount of$ (10%) which f said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or 'Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No Rate Received Bid ' ` ' nature 1 12/03/08 ---- C-2 . LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder. on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Marne and Address as"contractor. State License,:, Class of W6r4` Number 9sa� �y P:C eN el 3 31 rna I: E D G ly e c SZ// r .err �.. 10 40 ra. By submission of this proposal,the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 ITNTONC®LLUSION AFFIDAVIT � TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange K U R T I S A K A B 0 R I , being first duly sworn, deposes and says that he or she is VICE PRESIDENT of SILVIA CONSTRIICTTON TNC_the party making the foregoing bid that the bid is not made in the interest of, or on the 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, or 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 fee to any corporation, partnership, company association, organization,bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. SILVI.A CONSTRUCTION , INC . Name of Bidder c' Signature of Bidder 9007 CENTER AVENUE, RANCHO CUCAMONCA, CA Address of Bidder - 11 Subscribed and sworn to before me this 18th day of DECEMBER 20 08 -- - -- - - - - ----------- PATRICIA SURItE j Commission# 1798307 a ra Notary Public •California / Son Bernardino County wconymMU26,2012 NOTARY PUBLIC NOTARY SEAL C-4 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .I2' MAIN'd'ENANCE SERVICE CONTRACT# 454, (I)(we)(it)will employ and utilize only qualified persons, as hereinafter defined,to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned fizffier promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. SILVIA CONSTRUCTION, INC. Contractor By KURTIS AKABORI e VICE PRESIDENT Title Date: DECEMBER 18 , 2008 C-5 DISQUALIFICATION QUESTIONNAIRE if In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE -` Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified,removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? ❑ Yes M No If the answer is yes, explain the circumstances in the space provided. n/a Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. f� C-6 COMPENSATION.INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I I will comply with such provisions before commencing the performance of the work of this contract. SILVIA CONSTRUCTION , INC . Contractor €, By KURTIS AKABORI VICE PRESIDENT Title Date: DECEMBER 18 , 2008 00 C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. �a Dig Alert Identification Number: Contractor By Title a 1 Date: Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: SILVIA CONSTRUCTION , INC . Bidder Name 9007 CENTER AVENUE Business Address RANCHO CUCAMONGA , CA 91730-5311 City, State Zip ( 909 ) 481-8118 Telephone Number 568194 A State Contractor's License No. and Class x MAY 31 , 1989 Original Date Issued MAY 31 , 2009 F Expiration Date The work site was inspected by KURTTS AKABORI of our office on D E C E M B E R 11, 20 0.8 The following are persons, firms, and corporations having a principal interest in this proposal: -. SILVIA CONSTRUCTION , INC . JOSEPH W. SILVIA , PRESIDENT KURTIS AKABORI . VICE PRESIDENT CAROLYN D. PARKER , CO-SECRETARY BENJAMIN B. DAY , TREASURER C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. - SILVIA CONSTRUCTION INC" Company N e Signature of Bidder KURTIS AKABORI , VICE PRESIDENT Printed or Typed Signature Subscribed and sworn to before me this 18 day of D E C E M B E R , 2008 PATRICIA tiORKE Comm ulon# i 748307 Notaly PubllC-CcdiHomlo San l emadmo County NOTARY PUBLIC 7� NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: 1. CITY OF SAN BUENAVENTURA , 501 POLI STREET , VENTURA , CA 93002 Name and Address of Public Agency Name and Telephone No. of Project Manager: MARK Q U A D Y , (8 0 5 ) 6 5 8-4 7 8 9 $4 , 769 ,455 .00 ASM-ISLAND AREA SPEC . #2006-14 JUNE , 2008 Contract Amount Type of Work Date Completed 2, CITY OF PORT HUENEME , 250 N . VENTURA ROAD , PORT HUENEME , CA 93041 Name and Address of Public Agency. Name and Telephone No. of Project Manager: KIT N E L L , (8 0 5) 9 8 6-6 5 8 9 $ 912 ,491 .80 ST . REHAB . #3553-004 JUNE , 2008 Contract Amount Type of Work" Date Completed 3. CITY OF LAKEWOOD, 5050 N. CLARK AVENUE, LAKEWOOD , CA 90712 Name and Address of Public Agency Name and Telephone No. of Project Manager: MAX W I T H R O W, (5 6 2) 8 6 6-9 7 7 l x 2 5 0 2 $1 , 299 , 977 .00 PAVEMENT REHAB . #05-12-R SEPTEMBER , 2007 Contract Amount Type of Work Date Completed C-10 ............... 08560291 ------------ ----------- Bond No-- Fidelity and Deposit C®m pa IUM-ny POST ORFICE BOX 1227 OF MARYLAND BAL77MORE, MD 21203 R19) BOND KNOW ALL MEN BY THESE PRESENTS.: That we, S i lvia--Construct ion, Inc. as Principal, (hereinafter called the "Principal"), and She FIDELITY AND DEI�Mrr CoMpANy OF MARYLAND, P.O. Box 1227, Baltimore, Maryland 21203, a corporation duly organized under the laws of the State of Maryland, as Surety, (hereinafter called the "Surety"), are held and firmfy bound unto--City of Huntington Beach —-_-_-as Obligee, (hereinafter called the "Obligee"), in the sum of _percent of —amount bid ______Dollars ($ -10% for the payment of which sum well and truly to be nude,the said Principal and the said Surety,bind ourselves,our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid Various Residential Streets for Asphalt Maintenance Service Contract 4454 —---------- -—-——-------- NOW,THEREFORE,if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract, with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof,or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee thedifference not to exc eeei the penalty hereof between the amount specified in said bid and such larger amount f6r which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, ,otherwise to remain in full force and effect. 2th Signed and scaled —' ------day December 08 Silvia Construction, Inc --------(SEAL) Witness BY: KURTIS AKABORI 71de VICE PRESIDENT 13113ELITY AND DEPOSIT COMPANY OF MARYLAND Surety ------ --------- ���(SEAQ -------- ---—-------------- BY4- _ ej&Cy7--j- rVimess rile C315f-50M.1-92 Richard A. Coon C�fomi w AaWiCka IrWitutc of AmbdoM A-310., f1b.1y 1970 Ukio. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT .�mrsiaioisisisri®isieiaisraisiaisi®rsisi.�isisicamiaiaisi.�iaisrsiaisrairgiarsisisisisisi®ssaavisisii�israisisiaiaisi.®i.,�isisiaiaiaraisioi®isisisiaiaiwiaraisisisraisisiaiaim-i� o STATE OF CALIFORNIA COUNTY OF SAN BERNARDINO 0 On DECEMBER 18, 2008, before me, PATRICIA BURKE,NOTARY PUBLIC personally 0/ e appeared KURTIS AKABORI, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed 00 the same in his authorized capacity, and that by his signature on the instrument the person, or the I entity upon behalf of which the person acted, executed the instrument. sI certify under PENALTY OF PERJURY under the laws of the State of California that the s foregoing paragraph is true and correct. 01 WITNESS my and official seal. 01 01, PATRICI�BURKE Commission8307 g Notary Public-California e • ' San Bernardino County 0 Comm 26.2Q12 1 101 ature of Notary Publi 0/Place Notary Seat Above 10 ---------------------------------OPTIONAL-------------------------------- 01 eThough the information below is not required by law,it may prove valuable to persons relying on the document and 01 could prevent fraudulent removal and reattachment of this form to another document. 0/ g DESCRIPTION OF ATTACHED DOCUMENT 3 o TITLE OR TYPE OF DOCUMENT 10 m NUMBER OF PAGES: DATE OF DOCUMENT: r Signer(s) Other Than Named Above: 0 o CAPACITY CLAIMED BY SIGNER 0 e Q Singer's Name: Kurtis Akaborl o ❑ INDIVIDUAL FIGHTTHUMBFRWTOF o SI(7NFA o ❑ PARTNER CORPORATE OFFICER VICE PRESIDENT TITLE m, ❑ ATTORNEY IN FACT 0 ❑ TRUSTEE 0 GUARDIAN CONSERVATOR❑ GU IAN OR CONS VAR O oOther o Signer is Representing: SILVIA CONSTRUCTION, INC. a NAME OF PERSON(S)OR ENTTFY(S) �r.�rararara,.�r�rar�.rararararararar.�r�rar.�arar�rar.�rarar��,ararararararararararararar®rarar��rararar,�ara,�tar�,arrastar,�r�rararaarararararara�rararar�®r�r�rar�rar r CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of Orange On 12/12/08 before me, Lexie Sherwood, Notary Public , Date Nere Insert Name and Title of the Officer personally appeared Richard A. Coon 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 . A, LEXIE S}fERWOOD within instrument and acknowledged to me that he/she/they COWA.#1593951 executed the same in his/her/their authorized capacity(ies), f NOTARY PUBLIC®CALIFORNIA n and that by his/her/their signature(s) on the instrument the ORANGE COUNTY person(s), or the entity upon behalf of which the person(s) t✓omm.Exp.JULY 27,2009 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 Place Notary Seat Above Signature of ota ubtic 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s): ❑ Partner—❑ Limited❑General ❑ Partner—❑Limited❑General ❑ Attorney in Fact ❑ Attorney in Fact ❑ Trustee ° ❑ Trustee r ElGuardian or Conservator Top of thumb here ElGuardian or Conservator thumb here ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: ©2007 National Notary Association-9350 De Soto Ave..P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationaiNotary.org Item#5907 Reorder:Call Toll-Free 1-800-876.6827 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,a corporation of the State of Maryland, by WILLIAM J.MILLS,Vice President, and ERIC D. BARNES,Assistant Secretary, in pursuance of authority granted by Article VI, Section 2,of the By-Laws of said Company, are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date h e des by nominate,constitute and appoint Richard A.COON,Charles L. FLAKE,David L.CULB n ie SOOD,all of Anaheim,California, EACH its true and lawful agent and ma V d deliver,for, and on its behalf as surety,and as its act and deed: any an p n � t xecution of such bonds or undertakings in pursuance of these presen =1k in as fully and amply,to all intents and purposes,as if they had been d t ac n h gutarly elected officers of the Company at its office in Baltimore,Md.,i�R Per a attorney revokes that issued on behalf of Richard A.COON, Charles L. FLAKE, Ci� a ew P.FLAKE,Lexie SHERWOOD,dated November 7,2005. The said Assistant �ssaides ereby certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2,of the By- Company,and is now in force. IN WITNESS WHEREOF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 15th day of November,A.D.2006. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND *°°UPC?, O P im By: Eric D. Barnes Assistant Secretary William J. Mills Vice President State of Maryland ss: City of Baltimore On this 15th day of November, A.D. 2006, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn,severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Dunn Notary Public My Commission Expires: July 14,2011 POA-F 012-4150H e. City ®f Huntington Beach 2000 Main Street ® Huntington Beach, CA 92648 OFFICE OF THE CITY CLERK ® JOAN L. FLYNN CITY CLERK April 1, 2009 All American Asphalt PO Box 2229 Corona, CA 92878-2229 RE: MSC-454 —Various Residential Streets Asphalt Overlay Enclosed please find your original bid bond for MSC-454- Sincerely, Joan L. Flynn, CMC City Clerk JF:pe Enclosure Sister Citiy.Wotf t)WhcigW%pet 4o r&)cNew Zealand (Telephone:714-536-5227) 5 � - o .. T""'r -�. LK 1� T ' D "W Kasa, OT ALL AMERICAN ASPHALT , P.O. BOX 2229 CORONA, CA 92878-2229 C45 . z-7�j RETURN REQUESTED -- crY City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1, 2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1,dated December 1, 2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for 1. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, dated December 1, 2008. Company Name By vox- . bee'. Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. - Should you have any questions regarding this Addendum, please call Dereck Livermore at(714) 374-1732. Y I - CONTRACTOR'S SWORN STATEMENT AND WARRANTY REGARDING CONTINUING INSURANCE OBLIGATIONS FROM: PRO]ECT: (Coabrecbar Name) Meet Address) (sty,stabs and Zip) TO: CITY OF HUN TIN GTON BEACH DECLARATION At advd tweto is a true and wnred cwy of the oArent Gerftat+e of ireaarace and AdSbMai Inwed Endorsement OG 2010 im, wnich certlflcKe compiles with the insuranm requiremats of the Cw*W by and betweW the Gty of tiuntlrr$coro death raty")and the above wined contractor(`Contractor'}for the above-described project("Project"). I declare uroder pr fy of pe h ry under U*taws of the State of Cabibmia that the above staternent is titre and cme ct. Signed on_ 20_,at (date) (City,State) (Signature of Individual Who is bMakft Declaration) WARRANTY Ca*actor hereby warrants and agrees to maintain Product,and Convkted Operations insurance in comp wx*with the insurance regrrrrements of the CoT tract far the Project. Said insurance shall be maintained through and undo the eq*abon of ail Warranties provided by Contractm Said inm rarrce shall contain Addai"Invired Endlorsernent CG 20101185,naming City as an addlMonal insured. Contractor shall supply to City,on at least an annual bases,a Certificate of Inmrance and the aforementioned ftlorsement evidenciN continued coverage Witch meets the Contract requirements Signed on 20_,at (Daft) (city,state) cftmcrak- Marne: Name: — I'de: I"Wi.z This form to be turned in with Payment Bond L-5 1 - RESOLUTION NO. 2008-63 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH REVISING AND RESTATING THE. CITY'S INSURANCE AND INDEMNITY REQUIREMENTS WHEREAS, there are persons and organizations who are engaged in various activities in the City, thereby subjecting the City to substantial risk of liability for damage to property and injury to persons; and, The City desires to establish insurance and indemnification requirements; and, in appropriate cases, a procedure for the waiver thereof; and, The City desires to establish internal staff responsibility for the administration of the insurance required by this Resolution and delineate the authority to make adjustments to requirements based upon unique and unusual circumstances. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Huntington Beach that effective on the date of adoption of this Resolution, the insurance coverage and indemnity requirements shall be as follows: SECTION I. DEFINITIONS AND FORMS REQUIRED A. Definitions: 1. "Contractors' are any persons or entities who contract with the City and/or provide services to the City which are readily available and efficiently procured by competitive bidding. 2. "Design Professionals" are professional services contractors who contract with the City and/or provide architectural and/or engineering services to the City. 3. "Licensees/Lessees" are any persons or entities who contract with the City for the use of public property. 4. "Permittees" are any persons or entities who make application to the City for any use of or encroachment upon any public street, waterway, pier, or City property. 5. "Professional Services" are as defined by Huntington Beach Municipal Code section 3.03. 6. "Vendors" are any persons or entities who transfers property or goods to the City which may or may not involve delivery and/or installation. B. Indemnity and Insurance Coverage Requirements Defined 1. General Liability: Combined single limit bodily injury, personal injury and property damage: Minimum limits of$1,000,000 per occurrence. 19723 1 Resolution No. 2008-63 a. Coverage must include completed operations liability and unlimited blanket contractual liability and, where products are furnished, products liability. b. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 or an increased coverage as memorialized in the terms and conditions agreed to by the parties and the policy holder shall submit written notice of any known depletion of limits to City attached to the proof of insurance. C. Claims made policies are not acceptable, except that claims made insurance for pollution liability shall be acceptable. d. All deductibles in excess of $5,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. e. The City, its, officers, elected or appointed officials, employees, agents and volunteers are to be covered as additional insureds by separate attached endorsement(s) approved by the City Attorney as respects liability arising out of action performed by or on behalf of the contractor, products and completed operations of the contractor, premises owned, occupied or used by the contractor; or automobiles owned, leased or borrowed by the contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its agents, officers and employees. f. For any claims related to the project, the contractor's insurance coverage shall be primary insurance as respects the City, its agents, officers, and employees. Any insurance or self-insurance maintained by the City, its agents, officers, and employees shall be excess of the contractor's insurance and shall not contribute with it. g. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its agents, officers and employees. h. The contractor's insurance shall apply separately to each insured against Whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 2. Workers Compensation and-Employers' Liability: In accordance with the applicable state statutes with limits in the case of workers' compensation and employers' liability in amounts not less than the State statutory limits. Alternatively, a signed declaration of non-employee status shall be filed. A certificate or consent to self-insure issued by the California Director of Industrial Relations is also acceptable. 19723 2 T s Resolution No. 2008-63 3. Professional Liability Insurance: Coverage must be provided at a minimum of $1,000,000 per occurrence and in the aggregate. All deductibles in excess of $10,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. a. Claims made policies are acceptable if the policy further provides that: 1. The policy retroactive date coincides with or precedes the professional services contractor's start of work (including subsequent policies purchased as renewals or replacements). 2. The professional services contractor will make every effort to maintain similar insurance during the required extended period of coverage following project completion, including the requirement of adding all additional insureds. 3. If insurance is terminated for any reason, professional services contractor agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this agreement or permit. 4. The reporting of circumstances or incidents that might give rise to future claims. 4. Automobile Liability Coverage must be provided at a minimum of $1,000,000 per occurrence. a. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 and the policy holder shall submit written notice of any known depletion of limits to City attached to the proof of insurance. b. All deductibles in excess of $1,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. C. The City, its officers, elected or appointed officials, employees, agents and volunteers are to be covered as additional insureds by separate attached endorsement(s). The coverage shall contain no special limitations on the scope of protection afforded to the City, its agents, officers and employees. d. For any claims related to the project, the contractor's insurance coverage shall be primary insurance as respects the City, its agents, officers, and employees. Any insurance or self-insurance maintained by the City, its agents, officers, and employees shall be excess of the contractor's insurance and shall not contribute with it. 19723 3 s Resolution No. 2008-63 C. Certificate of Insurance Requirements Defined 1. Form. Evidence of insurance coverage and limits as required by the City shall be furnished to the City as a certificate holder on the "Acord' or similar form approved by the City-Attorney. (See samples attached herein as Exhibit"A"). a. The description of work to be performed, the City department involved in the performance, and the City staff contact person must be clearly identified on the "Acord" or similar form evidencing insurance coverage. b. All forms of insurance shall identify the City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers as an additional insured by separate attached endorsement with respect to general liability and automobile liability coverages. C. Contractors shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein. 2. Approval of Certificate Insurance certificates must be approved by the City Attorney prior to commencement of any performance under a contract or issuance of any permit, as authorized by the City Charter. 3. Acceptability of Insurers Insurance must be placed with insurer with a Best's rating of no less than A: VII and insurer must be a California admitted carrier. SECTION II INSURANCE AND INDEMNIFICATION REQUIREMENTS A. INSURANCE 1. Contractors and Permittees must meet the requirements as set forth in Exhibit "B" incorporated by reference and attached herein. Permittees who do not use vehicles or equipment in connection with the permit, shall not be required to provide auto insurance. To be exempt from this requirement, permittees must execute a declaration such as Exhibit I attached hereto and incorporated by this reference. 2. Professional Services providers must meet the requirements as set forth in Exhibit"C" incorporated by reference and attached hereto. 3. Licensees/Lessees must meet the requirements as set forth in Exhibit "D" incorporated by reference and attached hereto. 4. Vendors a. Vendors supplying goods including delivery, service and/or installation must meet the requirements of Exhibit "B". 19723 4 i Resolution No. 2008-63 b. Vendors supplying goods only without delivery, service and/or installation are required to provide products liability coverage only. 5. The insurance requirements of persons or organizations not identified herein shall be as designated by the agreement. All certificates of insurance designated must conform to the requirements of this Resolution. 6. Exceptions. a. Public entities are exempt from the requirements of this resolution. Any insurance and indemnity requirements of a public entity shall be pursuant to Section 11(A)(5). b. Persons providing judicial or quasi-judicial services as independent contractors, such as judges, arbitrators, hearing officers, expert witnesses, and court reporters shall be exempt from all insurance coverage requirements. Any insurance and indemnity requirements shall be pursuant to Section ll(A)(5). C. Each person making application for a permit for private property construction, alteration, improvement, demolition, or repair of any building or structure shall sign a declaration under penalty of perjury verifying workers' compensation coverage or exemption from coverage, as required by Section 19825 of the Health and Safety Code and, at the time of permit issuance, contractors shall show their valid workers' compensation insurance certificate. d. Persons contracting with the City under subdivision agreements are exempt from providing evidence of workers' compensation. e. Oil operators as regulated by Huntington Beach Municipal Code Section 15.16 and pipeline franchises as regulated by Huntington Beach Municipal Code Section 3.44 are exempt from the requirements of this resolution. f. TaxicabsNehicles-for-hire as regulated by Huntington Beach Municipal Code Section 5.50 are exempt from the requirements of this resolution. g. Trucking companies, including those regulated under Huntington Beach Municipal Code Section 10.32, are,exempt from the minimum insurance requirements of this resolution but must submit proof of workers' compensation insurance and general liability insurance in accordance with the requirements of the Public Utilities Commission (PUC) regulations which include: 1) the general liability insurance requirements are $600,000 combined single limit or $250,000 bodily injury or death of one person and $500,000 protection against total liability for bodily injury or death of more than one person from any one accident. 2) this is subject to the same $250,000 limitation for each person and $100,000 protection for accidental damage or destruction of property other than property being transported. 3) the City of Huntington Beach must be 19723 5 Resolution No. 2008-63 named as certificate holder but does not need to be named as additional insured. 7. Indemnity a. Contractors and Permittees shall be required to indemnify City, pursuant to the indemnity provision attached hereto and incorporated herein by this reference as Exhibit"E". b. All design professionals shall be required to indemnify City pursuant to the indemnity provision attached hereto and incorporated herein by this reference as Exhibit"F". C. All other persons or organizations, including but not limited to professional service providers other than Design Professionals as defined by this Resolution, shall be required to indemnify City, pursuant to the indemnity provision attached hereto and incorporated by reference as Exhibit "G". SECTION III. WAIVER OR MODIFICATION PROCEDURE A. Waivers or Modification Request Form. A department Request for Waiver or Modification, Exhibit "H" attached, shall be completed and forwarded to the Risk Manager for all requests for waiver or modifications of the minimum indemnification and insurance requirements. Claim history, financial statements and scope of work must be submitted as attachments with any request for waiver. B. Waiver or Modification Authority. The Risk Manager and the City Attorney may approve any waiver or modification of the insurance and indemnification requirements, including requests for indemnification of third parties. A denial may be appealed to the City Administrator. C Waiver Criteria. The criteria to evaluate any requests for waiver shall include the following: a. The type of waiver or modification requested; b. The reason for the waiver or modification; C. The nature of the scope of work; d. The cost of the contract; e. The liability exposure of the City; f. The cost and availability of the coverage requested; g. The claim history of the requesting party; h. The past experience of the City with the requesting party; and i. The past experience of the City with other contracting parties of a similar nature. 19723 6 Resolution No. 2008-63 SECTION IV. Resolution 2007-03 and all other resolutions in conflict herewith are hereby repealed. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting held 6th day of octoher 200_8_. e ND A P irecto f Hu n Resources VIEW PPROVED: §t*',4fm inistrator APPROVED AS TO FORM: City ttorney Attachments • �� Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G Exhibit H Exhibit I 19723 7 Resolution No.2008-63 AC®RD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWIN-M PRODUCER 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 NAIC p INSURED KSURERA: INSVRERB: INSURER C: INwRERD. INSURERS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IISUREDNAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAt41mG 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- "/SR Abox POUCYNUMSER POLICY EFFCCTIYE POLICYEXPBRATION LIMITS SURAKQE GENFAALUABM1ITY EACH OCCURRENCE S COMMERCLALGENERAL.UABILIIY PREWSESW3..r S CLMMSMADE OCCUR MGDE)PVAyom ) S PERSONALRAOVINRIRY S GEN.E'RtLA.GGREGATE S GEMLAGGREGATEUMLTAPPUESPER PRODUCTS-COMP/OP AGG S POLICY PRO-rcT LOC ALITOMOOKE LIABILITY COMBINEO SINGLE WAT ANY AUTO (EaamAerr) S ALL OWNED AUTOS 8001LYMUURY SCHEDULED AUTOS (Pe 11.) S HIREDAUTOS 800ILYINJURY N0N40WNEDAUTQS /1 (Peraoudem) S PROPERTYDAMAGE S (Pp aodda+tl GARAGELIABILITY \ AUTO ONLY-EAACCIOENT $ ANYAUTO t , OTHER THAN EA ACC S AUTOONLY: AGG $ EXCESWUMBRaAA LIABILITY EACHOCCURRENCE S OCCUR CLMNISMADE �i� AGGREGATE S DEOUCT18LE S RETENTION S s WC STATU- OTF4 WORKERS COMPENSATION AND EMPLOYERS'LNBM1I Y ARYPROPRIETORRARTNESLE%ECUnvE E.L.EACH ACgQENT $ OFAMRAAEUSEREXCLUDEM E.L.DISEASE-EAEMPLOYEE $ SPECfALPROV1 f0 SbaU.. E.L DISEASE-POUCYL"T S OTHER DESCRIPTION OF OPERATIONS i LOCATIONS I VEHKXPS/EXCLUSIONS ADDED BY ENDORSEMENTL SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCICS BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER VAU.ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUY FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABfUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(ZW1l08) EXHIBIT A-1 of 4 0 ACORD CORPORATION 1988 ` Resolution No.2008-63 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)- It 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(2001108) EXHIBIT A-2 of 4 Resolution No.2008-63 ' POLICY NUMBER: COMMERCIAL GENERAL CYtBtL17 r THIS ENDORSEMENT CHANGES THE POLICY. PLEASE R&O IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE Name of Person or Organization; THE CITY OF HUNTINGTON BEACH 2000 Main Street Huntington Beach, CA 92648 (if no entry appears above.information required to compteta :.his 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 orarganizadon shown in the Schedule, but only with respect to liability arising out of'your worl<for that insured by or for you RE: ALL OPERATIONS OF THE NAMED INSURED FOR THE CERTIFICATE HOLDER. City of Huntington Beach, its elected or appointed officials,agents, officers, employees and volunteers i CG 20 10 1185 Copyright.Insurance Services Office.Inc..1984 EXHIBIT A-3 of 4 Resolution No.2008-63 STATE P.O.BOX 420807.SAN FRANCWO<CA 94142-0807 COMPENSATION Fill BPtfslDff8AtdCE .; CERTlFlCAJfE'OF WORKERS°:E:OAAPEEdSATIfSN lNSl3Rp E" -�r v'�r. �jjyr�v.;,�v^, �''-=-✓'� Y.F='.%� %r;e::•. .�❖ti::._�IC.Y-...:. ...•.< ..�:7e. CITY (IF -�,%�. a7 �`-. ��.��'j.:':=',i•= s�';5:� 'may``. r ;�,,-��y�.�--�-•�-:_�i RISK MAMA f - >S+rH�;'-•ter' 2te®0 IARiN .STREEi'�.�t, :. I.7T'.-� :`<'¢•�:j`•` M• 3�I..' HUNTINGTON BEAGI, `CA 9n48 L_ This is to Certify that we have issued a valid Workers`Compensation insurance policy in a town approved by the California insurance Commissioner to the employer named below for the poll period indicated. This policy is not subject to cancellation by the Fund except upon tWiglays'advance written notice to the employe( 3 We will also give you TEW-days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend.extend or after the coverage afforded by the policies fisted herein. Notwithstanding any requirement,.term. or condition of any contract or other document with respect to which ttris'certificateits7irance matC:6e issi(ed_or may pertain, tF3e insiLrarfM_? `fiorife ,by the policies described herein is stibject to aq ^ e"rms:e�ocfusio[i§and coaiditioris of sucti pofici L:" `` :.�¢- G�< f ZYL AUTHORIZED REPRESEMTATnY ;•-• ^� r- €. 1 T EMPLOYER'S S LIABILITY LIMIT INCLUDING DEFENSE`COSTS: S1,000;:�0®:= ..��QCt�RREPDCE. qicENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07/01/ee IS ATTACHED TO AND FORMS'A PART OF THIS POLICY. d ^F EMPLOYER IF EXHIBIT A-4 of 4 L •Q �8 0 y Resolution No.2008-63 EXHIBIT B INSURANCE REQUIREMENTS FOR CONTRACTORS, AND PERMITTEES PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance ' City Council Resolution 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A:VIL 1. General Liability: $1,000,000 per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. "Claims made" designation is only acceptable for professional or pollution liability.insurance. The City of Huntington Beach its officers elected or appointed officials, employees, agents and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact.) 2. Workers' Compensation and Employer's Liability: State statutory limits of $250,000 bodily injury by disease, policy limit, and $100,000 bodily injury each employee for accident or disease per occurrence. If you have no employees, you must sign a Declaration of Non-employee Status foul available from the City. In lieu of a certificate of insurance, a certificate of consent to self-insure issued by the California Director of Industrial Relations is also acceptable. 3. Automobile liability of $1,000,000 per occurrence for bodily injury, personal injury and property damages. The City of Huntington Beach its officers, elected or appointed officials, employees, agents and volunteers must be named as certificate holder and as additional insured by separate attached endorsement_ (This wording must be exact)_ Deductibles, Self-Insured Retentions, or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Subcontractors Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and -endorsements for each subcontractor. All coverages for subcontractors shall be subject to -all of the requirements stated herein. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. PLEASE FORWARD THIS NOTICE TO YOUR INSURANCE AGENT. FOR ASSISTANCE, PLEASE CONTACT RISK MANAGEMENT. 0 6-39915 1 03 EXIMIT B a Resolution No.2008-63 EXHIBIT C INSURANCE REQUIREMENTS PROFESSIONAL SERVICE CONTRACTORS PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M_ Best's Rating of no less than A:VII : .Errors and.Omissions liability: $1,000,000 per occurrence. Deductibles, Self-Insured Retentions or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be .declared to and approved by the City of Huntington Beach. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. 06 399/5104 EXHIBIT C Resolution No.2008-63 EXHIBIT D INSURANCE REQUIREMENTS FOR LESSEESILICENSEES PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance City requires submittal of certificates of insurance pursuant to the form set forth in Resolution No. 2008-68" evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A:VI1: 1. General Liability: $1,000,000 per occurrence for bodily injury, personat injury and property damage: If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this projectflocation or the general aggregate limit shall be twice the required occurrence limit. "Claims made" designation is only acceptable for professional or pollution liability insurance. For general liability certificate holder, the City of Huntington Beach, its elected or appointed officials agents officers employees and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact). 2. Workers Compensation and Employer's Liability: State statutory -limits of $250,000 bodily injury by disease, policy limit, and $100,000 bodily injury each employee for accident or disease per occurrence. If you have no employees, you must sign a Declaration of Non-employee Status form available from the City. In lieu of a certificate of insurance, a certificate of consent to self-insure issued by the California Director of Industrial Relations is also acceptable.. 3. Property Insurance: Full replacement -cost with no coinsurance penalty provision. Deductibles, Self-Insured Retentions, or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. PLEASE FORWARD THIS NOTICE TO YOUR INSURANCE AGENT, FOR ASSISTANCE, PLEASE CONTACT RISK MANAGEMENT 06-399/5105 EXL!1B IT D Resolution No.2008-63 EXHIBIT E TO RESOLUTION NO. 2008-63 CONTRACTOR'S INDEMNIFICATION DEFENSE HOLD HARMLESS Contractor hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Contractor's employees and damage to Contractor's property, arising directly or indirectly out of the obligations or operations herein undertaken by Contractor, caused in whole or in part by any negligent act or omission of the Contractor, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Contractor will conduct all defense at its sole cost and expense and City shall approve selection of contractor's counsel. City shall be reimbursed for all costs and attorneys fees incurred by City in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Contractor. 06-399/5106 EXHIBIT E Resolution No.2008-63 EXHIBIT F TO RESOLUTION NO. 2008-63 INDEMNIFICATION DEFENSE AND HOLD HARMLESS To the fullest extent permitted by law (including, without limitation, California Civil Code Sections 2782 and 2782.6), CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, demands, and defense costs (including without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANTS (or CONSULTANT's subcontractors, If any) negligence, recklessness or willful misconduct related to performance of this Agreement or its failure to comply with any -of its obligations container) .in _this Agreement by CONSULTANT, its officers, agents or employees. CITY shall be reimbursed by CONSULTANT for all costs and attorneys fees incurred by CITY in enforcing this obligation. CONSULTANT will conduct all defense at its sole cost and expense, and the CITY shall approve selection of CONSULTANTs counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by the CONSULTANT. 06-399/5107 EX -E B I T F Resolution No.2008-63 EXHIBIT G TO RESOLUTION NO- 2008-63 INDEMNIFICATION DEFENSE AND HOLD HARMLESS CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT''s subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or wilful misconduct of CITY. CITY shall be reimbursed by CONSULTANT for all costs and attorneys fees incurred by CITY in enforcing this obligation. CONSULTANT will conduct all defense at its sole cost and expense and the CITY shall approve selection of CONSULTANTs counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as limitation upon the amount of indemnification to be provided by the CONSULTANT. 06-399/5t08 EXIIIBIT G Resolution No.2008-63 INSURANCE AND INDEMNIFICATION WAIVED MODIFICATION REQUEST 1. Requested by: 2. Date. 3. Name of contractor/pennittee: 4. Description of work to be performed: 5. Value and length.of contract: 6_ Waiver/modification request: 7. Reason for request and why it should be granted: 8. Identify the risks to the City in approving this waiver/modification- Department Head Signature Date: APPROVALS Approvals must be obtained in the order listed on this form. Two approvals are required for a request to be granted_ Approval from the City Administrator's Office is only required if Risk Management and the City Attorney's Office disagree. 1. Risk Management ❑ Approved ❑ Denied Signature Date 2. City Attorney's Office ❑ Approved ❑ Denied Signature Date 3. City Administrator's Office ❑ Approved ❑ Denied Signature Date If approved,the completed waiver/modification request is to be submitted to the City Attorney's Office along with the contract for approval. Once the contract has been approved, this form is to be filed with the Risk Management Division of Administrative Services EXHIBIT H • Resolution No.2008-63 S lty CITY OF HUNTINGTON BEACH 2000 Main Street Huntington Beach, CA 92648 DECLARATION OF PERMITI'EE I certify that no vehicle(s) will be used or operated in the performance of the task(s) or event(s) for which this permit is granted. I authorize the City of Huntington Beach to immediately and retroactively revoke the license or permit issued in connection with or in the performance of said task(s) or event(s) if any vehicle(s) is used. Signature of Permittee Print name Company name (if applicable) Date signed 16407 EXHIBIT I Res. No. 2008-63 STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH ) I, JOAN L. FLYNN the duly elected, qualified City Clerk of the City of Huntington Beach, and ex-officio Clerk of the City Council of said City, do hereby certify that the whole number of members of the City Council of the City of Huntington Beach is seven; that the foregoing resolution was passed and adopted by the affirmative vote of at least a majority of all the members of said City Council at a regular meeting thereof held on October 6, 2008 by the following vote: AYES: Hansen, Hardy, Bohr, Cook, Coerper, Carchio NOES: None ABSENT: Green ABSTAIN: None Citiberk and ex-officio erk of the City Council of the City of Huntington Beach, California SECTION C PROPOSAL for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT#454 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in t the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of 4 the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY 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 AGENCY of the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. 0 C-1 00 Bid Schedule . f. MSC e 454 Cold Plane 1 706,001 S.F. per S.F. Furnish and Install Petromatzc.� �2�j �w 2 2,537,923 S.F. at-C h',Yr �� per S.F. $ G_�� Furnish and Install Asphalt at .12' 3 22,841 Ton at S ee -s er Ton $ -5° $ © 2q Adjust Water Valves to Grade o 4 338 EA per Each $ 2 , vd $_71 W _ Adjust Manholes to Grade 5 262 EA per Each $2SC.- $ Install Traffic Loops 6 30 EA atTv��� .�� „a-� ���ir�.fs per Each $ �' $ _ Prepare Pre & Post Construction Corner Record and File with Appropriate Agencies 7 241 EA aar, per Each $ 2-w � $SS (43b otal Bid Amount in Figures $°2 32.Gt otal Bid Amount in Words i { �+ i C-ZS a nWT If.awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, fmd in the amount of$ 0�o which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or"Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received Bidder's! i attire C-2 LIST OF SUBCONTRACTORS in accordance with Government Code Section 4104, the Bidder shall set forth the name and "I business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of { the work to be done by such subcontractor. { Portion Name and Address of Subcontractor. State License Class I of Work Number �vU By submission of this proposal, the Bidder certifies: I. i' 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. i 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. 1 6 1 C-3 P NONCOI..LUSION AFFIDAVIT TO DE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. , County off fAlia CS(DG being first duly sworn, deposes and says that he es-she is V 0 of ¢a-U A.&UtAA.)~e party making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine asp 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, or 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 fee to any corporation, partnership, company association, organization, bid depository, or r. to any member or agent thereof to effectuate a collusive or sham bid. Name of Bidder Signature of Bidder P.o . 6of aaaq Address of Bidder Subscribed and sworn to before me this day of , 20 — NOTARY PUBLI oi NOTARY SEAL C-4 CALIFORNIA JURAT State of California County of Riverside Subscribed and sworn to (or affirmed) before me on this 17th day of December , 200 8 Date Month By (1) Robert Bradley Name of Signer Proved to me on the basis of satisfactory evidence BRENDA L. ROYSTER ) be the person who appeared before me commission # 1700922 z ? p." Notary Public -California ti , ° Riverside County (an i Comm.Exr'res Oct 26,2010 (2) Name of Signer Pro to me on the basis of satisfactory evidence be he person who appeared before me.) Signature Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document o a Title or Type of Document Noncollusion Affidavit Top of thumb here Top of thumb here Document Date: 12-17-08 Number of Pages: 1 Signer(s)Other Than Named Above: None M � UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL I CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .I2' MAINTENANCE SERVICE CONTRACT# 454, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Contractor f� i Title 1 1 1 1 Date: C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? ® Yes o If the answer is yes, explain the circumstances in the space provided. PIA- Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 � 1 , COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every I employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. i Contractor I� E. Title Date: r - G I IE .I 1 1 ;i it C-7 i i i UNDERGROUND SERVICE:ALERT IDENTIFICATION NUMBER (To be completed only by the awarded'Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Contractor W'6 NUDRjr- Title Date: f �(� Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Bidder Name P Business Address CAL City, , State Zip Telephone Number a6?o7 ? I State Contractor's License No. and Class � _11- 7 1 Original Date Issued Expiration Date The work site was inspected by of our office on , 20 C The following are persons, firms, and corporations having a principal interest in this proposal: C-9 1 � ' 9The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to .perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Company Na�mA SiCnat6e of Bidder Vt c. p Printed or Typed Signature Subscribed and sworn to before m is of , 200_ . NOTARY P LIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: n 1• ��; Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type o Date Completed 2. Name and Address of Public Agencyl s. Name and Telephone No. of ct Manager: Contract Amount Type of Work Date Completed 3. A Name and AddreX of Public Agency A Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed C-10 CALIFORNIA JURAT State of California County of Riverside Subscribed and sworn to (or affirmed) before me on this 17th day of December , 200 8 Date Month By (1) Robert Bradley Name of Signer Proved to me on the basis of satisfactory evidence BRENDA L. ROYSTER be the person who appeared before me (.) (,) k'� Commission # 1700922 W .A, =-� � Notary Public -California If Z ` 3 F a Riverside County (and My�comm.Exoresoc— 2010 (2) Name of Signer Prove o me on the basis of satisfactory evidence be a person who appeared before me.) Signature-- Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document Title or Type of Document Bidder's Information Top of thumb here Top of thumb here Document Date: 12-17-08 Number of Pages: 2 Signer(s)Other Than Named Above: None "2008" PAST WORK REFERENCES City of Irvine University Drive Rehabilitation One Civic Center Plaza Contract Amount: $3,445,289.40 P.O. Box 19575 Start: 1/2008 Irvine, CA 92606-5268 Completed: 6/2008 Contract: Kal Lambaz, (949) 724-7555 City of Anaheim Anaheim Blvd. Improvements 200 South Anaheim Blvd. Contract Amount: $278,391.00 Anaheim, CA 92805 Start: 4/2008 Contact: Sean Razmy, (714) 765-5069 Completed: 6/2008 City of Newport Beach Superior Avenue Improvements 3300 Newport Blvd. Contract Amount: $862,862.00 Newport Beach, CA 92658 Start: 1/2008 Contact: Andy Tran, (949) 644-3315 Completed: 6/2008 City of Westminster Citywide Street Improvements 8200 Westminster Blvd. Contract Amount: $1,118,383.00 Westminster, CA 92683 Start: 3/2008 Contact: Theresa Tran, (714) 898-3311 Ext. 282 Completed: 7/2008 City of Lake Forest Street Resurfacing& Slurry Seal 25550 Commercentre Drive, Suite 100 Contract Amount: $1,638,523.00 Lake Forest, CA 92630 Start: 2/2008 Contact: Luis Estevez, (949) 461-3485 Completed: 4/2008 City of Santa Ana Santa Clara Avenue Improvements 20 Civic Center Plaza Contract Amount: $2,219,523.00 Santa Ana, CA 92701 Start: 11/2007 Contact: Ed Torres, (714) 647-5018 Completed: 3/2008 ® D Fidelity and Deposit Company of Maryland Home Office: P.O.Box 1227.Baltimore.MD 21203-1227 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, ALL AMERICAN ASPHALT BOND NO. 085 97 423 as Principal,(hereinafter called the"Principal"), and FIDELITY AND DEPOSIT COMPANY OF MARYLAND P.O. Box 1227, Baltimore, Maryland 21203, a corporation duly organized under the laws of the State of Maryland, as Surety,(hereinafter called the"Surety"),are held and firmly bound unto City of Huntington Beach as Obligee,(hereinafter called the"Obligee"),in the sum of TEN PERCENT OF THE TOTAL BID PRICE IN-------- Dollars($ 10%OF TOTAL BID PRICE ),for the payment of which sum well and truly to be made,the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS,the Principal has submitted a bid for Various Residential Streets for Asphalt Overlay at 12', Maintenance Service Contract 4454 Bid Date: December 18,2008 NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 8th day of December A.D., 2008 ALL AMERICAN ASPHALT (SEAL) I Pr' cipal fitness 4 Title FIDELITY AND DEPOSIT COM NY OF MARYLAND Sure By - (SEAL) Witness WEN M. BROWN Attorney-in-Fact Printed in cooperation with the American Institute of Architects(AIA)by Fidelity and Deposit Company of Maryland. Fidelity and Deposit Company of Maryland vouches that the language in the document conforms exactly to the language used in AIA Document A-310,February 1970 Edition. BID70000ZZ0701f CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT State of California County of Riverside On December 17, 2008 before me, Brenda L. Royster,Notary Public Date Here Insert name and Title of the Officer personally appeared Robert Bradley Namellliili}e Signer(V_ 7 who proved to me on the basis of satisfactory evidence to be the A e e _ __ person(s) whose name(s) is/are subscribed to the within instrument BRENDA L. ROYSTER and acknowledged to me that he/she/they executed the same in Commission # 1700922 his/her/the+r authorized capacity(ies), and that by his/he4their Notary Public -California = signature(s) on the instrument the person(s), or the entity upon behalf Riverside County of which the person(s)acted,executed the instrument. Comm.Ex dyes Oct26,2010 I certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing paragraph is true and correct. WITNESS m and and official seal. kt4&W-4 , _Ac� Signature Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law,it may prove valuable to person 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 Bid Bond— City of Huntington Beach Document Date: December 8, 2008 Number of Pages: 3 Signer(&)Other Than Named Above: Owen M. Brown, Attorney-In-Fact Capacity(ies)Claimed by Signer(s) Signer's Name: Robert Bradley Signer's Name: ❑ Individual ❑ Individual X Corporate Officer—Title(&): Vice President ❑ Corporate Officer—Title ❑ Partner—❑ Limited❑ General ❑ Partner—❑ Limited eneral ❑Attorney in Fact ❑Attorney in Fact ° ❑Trustee "thumb Top of thumb here ❑Trustee ❑Other: ❑Other: Signer is Representing: Signer s Representing: All American Asphalt r - CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On 12-8-08 before me, BARBARA J. BENDER NOTARY PUBLIC we Hem itsert Name of me dicer personally appeared OWEN M. BROWN rosy 61 side.{s) B0 Q -, J.BE- - who proved to me on the basis of satisfactory evidence to Commission*1801899 be the person(s) whose name(*) is/M subscribed to the Notary Public-California within instrument and acknowledged to me that Orange County executed the same in hisiVOOM authorized MY Comm.Ex Qires Jul 13,2012 capacdy*r,), and that by i signature(w) on the instrument the person(s), or the entity upon behalf of which the person(®) acted, executed the instrument. r. C210411188110111BARBARA J.BENDER I certify under PENALTY OF PERJURY under the laws Pdft-Camervft of the State of California that the foregoing paragraph is true and Corr WITNESS Ao�ffz-�/ Signature Place rotary seat Move Sig- Notary OPTIONAL Though the inforrradon below is not required by law,it may prove valuable to persons retying on the document and could prevent fraudWent removal and reattachment of this form to another document. Description of AthwJwd Document Title or Type of Document: BID BOND Document Date: 12—.8,08 Number of Pages: Signer(s)Other Than Named Above: ALL AMERICAN ASPHALT Capacity(ies)Claimed by Signer(s) Signer's Name: OWEN M. BROWN Signer's Name: D individual ❑Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑Limited ❑General ❑Partner—❑ Limited ❑General r X!NXAftomey in Fact ❑Attorney in Fact ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: FIDELITY AND DEPOSIT COMPANY OF MARYLAND - �.S.cs""��,��C�v.. :-'+ - c..L u c_r�'c:l,`C.�,`V c.S.`�C%c..'v�vcG•.Iv�r.r�-<l '-�.= 02W Nabonal Notary A •9350 Do Soto Ave..P.O.Box 2402-Chatwworth,CA 91313.2402-www.NauonaiNotary org Item#5907 Reorder:Cali ToA-Freer-7?f tF s!r;,si'�"7 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,a corporation of the State of Maryland, by WILLIAM J. MILLS,Vice President,and ERIC D. BARNES,Assistant Secretary, in pursuance of authority granted by Article VI, Section 2,of the By-Laws of said Company, are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date liff e dds by nominate,constitute and appoint Owen M.BROWN,of Anaheim,California, its true and or act,to make,execute, seal and deliver, for,and on its behalf as surety,and as its act a a takings,and the execution of such bonds or undertakings in pursuan s,s ° pon said Company,as fully and amply,to all intents and purposes,as if th xe, 6 ged by the regularly elected officers of the Company at its office in Bat ' irj heir r This power of attorney revokes that issued on behalf of Owen M. at ru y The said Assistant c o that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2,of the By- any,and is now in force. IN WITNESS W R OF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 27th day of December,A.D.2004. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND 'gyp 9EPpsri _ti p°IOjv �' t fa o W �O im ? 4 � ; U By: Eric D. Barnes Assistant Secretary William J. Mills Vice President State of Maryland ss: City of Baltimore On this 27th day of December, A.D. 2004, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn,severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Maria D. Adamski Notary Public My Commission Expires: July 8,2011 POA-F 012-4160 r i >s-,�> , x :..: v� k,.,. c, ,,...:.n� rt ,... _ v f .:.. .5, .. ,. s•^ --,.. � 1 ti6a-4�r"�• "� i 1 wu-1 ,..,. 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"`.' r .emu. rx.>,.�. t2;�'�.,x.w '3^a r� -a : r k .� x., :; _xs.��fb SECTION C ND PROPOSAL for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT # 454 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish I all labor, material, 'equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY 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 AGENCY of the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 18. Addenda The effect of all addenda to the contract documents shall be considered in the bid package and said addenda shall be made part of the contract documents and shall be returned with the bid package. Failure to submit any such addenda with the bid package may render the bid irregular and may result in its rejection by the AGENCY. 19. Bid Protest To be considered timely, a bid protest must be filed within the following time limits: (a) Protests based upon alleged defects or improprieties in the bid documents shall be filed prior to the date of bid opening. (b) All other protests must be filed within five calendar days after the protester knew or should have known the basis of the protest, but no later than five calendar days after the date of when the Bids were due to the AGENCY. 20. Questions to the Engineer Questions regarding the bid documents (i.e. plans, specifications, contract documents, bid forms, etc.) will be received by the Engineer up to five working days prior to the bid opening as specified in SECTION A. Questions asked of the Engineer after this time will not be addressed. B-5 'id Schedule MSC - 454 Cold: pe �3 1 706,001 S.F. at per S.F. Fu tall Petromat yq 2 2,537,923 S.F. at per S.F. Furnish and Install Asphalt at S. 3 22,841 Ton at r Ton $ $ Adjust ater V vest rade 4 338 EA a per Each Adj st Manholes Io r e 5 262 EA at per Each $ Z $ Install Traffic Loops 6 30 EA at 9*1 per Each $4 $ Prepare Pre & Post Construction Corner Record an File wit Appropriate Agencies V® — �® &10 7 241 EA atl per Each $ $ dotal Bid Amount in Figures $ Z 3'� GG�• !�Z - Total Bid Amount in Words " C-2s If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option,be considered null and void. Bidder' s Bond Accompanying this proposal of bid, find in the amount of$ 10 o which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or"Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received dder's srenature 1 12/4/08 6 6 A - f Steve/ Kirschner, Vice President C-2 LIST OF-SUBCONT'RAC ORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name and Address of Subcontractor State License Class of Work Q Number J2 ) G7? /cp ZI VAE,e4 904 o By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO DE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange Steve Kirschner_ , being first duly sworn, deposes and says that he or she is v; ot- P rp--J den t- Of lard Z— T-J-4rFer' Tne the parry making the foregoing bid that the bid is not made in the interest of, or on the 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, or 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 fee to any corporation, partnership, company association, organization,bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Hardy & THar=Pr.,Tnr Name of Bidder C6- 11t U�,()AIA -- Signature d4i\dder-5f6ve Kirschner Vice President 1312 E. Warner Ave. , Santa Ana, CA Address of Bidder Subscribed and sworn to before me this day of , 20 NOTARY PUBLIC NOTARY SEAL C-4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On December 18, 20ng before me, ,lo-Ann Lyons Nota Public Date Here Insert Name and itle of the Officer personally appeared Steve Kirschner Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(M whose name(&) is/am subscribed to the within instrument and acknowledged to me that he/stm/ety executed the same in his/her/fir authorized capacity(i&), and that by his/ler/tkair signature(p on the instrument the person(6), or the entity upon behalf of 1, which the person(&) acted, executed the instrument. 9M YO JO—ANN LNS� vj COMM. #1570145N I certify under PENALTY OF PERJURY under the laws NOTARY PUBLIC-CALIFORNIA6 of the State of California that the foregoing paragraph is ORANGE COUNTY true and correct. Y COMM. EXP. APR. 17, 2009 WITNESS y nd and cial seal. Signature — 6-� Place Notary Seal Above Signature of Not ry Pub' 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: NonCollusion Affidavit Document Date: December 17, 2008 Number of Pages: 1 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Steve Kirschner Signer's Name: ❑ Individual ❑ Individual Corporate Officer—Title(s): VicePresdent ❑ Corporate Officer—Title(s): Partner—❑ Limited ❑ General ❑ Partner—❑ Limited ❑ General _ ❑ Attorney in Fact 100;15 ❑Attorney in Fact ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: Haul„R Horne. Inn. 02007 National Notary Association•9350 De Soto Ave.,PO.Box 2402•Chatsworth,CA 91313-2402•www.NationalNotary.org Item#5907 Reorder:Call Toll-Free 1-800-876-6827 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT# 454, (I)(we)(it)will employ and utilize only qualified persons, as hereinafter defined,to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Hardy & Harper, Inc. Contr for By StevW Kirschner,. Vice President Title Date: 12/17/0 8 C-5 I IDISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulatioia? ❑ Yes ® No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I I will comply with such provisions before commencing the performance of the work of this contract. Hardy & harper-, ine Con actor 91 By Steve j�irschner , Vice President Title Date: 12/17/0 8 C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Hardy & Harl2er, Tnc-_ Contr r , By , teve `Er1 schner Vice President Title Date: Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 i BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: Na rdW F. Tja rpi r Tn C: Bidder Name 1312 E. Warner Ave . 1 Business Address a-P-ta A n a eT 92:765 City, State Zip ( 714 ) 444-1851 Telephone Number 215952 A, C-8, C-12 State Contractor's License No. and Class 3/1 3/6 3 Original Date Issued Expiration Date The work site was inspected by r , K i r z c n A,of our office onDe cembe r 10 � 20 0 8 The following are persons, firms, and corporations having a principal interest in this proposal: Fred T_ Maa-t ,Tr,� Prer-qidnnt Dan T. Maas , CEO Steve Kirschner, Vic--(- President Kristen S. Paulino , Corporate Secretary C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Ha d.-.- & H r er Inc. Co Name Signature of Bidder Steve Kirschner, vice President Printed or Typed Signature Subscribed and sworn to before me thisl?thday of December ,2008 . NOTARY PUBLIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: 1 See Attachinent A B r -- Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed 2. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed 3. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed C-10 Attachment A Yfardy c0farper, Inc. Owner/Agency Contact Project (Amount & End Date) Anaheim Union High School John Oskoui, P.E. Loara High School District (949)999-5456 Paving Improvement Project 501 Crescent Way $2,300,000.00 11/08 Anaheim, CA 92803 City of San Jacinto Habib 2007 Downtown Pavement 248 E. Main St (951)487-7330 $2,023,667.00 4/08 San Jacinto, CA 92583 County of Riverside Gabriel Munoz Indio Resurfacing & 2950 Washington St (714)985-8440 Reconstruction Riverside, CA 92504 $2,028,769.00 2/08 City of Westminster Dave Sanchez Citywide Cap & Slurry Seal 8200 Westminster Blvd (714)898-3311 $816,300.00 8/07 Westminster , CA 92683 City of Fontana Keith Kramer Paving Various Locations Per 8353 Sierra Ave (909)350-6760 Bid # DB-58-01 Fontana, CA 92335 $2,683,906.00 7/07 Attachment B 5Tardy &Yfarper, Inc. Owner/Agency Contact Project (Amount & End Date) County of Orange Holly Phillips Annual Asphalt, Concrete 1750 S. Douglass Rd (714)567-6253 Pavement Maintenance Anaheim, Ca. 92806 $1,450,000.00 (ongoing) City of Rancho Palos Verdes Bindu Rash Annual Roadway Maintenance 30940 Hawthorne Blvd (310) 544-5252 $747,600.00 (ongoing) Rancho Palos Verdes, CA 90275 Placentia-Yorba Linda USD Rick Guadarama Masonry/Earthmoving/Grading 1301 E. Orangethorpe Ave (714) 985-8440 Various Schools Placentia, CA 92870 $ 1,150,000.00 (ongoing) City of Corona David Vigil Paving & Asphalt Maintenance 400 S. Vicente Ave (951) 736-2481 $ 125,000.00 (ongoing) Corona, CA 92882 City of Mission Viejo Kim Lemlin Annual Routine Maintenance 27204 E. La Paz Rd (949) 470-3064 Program for R & R Asphalt Mission Viejo, CA 92692 Pavement $ 751,044.00 (ongoing) CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On Deceimbpr 18, 9nnA before me, do-Ann Lys, Nota��[ Public Date Here Insert Name andfitle of the Officer personally appeared Steve Kirschner Names)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(gp whose name(0) is/a& subscribed to the within instrument and acknowledged to me that he/sue/tl;�Py executed the same in his4M fir authorized capacity(ieo), and that by his/Mr/tl%ir signature(q) on the _ instrument the person(a), or the entity upon behalf of V •� ! VO—ANN LYONS which the person(®) acted, executed the instrument. .M�. COMM. #1570145N NOTARY PUBLIC-CALIFORNIAt4 I certify under PENALTY OF PERJURY under the laws ORANGE COUNTY 1. of the State of California that the foregoing paragraph is MY COMM. EXP. APR. 17. 2009 true and correct. WITNESS my nd and ^ial seal. Place Notary Seal Above Signature Signatur&of Note Cublic 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: Bidder's Information Document Date: December 17, 2008 Number of Pages: 1 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Steve KirsehaeF Signer's Name: ❑ Individual ❑ Individual F Corporate Officer—Title(s): Vice Piesident ❑Corporate Officer—Title(s): ❑ Partner—❑ Limited ❑ General _ ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact • ❑Attorney in Fact • ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: Hardy Harper, IPC. 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 a I c5urely`Zlonds c5ince/90l One Newark Center I International Fidelity Newark, New Jersey 07102 I N S U R A N C E C O M RA, N Y (973)624-7200 KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, HARDY&HARPER, INC. as Principal, and THE INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation of the State of New Jersey, as Surety, are hereby held and firmly bound unto CITY OF HUNTINGTON BEACH in the penal sum of TEN PERCENT OF THE TOTAL AMOUNT BID------------------- ($ 10%------------ ) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns. Signed, this 4TH day of DECEMBER , 20 08. The condition of the above obligation is such that whereas the Principal has submitted to CITY OF HUNTINGTON BEACH a certain bid, attached hereto and hereby made a part hereof, to enter into a contract in writing for VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT 12', MAINTENANCE SERVICE CONTRACT#454 NOW, THEREFORE, (a) If said bid shall be rejected, or in the alternate (b) If said bid shall be accepted and the Principal shall execute and deliver a contract in the form of contract attached hereto, properly completed in accordance with said bid, and shall furnish a bond for the faithful performance of said Contract, and for the payment of the persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said bid; THEN,THIS OBLIGATION SHALL BE VOID,otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligation of said Surety and its bond shall be in no way impaired or affected by any extension of time within which the said bid may be accepted; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF,the Principal and the Surety have hereto set their hands and seals, and such of them as are corporations have caused their corporate seals, to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above. Signed, sealed and delivered in the presence of: HARD &HARP ' , INC. ATTEST: � PrincipalSteve Kirschner, Vice President ATTEST: INTERNATIONAL FIDELITY INSURANCE CO. e By: Bid Bond Date 2/4/08 DWIGHT REILLY �- Attorney-In-Fact CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT GMENT State of California County of Orange On December 1 88 before me, Jo-Ann L Notar Pblic Date Officer personally appeared Steve Kirschner Name(s)of Signer(s) 0 who proved to me on the basis of satisfactory evidence to be the person(a) whose name(o is/Me subscribed to the within instrument and acknowledged to me that he/ewe/#kTfff executed the same in his/M/tt%ir authorized capacity(igM), and that by hisMr/t=r signature(@) on the instrument the person(6), or the entity upon behalf of which the person(o) acted, executed the instrument. ,;0—ANN LYONS COMm. #1570145V, ;,+GY,_. Vj I certify under PENALTY OF PERJURY under the laws r NOTARY PUBLIC-CALIFORNIA ORANGE COUNTY of the State of California that the foregoing paragraph is MY COMM. EXP. APR, 17. 2009 true and correct. WITNESS my h nd and i ial seal. Signature Place Notary Seal Above Signature of Notary ublic 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: Bid Bond Document Date: December 4, 2008 Number of Pages: Signer(s) Other Than Named Above: Dwmqht Reilly Capacity(ies) Claimed by Signer(s) Signer's Name: Stave Kirschner Signer's Name: ❑ Individual ❑ Individual Corporate Officer—Title(s): Viee PFesidefit ❑Corporate Officer—Title(s): Partner—❑ Limited ❑ General ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact ° ❑Attorney in Fact ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: Hardy P Harnar, Inr ©2007 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationaiNotaryorg Item#5907 Reorder:Call Toll-Free 1-800-876-6827 ACKNOWLEDGMENT State of California County of ORANGE ) On DECEMBER 4TH, 2008 before me, ALLISON RITTO, NOTARY PUBLIC (insert name and title of the officer) personally appeared DWIGHT REILLY who proved to me on the basis of satisfactory evidence to be the person(() whose name(s) is/aye subscribed to the within instrument and acknowledged to me that he�she/they executed the same in his/"T,ar`r`i en authorized ca acit p y(*es), and that by his{I°reNtl -en-signatures) 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. ALLISON f2IT Commission#ts3y WITNESS my hand and official seal. 7aba 01MV Notary Public-California Orange CR23,2008 Comm.Expires Signature (Seal) ALLISON RITTO Tcl(973)624-7200 POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY HOME OFFICE:ONE NEWARK CENTER,20TH FLOOR NE•WARK, NEW JERSEY 07102-5207 FOR BYD BONDIRIDER/CONSENTSIAFFMAVTfS KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing laws of the State of New Jersey,and having its principal office in the City of Newark,New Jersey,does hereby constitute and appoint DWIGHT REILLY. HAL DUECK Anaheim,CA. its true and lawful attorrhey(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 wridags obligatory in the nature thereof,which are or may be allowed,required or permitted by law,stature rule regulation,cohtract or otherwise and the execution of such instumengs) in pursuance of Hu d-i se presents, shall be as binng upon the said &fti NAi%NAL FIDELITY INSURANCE COMPANY,as fully and amply, to all intents and purposes,as if the same had been duly executed and acknowledged by its mgulady elected officers at its principal office. This Power of Attorney is executed,and may be revoked pursuant to and by authority of Article 3-Section 3,of the By-Laws adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCk COMPANY at a meeting called and held on the 7th day of Tebruary, 1974. The President or any Vice President,Executive Vice President,Secretary or Assistant Seereury,shall have power and authority (1)To appoint Attorneys-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 remove,at any time.any such attorney-in-fact and revoke the authority given. Further,this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of saW Company adopted at a meeting duly called and held on the 29th day of April, 1992 of which Elie following is a true excerpt: Now therefore the signatures of such officers and the seal of the Company may be affixed to any such power of attorney or any certificate relating tMreto by facsimile,and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any such power so executed and rtted by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is anached. dk y ryf IN TESTIMONY WHEREOF,INTERNATIONAL FIDELITY INSURANCE COMPANY hu caused this nsoument to be IN®�® signed and its corporate seal in be affixed by its authorized officer,this 29th day of August.A.D.2003. 4 SEAL sue.+ INTERNATIONAL FIDELITY INSURANCE CO NY STATE OF NEW JERSEY g � y County of Flux �7''1Md $ � a • SecrcW On this 29th day of August 2003.before me came the individual who executed rim p ing uutsument,tome personally known and, being by me duly sworn,said the he is the therein described and authorized officer of the R11 ERNATiONAI,frTREL17Y INSURANCE COMPANY';that the seal affixed to said instrument is the Corporate Seal of said Company;that the said Corporate Seal and his signature were duly affixed by order of the Board of Directors of said Company. e49,, ,1,k IN TESTIMONY WHEREOF,1 have hereunto set my hated affixed my Official Seal, at the Ciry of Newark,New Jersey the day and year first above written. A NOTARY PUBLIC OF NEW JERSEY CERTIFICATION My Commission Expires Nov.21,2010 1,the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregning copy of the Power of Attorney and affidavit,and the copy of the Section of the By-Laws of said Company as set forth in said Power of Attorney,with the ORIGINALS ON IN THE HOME OFFICE OF SAID COMPANY,and that the same am correct transcripts thereof,and of the whole of the said originals,and that the said Power of Attorney has not been revoked and is now in full force and effect IN TESTIMONY WHEREOF,I have hereunto set my hand this 4th day of DECEMBER,2008. / �/" Assistant Secretary City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1,2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1,dated December 1, 2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for I. Various Residential Street Overlay, MSC-464 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum lNumr one, d t De ber 1, 2008. Compa By Name Steve Kirschner, Vice President 12/17/08 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714)374-1732. CONTRACTOR'S SWORN STATEMENT AND WARRANTY REGARDING CONTINUING INSURANCE OBLIGATIONS FROM PROEM (Catrtractor Name) (Street Address) (City,State arsd Zip) TO: CM OF HUIMNGTO(d BEACH DECLARATION Attached hereto is a true and ovrect cry of the curmt CerMicate of Irexa r4ce and A&MJonal Insured Endorsement CG 2010 1185, which Certkate complies with the insurance requirements of the Contract try and between the City or Muntington Beach("aty')and the above-named Contractor montracw)for the above rtued pra!ed("Projoct)• I declare under meshy of perry under the laws of the State of CalIvfornia that the abm staternent is tive and correct. Signed on_ __ 20—at (Date) (C+ty,State) (Signature of Individual Who is Making Declaration) WARRANW Contractor hereby warrants and agrees to maintain Products and Competed Operations insurance in romc#nce with the insurance requirements of the C retract for the Project Said insurance shall be maintained through and"ttre espiratim of all Warranties prcvi ied by Contractor. Said hR rance shall contain AddtCrO W Insured&xWrsesnent GG 20101185,naming City as an addctional krsured. Contractor shall supply to Oty,on at least an annual t>asi4 a Certificate of ln&"nce and the aforementioned Endorsement eviderusng continued coverage%hich meets the Contract requirements. Signed on 20_ist ( ) (err,siate) CONTRACra►t: Man". W. -- Name: tamer Tme: 777r37.2 This fr®rm t® be turned in with Payment Band L-s RESOLUTION NO. 2008-63 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH,REVISING AND-tES-TATI.N_G-THE CITY'S INSURANCE AND INDEMNITY REQUIREMENTS WHEREAS, there are persons and organizations who are engaged in various activities in the City, thereby subjecting the City to substantial risk of liability for damage to property and injury to persons; and, The City desires to establish insurance and indemnification requirements; and, in appropriate cases, a procedure for the waiver thereof; and, The City desires to establish internal staff responsibility for the administration of the insurance required by this Resolution and delineate the authority to make adjustments to requirements based upon unique and unusual circumstances. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Huntington Beach that effective on the date of adoption of this Resolution, the insurance coverage and indemnity requirements shall be as follows: SECTION I. DEFINITIONS AND FORMS REQUIRED A. Definitions: 1. "Contractors" are any persons or entities who contract with the City and/or provide services to the City which are readily available and efficiently procured by competitive bidding. 2. "Design Professionals" are professional services contractors who contract with the City and/or provide architectural and/or engineering services to the City. 3. "Licensees/Lessees" are any persons or entities who contract with the City for the use of public property. 4. "Permittees" are any persons or entities who make application to the City for any use of or encroachment upon any public street, waterway, pier, or City property. 5. "Professional Services" are as defined by Huntington Beach Municipal Code section 3.03. 6. "Vendors" are any persons or entities who transfers property or goods to the City which may or may not involve delivery and/or installation. B. Indemnity and Insurance Coverage Requirements Defined 1. General Liability: Combined single limit bodily injury, personal injury and property damage: Minimum limits of$1,000,000 per occurrence. 19723 1 Resolution No. 2008-63 a. Coverage must include completed operations liability and unlimited blanket contractual liability and, where products are furnished, products liability. b. If coverage is provided under a form which.includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 or an increased coverage as memorialized in the terms and conditions agreed to by the parties and the policy holder shall submit written notice of any known depletion of limits to City attached to the proof of insurance. C. Claims made policies are not acceptable, except that claims made insurance for pollution liability shall be acceptable. d. All deductibles in excess of $5,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. e. The City, its, officers, elected or appointed officials, employees, agents and volunteers are to be covered as additional insureds by separate attached endorsement(s) approved by the City Attorney as respects liability arising out of action performed by or on behalf of the contractor, products and completed operations of the contractor, premises owned, occupied or used by the contractor; or automobiles owned, leased or borrowed by the contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its agents, officers and employees. f. For any claims related to the project, the contractor's insurance coverage shall be primary insurance as respects the City, its agents, officers, and employees. Any insurance or self-insurance maintained by the City, its agents, officers, and employees shall be excess of the contractor's insurance and shall not contribute with it. g. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its agents, officers and employees. h. The contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 2. Workers Compensation and-Employers' Liability: In accordance with the applicable state statutes with limits in the case of workers'compensation and employers' liability in amounts not less than the State statutory limits. Alternatively, a signed declaration of non-employee status shall be filed. A certificate or consent to self-insure issued by the California Director of Industrial Relations is also acceptable. 19723 2 Resolution No. 2008-63 3. Professional Liability Insurance: Coverage must be provided at a minimum of $1,000,000 per occurrence and in the aggregate. All deductibles in excess of $10,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. a. Claims made policies are acceptable if the policy further provides that: 1. The policy retroactive date coincides with or precedes the professional services contractor's start of work (including subsequent policies purchased as renewals or replacements). 2. The professional services contractor will make every effort to maintain similar insurance during the required extended period of coverage following project completion, including the requirement of adding all additional insureds. 3. If insurance is terminated for any reason, professional services contractor agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this agreement or permit. 4. The reporting of circumstances or incidents that might give rise to future claims. 4. Automobile Liability Coverage must be provided at a minimum of $1,000,000 per occurrence. a. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 and the policy holder shall submit written notice of any known depletion of limits to City attached to the proof of insurance. b. All deductibles in excess of $1,000, or alternative forms of providing coverage must be approved through the Waiver Procedure set forth in Section III to this Resolution. The requirement for self-insured retention remains at zero. C. The City, its officers, elected or appointed officials, employees, agents and volunteers are to be covered as additional insureds by separate attached endorsement(s). The coverage shall contain no special limitations on the scope of protection afforded to the City, its agents, officers and employees. d. For any claims related to the project, the contractor's insurance coverage shall be primary insurance as respects the City, its agents, officers, and employees. Any insurance or self-insurance maintained by the City, its agents, officers, and employees shall be excess of the contractor's insurance and shall not contribute with it. 19723 3 Resolution No. 2008-63 C. Certificate of Insurance Requirements Defined 1. Form. Evidence of insurance coverage and limits as required by the City shall be furnished to the City as a certificate holder on the "Acord' or similar form approved by the City Attorney. (See samples attached herein as Exhibit "A"). a. The description of work to be performed, the City department involved in the performance, and the City staff contact person must be clearly identified on the "Acord" or similar form evidencing insurance coverage. b. All forms of insurance shall identify the City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers as an additional insured by separate attached endorsement with respect to general liability and automobile liability coverages. C. Contractors shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein. 2. Approval of Certificate Insurance certificates must be approved by the City Attorney prior to commencement of any performance under a contract or issuance of any permit, as authorized by the City Charter. 3. Acceptability of Insurers Insurance must be placed with insurer with a Best's rating of no less than A: VII and insurer must be a California admitted carrier. SECTION II INSURANCE AND INDEMNIFICATION REQUIREMENTS A. INSURANCE 1. Contractors and Permittees must meet the requirements as set forth in Exhibit "B" incorporated by reference and attached herein. Permittees who do not use vehicles or equipment in connection with the permit, shall not be required to provide auto insurance. To be exempt from this requirement, permittees must execute a declaration such as Exhibit I attached hereto and incorporated by this reference. 2. Professional Services providers must meet the requirements as set forth in Exhibit "C" incorporated by reference and attached hereto. 3. Licensees/Lessees must meet the requirements as set forth in Exhibit "D" incorporated by reference and attached hereto. 4. Vendors a. Vendors supplying goods including delivery, service and/or installation must meet the requirements of Exhibit "B". 19723 4 Resolution No. 2008-63 b. Vendors supplying goods only without delivery, service and/or installation are required to provide products liability coverage only. 5. The insurance requirements of persons or organizations not identified herein shall be as designated by the agreement. All certificates of insurance designated must conform to the requirements of this Resolution. 6. Exceptions. a. Public entities are exempt from the requirements of this resolution. Any insurance and indemnity requirements of a public entity shall be pursuant to Section II(A)(5). b. Persons providing judicial or quasi-judicial services as independent contractors, such as judges, arbitrators, hearing officers, expert witnesses, and court reporters shall be exempt from all insurance coverage requirements. Any insurance and indemnity requirements shall be pursuant to Section II(A)(5). C. Each person making application for a permit for private property construction, alteration, improvement, demolition, or repair of any building or structure shall sign a declaration under penalty of perjury verifying workers' compensation coverage or exemption from coverage, as required by Section 19825 of the Health and Safety Code and, at the time of permit issuance, contractors shall show their valid workers' compensation insurance certificate. d. Persons contracting with the City under subdivision agreements are exempt from providing evidence of workers' compensation. e. Oil operators as regulated by Huntington Beach Municipal Code Section 15.16 and pipeline franchises as regulated by Huntington Beach Municipal Code Section 3.44 are exempt from the requirements of this resolution. f. Taxicabs/Vehicles-for-hire as regulated by Huntington Beach Municipal Code Section 5.50 are exempt from the requirements of this resolution. g. Trucking companies, including those regulated under Huntington Beach Municipal Code Section 10.32, are exempt from the minimum insurance requirements of this resolution but must submit proof of workers' compensation insurance and general liability insurance in accordance with the requirements of the Public Utilities Commission (PUC) regulations which include: 1) the general liability insurance requirements are $600,000 combined single limit or $250,000 bodily injury or death of one person and $500,000 protection against total liability for bodily injury or death of more than one person from any one accident. 2) this is subject to the same $250,000 limitation for each person and $100,000 protection for accidental damage or destruction of property other than property being transported. 3) the City of Huntington Beach must be 19723 5 Resolution No. 2008-63 named as certificate holder but does not need to be named as additional insured. 7. Indemnity a. Contractors and Permittees shall be required to indemnify City, pursuant to the indemnity provision attached hereto and incorporated herein by this reference as Exhibit"E". b. All design professionals shall be required to indemnify City pursuant to the indemnity provision attached hereto and incorporated herein by this reference as Exhibit "F". C. All other persons or organizations, including but not limited to professional service providers other than Design Professionals as defined by this Resolution, shall be required to indemnify City, pursuant to the indemnity provision attached hereto and incorporated by reference as Exhibit "G". SECTION III. WAIVER OR MODIFICATION PROCEDURE A. Waivers or Modification Request Form. A department Request for Waiver or Modification, Exhibit "H" attached, shall be completed and forwarded to the Risk Manager for all requests for waiver or modifications of the minimum indemnification and insurance requirements. Claim history, financial statements and scope of work must be submitted as attachments with any request for waiver. B. Waiver or Modification Authority. The Risk Manager and the City Attorney may approve any waiver or modification of the insurance and indemnification requirements, including requests for indemnification of third parties. A denial may be appealed to the City Administrator. C Waiver Criteria. The criteria to evaluate any requests for waiver shall include the following: a. The type of waiver or modification requested; b. The reason for the waiver or modification; C. The nature of the scope of work; d. The cost of the contract; e. The liability exposure of the City; f. The cost and availability of the coverage requested; g. The claim history of the requesting party; h. The past experience of the City with the requesting party; and i. The past experience of the City with other contracting parties of a similar nature. 19723 6 Resolution No. 2008-63 SECTION IV. Resolution 2007-03 and all other resolutions in conflict herewith are hereby repealed. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting held 6th day of. October 200_3 . I ND A P irecto f Hunirn Resources VIEW PPROVED: i A inistrator APPROVED AS TO FORM: City Attorney Attachments . 4 Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G Exhibit H Exhibit I 19723 7 Resolution No.2008-63 A(ZO D. CERTIFICATE ®F LIABILITY INSURANCE GATE(MwDDrrYYn PRODUCER 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 NAIC III INSURED INSURERA INSPIRER B: INSURER C: INSURER D: WSURERE 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- INSR POLICYNUMBER POUCYEFFECTNE POUCYEXPIRATION LIMITs GENERALLIAB0.RY EACH OCCURRENCE f GMMERCLALCENFRALLMaLITY S EZOO— nce) f CLAIMS MADE 0OCCUR MEOExA(Myona Dawn) f PERSONAL a ADV 94JURY f GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPi0P AGG f PtTLICY PRO• LOC -- AUTOM08riE LJABKJTY COMBINED SiNGI.E LIMIT S ANY AUTO (Ea acod-* ALL OWNED AUTOS BOOILYMUURY f SCHEDULED AUTOS (Par ParsonT HIREOAUTOS BOOILYIKKKY S NON-OWNEOAUTOS /�� (Paacddcnt) \\✓// PROPERTY DAMAGE S (Pe.aocde„t1 GARAGE LIABILITY \ AUTO ONLY-EAACCIOENT S ANY AUTO OTHER THAN EA ACC S / AUTO ONLY: AGG f EXCESSNM11REL AUA8AtTY / EACHOCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S ✓1 $ OEOLICTIBL E f RETENTION f S WORIOM COMPENSATION AND WC 57AT6 OTH- ENPLOVERT UADI IIY ANYPROPRIETOP.PARTNERIE%ECUTIVE EI-EACHACCIOENT $ _ OFFICERAAEMBER EXCLLIDEDT E.L.DISEASE-EAEMPLOYEE f Uya.-s,=pwRsuydar SPECL1LPfiO4ASIONS beb,. E.t_DISEASE-POLICY UhHT f OTHER OESCRWIION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENO ORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EITPBIATION DATE THEREOF,THE ISSUP40 INSURER WILL ENDEAVOR TO MALL 3®DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL AWOSE NO O8UGAn0H OR UABNJTY OF ANY WNO UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORED REPRESENTATIVE ACORD25(2001f08) EXHIBIT A-1 Of 4 ©ACORD CORPORATION 1988 Resolution No.2008-63 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 after the coverage afforded by the policies listed thereon. ACORD 25(2001108) EXHIBIT A-2 of 4 Resolution No.2008-63 POLICY NUMBER: COMMERCIAL GENERAL MSI I i Y' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR . CONTRACTORS (Form B) This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL tlABILITY SCHEDULE Name of Person ororgani2itlon; THE CITY OF HUNTINGTON BEACH 2000 Main Street Huntington Beach, CA 92648 (if no entry appears above.information required to complete this endorsement Will be shown in the Declarations as applicable to this endorsement) MO IS AN INSURED(Section 11)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 far you RE: ALL OPERATIONS OF THE NAMED INSURED FOR THE CERTIFICATE HOLDER City of Huntington Beach, its elected or appointed officials,agents, officers, employees and volunteers CG 20 10 1185 Copyright.Insurance Services Office,Inc.,1884 EXHIBIT A-3 of 4 Resolution No.2008-63 STATE P.O_SOX 420807.SAN FRANC(SCO<CA 94142-0807 COMPENSATION F UN tNSISRdaO•tC� ,CERTIFICITE-OF WORKERS°.'COMPENSA-"(3 V-INSUR CE""'l' �• '�/ 'E-:. •. ?�'.,.�/:<.;ifr ;,..�i'- Sy-'L'.'st•p� 4z/ikJ;Biti?- "�t _ =Eu�y,Y.: �t.:y., .. ..S. -, 3-:CEA�iFIC.IITE�C+Y�pt�ppC-�+•1C�J _ �._ .`- d •t.:;:=..a•. s, ' 7y•:'ter- ).�r7•:t3 • - )- :',,}•`4: �� � may'i i�•rxN. �, a.- .t`•.y �± 4«. ..1�.fly +may'•4Y _4 f ,"lr.. • 1•;_t. .,•4..5+�-'ti3 '^•#'.� SSai'' �: . CITY OFN1kdTINBJiIM -t ;V a._ �� - IT RISK MAMA •• gut 3-.. `� sys..: ' 4•-.v �v,��:.."LL,y� �• ,7• me I AiN STREET HUNT I NGTON BEAt',9i,'. RICA 92648 L_ This is to Certify that we have Issued a valid Workers'Compensation Insurance policy in a lorm approved by the California Insurance Commissioner to the employer named below for the policy period indicated. 3 This policy is not subject to cancellation by the Fund except upon ton0ays advance written notice to the empkW We will also give you TRRidays'advance notice should this policy be cancelled prior to it9 normal expiration. _. This certificate of insurance is not an insurance policy and does not amend,extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, tarm. or condition of any contract or other document with respect to which this°certificate o 1- i1rance may be`issi(ed_or-may per'taarn. tt3e inst{raifce7�?�orde�by the policies described herein i8 stit>Mct to all th eiin§ exciusioris 4nd coriditiont of such police§. .<- `+FAG+ ''v �. fit'.:- 'y..�iS,R%' _ ..•• ''_,; �T.'. t.7 .• . ...t;y�Ki ;1 ` '• r ?��' F'r5, t�:r. •'`l.._ A. - `.+:lrfV.f'� Al AUTHORIZEQ REPRES£IyTATiY '• _ -": -i,'w�i7Ar- .; t T EMPLOYER'S LIABILI�TY'LIMIT INCLIJt}IN6 DEFENSE COSTS: $1,,000,:000� 'QGCtIRRENCE. ENDORSEMENT ##2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07/01/ee IS ATTACHED TO AND FORMS A PART OF THIS POLICY. �♦.- .•l t N( EMPLOYED w EXHIBIT A-4 of 4 ae Ala zo a Resolution No.2008-63 EXHIBIT B INSURANCE REQUIREMENTS FOR CONTRACTORS, AND PERMITTEES PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance ' City Council Resolution 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A:VII: 1. General Liability: $1,000,000 per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used,either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. `Claims made" designation is only acceptable for professional or pollution liability.insurance. The City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact.) 2. Workers' Compensation and Employer's Liability: State statutory limits of $250,000 bodily injury by disease, policy limit, and $100,000 bodily injury each employee for accident or disease per occurrence. If you have no employees, you must sign a Declaration of Non-employee Status form available from the City. In lieu of a certificate of insurance, a certificate of consent to self-insure issued by the California Director of Industrial Relations is also acceptable. 3. Automobile liability of $1,000,000 per occurrence for bodily injury, personal injury and property damages. The City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact). Deductibles, Self-insured Retentions, or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Subcontractors Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and -endorsements for each subcontractor. All coverages for subcontractors shall be subject to -all of the requirements stated herein. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. PLEASE FORWARD THIS NOTICE TO YOUR INSURANCE AGENT. FOR ASSISTANCE, PLEASE CONTACT RISK MANAGEMENT 0&39915103 EXHIBIT B Resolution No.2008-63 EXHIBIT C INSURANCE REQUIREMENTS PROFESSIONAL SERVICE CONTRACTORS PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A:VII .- Errors and Omissions liability: $1,000,000 per occurrence. Deductibles. Self-Insured Retentions. or Similar Forms of Coverage Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. 06-39915104 EXHIBIT C Resolution No.2008-63 EXHIBIT D INSURANCE REQUIREMENTS FOR LESSEES/LICENSEES PLEASE GIVE THESE INSURANCE REQUIREMENTS TO YOUR INSURANCE AGENT Minimum Limits of Insurance City requires submittal of certificates of insurance pursuant to the form set forth in Resolution No. 2008-63- evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A:Vil: 1. General Liability: $1,000,000 per occurrence for bodily injury, personat injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this projectflocation or the general aggregate limit shall be twice the required occurrence limit. "Claims made" designation is only acceptable for professional or pollution liability insurance. For general liability certificate holder, the City of Huntington Beach, its elected or appointed officials, agents, officers, employees, and volunteers must be named as certificate holder and as additional insured by separate attached endorsement. (This wording must be exact). 2. Workers Compensation and Employer's Liability: State statutory limits of $250,000 bodily injury by disease, policy limit, and $100,000 bodily injury each employee for accident or disease per occurrence. If you have no employees, you must sign a Declaration of Non-employee Status form available from the City. In lieu of a certificate of insurance, a certificate of consent to self-insure issued by the California Director of Industrial Relations is also acceptable.. 3. Property Insurance: Full replacement cost with no coinsurance penalty provision. Deductibles, Self-Insured Retentions, or Similar Forms of Coveraqe Limitations or Modifications Any deductibles, self-insured retentions or similar forms of coverage limitations or modifications, must be declared to and approved by the City of Huntington Beach. Description of Work to be Performed The staff contact and purpose of the evidence of coverage must be identified. PLEASE FORWARD THIS NOTICE TO YOUR INSURANCE AGENT, FOR ASSISTANCE, PLEASE CONTACT RISK MANAGEMENT 06-399/5105 EXHIBIT D Resolution No.2008-63 EXHIBIT E TO RESOLUTION NO. 2008-63 CONTRACTOR'S INDEMNIFICATION DEFENSE HOLD HARMLESS Contractor hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Contractor's employees and damage to Contractor's property, arising directly or indirectly out of the obligations or operations herein undertaken by Contractor, caused in whole or in part by any negligent act or omission of the Contractor, any subcontractors, anyone directly or indirectly employed by.any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Contractor will conduct all defense at its sole cost and expense and City shall approve selection of contractor's counsel. City shall be reimbursed for all costs and attorneys fees incurred by City in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Contractor. 06-39915106 EXHIBIT E Resolution No.2008-63 EXHIBIT F TO RESOLUTION NO. 2008-63 INDEMNIFICATION DEFENSE AND HOLD HARMLESS To the fullest extent permitted by law (including, without limitation, California Civil Code Sections 2782 and 2782.6), CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, demands, and defense costs (including without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANTs (or CONSULTANT's subcontractors, If any) negligence, recklessness or willful misconduct related to performance of this Agreement or its failure to comply with any -of its obligations contained .in .this Agreement by CONSULTANT, its officers, agents or employees. CITY shall be reimbursed by CONSULTANT for all costs and attorney's fees incurred by CITY in enforcing this obligation_ CONSULTANT will conduct all defense at its sole cost and expense, and the CITY shall approve selection of CONSULTANTs counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by the CONSULTANT. 06-399/5107 EXMIT F Resolution No.2008-63 EXHIBIT G TO RESOLUTION NO. 2008-63 INDEMNIFICATION DEFENSE AND HOLD HARMLESS CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or wipfui misconduct of CITY. CITY shall be reimbursed by CONSULTANT for all costs and attorney's fees incurred by CITY in enforcing this obligation. CONSULTANT will conduct all defense at its sole cost and expense and the CITY shall approve selection of CONSULTANTs, counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as limitation upon the amount of indemnification to be provided by the CONSULTANT. 06-399/5108 EXHIBIT G Resolution No.2008-63 INSURANCE AND INDEMNIFICATION WAIVER MODIFICATION REQUEST 1. Requested by: - - -- - 2. Date. 3. Name of contractor/permittee: 4. Description of work to be performed: 5. Value and length of contract.- 6- Waiver/modification request: 7. Reason for request and why it should be granted: 8. Identify the risks to the City in approving this waiver/modification- Department Head Signature Date: APPROVALS Approvals must be obtained in the order listed on this form. Two approvals are required for a request to be granted. Approval from the City Administrator's Office is only required if Risk Management and the City Attorney's Office disagree. 1. Risk Management ® Approved ❑ Denied Signature Date 2. City Attomey's Office ❑ Approved ❑ Denied Signature Date 3. City Administrator's Office ❑ Approved ❑ Denied Signature Date If approved,the completed waiverimodfication request is to be submitted to the City Attomey's Office along with the contract for approval. Once the contract has been approved, this form is to be filed with the Risk Management Division of Administrative Services EXHIBIT H Resolution No.2008-63 S 1`J CITY OF HUNTINGTON BEACH Hun. s 2000 Main Street - Huntington Beach, CA 9264s DECLARATION OF PERMITTEE I certify that no vehicle(s) will be used or operated in the performance of the task(s) or event(s) for which this permit is granted. I authorize the City of Huntington Beach to immediately and retroactively revoke the license or permit issued in connection with or in the performance of said task(s) or event(s) if any vehicle(s) is used. Signature of Permittee Print name Company name (if applicable) Date signed 16407 EXHIBIT I Res. No. 2008-63 STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH ) I, JOAN L. FLYNN the duly elected, qualified City Clerk of the City of Huntington Beach, and ex-officio Clerk of the City Council of said City, do hereby certify that the whole number of members of the City Council of the City of Huntington Beach is seven; that the foregoing resolution was passed and adopted by the affirmative vote of at least a majority of all the members of said City Council at a regular meeting thereof held on October 6, 2008 by the following vote: AYES: Hansen, Hardy, Bohr, Cook, Coerper, Carchio NOES: None ABSENT: Green ABSTAIN: None Ci lerk and ex-officio 66rk of the City Council of the City of Huntington Beach, California a .• City ®f Huntington Beat r. e 2000 Main Street • Huntington Beach, CA 92648 ., . OFFICE OF THE CITY CLERIC �7�S9i e JOAN L. FLYNN CITY CLERK April 1, 2009 Ruiz Engineering Co. 1344 Temple Ave. PO Box 4177 Long Beach, CA 9804 RE: MSC-454 —Various Residential Streets Asphalt Overlay Enclosed please find your original bid bond for MSC-454. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe Enclosure Sister Citi94.i,"/c6p(�Mt/-ret�,i�/rj�WW.@,,jNew Zealand (Telephone: 714-536-5227) P44 Terp,plo- five.,, R..Q. DOX 417. 7 Wns; Doach, CA 9QSq4 k 2000 DEC 18 F c 61d /2-Ir--C Jf C/ C-7 SECTION C PROPOSAL 'tong 'Bep;li<. t 4 ,..: for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT.12' MAINTENANCE SERVICE CONTRACT#454 in the CITY OF HUNTINGTON BEACH � TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids,the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and 14 incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is 1-4 accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to 14 enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of 14 the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid,unit prices shall govern over extended amounts, and words shall govern over figures. 14 A C-1 Bid Schedule msc - 454 Cold. Plane 1 706,001 S.F. at vnx� �� per S.F. $ foyl - $ c? Furnish and Install Petromat 2 2,537,923 S.F. at- 5-t, C., 0* per S.F. $ C) 8 t3 $3 ET2`1.�� Furnish anq Install Asp alt at 1 ' 3 22,841 Ton at per I on $1 ,-7 0 Adjust W,at�r V Ives trade 4 338 EA at _ , L ` er Each $.I'7$ 2 $ 9y, 047 _ S6 Adjust Manholes t Grade / 5 262 EA at m_ ,�{, per Each $X73 $ —71,526 — Install Traffic Loops 6 30 EA at ua� � _per Each $Z146 p.� $ ". )-c3n . Prepare Pre & Post Construction Corner Record and ail it�A prropriate Agencies 7 241 EA at �- , A4, � per Each $-:2o — $ 4 o s Total Bid Amount in Figures - 'Total Bid Amount in Words / C-2s If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option,be considered null and void. Accompanying this proposal of bid, find 64� in the amount of$ o. &Whathich said amount is not less than 10% of the aggregate of the total bid price, as requirld by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received. - BiVv— S' natur 12-15^0 C-2 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name and Address of Subcontractor State License Class o`. Work Number (-o L 4 o\r\J c em_s4 1-7 +` Cook ti S Li t LI � s , 3;4 L'L CA 9 ems• °�,�"�" By submission of this proposal, the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange At do 6 , being first duly sworn, deposes and says that he or she is A Pa rt l e yr of &Lt r7- &1161164QV" the parry making the foregoing bid that the bid is not made in the interest of, or on the 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, or 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 fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Name of Bidder J Signatur o idder 13v/ 7e—imie Ale. trna &4 a Address o Bidder Subscribed and sworn to before me this ] day of Vw , 20ae . NOTARY PUBLIC NOTARY SEAL C-4 CAUFORNIA M.-KNOWL.E000RNT Stace of C�drfomifa Cw*of S ,qv c .,g3::a�:2_er,_ ,U& 4age Phr who Proved b me an to bas of saftwiny wAdow to be the p s)whose nen*sLWam mfinwbW to the Ord &dowwkdpd to me tttet dwffiW a wafi d ute serrta h>'hkAmVndr auf dzed a"cillyfesD, and doss by NWNW i*- slgna m(o)on the MARIA KANLILAR Ir k the psrson(s), or the arilly upon behalf of V RIA # NLIL0 9 whIM ftte t (s) see bad fhe N� (ry NOTARY PUBLIC-CALIFORNIA LOS ANGELES COUNTY 0 f 090Y under PENALTY OF PERJURY under the haws COMM.EXPIRES OCT.16,2009 '' Of the Shft of Caftr a.dw#w• mgoi"mparagraphis tr119 erld COffiBCl. WITNIM my hand and onwi slat. PmoePq ►&mAbowI T ft ftwarmeawwtonot Lya m itAWP ab"toP eraM onaheab maw e�areourrt�,we»rsmrenoYa�ana�mdtaa�nm roenodier� Dascrtpttan of A f>dd Dot llft orlww of Documot: Monet Da* Number of Pam 9WwW0VwThwNWmdAb= cgm*y(w.)Ctetmed by w(s) Sr oft Now 8"es Memo; O indtvww p trt whw 0 CorporefeOtt®r—Tote?= OC —T"o); o —o Lblftd a GeruM o FWbw--a Umb d o amid 0 M fit 0 Aftmy hi Fktd 0 TnNne �a� nss® 01hifte- tq,� ,axue 0 MmfdhM or COMWvakw 0 Qum or t 4or 0 Offwr: 0 siwwui b 18 �e9re�M�anrao�a�.s�oceeaow�a.uoteme��.o�r�► taa�oem�► o+. UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT#454, (I)(we)(it)will employ and utilize only qualified persons, as hereinafter defined,to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. lc liz 5yc r`,Vc `,VA C--0 Contractor By r^- Title Date: C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury,the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? � ❑ Yes U No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Contractor By Title Date: z/8-06 C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 17800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Contractor By Title Date: Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: kui Z t� G i NC7=Pt4 N'6 Bidder Name Business Address tnylg & City, State Zip t � Z) U 31'-3o _7 Telephorie Number State Contractor's License No. and Class _ 1967 Original Date Issued Expiration Date The work site was inspected by 8 do /2tQ`.Z_- of our office on l-f , 20C' The following are persons, firms, and corporations having a principal interest in this proposal: 6-7,7 uiZ- C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. /20z cwc' Company Name Signature B dder Dl - Printed or Typed Signature Subscribed and sworn to before me this day of /�-c� r' , 2008. MARIA KANLILAR n COMM.#1613570 ON•�► � NOTARY PUBLIC-CAUFORNIA rl LOS ANx ELES COUNTY n COMM.EXPIRES OCT.16,2009 '` NOTARY PUBL NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: C_5?C 1. �',7T 6� ��m s I ZS l�l or�n�l►���� 5, �A Name and Address of Public Agency p �t Name and Telephone No. of Project Manager: �116_ )Z.z-( 12 a jA -j 5, Contract Amount Type of Work Date Completed 2. ,�N �7��r OCR ��a m J C •. V yd m CA Z Name and Address of Public Ag cy Name and Telephone No. of Project Manager: (71 g) 71/y 1-73 r� Contract Amount Type oftork Date Completed 3. C't / rl �-,'�.t 1�Go its 16Z"`� ri rf Cf� J oZti7 Name and Address of Public Agency Name and Telephone No. of Project Manager: I V Z Tot) De 61 2221 3 t-re k u9 Ls ;I he Ice Contract Amount T— Type of ork Date Completed C-10 RUIZ ENGINEERING CO. ASPHALT GRINDING&c PAVING 1344 TEMPLE AVE.,P.O.BOX 4177 LONG BEACH,CA.90804 PHONE(562)439-3070 FAX(562)434-6350 JOB REFERENCES OWNER JOB AMOUNT DATE City of Bell Home Ave. St.Improvements $ ,9000 "vim_09 6330 Pine Avenue A.C.Overlay Project Bell,CA.90201 Project#04-525-3737-0984 Carlos Alvarado (626)960-1889 City of Gardena Gramercy Place Street $ 227,438.00 .June 2008 1700 W. 162°d Street Improvements-Marine Ave. Gardena,CA.90247-3778 to Redondo Beach Blvd. Jun De Castro JN 793 (310)217-9642 City of Cerritos Construction of Street $ 597,527.00 December 2007 18125 Bloomfield Ave. Improvements in Residential Cerritos,CA.90703 Street-Various Location Rash Syed Project# 14088-07-01 (562)916-1221 City of Orange Annual Street Overlay $ 1,473,488.00 October-2007 300 E.Chapman Ave. Various Locations,Phase II Orange,CA.92866 Bid#067-36 SP3591 Alan Truong (714)744-5573 City of Gardena Halldale Avenue $ 345,877.00 May 2007 1700 W. 162°d Street Improvements Gardena,CA.90247-3778 Project#785 Jun De Castro (310)217-9642 City of Cudahy Cecelia Street AC Overlay $ 57,300.25 March 2007 5220 Santa Ana Street Project from Wilcox Avenue P.O.BOX 1007 To Ferndale Avenue Cudahy,CA.90201 Project No.251-7034-6725 Carlos Alvarado (626)960-1889 City of Cudahy Olive Street AC Overlay $ 59,437.10 February 2007 5220 Santa Ana Street Project From Otis Ave. P.O.BOX 1007 To Salt Lake Ave. Cudahy,CA.90201 Project No.230-7033-6725 Carlos Alvarado (626)960-1889 JOB REFERENCES OWNER JOB AMOUNT DATE City of Long Beach,i Oa`Floor Citywide Local Street Program $ 1,084,728.00 December 2006 333 West Ocean Blvd. Area 3 &4 Long Beach,CA.90802 Douglas G.McLaughlin (562)570-6964 City of Pico Rivera Street Improvement Project $ 623,951.00 Augusf 2006 6615 Passons Blvd. (Cape Seal Project) Pico Rivera,CA 90660-3645 Project#21172 Juan Balanay (562)801-4415 City of Paramount Neighborhood St.Improvements $575,959.00 June 2006 16400 Colorado Ave. Various Street Improvements Paramount,Ca.90723 Project#9643 Kenny Riggins (562)908-6222 City of Huntington Beach Various Residential Streets Overlay $ 1,645,786.00 February 2006 2000 Main Street Msc-426 P.O.BOX 190 Huntington Beach,CA.92648 Duane Wentworth (714)536-5517 City of Glendora Grinder Overlay Project 2004-2005 $88,677.00 August 2005 116 East Foothill Blvd. Various Locations Glendora,CA.91741 Project Plan#863 Carlos Cisneros or Bardia Rastan (626)914-8251 City of Beverly Hills Improvements to Miscellaneous $932,935.00 May 2005 455 North Rexford Drive street North of Sunset Blvd. Beverly Hills,CA.90210-4817 Project:040014372 Vincent Chee (310)285-2504 City of Cudahy Otis Ave.Overlay $ 109,434.08 December 2004 5220 Santa Ana Street (Salt Lake to Clara)North Section Cudahy,CA.90201-6024 (Otis to Walnut) (323)773-5143 Project#006-5000-5469 City of La Verne Various Miscellaneous Streets $ 193,103.00 November 2004 3660"D"Street La Verne,CA.91750 Dominic Malano (909)596-8755 City of Cerritos Construction of Street $390,255.00 August 2004 18125 Bloomfield Ave. Improvements in Residential Streets Cerritos,CA.90703 Project No. 14088-03-11 Vic-Masaya (562)916-1231 JOB REFERENCES OWNER JOB AMOUNT DATE City of Seal Beach Annual Paving Rehabilitation $ 135,545.00 July 2004, 211 Eight Street Clipper Way,Caravel Way,and Seal Beach,CA.90740 Corsair Way FY 2003-2004 Jeffrey Finn Project#50172 (562)431-2527 City of West Hollywood FY 03/04 Residential Street $ 177,409.00 June 2004 8300 Santa Monica Blvd. Paving Program West Hollywood,CA.90069-6216 CIP 0401 Sharon Perlstein (323) 848-6379 City of Downey Residential Street Resurfacing $305,453.00 May 2004 11111 Brookshire Ave. Cash Contract No.S.S.565 P.O.BOX 7016 Downey,CA.90241-7016 Jim Bautista (562)904-7296 (City of Industry) Albatross Road,Almahurst St., $274,367.00 April 2004 CNC Engineering Keystone St.Walnut Hall Road 255 N.Hacienda Blvd. Suite 222 Resurfacing City of Industry,CA.91744 Contract No.City-1338 Tony Farrahi (626)333-0336 City of San Dimas Alley Reconstruction: Alley E- $ 131,669.00 April 2004 245 East Bonita Avenue North of Fourth St.Between San Dimas,CA.91733-3002 North Eucia Ave.and North Mark A.McVoy Acacia;Between North Acacia St. (909)394-6200 and North Cataract Ave. City of Covina Street Improvements $398,343.00 January 2004 125 E.College Street Projects#P-0310 Covina,CA.91723-2199 Leo Tolentino (626)858-7244 City of Thousand Oaks Asphalt Concrete Street Overlay $74,000.00 January 2004 2100 Thousand Oaks (Cl 4356-Specification No.2003/2004-II) Thousand Oaks,CA.91362 (805)449-2432 City of Long Beach, 10`h Floor South Street $ 111,500.00 December 2003 333 W.Ocean Blvd. (R-6583) Long Beach,CA.90902 Teddy Noel (562)570-5160 City of Cypress Residential Street Phase I $297,000.00 April 2003 5275 Orange Avenue (200247) Cypress,CA.90630 (714)229-6747 v e City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1,2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1,dated December 1,2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for I. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, dated December 1, 2008. Company Name By 17 -f 8_0 Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714) 374-1732. Fidelity and Deposit Company of land BID BOND KNOW ALL 3MN BX'ME PMSEN-M that we RUI Z ENGINEERING COMPANY as Paucipal,hereinafter called the Principal,and Fidelity and Deposit Company of-Maryiane3,a carporation duty organized under the Saws of the State of 1Viary3and,as S�eiy,hezz�zrnafter calle3 Surety, are Feld and Sly bound unto CITY OF HUNTINGTON BEACH as Obligee,hereinaiker called Obligee,in the sum of ***TEN PERCENT OF AMOUNT RID*** Dollars( j or ( 10 97 percent of the amount bid,whiarever is less, for the payment of which sum well and truly to be made,the said Principal and the said Surety,bind ourselves,our hens, executors,adrauustnaWrs,successors and assigns,jointly and severally,firmly by tbese P - the Principal has submitted a bid for "VARIOUS RESIDENTIAL STREETS ASPHALT OVERLAY, NO. MSC 454" NOW,TMEFORF-if the OBi4pe sha]l accept the bid of the Principal and the Fmcipai shall enter into a Cantractwith the Obligee in - accmdance with the terms of such bid,and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful perfornauce of such Contract and for the prompt payment of labor and material f nnislbcd in the — prosecation thereof;or is the event of the failure ofthe Principal to enter such Caahact and give mch bond or bonds,ifthe Principal shall pay to the Obligee the differ-=i3ot to mceed the penalty hezetsf betwc=the amount specified in said bid and such lwgcr aniami fcrwhich the Obligee may in good faith contract with another party to pafcmn the Work covered by said bid,then this obligation sbalt be nail and void,otherwise to remain in h4 force and effect Signed and Sealed this15th day of DECEMBER,20 08 t2UIZ ENGINF7IN COMPANY . (Principal) (Seal) Pa Cr) AI,TIA OF MARYLAND (wiil=) By. Gael A.Q (Aibnraey- not) Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland,by THEODORE G.MARTINEZ,Vice President,and GREGORY E.MURRAY, Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By-Law id Company,which are set forth on the reverse side hereof and are hereby certified to be in full force and eft t �t ell reof,does hereby nominate,constitute and appoint Michael A.QUIGLEY,of Laguna Ni p► T its t lawful agent and Attorney-in-Fact, to make,execute,seal and deliver,for,and ' y is p eed: any and all bonds and undertakings,and the execution of suc �uertcin c� _ ese presents, shall be as binding upon said Company,as fully and I}� is tan4d� �S y had been duly executed and acknowledged by the regulate ql � I e ju ice in Baltimore, Md.,in their own proper persons. he A. UIGLEY,dated March 17,2005. This power of attor �l thbt et q / Q The said Assistant c o }fythat the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2,of the By-L pany,and is now in force. IN WITNESS Wl]-_R OF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 4th day of March, A.D. 2008. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND Pip DEPOs�i e o e p b tm 2 /7 By: Gregory E. Murray Assistant Secretary Theodore G. Martinez State of Maryland ss: City of Baltimore On this 4th day of March, A.D. 2008. before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument,and they each acknowledged the execution of the same, and being by me duly sworn,severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. ne-"S "" Dennis R. Hayden Notary Public My Commission Expires: February 1,2009 POA-F 012-0626 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ORANGE On December 15,2008 before me, MEG QUIGLEY, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared MICHAELr A• QUI= Names)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person( whose name(A isAw subscribed to the - within instrument and acknowledged to me that MEG QU IG E F. he/sbedwA executed the same in his/ authorized pffi COMM...1786547 capacity(ica), and that by his/ signature( on the NOTARY PUBLIC-CALIFORNIA I instrument the person(, or the entity upon behalf of Y '�" ORANGE COUNTY LJ which the person(:s) acted, executed the instrument. My Term Exp.January 10,2012 1 certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and c�xrec ; i) � l WITNESS ` offi I seal. r Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law,it may prove valuable to persons 01xing o e document and could prevent fraudulent removal and reattachment of this forma to anot eta cume Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s)Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—❑Limited ❑General _ ❑Partner—❑Limited ❑General _ _ ❑ Attorney in Fact ❑Attorney in Fact ° ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: M007 National Notary Association•9350 De Sob Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationalNotaryorg Item#5907 Reorder.Call Top-Free 1-800-876-6827 CAUFORNIA ALUPURPOGE ACKNOWLEDGMIENT State of California County of 1-r Ao G7 p/r, S on 1 Z-tF-Cf ream me, A1fi2�- L�t�i ywmhsw , P0dLjc- Offtpersonally appeared_ D 0 who proved to me on the basis of safistac y to be fhe persons)whm Mme(s)-Ware skscribed to the within Instrixnent and actin to me that « MARIA iCANLiLAR lrfsh ft same ln t� elr autfa�ed ( ) bytdtfrair sigrrsiure(s)on the U COMM.#1613570 Instrument the (s). or the en ty Upw behalf of NOTARY PUBLIC•CALIFORNIA Wh�lr�e peOn(tr)acted, executed the Iniotmat LOS NOTE COUNTY n COMM.EXPIRES OCT.16,2009 1 Cartgy under PENALTY OF PERJURY under the laws Of the State Of Callfornia.ihat the paraliraph IS true and Correct. WITNESS my hand and official seat. aeon eem S>gnalaure r t ��p � ���1 ordNaA mho TnlevrTypeci Docurnera. Document lam: Number of Pages: SVw(a)Other Than Named Above: Capactly0m)Claimed by S spa) Signe►'s Nam: signer's Name: O Individual 0111M Iual D Corporate Cotter—Tle(e): ❑Corporate Ctficer—•TNe(S): ❑ Partner--❑Limited ❑eisnerai ❑Plartrierr—®UmNed 0 Generel ❑ Aftntey In Fed ❑Anorney In Fad ❑ Those lbp of Ounb h ma 0 hA t e Top of tMa�ltws ❑ Quadan or Conservator ❑®uwdlan or Coraervalar Signer Is RepresentkV Suer is Ming: e ®8007WINrAt�0c�a1.9�OW@Y�DAt�.PAC80a2/09tCR01019dA0!• YanlR9�P :CB®lO�Rwe/ 66937 City of Huntington Beach 2000 Main Street • Huntington Beach, CA 92648 ' OFFICE OF THE CITY CLERIC JOAN L. FLYNN CITY CLERK April 1, 2009 Imperial Paving Co., Inc. 10715 Bloomfield Ave. Santa Fe Springs, CA 90670 RE: MSC-454—Various Residential Streets Asphalt Overlay Enclosed please find your original bid bond for MSC-454. Sincerely, Joan L. Flynn, CMC City Clerk JF:pe Enclosure Sister Citid?hol&jpcjgVi&rgtAb)t6,gr(focNew Zealand (Telephone:714-536-5227) mperial Paving Co., Inc. 0715 Bloomfield Ave. >anta Fe Springs, CA 90670 ely OF �,Ty CA Vk-14'b co N SEALED BID ''IDate: `r• 6/V2 a mcame ma ese rt�++cnwir. n f"> Of, A _ - S ry t City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732,' Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1, 2008 Notice To All Bidders: Tease note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the.Various Residential Street Overlay Project, MSC-454 plans and specifications is Addendum No. 1, dated December 1, 2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID„ for 1. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for thisroject. j4 ; y �x Y� This is to acknowledge receipt and review of Addendum Number one, ate co e 1 008. Comp Any Name /By s Date - All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714) 374-1732. M?641 A i, '?AU*1 SECTION C PROPOSAL for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT# 454 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and ! incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date Asa of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to v. enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of OP the guaranty accompanying this proposal. 0-0 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the J bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. - C-1 1 "lid Schedule MSC - 454 Cold Plane 1p 1 706,001 S.F. at per S.F. $ , $ 141,2 ' Furnish and Install Petromat 2 2,537,923 S.F. at per S.F. $ _ $ _ Furnish and Install Asphalt at .12' 3 22,841 Ton at per Ton $ 7'¢ - $ Z Adjust Water Valves to Grade 4 338 EA at per Each $ -7; $ Adjust Manholes to Grade 5 262 EA at per Each $ "yz)z_ $ — Install Traffic Loops 6 30 EA at per Each $ � , :� $ -7 Prepare Pre & Post Construction Corner Record and File with Appropriate Agencies 7 241 EA at per Each otal Bid Amount in Figures $ - otal Bid Amount in Words Niue—�'�.! Gc�C7r'S C-2s If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the a proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. Accompanying this proposal of bid, findp�%wpes Y--x,,join the amount of$ which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids payable to the AGENCY. (Please insert the words "Cash", "Certified Check", idder's Bon ", as the case may be). Bidder shall signify receipt of all Addenda her ,`fan : Addenda No. Date Received de Signature y jj ` • `. � � t-��� �"3'f SSE J%7t1� C-2 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion Name and Address of Subcontractor State License Class of Work Number 7qaelc oil f. 14 �. l y By submission of this proposal,the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. v C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID 61 State of California ss. County of Orange "OAP..a C-0L'L'wS , being first duly sworn, deposes and says that he or she is ,4�5T. S6G2E-�,A�2 of ,M�)F�AA_ pqx)g,�C, (,,n. the party making the foregoing bid that the bid is not made in the interest of, or on the 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 40 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, or 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 fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. ON Name o i der Signature of Eddedae>C A-%-1°J�. SCLY��T� Address of Bidder Subscribed and sworn to before me this f3 day of De--&un-us 20�. C NOTARY PUBLIC NOTARY SEAL C-4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of LOS ANGELES On lZ- 10- VB before me, FRI.TZ DOW COY, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ROBERT COLLINS , . ASST. SECRETARY Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person( whose name) is/ameKsubscribed to the within instrument and acknowledged to me that he/s'SMl ;§�executed the same in his/t ffi4Xauthorized capacity("), and that by his/h%KMNir signature( on the instrument the person(, or the entity upon behalf of which the person(�q acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws FRITZ DOW COY of the State of California that the foregoing paragraph is Commission* 1801776 true and correct. Notary RuWic-California Los Angeles County WITNESS my hand and of ' seal. My Comm.Wires Jun 15,2012 Signature Place Notary Seal Above Signature of Notary ublic 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s): ❑ Partner—❑ Limited ❑ General ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact ❑Attorney in Fact o ❑ Trustee Top of thumb here ❑Trustee Top of thumb here rl Guardian or Conservator a Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: 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 UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT# 454, (I)(we)(it)will employ and utilize only qualified persons, as hereinafter defined,to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved. " The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. A ,',0. Cr, Contract UByy 1�' Cori►�� A��--C. `mac C..i�-�Ti,P�2� Title Date: C-s DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty Owl of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety 001 regulation? ® Yes �,No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. �a Con act By Title Date: 12- t?, c%�3 C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: WAk Contr for By oil ( emu �.�� AS�aTC r2Ta( Title Date: 12 e i � ca s3 Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: ?,Aylam►& Oo I►�C- Bidder Name 10-7 1— y4yF--. Business Address City, State Zip `542,) CJA4 - U9-75- Telephone Number State Contractor's License No. and Class rF„T Original Date Issued Expiration Date ire}. The work site was inspected by I L`-.(- of our office on O-?e -�(� , 200 The following are persons, firms, and corporations having a principal interest in this proposal: ���'_,, 17 ST\r� 1 i(J�.► =-�vy � �t Gam. `�-�f[-�S 1�-��T f i,. C-9 qP 1 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Comp Signature$ofidd�er Printed or Typed Signature Subscribed and sworn to before me this i D"2lay of c t��r��,rz , 200 . NOTARY PUBLIC NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which1 the bidder has performed similar work within the past two years: Name and Address of Public Agency �s Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed 2. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed 3. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed C-10 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of LOS ANGELES On 1 Z- t F, - C& before me, FRI-TZ DOW COY, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ROBERT COLLINS , ASST. SECRETARY Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person( whose name) is/atesubscribed to the within instrument and acknowledged to me that he/AiM;k�executed the sanie in his/I ffi4i1Kauthorized capacity("), and that by his/hVKMNr signature( on the instrument the person(, or the entity upon behalf of which the person(!) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is FRITZ DOW COY true and correct. Commission#1801778 Q "® Notary Public-California at Los Angeles County WITNESS my h d and of seal. M Comm.Ex free Jun 15,2042 Place Notary Seal Above Signature Signature o Notary ubl 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s): ❑ Partner—n Limited C. General _ ❑ Partner—❑ Limited ❑ General Attorney in Fact ❑ Attorney in Fact ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing: ©2007 National Notary Association-9350 De Soto Ave.,PO.Box 2402-Chatsworth,CA 91313-2402-www.NationalNotary.org Item#5907 Reorder.Call Toli-Free 1-800-876-6827 r m a `•na 8; � T fan Et(:L. 13rial o� 'Sires_" c. IL�`_�'',iZyn/L't-y ,ua, .I t, ^) ()rv.i Fk1. C NL,.iL U r- 2-S 0/3 _tom Lie., a"a.LLCS id i,. i}. 7", 9,4 l'l.1li j Z6 'Vj -I U 1 0) S at"Auq --V Ci -o T i-, a 7- Q I U T U 0 V J C T T 7 �—jQ 113 Q 7 G All d u Iry LM; IQ SA 1 1) T 323 OPCII-1-1-1 i—p WI-JoLt-le-, CA ricilit." 1`4111-1'DC1'" IFI, B -r-,A Q, jj IS c 01 y ana'j' -12 3'0 —,,ificjulitz all )006 3 ifllii K- L LH 6 5 ot la c C p a n"D CIO of onmy 300 E. Chapma Aw. Change, CA, 92366 projeci: SaWago Qght Turn... $125MOM com Won My: 1 W3 W canom RandyNguyvi Phone Number C?Q MOST 21225 Copley Q- Dl;iL,i--,c-,ni d Sa i, ,,--'A '76:5-4 i 7is 1,4eiginbor-1hrood 'I raffiic' S135,0010 ple-L, I j m g e 0 a (909) SNOOK,N be 00 of San For andc 117 Macadi Lt., San Rmandw Cis 91340-299-' 9B 1 M T'l-c (918) 098-1243 no 5 2��097 4150; A 1039 23 so 15 5 ni The Guarantee Company of North America USA 25800 Northwestern Highway, Suite 720, Southfield, MI 48075 BID BOND BOND NO. N/A KNOW ALL MEN BY THESE PRESENTS, That we, Imperial Paving Company, Inc. as Principal, and The Guarantee Company of North America USA, a corporation duly organized under the laws of the State of Michigan, as Surety, are held and firmly bound unto City of Huntington Beach as Obligee, in the sum of Ten percent of amount bid ($ 10% } Dollars for the payment of which Principal and Surety bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, Principal has submitted a bid for Various Residential Street Asphalt Overlay , the Project. NOW, THEREFORE, if the Obligee accepts the bid of the Principal and the Principal enters into a Contract with the Obligee for the Project; or, if the Principal pays the Obligee the amount of this Bond or the difference between Principal's bid and the next lowest bid for the Project, whichever is less: this obligation is null and void, otherwise to remain in full force and effect. Signed and sealed this 4th day of December , 2008 In Company, inc, BY: (Witness) Principal ITS: I�xat3 col,L I ..A A��T ���►���z� The Guarantee Company of North America USA BY: Willia yr{ ' Attorney-in-Fact CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of LOS ANGELES On 12- \g—C1 ? before me, FRITZ DOW COY, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared ROBERT COLLINS , ASST. SECRETARY Name(s)of Signers) who proved to me on the basis of satisfactory evidence to be the person( whose name(8) is/aYaXsubscribed to the within instrument and acknowledged to me that he/sU"/ executed the sarr e in his/%W i4i�authorized capacity(), and that by his/NiMN& signature(A on the instrument the person(.), or the entity upon behalf of which the person( acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws 1801176 of the State of California that the foregoing paragraph is County true and correct. LOS Anonmy COnan, jun 16 "lit WITNESS my hand and official seal. Signature Place Notary Seal Above Signa of Notar u61ic OPTIONAL u 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: _ Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: 1 Individual ❑ Individual `J Corporate Officer Title(s): : Corporate Officer — Title(s): Partner— Limited L,' General Partner—,7 Limited General F 1 Attorney in Fact Attorney In Fact Top of thumb here Top of thumb rrre Trustee i`Trustee _i Guardian or Conservator O Guardian or Conservator I Other 7 Other: I Signer Is Representing: Signer Is Representing: j ©2007 National Notary Association•9350 De Soto Ave PO Box 2402•Chatsworth,CA 91313-2402•www NanonalNotary org Item#5907 Reorcer Call Toll-Free 1-800-eie-6827 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Orange On 12/04/08 before me, R. Haas-Bates,Notary Public Date Here Insert Name and Title of the Officer personally appeared William Syrkin Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(r4 is/are subscribed to the within instrument and acknowledged to me that ,- 7p � he/sl°t executed the same in his/l�authorized a .- ; -t, C0fimAl,, y616,L, capacity(iefs), and that by his/�i signature( }on the TAay PUBLIC •CALlrpP�,, instrument the person(*, or the entity upon behalf of e cvniv E COUNTY COft9�f which the persons}acted, executed the instrument. •EHPiRS APRik 22.i0i2 r` 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 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: Number of Pages: _______—.. Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual ❑ Individual J, Corporate Officer—Title(s): ❑Corporate Officer—Title(s): Partner—O Limited ❑ General ❑ Partner—❑Limited ❑ General _ Attorney in Fact 02.01041timmo ❑Attorney in Fact • El Trustee Top of thumb here ❑Trustee Top of thumb here Guardian or Conservator Guardian or Conservator Other: ❑Other: Signer Is Representing: Signer Is Representing: 02007 National Notary Association-9350 De Soto Ave..P.O.Box 2402-Chatsworth,CA 91313-2402-wwwNafionalNetary.org hem#5907 Reorder:Call Toll-Free 1 800-976 61,127 THE GUARANTEE COMPANY OF NORTH AMERICA USA Southfield,Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS:That THE GUARANTEE COMPANY OF NORTH AMERICA USA,a corporation organized and existing under the laws of the State of Michigan,having its principal office in Southfield,Michigan,does hereby constitute and appoint William Syrkin,Matthew C.Welty Millennium Corporate Solutions,Inc. its true and lawful atbomey(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 AMIERICA USA as fully and amply,to all intents and purposes,as if the same tiad 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 31"day of December,2003. The,President,or any Vice President,acting with any Secretary or Assistant Secretary,shall have power and,authority: 1. Tp appoint Attomey(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 Attomey-in-fact and revoke the authority given,except as provided below 3. 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 Attomey-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 3VA day of December 2003,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 13th day '�Ogr of November,2007. o� G �Q THE GUARANTEE COMPANY OF NORTH AMERICA USA •MA STATE OF MICHIGAN Stephen Dullard,Vice President Randall Musselman,Secretary County of Oakland On this 13th day of November,2007 before me came the individuals who executed the preceding instrument,to me personally known,and being by me duly swom,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 said Company. Y. Cynthia A. Takai IN WITNESS WHEREOF,I have hereunto set my hand at The Guarantee Notary Public,State of Michigan Company of North America USA offices the day and year above written. County of Oakland My Commission Expires February 27, 2012 �,�/JjJ � t «;.;:.:• IL/u't.d ICJ Acting in Oakland County 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. IN WITNESS WHEREOF,I have thereunto set my hand and attached the seal of said Company this 4th day of December,2008 6J �Qfp Randall Musselman,Secretary O� A�P .:a BY City ®f Huntington Reach 2000 Main Street • Huntington Beach, CA 92648 OFFICE OF THE CITY CLERIC ® . JOAN L. FLYNN CITY CLERK April 1, 2009 Palp, Inc., dba Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 RE: MSC-454 —Various Residential Streets Asphalt Overlay Enclosed please find your original bid bond for MSC-454. Sincerely, tnnFlynn, CMC City Clerk JF:pe Enclosure Sister Citiy�fot thioic14Iah*vret i� re,,New Zealand (Telephone:714-536-5227) PALP,INC.DBA EXCEL PAVING COMPANY 2230 LEMON AVENUE LONG BEACH, CA 90806 �. -- - 1Y 4 - �u c C"v+J SEALED 010 ENCLOSED SEALED 0 E,0ZLOSED LED 810 ENCLOSED 9�® City of Huntington Beach Public Works Department 2000 Main Street Tel. (714) 374-1732, Fax (714) 375-8430 ADDENDUM NUMBER ONE For VARIOUS RESIDENTIAL STREET OVERLAY MAINTENANCE SERVICE CONTRACT # 454 December 1,2008 Notice To All Bidders: Please note the following clarification to the City's Insurance and Indemnity Requirements: Incorporated into the Various Residential Street Overlay Project, MSC-464 plans and specifications is Addendum No. 1,dated December 1,2008 and the following attached documents: 1) Resolution 2008-63; A resolution to the City Council of the City of Huntington Beach revising and restating the City's insurance and indemnity requirements. The Contractor's submitted proposal shall be enclosed in a sealed envelope plainly marked on the outside: "SEALED BID" for I. Various Residential Street Overlay, MSC-454 Project Description: Grind and cap various residential streets, adjust utilities, and re-install loop detection, as needed. Engineer's Estimate: $2,600,00 This modification does not change the Engineer's Estimate for this project. This is to acknowledge receipt and review of Addendum Number one, dated December 1, 2008. Company Name By c t ofiov .oHIRSll)ENT Date All bidders must acknowledge the receipt of this Addendum with your bid proposal. Should you have any questions regarding this Addendum, please call Dereck Livermore at(714) 374-1732. SECTION C PROPOSAL for the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT .12' MAINTENANCE SERVICE CONTRACT# 454 in the CITY OF HUNTINGTON BEACH TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF HUNTINGTON BEACH: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of Huntington Beach. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of Huntington Beach, and to enter into a contract at the following prices. The undersigned agrees to complete the work within Sixty (60) working days, starting from the date of the Notice to Proceed. BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY 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 AGENCY of the guaranty 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 AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will readvertise the project. In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures. C-1 Bid Schedule MSC - 454 Cold Plane 1 706,001 S.F. at per S.F. $ Furnish and Install Petromat 2 2,537,923 S.F. at .Pl1 per S.F. $ 0 $ 355320q 02 Furnish and Install Asphalt at .12' 3 22,841 Ton at per Ton $ $ Adjust Wate alves to-Grade 4 338 EA atJUW tMAYWA4 per Each $ 150 $ Adjust Manholes to rade 5 262 EA at a per Each $ $ 0`1 Q-72 Install Traffic Loops 6 30 EA, at , � A per Each $ 106 p® $ r Prepare Pre & Post Construction Corner Record and File with Appropriate Agencies 7 241 EA at M gJAMvr*j per Each $ V`S4 $ I �( Total Bid Amount in Figures Is P.M' . Total Bid Amount in Words A4 C-2s If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER,the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void. "YEN PERCENT OF AMOUNT BID' Accompanying this proposal of bid, find in the amount of$ which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be). Bidder shall signify receipt of all Addenda here, if any: Addenda No. Date Received Bidder's Signature 1 PRESIDENT C-2 LIST OF SUBCONTRACTORS In accordance with Government Code Section 4104, the Bidder shall set forth the name and • business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor. Portion: Name and Address of Subcontractor State License Class Of Work Number ® yU ��� 1111 b ZOOM 16FA) - C4 L55g11 Loaps 01 S10 M • -1 A5 Ol9 �• JVST) J �aGg 217 By submission of this proposal,the Bidder certifies: 1. That he is able to and will perform the balance of all work which is not covered in the above subcontractors listing. 2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project. C-3 NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID State of California ss. County of Orange being fiisf''dul}� sworn, deposes and says that he or she is �PepsinpVT of the parry making the foregoing bid that the bid is not made in the interest of, or on the 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, or 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 fee to any corporation,partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Name of Bidder 0 Signature of Bidder 4 r SMWN, PRFSI®ENT- 2230 LENION AVENUE l_QNG B�.AC'H, CA 90806 Address of Bidder Subscribed and sworn to before me this day of , 20 _ . C.PHILLIPS ` COMM,#1809758 n Notary Public-California N ° LOS ANGELES COUNTY a M1!y+'0mm,ExPl sAug.16,2012 NOTARY PUBLIC NOTARY SEAL C-a UTILITY AGREEMENT HONORABLE MAYOR AND CITY COUNCIL CITY OF HUNTINGTON BEACH, CALIFORNIA Gentlemen: r The undersigned hereby promises and agrees that in the performance of the work specified in the - contract, known as the VARIOUS RESIDENTIAL STREETS FOR ASPHALT OVERLAY AT.12' MAINTENANCE SERVICE CONTRACT#454, (I)(we)(it)will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows: "Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved." The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal-OSHA requirements. The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall "take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein. Contractor b C� By C.Pv BROWN, PRESMENT Title f) Date: C-5 DISQUALIFICATION QUESTIONNAIRE In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire. QUESTIONNAIRE Has the Bidder, any officer of the Bidder or any employee.of the Bidder who has a proprietary interest in the Bidder ever been disqualified,removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation? ® Yes O No If the answer is yes, explain the circumstances in the space provided. Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire. C-6 COMPENSATION INSURANCE CERTIFICATE Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. Contractor By Q a BROWN, FRFSIDEN7 Title Date: C-7 UNDERGROUND SERVICE ALERT IDENTIFICATION NUMBER (To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY. Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid. To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation. Dig Alert Identification Number: Contractor By Title Date: Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request. C-8 BIDDER'S INFORMATION BIDDER certifies that the following information is true and correct: PALO INC.DBA EXCEL PAVING COMPANY Bidder Name 2230 LEMON AVENUE LONG BEACH,CA 90806 Business Address City, State Zip (562)599-SB T Telephone Number STATE LIC. 688659"Aa State Contractor's License No. and Class 6�gig - Original Date Issued Expiration Date The work site was inspected by bWj 1�t1l�l of our office on TA 1b 2003 The following are persons, firms, and corporations having a principal interest in this proposal: CURTIS P. BROWN,PRESIDENT b CHIEF OPERATING OFFICER ICER GEORGE R. McRAE,SENIOR VICE PRESIDENT ,VICE PRESIDENT MICHELE E.DRAKULICH,ASSISTANT SECRETARY EF&L.? I 4MMA C-9 The undersigned is prepared to satisfy the Council of the City of Huntington Beach of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth. Pn11MV�JA1 MW Company Name Signature of Bidder C;P�BROWP4, PRESIDENT Printed or Typed Signature Subscribed and sworn to before me this_day of , 200_ . EVLOS C.PHILLIPS COMM.#1809758It tary Public California ANGELES COuNTy u. thm,EVIres beg;18;2012 NOTARY PUBLIC CAP& NOTARY SEAL Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years: 1. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed 2. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed 3. Name and Address of Public Agency Name and Telephone No. of Project Manager: Contract Amount Type of Work Date Completed C-10 gg PAVING COMPANY L P.O. BOX 16405 A GENERAL ENGINEERING CONTRACTOR LONG BEACH, CA 90806-5195 STATE LICENSE NO. 688659A (562) 599-5841 FAX (562) 591-7485 C. P. Broom, President: 30+ years experience working for other general contractors with the past 24 years being self employed in own general engineering contracting business. R ;VC11 INC DMA PAVING COMPANY F.O. BOX 16406 A GENERAL FJd(MVEEtING CONTRACLbR LONG BEACH, CA 90W"195- STATE LICENSE NO. 688659A (56M b9915841 FAX(562) 591-7485 DESCRIPTION OF OPERATIONS Excel Paving Company is a general engineering and paving contractor that has been in business for the past 25+years. The company is a corporation owned by C.P. Brown,Jr. Their operations Include street and road construction, widening, and repairs; related sidewalk, curb and gutter construction; paving of school yards and parking lots; pipe work; and excavation and grading of"pads" for building sites. On approximately 80% of their jobs the company will operate as a general contractor, responsible for all off-site improvements, grading, removal, etc., but will subcontract any work which Is not specifically within their domain. Occasionally the company will perform work at airports. They may also occasionally perform work in the "THUMS " area of Long Beach Harbor, requiring them to transport their equipment and personnel by barge to these islands, approximately '/2 mile from the harbor. The company estimates 2006-2007 gross revenues of$85 Million, $60 Million of which Is subcontractor and material costs. All work is performed In Southern California, with most in Los Angeles and Orange County. A great deal of work Is done for public entities, repairing/widening existing surface streets and roads (75% public entities and 25% private entities); concrete, landscaping, electrical, cold milling, highway, bridge, or overpass work is subcontracted out to other firms. Excel Paving Company also repairs a great number of school yards and parking lots (30%)and usually has a small amount of ongoing work at the Los Angeles, Burbank, and Long Beach airports. INCUMBENCY AND SIGNATURE CERTIFICATE OF PALP, INC. The undersigned, Marcia S. Miller, being the duly elected and Incumbent Secretary of PALP, Inc., dba Excel Paving Company, a California corporation (the"Corporation'), hereby certifies that the persons named below are, on and as date hereof, the duly qualified, elected and acting Officers of the Corporation holding the office set forth opposite their names below, such officers being authorized to sign, in the name of and on behalf of the Corporation. Curtis P. Brown President and Chief Operating Officer Marcia S. Miller Secretary and Chief Financial Officer George McRae Senior Vice President Curtis P. Brown III Vice President Michele E. Drakuliich Assistant Secretary IN WITNESS WHEREOF,, the undersigned has executed this Certificate as of the date set forth below. Date: August 20, 2008 MARCIA S. MILLER, Secretary EXCEL PAVING COMPANY P.O. BOX 1640i✓ A GENERAL ENGINEERING CONTRACTOR LONG BEACH, CA 90806-5195 STATE LICENSE NO. 688659A (562) 599-5841 FAX (562) 591-7495 CREDIT APPLICATION Excel Paving Company 2230 Lemon Avenue P.O. Box 16405 Long Beach, CA 90806 Telephone: 562-599-5841 Fax: 562-599-3679 Type of Business: General Engineering Contractors Contractors License# 688659A Fed I.D.#95-3672914 Excel Paving Company is a Corporation Owner. Palp, Inc. 2230 Lemon Avenue Long Beach, CA 90806 In business since October 1981 Same location since October 1981 Property owned by Brown & Mills Financial rating with Dun & Bradstreet: Rating 3A2, SIC# 1611 US Bank, 2633 Cherry Ave., Signal Hill, CA 90806 Account Representative: Liz Acres or Celine Gonzalez Telephone: 562-490-2068 or 562-490-2079 Checking Account#1534-9195 8689 TRADE REFERENCES: Company Phone Fax Contact Vulcan Materials 323-258-2777 323-254-6102 Silvia Arredondo R.E.H.Trucking 909-591-0871 909-591-0506 Gina Mendiola Blue Diamond Materials 714-578-9507 714-449-2831 Jerry Easterwood Savala Equipment 800-223-2473 949-552-8597 Mona Covington SPECIAL BILLING REQUIREMENTS: Show job number on invoices to expedite payment. I certify that the above information is true and correct, and that we can and will comply with your terms. C.P. Brown Date President Bonding Agent: Rapp Surety Services 23461 South Pointe Drive Suite 345 Laguna Hills CA 92653 Office: (949)457-1060 Fax: (949)457-1070 Contact: Douglas A. Rapp Surety: Federal Insurance Company C/O Surety Department 801 South Figueroa Street 2V Floor Los Angeles CA 90017 P.O. Box 30127 Los Angeles CA 90030-0127 Insurance Cannier: The Wooditch Company One Park Plaza Suite 400 Irvine CA 92614 Contact: William Wooditch Office: (949) 553-9800 Fax: (949) 553-0670 Excel Paving Co. Work Experience February 28, 2008 7/8/08 OPEN JOBS 2008 EST. FINAL % JOB Open Jobs 1st. Qtr. 2008 SALES WORK Work NO. Project Name AMOUNT COMPL. Backlog 3843 LAUREL CYN BLVD. LOS ANGELES 807,100 100.0% 3947 TUSTIN AVE., ANAHEIM 4,370,876 99.9% 3,730 3959 SANTA MONICA BLVD., LOS ANGELES 49,757,848 99.8% 91,894 4042 TUDOR WEST/UCLA JOBS 2,529,930 96.3% 93,264 4062 SANTA MONICA/MWD 7,739,622 100.0% 4093 SAN FERN VLY LA 1,473,973 100.0% 4103 HOWLAND CNL CRT LA 299,925 100.0% 4123 ANAHEIM ST LONG BEACH 3,249,006 100.0% 4126 UNIVERSITY AVE RIVERSIDE 2,067,233 100.0% 4129 MT. SAC WALNUT 910,385 100.0% 4164 KENNEDY HS ANAHEIM 1,037,004 99.8% 2,153 4165 EL TORO RD LK FOREST 11,091,333 99.9% 9,232 4211 VARIOUS LOC LONG BEACH 306,515 99.9% 4232 VALENCIA MESA FULLERTON 750,000 42.2% 433,210 4240 LINCOLN BLVD. CALTRANS 12,085,000 84.6% 1,863,592 4240 CMB QTY/PLAYA VISTA 8,937 0.0% 8,937 4242 CHANDLER/LANKERSHIM LOS ANGELES 5,414,851 100.0% 4245 LINNIE CANAL LOS ANGELES 351,920 89.3% 37,522 4247 7TH/710 FRWY LONG BEACH 606,153 100.0% 4266 CENTINELA AVE. LOS ANGELES 2,880,145 99.3% . 21,377 4282 LOOP & PARK PL. IRVINE 1,112,969 100.0% 4295 CULVER BLVD VISTA DEL MAR 1,601,060 100.0% 4296 GLENDALE BLVD LOS ANGELES 597,309 100.0% 4302 VERMONT AVE. LOS ANGELES 1,392,670 100.0% 4316 MONTROSE AVE. LACPW 2,447,026 100.0% 4319 REDONDO AVE. LONG BEACH 221,979 100.0% 4324 USC, FIGUEROA& JEFFERSON 1,584,000 99.3% 10,727 4328 HIGHLAND AVE. LOS ANGELES 3,105,853 89.2% 335,168 4329 SUNSET BLVD. LOS ANGELES 2,075,586 99.9% 1,302 4330 HARBOR GATEWAY LOS ANGELES 2,722,826 100.0% 4332 SO. BRAND BLVD GLENDALE 1,867,221 100.0% 4336 VERMONT AVE. GARDENA 1,204,230 99.0% 12,612 4337 MCFADDEN AVE. 1,121,382 100.0% 4339 VARIOUS LOCATIONS LONG BEACH 1,353,277 100.0% 4340 SLAUSON AVE. CULVER CITY 2,550,397 86.6% 342,763 4343 BRAND & HARVARD GLENDALE 134,000 100.0% 4348 PH 3-PIER T LONG BEACH 23,465,530 99.8% 38,782 4359 MICHELSON BLVD. IRVINE 2,909,722 99.7% 8,186 4365 WEIDLAKE IMPRV LOS ANGELES 465,183 100.0% WPFEBCBJ Final Run III 01r WIP5208 Open Jobs-C 7.7-2CV8 Page 1 of 11 7-8-08 Excel Paving Co. Work Experience February 28, 2008 EST. FINAL % JOB Open Jobs 1st. Qtr. 2008 SALES WORK Work NO. Project Name AMOUNT COMPL. Backlog 4367 GRANADA AVE. LA MIRADA 564,180 100.0% 4370 ALAMEDA ST. LOS ANGELES 3,297,043 57.5% 1,402,782 4373 CENTURY PKG LOT E. LOS ANGELES 736,152 100.0% 4374 WOODRANCH PKWY SIMI VALLEY 1,982,642 99.9% 1,828 4377 PIER E PORT LB 5,295,408 100.0% 4393 JEFFERSON BLVD. PLAYA VISTA 7,938,248 99.8% 13,759 4401 NO. MCLAY ST SAN FERNANDO 4,950,481 98.5% 73,410 4404 UCI IRVINE 22,443 100.0% 4408 HOLLYWOOD WAY BURBANK 23,710 100.0% 4413 VERMONT LOS ANGELES 141,029 100.0% 4414 TOPANGA/VICTORY LOS ANGELES 2,166,954 100.0% 4415 CASE AVE. LOS ANGELES 186,308 100.0% 4416 STIMSON AVE. LA PUENTE 397,215 100.0% 4417 PROSPECT TUSTIN 925,440 94.1% 54,590 4420 VERMONT AVE. LOS ANGELES 915,500 100.0% 4421 LB TAXIWAY LONG BEACH 59,379 100.0% 4425 FIRST ST-LOS ANGELES 212,758 0.0% 212,758 4427 05-'06 ST. REHAB LAGUNA BCH 3,848,764 100.0% 1,656 4429 RANDALL ST. ORANGE CO. 824,976 99.4% 5,204 4434 IMPERIAL HWY DOWNEY 2,432,234 99.6% 10,726 4435 NATIONAL BLVD. CAL TRANS 90,524 100.0% 4440 226TH ST HAWTHORNE 92,155 100.0% 4442 SEPULVEDA BLVD. LA/CC 583,268 43.5% 329,625 4443 INGLEWOOD AVE. REDONDO BCH 540,525 100.0% 4444 ALLEN AVE. GLENDALE 279,890 100.0% 4448 MARYMOUNT HS 856,482 98.8% 10,265 4451 OVERLAY SANTA CLARITA 5,503,564 99.4% 32,503 4452 GLENCOE LOS ANGELES 310,876 100.0% 4453 ST. IMPRV INGLEWOOD 479,793 100.0% 4454 UCI IRVINE 58,853 81.9% 10,656 4456 EL DORADO HS LAUSD 794,632 100.0% 4458 TAPO CYN SIMI VLY 2,957,390 96.0% 119,242 4462 VIRGINIA ST, EL SEGUNDO 92,774 100.0% 4463 SERVICE MOD EL CAMINO COLLEGE 147,800 99.9% 160 4464 WASHINGTING/GRANDE BNSF 1,100,000 58.4% 458,002 4466 FIGUEROA/SEPULVEDA LACO SANI 2,185,724 93.4% 144,874 4467 VALLYHEART ST. FRANCIS 135,875 100.0% 4468 LACC LOS ANGELES 6,085 100.0% 4469 HALDEMAN RD. RUSTIC CYN HOA 57,900 45.5% 31,537 4470 LATIMER RD. RUSTIC CYN HOA 66,500 21.2% 52,390 4471 ANAHEIM ST. LB TRANSIT 244,032 100.0% WPFEBW,F1111 Ru,I sl Qtr WIPS 208.OPn Jobs.C 7-7.2W8 Page 2 of 11 7-8-08 Excel Paving Co. Work Experience February 28, 2008 EST. FINAL % JOB Open Jobs 1st. Qtr. 2008 SALES WORK Work NO. Project Name AMOUNT COMPL. Backlog 4474 NO. LOOP RD. HATHAWAY 2,996,158 98.2% 52,798 4479 UNION AVE SNYDER LANGSTON 55,297 77.2% 12,594 4480 EAST OLIVE AVE BURBANK - '313,656 100.0% 4481 CERRITOS/EL RITO GLENDALE 1,169,247 98.8% 13,459 4482 20TH/REDONDO LONG BEACH 1,823,287 7.8% 1,681,109 4483 BOB HOPE AIRPORT BURBANK 12,760,691 25.8% 9,468,628 4486 BLUFF CREEK DR COLICH &SONS 213,242 83.8% 34,626 4489 ENT PKG LOT BURBANK AIRPORT 380,925 99.8% 857 4490 VARIOUS LOC LB TRANSIT 808,600 42.5% 464,991 4491 WESTFIELD CENTER ARCADIA 29,118 94.1% 1,719 4492 TIERRA REJADA RD MOORPARK 3,167,305 99.8% 5,952 4493 FREEMAN DR. CALABASAS 82,619 98.1% 1,568 4495 PORT OF LB RYAN CO. 16,091 100.0% 4497 CALIFORNIA BLVD. CSI ELECT 14,982 100.0% 4498 VAGABOND STRM DRN MONTEREY PARK 89,325 100.0% 4499 CANTARA KAISER FOUND 124,698 12.0% 109,748 4500 CAMPUS/ARTISAN CSI ELECT 4,200 0.0% 4,200 4501 GAGE AVE BELL 25,375 100.0% 4502 GARDEN GROVE SANI 1,946,000 16.7% 1,621,801 4503 GRANADA HILLS TORRES CONST 50,496 99.1% 444 4504 BERENDO M.S. TORRES CONST 201,392 22.1% 156,837 4505 TOPANGA/VICTORY WESTFIELD 1,850,000 58.3% 771,183 4506 VARIOUS LOC CO OF ORANGE 32,744 97.3% 892 4507 BRAND BLVD. HATHAWAY 152,200 0.0% 152,200 4508 ALVARDO TRANSIT LACRA 2,140,870 1.0% 2,118,973 4509 ROSCOE BLVD. KAISER FOUND 100,937 45.3% 55,173 4510 LIGGETT E.S. TORRES CONST 84,479 100.0% 4513 LEAPWOOD E.S. TORRES CONST 142,331 99.8% 250 4514 FOOTHILL BLVD. BERNARDS 81,317 97.2% 2,265 4515 GRAND AVE. MT. SAC 224,920 83.6% 36,938 4516 TUSTIN & 1ST ST MCCARTHY 235,000 1.2% 232,167 4518 NORMANDIE ARB STRUCTURES 94,545 9.1% 85,919 4519 MOORPARK HIGHLANDS CHAPARRAL 616,202 99.9% 473 4520 AMBLER AVE SCH TORRES 134,940 33.7% 89,530 4521 ZANE GREY H/S TORRES 77,449 99.2% 650 4522 BELMONT PLAZA LONG BEACH 658,618 1.2% 650,935 4523 BESS/LEORETTA KAISER 192,167 1.5% 189,250 4524 VERDUGO/BARRINGTON GLENDALE 449,773 0.9% 445,832 4525 TAPER AVE SCH TORRES 108,842 100.0% 4526 LAKEWOOD BLVD. DOWNEY 1,988,635 1.1% 1,966,825 WPFEBO8J Final Run ist Otr WIP52008-Open J&-7-1-2M8 Page 3 of 11 7-8-08 Excel Paving Co. Work Experience February 28, 2008 EST. FINAL % .JOB Open Jobs 1st. Qtr. 2008 SALES WORK Work NO. Project Name AMOUNT COMPL. Backlog 4527 SUNNY BRAE SCH TORRES 15,345 90.5% 1,458 4528 GETTY CENTER HATHAWAY-,__. :.,,__.,.. t _ 37,887 0.4% 37,728 4529 NORTHRIDGE M/S TORRES 6,542 94.5% 359 4530 VARIOUS LOCATIONS CULVER CITY 770,000 64.7% 271,936 4531 LONG BEACH CALCARTAGE 4,284 100.0% 0 4532 SAN MIGUEAL E/S TORRES 315,091 62.0% 119,794 4533 USC CINEMATIC HATHAWAY 2,134 100.0% 0 4534 7TH/CATALINA HENSEL PHELPS 73,954 96.8% 2,352 4535 SHENANDOAH E/S LAUSD 486,177 4.8% 462,900 4536 W.4TH ST BNSF 378,505 0.0% 378,505 4537 26TH ST.NERNON CBRE 47,343 42.2% 27,367 4538 PERSHING DR CSI ELECT 86,018 0.0% 85,981 4539 W. BURBANK LOT BURBANK AIRPORT 63,382 6.4% 59,346 4540 EVEWARD RD. DLSB 47,967 56.4% 20,922 4541 CAMINO REAL REDONDO BCH 398,379 0.6% 395,815 4542 PASEO DEL MAR VAL VERDE 13,374 96.0% 529 4544 BURBANK AIRPORT BURBANK AIRPORT 16,585 93.7% 1,046 4545 BERTHS 261-267 CONNELLY-PACIFIC 176,000 0.0% 176,000 4546 ORCHARD ST. BELL 19,375 54.6% 8,795 4547 WRIGHT M/S TORRES 99,889 12.5% 87,431 4548 NORMANDIE KAISER 39,391 0.0% 39,391 4549 RAMIREZ CANYON TORRES 285,000 26.8% 208,583 4550 4TH ST. CHLS KING 18,527 69.3% 5,685 4551 GEPRGE BURNS AVE. WEST HOLLYWOOD 39,219 54.4% 17,897 4552 JOHN WAYNE AIRPORT ORANGE CO 1,394,750 0.7% 1,385,280 4553 PACIFIC OCAST HWY DANA POINT 5,762,269 0.7% 5,724,194 4554 BLUFF CREEK FINVEST 86,465 0.2% 86,255 4555 VICTORY BLVD. NO. HOLLYWOOD 400,000 0.1% 399,517 4556 GARVEY AVE. REYES CONST 38,218 0.3% 38,096 WPFEB00J Ffnl Run 1,t Q11 WIP520M-Open Jobs-C]-]2006 Page 4 of 11 7-8-08 Work Experience February 28, 2008 Excel Paving Co. CLOSED JOBS 2007- 2008 07/08/08 JOB SALES NO. PROJECT NAME AMOUNT 3704 TAXIWAY D L.B. AIRPORT 3,720,722 3865 2627 HOLLYWOOD, BURB/GLEN/AIRP 377,031 -' 4084 SAND CANYON IRVINE 720,447 4088 ANNUAL RD RESURF DANA POINT 1,490.592 4099 03 ST IMPRV INGLEWOOD 593,520 4144 CASE AVE LA 432,963 4157 YL/PLACENTIA FULLERTON 137,338 4176 SILVER LAKE LOS ANGELES 1,317,464 4182 UCLA LOS ANGELES 38,066 4182 UCLA CAMPUS LOS ANGELES 103,828 4218 ASHCROFT/ROBERTSON LOS ANGELES 52,900 4233 VAN BUREN VLD. CO RIVERSIDE 2,461,429 4237 S/W AREA LAX 4,876,048 4253 S.A. STADIUM SANTA ANA 397,289 4257 MIRAMONTE ES LOS ANGELES 677,111 4269 KINNELOA DEBRIS BASIN LOS ANGELES 237,063 4274 HARBOR BLVD LOS ANGELES 1,249,459 4275 CLAY MS LOS ANGELES 620,819 4281 HILLCREST ES LOS ANGELES 903,237 4306 10TH ST. LONG BEACH 1,192,729 4307 NEWPORT SHORES NEWPORT BEACH 1,584,279 4309 KING MS LOS ANGELES 985,753 4314 PARK PLACE IRVINE 998,231 4314 PARK PL PKG 76,267 4317 BERTHS 226-236 POLA 2,811,047 4334 710 FRWY CALTRANS 700,680 4344 PKG LOT PH 1 RANCHO SANTIAGO CC 896,694 4346 DAMON, CONSTELL OF STARS 202,454 4347 HAMILTON HS LOS ANGELES 603,569 4349 FIRESTONE BLVD. SEPULVEDA DEV 325,075 4353 FOUNTAIN VLY HS HUNT BCH UHSD 1,074,427 4354 LA BREA AVE. WEST HOLLYWOOD 496,890 4361 ORANGE AVE LAWNDALE 209,832 4362 ST. REHAB LEISURE VILLAGE 799,326 4366 ANNUAL ST. ALHAMBRA 651,988 4371 VARIOUS STS REDONDO BCH 960,788 4372 WALNUT ST. SIMI VALLEY 412,988 4380 POINT FERMIN PASCHEN 359,607 4383 VERMONT AVE. KAISER FOUND 117,035 4384 VERMONT AVE KAISER FOUND 182,820 HISTO-REPORT 2-28-2008-7808-S lots.t."IPS-CbseO Jobs 3,d&-OTR5 2OO7&Isi OTR 2OOe Page 5 of 11 7-8-08 Work Experience February 28, 2008 Excel Paving Co. CLOSED JOBS 2007- 2008 07/08/08 SALES AMOUNT 4385 VARIOUS STS INGLEWOOD 379,574 4387 PALOS VERDES DR. PV EST 95,060 4394 CLARA ST. CUDAHY 556,434 4395 E. LOOP RD. IRVINE 363,771 4407 ORANGETHORPE BUENA PARK 1,038,513 4412 TRUNK SEWER REHAB CARSON 16,824 4418 PCH WILMINGTIN 22,830 4419 MICHELSON DR. IRVINE 460,419 4424 BNSF-TRACK 114 VERNON 1,108,470 4426 BNSF-SHEILA AVE. COMMERCE 528,245 4430 BNSF-ESPARANZA YORBA LINDA 352,990 4431 HAVEN AVE. RANCHO CUCUMONGA 155,069 4433 TRADE MARK IRVINE 29,025 4436 FULLER/GARNER WEST HOLLYWOOD 235,383 4439 DESOTO CHATSWORTH 9,437 4445 RAYMOND ST. PASADENA 25,155 4446 EASTERN/BANDINI BNSF 73,995 4449 WILLOW LANE WESTMINSTER 132,524 4450 ST. IMPRV LYNWOOD 766,795 4455 MAIN ST. NT2 PRODUCTIONS 2,700 4457 ACCESS RD. LOS ANGELES 499,954 4459 CLARK/SPRING LONG BEACH 70,775 4460 WASHINGTON/IND BNSF 171,668 4461 CDR 233 UPGRADE 374,942 4465 CANTERA ST. KAISER PERM 106,978 4472 BALL/HARBOR CHLS KING 16,626 4473 FIRST/BOYLE LOS ANGELES 60,771 4475 6TH/PCH BOVIS 10,886 4476 SLAUSON/VAN NESS MLADEN BUNTICH 23,570 4477 WEST LA COLLEGE LOS ANGELES 186,054 4478 VALLEY BLVD. INDUSTRY 7,900 4484 UNIVERSITY HS TORRES CONST 88,537 4485 FLINTRIDGE HS LA CANADA/FL 1,400 4487 ROSEMEAD/SLAUSON BNSF 96,849 4488 GETTY CENTER GETTY TR 3,020 4494 SPAZIER ENVIRON 25,977 4496 POL SHOOTING LAGUNA BCH 51,837 4511 PIER F-POLB B & D 3,100 4512 L ST-WILLMINGTON BNSF 146,806 4517 18TH ST. SANTA MONICA 15,198 4543 AMELIA AVE. ROYAL ELECT 21,950 HISTORYRE PORT 228-2W0 7808-S WO IWIPS Closed J.b13rd&Q,OTRS 200781st OTR 20W8 Page 6 of 11 7-8-08 Excel Paving Co. Work Experience May 31, 2007 JOB Closed Jobs 2006 SALES NO. PROJECT NAME AMOUNT 3716 710 FWY PCH TO 405 21,510,942 3990 OCEAN BLVD LONG BEACH 1 ,196,229 - 4004 GREEN VALLY CIRCLE CULVER CITY 1,173,791 4024 UCLA KINROSS 2,329,669 4045 5 FRWY, OR. CO 180,290 4057 PALO VERDE HSG 611,836 4061 PANKOW BLDRS M.B. 720,917 4064 WALGROVE E.S. L.A. 767,069 4083 HARBOR BLVD FULLERTON 214,172 4098 BLEND E.S LA 273,966 4102 DENA E.S. LA 177,306 4104 MOULTON PKWY CO OF ORANGE 478,612 4106 PIER S BRTH S102-S110 LONG BEACH 4,077,253 4109 VARIOUS STS REDONDO BEACH 761,751 4115 WASHINGTON BLVD CULVER CITY 741,069 4117 VANUYS AIRPORT VAN NUYS 620,336 4120 SOUTHGATE HS LOS ANGELES 681,858 4142 ROSECRANS LAWNDALE 233,216 4143 CALLE MIRAMAR REDONDO BCH 536,987 4156 STERRY E.S. LA 223,520 4160 WARNER ES LA 988,639 4161 ST OVERLAY SIMI VLY 704,970 4168 MARINA DEL REY LA 459,915 4169 CEN PK WEST LA 50,550 4174 SHERMAN OAKS CNTR RESEDA 1,044,265 4175 GLEDHILL ES NO HILLS 506,079 4181 STATE ST ES LAUSD 334,787 4185 WHITTIER/PRESBY WHITTIER 7,400 4186 GETTY TRUST LOS ANGELES 850 4191 HARVARD AVE. IRVINE 329,938 4192 COMPTON/61 ST LOS ANGELES 17,722 4195 NEW JOB SAN CLEMENTE 10,966 4196 MWD/SEARL HEMET 9,109,427 4197 LYNOOD USD LYNWOOD 1,520,919 4198 AGOURA BIKE AGOURA HILLS 1,032,236 4209 PCH/CATALINA LONG BEACH 657,469 4210 GLENDALE BLVD LOS ANGELES 36,630 4212 GLENDORA/HILL LA PUENTE 11,833 HW«y F8,20(6.2W�",-2W A&Z-2W7 Page 7 of 11 7-8-08 Excel Paving Co. Work Experience May 31, 2007 JOB Closed Jobs 2006 SALES NO. PROJECT NAME AMOUNT 4213 ALDAMA ST SCH 19,097 4214 PCH/ZUMIREZ MALIBU 453,886_� ., 4215 THE TOLEDO LONG BEACH 7,449 4216 REEVES/NAVY PORT OF LB 268,611 4217 KANAN RD/101 FRWY 13,589 4220 SO CENTRAL HS LOS ANGELES 54,026 4222 PKG LOT 6 MONROVIA 406,899 4224 SUNSET BLVD. W. HOLLWOOD 166,602 4227 SEWER REHAB REDONDO BCH 550,196 4229 BLDG 10 & 28 24,697 4230 VARIOUS LOC LOS ANGELES 441,551 4235 VICTORY BLVD. CANOGA PARK 687,374 4243 ANDASOL ES NORTHRIDGE 131,502 4246 SOUTH ST. ANAHEIM 492,994 4248 MANHATTAN &AVIATION REDONDO BEACH 49,589 4249 CAL TECH PKG PASADENA 39,406 4250 2 FRWY GLENDALE 13,200 4251 5M FRWY CAL TRANS 188,210 4254 PCH CAL TRANS 1,204,048 4256 GARDENA HS GARDENA 1,009,381 4258 N/E INTER SEWER LOS ANGELES 360,460 4259 LOMA VISTA ES LOS ANGELES 277,404 4261 MULHOLLAND DR. LOS ANGELES 17,598 4263 BEVERLY VISTA ES BEVERLY HILLS 734,246 4265 INDIANA/WASH BNSF 15,290 4271 GETTY CENTER DR. CENT. CITY 28,907 4276 GETTY CENTER DR. CENT. CITY 262,399 4277 GETTY CENTER DR. CENT. CITY 4,384 4278 CLARK AVE. LONG BEACH 517,203 4279 41 ST ST. LOS ANGELES 440,218 4280 VIA ROSA/PV BLVD, PV ESTATES 504,157 4284 CENT/LINC CULVER CITY 263,999 4286 WESTERN AVE. TORRANCE 28,640 4287 GRAND AVE. EL SEGUNDO 144,403 4289 LUGO E.S. LYNWOOD 15,435 4291 05-06 St.Maint AGOURA HILLS 831,113 4292 PICO BLVD. LOS ANGELES 67,308 4293 HOLLYWOOD WAY BURBANK ARPRT 38,800 4294 5 FRWY MISSION VIEJO 3,359 HM.y Rk,2M&2WZ th,u"I-2 7-A 827-2W7 Page 8 of 11 7-8-08 Excel Paving Co. Work Experience May 31, 2007 JOB Closed Jobs 2006 SALES NO. PROJECT NAME AMOUNT 4297 VICTORY/TOPNGA LOS ANGELES 606,202 4298 ST. JOSEPH'S SCH LONG BEACH 2,000 4300 PV LANDFILL LA SANI DIST 19,650 4301 MICHELSON IRVINE 201,698 4304 MEDIA STUDIOS BURBANK 18,700 4310 VAIL/CLEVELAND MONTEBELLO 10,790 4311 PLAYA VISTA LOS ANGELES 16,854 4312 INDIANA/WASHINGTON BNSF 147,323 4315 190TH/GREENLANE REDONDO BEACH 2,000 4318 RON REAGON FRWY SYLMAR 16,304 4321 SO. EAST HS SOUTH GATE 12,000 4322 E. PCH WILMINGTON 14,216 4325 BLUFF CREEK PLAYA VISTA 50,310 4326 BNSF, IND & WASH COMMERCE 334,616 4327 UNION STATION LOS ANGELES 10,000 4331 OLIVE & LAKE BURBANK 12,876 4333 VINEYARD & SATURN LOS ANGELES 8,545 4335 CSI/BOEING-BOLSA HUNT. BCH 101,500 4338 BNSF, WASH & IND NERVON 37,840 4341 FIRE STATION BURBANK 0 4342 MOOG, WESTERN WAY TORRANCE 37,031 4345 3355 EMPIRE BURBANK 79,193 4351 LAX-SO VAULT LOS ANGELES 26,514 4355 HAWTHORNE BLVD TORRANCE 4,000 4356 LAAFB RMA LAND 3,858 4357 PICO BLVD. LOS ANGELEWS 20,400 4363 DUESLER LANE DUESLER ASSOC 36,000 4364 WASHINGTON BLVD. PICO RIVERA 23,265 4375 VAN NUYS BLVD, ARLETA 6,140 4376 OBSERVATORY RD. LOS ANGELES 13,151 4379 E. SOUTH ST. MARKET RECYCLE 1,885 4382 FIGUEROA/JEFF LOS ANGELES 5,995 4386 INDIANA/WASH BNSF 83,456 HLory rll 20 2007 thw S31-200;-F 627.2W7 Page 9 of 11 7-8-08 Excel Paving Co. Work Experience May 31, 2007 JOB CLOSED JOBS 2007 SALES NO. PROJECT NAME AMOUNT 3876 PARTHENIA, LA 1,153,774 _- 4067 DEL AMO BLVD LONG BEACH 393,459 4076 JESSE OWENS PK INGLEWOOD 562,447 4077 CHAPMAN/ST COLL FULLERTON 135,411 4112 BELMONT PIER LONG BEACH 479,513 4113 NO LONG BEACH LONG BEACH 1,673,247 4127 UNION STATION LOS ANGELES 429,149 4154 STS & ALLEYS W. HOLLYWOOD 205,131 4177 COLD CANYON LOS ANGELES 481,211 4179 PE BIKE TRAIL UPLAND 2,418,540 4183 CAHUENGA LOS ANGELES 33,205 4189 AVE OF STARS CENT CITY 465,184 4205 DREW MID SCH LOS ANGELES 1,097,527 4206 107TH ST ES LOS ANGELES 400,544 4207 93RD ST ES LOS ANGELES 348,165 4226 MONTANOSO DR. MISSION VIEJO 163,838 4236 THOMAS EDISON MS LAUSD 814,878 4241 BRACKETT ARFLD POMONA 373,977 4252 W. PICO BLVD. LOS ANGELES 518,766 4255 ROMOLAND CALTRANS 200,540 4260 WESTLAKE VILLAGE 958,888 4264 BELLA TERRA MALL HUNT. BCH 3,166,715 4268 RANCHO CUCAMONGA RANCHO CUCAMONG 234,424 4272 CHIQUITA BLDG PORTOF LB 6,922,874 4273 UCLA CAMPUS LOS ANGELES 71,597 4281 PALISADES HS 1,942 4285 MARLTON ES LOS ANGELES 278,427 4305 JEFF/CENTINELLA LOS ANGELES 1,486,623 4308 LAX AA MAINT AMERICAN AIRLINES 57,975 4313 SSA PKG LOT CO ORANGE 189,508 4320 CERRITOS PARK GLENDALE 305,537 4323 6TH & PCH HUNTINGTON BCH 16,092 4350 SHEILA ST. BNSF 256,660 4352 PREV MAINT REDONDO BEACH 254,596 4358 EL MODENA ALLEY ORANGE 97,222 4360 BESS/LEORITA KAISER FOUND 300,107 4368 SCHOOLWOOD DR. LA HABRA 170,908 4369 SHERMAN OAKS CNTR KBR SRV 39,323 4378 E. SLAUSON AVE. MARMOL RADZINER 60,718 4381 E. 7TH ST. INTERSCAPE 16,995 4388 PICO BLVD LOS ANGELES 22,255 History R.200 2007 Mry 5 3I-2(?7-P B-r 2� Page 10 of 11 7-8-08 Excel Paving Co. Work Experience May 31, 2007 JOB CLOSED JOBS 2007 SALES NO. PROJECT NAME AMOUNT 4389 UPPER CLOVERLEAF RD MONROVIA 178,395 - 4390 COLDWATER CYN NO. HOLLYWOOD 10,855 4391 U OF WEST ROSEMEAD 351,139 4392 OLDEN ST. SYLMAR 92,684 4396 BURBANK AIRPORT BURBANK 18,283 4397 DURFEE/MICHAEL HUNT 17,989 4398 DIEMER PLANT MWD 116,205 4399 WARDLOW/CHERRY BOEING 156,900 4400 ELSMERE CARSON 7,780 4402 MOORPARK COLLEGE 91,578 4403 BNSF/WASH VERNON 506,615 4405 HAALAND DR THOU OAKS 148,500 4406 TROY H/S FULLERTON 321,451 4409 MAARKET ST SWR CHLS KING 5,270 4410 LOT A BURBANK ARPRT 47,124 4411 BRAVO BASE REPAIR LOS ANGELES 17,390 4422 PUENTE HILLS LACO SANI 12,500 4423 PIER J-BERTH 247 LONG BEACH 8,200 4428 SIXTH ST. SAN PEDRO 3,200 4432 BURBANK AIRPORT BURBANK 43,500 4441 INDIANA/3RD BNSF 3,900 4447 PIER F LONG BEACH 8,300 Hhto y F1W,2OW2W7 Mni 531-200"1-A&27-20V Page 11 of 11 7-8-08 CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSIBILITY STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: Jefferson Blvd. Widening PROJECT DESCRIPTION: Street widening, Infrastructure reconstruction, Street lighting, traffic signals, landscape & irrigation, Storm drain impvts, and LOCATION: Jefferson Blvd. , Playa Vista, Los Angeles 'sewer. CONSTRUCTION VALUE: 6,306,687.00 _ IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR: ARCHITECT: KATZ, OKITSU & ASSOC. PSOMAS GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: David Cook TELEPHONE: 562) 599-5841 Ext. 239 OWNER INFORMATION: NAME: Playa Capitol Company, LLC _ CONTACT: Mr. Lary Chambers TELEPHONE: 310)448-4705 or 310)345-7856 CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSBILITY STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECTNAME: Slauson Ave/ SR-90 Impvts. PROJECT DESCRIPTION: On ramp & off ramp widening on SR90, Traffic Mitigation added left turn on Slauson Signalization & Signing & Storm Drain Impvts. LOCATION: Slauson Ave @ SR90 Culver City, Los Angeles CONSTRUCTION VALUE: 2 136,269.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR: ARCHITECT: KATZ, OKITSU & ASSOC PSOMAS GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: David Cook TELEPHONE: 562)599-5841 Ext. 239 OWNER INFORMATION: NAME: Playa Capitol Company LLC _ CONTACT: Mr. Lary Chambers TELEPHONE: 310)448-4705 or 310)345-7856 i- CONTRACTOR'S NAME PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE (REFERENCE 1,05 OF THE RESPONSIBILITY STATEMENT) PROVIDE THE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF $2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: SANTA MONICA TRANSIT PARKWAY PROJECT PROJECT DESCRIPTION: UNDERGROUND, RETAINING WALLS, FWY. ON RAMPS, A/C PAVE, SIDEWALK, CURB & GUTTER, SIGNALIZATION, LANDSCAPING, STORM DRAIN IMPVTS,SEWER, WATER, AND RETAINING WALL. LOCATION: FROM 405 FWY. TO BEVERLY HILLS CITY LIMIT, LOS ANGELES CONSTRUCTION VALUE: $14,455,152.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACT VALUE: ARCHITECT: C/O LOS ANGELES GENERAL CONTRACTOR INFORMATION NAME: PALP INC. DBA EXCEL PAVING COMPANY CONTACT: BRUCE FLATT TELEPHONE: 562/599-5841 OWNER INFORMATION NAME: CITY OF LOS ANGELES CONTACT: CARL NELSON TELEPHONE: 21 485--4-4-74 CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSEBILITY STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: Alameda Street PROJECT DESCRIPTION: Redesign of Arterial Streets and Storm Drain Impvts. LOCATION: Intersection of Alameda Street and N. Spring St Los Angeles CONSTRUCTION VALUE: 3,197,043.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR. ARCHPTECT: City of Los Angeles GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: Bob Pace TELEPHONE: 562) 599-5841 Ext. 248 OWNER INFORMATION: NAME: City of. LaAngeles Board of Public Works CONTACT: Raphael Villegas TELEPHONE: 213)485-4556 CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSIBILITY STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: Phase 3 Container Yard Expansion Pier T PROJECT DESCRIPTION: Container Yard Parking Lot Expansion, Storm Drain Impvts, Sewer and Water. LOCATION:Pier T, Long Beach, Ca. CONSTRUCTION VALUE: 21 ,703,834.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR: ARCHITECT: Port of Long Beach GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: Bob Pace TELEPHONE: 562)599-584I ext 246 OWNER INFORMATION: NAME: The Por • of Long Beach CONTACT: Gary Cardemone TELEPHONE: 562) 590-4172 o CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSBELM STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: pier F R rths 24-326 PROJECT DESCRIPTION: Asphalt Utility Removals, Grade, New Asphalt Paving and New Concrete RTG Runways, Storm Drain Impvts, Sewer and Water. LOCATION: Pier CONSTRUCTION VALUE: 5,251,800.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR: ARCHITECT: Port of Long Beach GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: Bob Pace TELEPHONE: 562)599-5841 Ext. 246 OWNER INFORMATION: NAME: The Port of Long Beach CONTACT: Peter Forsythe TELEPHONE: 562) 244-9077 v CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSIBILITY STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: Highland Avenue Widening PROJECT DESCRIPTION.- Redesign of Highland Ave and Adjacent Streetsi Storm Drain Impvts. LOCATION: Highland Ave @ Franklin Ave, City of Los Angeles CONSTRUCTION VALUE: 2,754,889.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR: ARCHITECT: City of Los Angeles GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: Bob Pace TELEPHONE: 562) 599-5841 Ext 246 OWNER INFORMATION: NAME: __City nf Los Angeles Board of Public Works CONTACT: Rafael Villegas TELEPHONE: 213)485-4556 CONTRACTOR'S NAME: PALP INC. DBA EXCEL PAVING COMPANY A. COMPANY EXPERIENCE(REFERENCE 1.05 OF THE RESPONSIBELITY STATEMENT) PROVIDE FOLLOWING INFORMATION FOR ALL PROJECTS WHICH INVOLVE CONSTRUCTION WORK WITH A VALUE IN EXCESS OF$2,000,000 PRESENTLY UNDER CONSTRUCTION. PROJECT NAME: North Maclay Ave PROJECT DESCRIPTION: Street Beautification and Improvement of North Maclay Ave LOCATION: North Malay Ave. from 1st Street to Eighth Street CONSTRUCTION VALUE: 3,682,624.00 IF YOUR WORK WAS PERFORMED AS A SUBCONTRACTOR: N/A INITIAL SUBCONTRACT VALUE: FINAL SUBCONTRACTOR: ARCHITECT: City of San Fernando GENERAL CONTRACTOR INFORMATION: NAME: Excel Paving Company CONTACT: Bob Pace TELEPHONE: 562) 599-5841 Ext 246 OWNER INFORMATION: NAME: Ci tV f can Fernando CONTACT: Daniel Wall/ City Engineer TELEPHONE: 818) 898-1225 Bond No. Bid Bond BID BOND The American Institute of Architects, AMA Document No.A310(February, 1970 Edition) KNOW ALL MEN BY THESE PRESENTS,that we PALP Inc.dba Excel Paving Company as Principal hereinafter called the Principal,and Federal Insurance Company a corporation duly organized under the laws of the state of Indiana as Surety, hereinafter called the Surety, are held and firmly bound unto City of Huntington Beach as Obligee,hereinafter called the Obligee,in the sum of Ten percent of the total amount of the bid Dollars ($I o% ), for the payment of which sum well and truly to be made,the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. WHEREAS,the Principal has submitted a bid for various Residential Streets for Asphalt Overlay(454) NOW,THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material famished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect. Signed and sealed this 8th day of December 2008 PALP Inc. dba Excel Paving Company Witness Principal (Seat) By. 7175 3 M Name/Title _Federal Insurance Company ��--� Surety (Sea]) Witness By.— othy D. Rapp Attorney-in-Fact ORSC 21328(5f97) CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Orange On Dec. 8, 2008 before me, Adelaide C. Hunter, Notary Public (Hem insert name and title of the officer) personally appeared Timothy D. Rapp who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/aF,-subscribed to the within instrument and acknowledged to me that he executed the same in his/herMteir authorized capacity(ies), and that by hisAteeWgwir signature(s)on the instrument the person(s), or the entity upon belhalf of which the person(s) acted, executed the'instrument. 1 certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ADELAIDE C. HUNTER Commission # 1808793 WI SS my hand and lcial seal. a Notary Puwiic --Caiifornia ; x `F Orange County Y My Comm.Expires Aug 8, 2012 (Notary Seal) signature of Notary Public ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COfW'LETING THIS FORM A* acbrowledgmat completed In Cal(jonia must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT aWws above in the Rotary section or a separate acbwwledgmem form must be props* complaud and attached to that document. 77w only exception is if a ••• doeainvew is to be rvcordad owuide of Cal(ror i In such instances,any adternarrve (Title or description of attached docwrorit) aebvioledgment verbage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in Cal(fornia (i.e. con-Wing the authorised capacity of the signer). Please check the (ride or description of attached document continued) doct""e1t carodly for proper notarial wording and attach drir form if requued Ntunber of Pages Document Date • State and County information must be the State and County where the document signer(#)personally app=W before the notary public for acknowlodgmonc e Date of notarirstias must be the date that the signers)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The rotary public must print his or her name as it appears wirhrn his or her commission followed by a connna and then your tide(notary public) • Print the narne(s) of documrnt signers) who personally appear w the ume of notarization CAPACITY CLAIMED BY THE SIGNER • Indicate the oo rect singular or plural forms by crossing off incorrect fortes(i e ❑ Individual(s) war b/on)or circling the correct forms.Failure to correctly indicate this information may bed to rejection of document rocording. ❑ Corporate Officer Y The notary seal impression mutt be clear and photographically reproducible Impression must not cover text or lints. If seal impression smudges, rt-seal if a (Tide) sufficient area permits,otherwise complete a different acknowledgment form ❑ Partner(s) • Signature of the rotary public must match the signatust on file with the office of the county clerk. O Attorney-in-Fact t' o Additional Information is not required but could help to eruure this ❑ Trustee(s) wknowledgractit is not tnisusod or attached to a different docurnenc ❑ Other O India' dtk or type of attached document,number of pages and date O tadieata the capacity claimed by the signer. If the claimed capacity is a corporate of scar,indicate the tide(i.e.CEO,CFO,Secretary) • Securely attach this document to the signed document 2009 Version CAPA vl2.10.07 900-973-9965 www.NotaryCtasses.00m Chubb POWER Federal Insurance Company Attn: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 c�-ec�B�s Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY,a Wisconsin corporation, do each hereby constitute and appoint Linda D. Coats, Douglas A. Rapp and Timothy D. Rapp of Laguna Hills, California-------------------------------- each as their true and lawful Attorney-in-Fad to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or executed in the course of business,and any instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 29th day of August,2008 r- Kenneth C.Wendel.Assistant Secretary .Norris.Jr.,Vice President STATE OF NEW JERSEY ss. County of Somerset On this 29th day of August,2008 before me,a Notary Public of New Jersey,personally came Kenneth C.Wendel,to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly swom, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By-Laws of said Companies:and that he signed said Power of Attorney as. Assistant Secretary of said Companies by like authority,and that he is acquainted with David B.Norris,Jr.,and knows him to be Vice President of said Companies;and that the signature of David B.Norris,Jr.,subscribed to said Power of Attorney is in the genuine handwriting of David B.Norris,Jr.,and was thereto subscribed by authority of said By- Laws and in deponent's presence. Notarial STUHMILBMW Notary Public,State of New. y j! J No.2321097 !') commission Expires Oct.25,2009 A j Notary Public ' CERTIFICATION Extract from the By-Laws of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY: 'All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company,either by the Chairman or the President or a Vioe President or an Assistant Vice President,jointly with the Secretary or an Assistant Secretary, under their respective designations.The signature of such officers may be engraved,printed or lithographed.The signature of each of the following officers:Chairman,President.any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." 1,Kenneth C.Wendel,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY (the'Companies')do hereby certify that (i) the foregoing extract of the By-Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S.Treasury Department;further,Federal and Vigilant are licensed in Puerto Rico and the U.S.Virgin Islands,and Federal is licensed in American Samoa,Guam,and each of the Provinces of Canada except Prince Edward Island;and (iii) the foregoing Power of Attorney is true,correct and in full force and effect. Given under my hand and seals of said Companies at Warren,NJ this 8t h day of DeceIni 2008 VA�c �.vF°vunr a0 ��js�c�c r S 'Ivo,�„r •,s KS.`� SEW voAf- / . Kenneth C.Wendel.Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM,VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER,PLEASE CONTACT US AT ADDRESS LISTED ABOVE,OR BY Telephone(908)903-3493 Fax(908)903-3656 e-mail: surety@chubb.com Form 15-10-0225B-U (Ed.5-03) CONSENT CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Los Angeles On before me, C. PHILLIPS, NOTARY PUBLIC (Here insert name end title of the officer) personally appeared.'-PALP DBA EXCEL PAVING COMPANY BY C.P. BROWN, PRESIDENT who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/am subscribed to the within instrument and acknowledged to me that het 753�executed the same in hisAt€WOWff authorized capacity(ies),and that by hisAxWt I&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. C,PHILLIPS Jt COMM,OIS097M n WITNESS m hand and official seal. NOWY Publio�lifornla V y LOs ANQURS C®uN �. MY Comm,101M Aga,16,2012 Signature of Notary Pt (Notary Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM DESCRIPTION OF THE ATTACHED DOCUMENT 'pry acknowledgment notary in California must contain vment o exactly as be appearsLary section or a separate aeAnawledgment form must be properly completed and attached to that document- The only exception is if a document it to be recorded outside of California.In such romances,arty alternative (Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that u Illegal for a notary in California(i.e. cergfying the authorized capacity of the signer). Please check the (Title or description of attached document continued) document carefellyfor proper notarial wording and attach this form Ifrequired Number of Pages Document Date • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the narno(s) of document signer(s) who personally appear at the time of notarization CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. ❑ Individual(s) helshe/*oy is/ara)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording- El Corporate Officer • The notary seal impression must be clear and photographically reproducible —__LmWuionaaus€not cover tent or lines.If seal impression smudges,re-seal if a (fide) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact . Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document ❑ Other Indicate title or type of attached document,number of pages and date. tudicate the capacity claimed by the signer.If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document Mpg a 2008 Version CA-PA v12 1007 800-873-9865 wwwNotaryClasses.com