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Contract 1643
� . C I�y3 4E) otc404L SECTION 1300 AGREEMENT THIS CONTRACT, by and between the CITY OF CATHEDRAL CITY, a municipal corporation, herein referred to as"City,"and PAVEMENT COATINGS COMPANY.,herein referred to as, "Contractor." WITNESSETH: In consideration of their mutual covenants,the parties hereto agree as follows: 1. Contractor shall furnish all necessary labor, material, equipment, transportation and services for EAST PALM CANYON DRIVE PAVEMENT PREVENTIVE MAINTENANCE, BID NO. B13-153E,CITY PROJECT NO. 8901, FEDERAL PROJECT NO. STPL 5430 (032) in the City of Cathedral City, California pursuant to the Invitation to Bid, dated May 15, 2015, and Contractor's Bid, dated June 9, 2015, all of which documents shall be considered a part hereof as though fully set herein. Should any provisions of Contractor's Bid be in conflict with the Notice Inviting Bids, Specifications, or this Contract, then the provisions of said Contract, Specifications, and Invitation to Bid shall be controlling, in that order of precedence. The time frame for construction work shall be in accordance with that specified in the Invitation to Bid. 2. Contractor shall comply with all Federal, State, County, and Cathedral City Municipal Code, which are,as amended from time to time,incorporated herein by reference. 3. All work shall be done in a manner satisfactory to the City Engineer. 4. Contractor shall commence work after the issuance of a written Notice to Proceed and agrees to have all work completed within the specified 15 working days completion time period. 5. In consideration of said work,City agrees to pay Contractor such sums as shall be approved by the City Engineer at lump sums and/or unit prices stated in the Contractor's Bid, the base consideration ONE HUNDRED SIXTY FIVE THOUSAND, FOUR HUNDRED DOLLARS ($165,400.00). All payments shall be subject to approval by the City Engineer and shall be in accordance with the terms, conditions, and procedures provided in the Specifications. 6. The Contractor shall not knowingly pay less than the higher of the Federal minimum wage rate or the general prevailing rate for per diem wages, as determined by the State of California Department of Industrial Relations and referred to in the Invitation to Bid,to any workman employed for the work to be performed under this contract; and the Contractor shall forfeit as a penalty to the City the sum of Twenty-Five Dollars($25.00)for each calendar day, or fraction thereof, for such workman paid by him or by any subcontractor under him in violation of this provision(Sections 1770-1777,Labor Code of California). 7. Concurrently with the execution of this Contract, Contractor shall furnish bonds of a surety satisfactory to City, as provided in said Specifications or Invitation to Bid, the cost of which shall be paid by Contractor. 8. Contractor agrees to indemnify, hold harmless, release and defend (even if the allegations are false,fraudulent or groundless),to the maximum extent permitted by law,the City, its City Council,the County of Riverside, its Board of Supervisors, and each member thereof, and its officers, employees, commission members and representatives,from any and all liability,loss,suits,claims,damages,costs,judgments and expenses(including attorney's fees and costs of litigation)which in whole or in part are claimed to result from or to arise out of the usage or operation, including the malfunctioning of, or, any injury caused by, any product purchased herein; or any acts, errors or omissions (including, without limitation, professional negligence) of Contractor, its employees, representatives,subcontractors,or agents in connection with the performance of this Contract. This agreement to indemnify includes, but is not limited to, personal injury (including death at any time) and damage to property (including, but without limitation, contract or tort or patent, copyright, trade secret or trademark infringement) sustained by any person or persons (including, but not limited to, companies, or corporations,Contractor and its employees or agents,and members of the general public). 9. Except as otherwise required, Contractor shall concurrently with the execution of this contract, furnish the City satisfactory evidence of insurance of the kinds and in the amounts provided in said Specifications. This insurance shall be kept in full force and effect by Contractor during this entire contract and all premiums thereon shall be promptly paid by it. Each policy shall further state that it cannot be canceled without 30 days unconditional written notice to the City and shall name the City and the County of Riverside as additional insured. Contractor shall furnish evidence of having in effect,and shall maintain,Workers Compensation Insurance coverage of not less than the statutory amount or otherwise show a certificate of self-insurance, in accordance with the Workers Compensation laws of the State of California. Failure to maintain the required amounts and types of coverage throughout the duration of this Contract shall constitute a material breach of this Contract. 10. Contractor shall forfeit as a penalty to City $25.00 for each laborer, workman, or mechanic employed in the execution of this Contract by said Contractor,or any subcontractor under it,upon any of the work herein mentioned,for each calendar day during which such laborer,workman,or mechanic is required or permitted to work,at other than a rate of pay provided by law for more than 8 hours in any one calendar day and 40 hours in any one calendar week, in violation of the provisions of Sections 1810-1815 of the Labor Code of the State of California. 11. In accepting this Contract, Contractor certifies that in the conduct of its business it does not deny the right of any individual to seek, obtain and hold employment without discrimination because of race, religious creed,color,national origin,ancestry,physical handicap,medical condition,marital status,sex or age as provided in the California Fair Employment Practice Act(Government Code Sections 12900, et seq.) Contractor agrees that a finding by the State Fair Employment Practices Commission that Contractor has engaged during the term of this Contract in any unlawful employment practice shall be deemed a breach of this Contract and Contractor shall pay to City$500.00 liquidated damages for each such breach committed under this contract. 12. Contractor also agrees that for contracts in excess of$30,000 and more than 20 calendar days duration,that apprentices will be employed without discrimination in an approved program in a ratio established in the apprenticeship standards of the craft involved (Sections 1777.5 and 1777.6, Labor Code of California). Contractors who willfully fail to comply will be denied the right to bid on public projects for a period of six months in addition to other penalties provided by law. 13. This Contract shall not be assignable by Contractor without the written consent of City. 14. Contractor shall notify the City Engineer (in writing) forthwith when the Contract is deemed completed. 15. In accepting this Contract,Contractor certifies that no member or officer of the firm or corporation is an officer or employee of the City except to the extent permitted by law. 16. Contractor certifies that it is the holder of any necessary California State Contractor's License and authorized to undertake the above work. 17. The City, or its authorized auditors or representatives, shall have access to and the right to audit and reproduce any of the Contractor records to the extent the City deems necessary to insure it is receiving all money to which it is entitled under the contract and/or is paying only the amounts to which Contractor is properly entitled under the Contract or for other purposes relating to the Contract. 18. The Contractor shall maintain and preserve all such records for a period of at least four years after termination of the contract. 19. The Contractor shall maintain all such records in the City of Cathedral City. If not,the Contractor shall,upon request,promptly deliver the records to the City or reimburse the City for all reasonable and extra costs incurred in conducting the audit at a location other than at City offices including,but not limited to, such additional (out of the City)expenses for personnel,salaries,private auditors,travel,lodging,meals and overhead. 20. The further terms, conditions, and covenants of the Contract are set forth in the Contract Documents,each of which is by this reference made a part hereof. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK IN WITNESS WHEREOF,the parties have executed this Agreement as of the dates stated below. "CITY" CITY OF CATHEDRAL CITY, a California unicipal corporation By: / i Dated l U,VL 23, 215 CHARLES P. McCLENDON,City Manager ATTEST: LA Dated Lt l L 23 ,201c GARY HO ' LL,City Clerk gib APPROVED APPROVED AS TO FORM: •14 � �i+./40,047 Dated:%/pilaf bi 20 CHARLES GREEN,City Attorney if "CONTRACTOR" Dated: ( ` /0-1S-- By: mar- Name: DOtl& FOp,D Title: PRES/ OEAIT Dated: By: Name: Title: "CONTRACTOR" (If corporation,affix seal) '; Bond No. 024060045 Premium: $1,389 SECTION 1310 FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: THAT the City of Cathedral City,a municipal corporation,hereinafter designated the City,has,on June 22, 2015,awarded to Pavement Coatings Co.,hereinafter designated as the Principal,a Contract for the EAST PALM CANYON DRIVE PREVENTIVE MAINTENANCE NO.B13-153E,CITY PROJECT NO.8901,and WHEREAS,said Principal is required under the terms of said Contract to furnish a bond for the faithful performance of said Contract: NOW,THEREFORE,we, the Principal,and The Ohio Casualty Insurance Company ,as Surety,are held and firmly bound unto the City in the just and full amount of ONE HUNDRED SIXTY-FIVE THOUSAND FOUR HUNDRED DOLLARS($165,40000)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 said Principal, his or its heirs, executors, administrators,successors,or assigns,shall in all things stand to and abide by,and well and truly keep and faithfully perform the covenants,conditions,and agreements in the said contract and any alterations made as therein provided, on his or their part to be kept and performed, at the time and in the manner therein specified,and in all respects according to their true intent and meaning,and shall indemnify and save harmless,the City,its officers and agents as therein stipulated,then this obligation shall become null and void;otherwise it shall be and remain in full force and virtue. • It is acknowledged that the Contract provides for one-year guarantee period, during which time this bond remains in full force and effort. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the Contract or to the work to be performed thereunder or the specifications accompanying the same shall,in any way,affect its obligations on this bond,and it does hereby waive notice of any such change,,extension of time, alteration, or addition to the terms of the Contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2819 and 2845 of the Civil Code of the State of California. THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Faithful Performance Bond 1310.1 IN WITNESS WHEREOF,the Principal and Surety have executed this instrument under their seals this 6th day of July ,20 15, the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. Pavement Coatings Co. Principal (Seal) • Signature for Principal Doll FORD , PRES/be JIT Title of Signatory The Ohio Casualty Insurance Company Surety (Seal) / /I/ ( A// Signature for Surety Richard L. Wells (Attorney-In-Fact) Title of Signatory 625 Maple Avenue, Keene, NH 03431 Address of Surety 800-763-9268 Phone#of Surety Contact Person for Surety Faithful Performance Bond 1310-2 CALIF®-'WA:ALL-PURPOSE ACICINOWLE.'.GMENY CIVIL CODE§ 1189 C.!�. .!�.G:� .! .%�L�: •'e�^....tee!"—.'. •!:�.'/'/ �•'' v'�/S•rte. e�-.�c'Sv• .G:�/ .. .. A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of kltfI625 On Ti-t u'.( ([9s zol 5 before me, V IA e. 4 I n-iG4 j: .No nil/6V : 1O1-(4 L I Date Here Insert Name and Title of the Officer F personally appeared. . .. 100/4.Cr- o✓z� Name((.of Signer who proved to me on the basis of satisfactory evidence to be.the p erson(y' whose name($) is/are subscribed to the within instrument and acknowledged to me that he/shettbey.executed the same in his/fher/thoir authorized capacity(ies),and that by his/hex/their signature(%)on the instrument the person(sj, 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 i t d VAN P.DUNCAN s rue:an correct. ^ Commission 11.2084795 WITNESS my hand and official seal. t. )11 Notary Public•California z z ,,% Rlvorside County Comm. Iran Oct 30 2018 J Signature 1/62-z. - Signature of Notary Public Place Notary Seal Above OPTIONAd. Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of:Document: Pevz.Fover-n ice_ rho/‘--1,2 Document.Date: —:L s Number of Pages: Signer(s) Other Than Named Above: Cap aci p ty(ies) Claianed.by Signer(s) Signer's Name: :. Signer's Name: ❑Corporate Officer — Title(s): Corporate Officer — Title(s):.. Partner — ❑ Limited. 0 General : 0 0 Partner—. :� Limited i General ❑.Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or.Conservator ❑Trustee ❑.Guardian or Conservator ❑Other: Other: .. Signer Is Representing: Signer Is Representing: ©2014 ational Notary Association www.NationalNotary.org 1-800-US NOTARY(1-800-876-6827) Item#5907 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. : - - - This?olr�er of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the-extent herein stated. - _ - - - - - - . - .. - Certificate No.6944928 - -- - American Fire and Casualty Company - . Liberty Mutual Insurance Company . - - -- The Ohio.Casualty Insurance Company West American Insurance Company -_ _ --: - _POWER OF_-ATTORNEY::; _ - , KNOWN ALL PERSONS BY THESE PRESENTS: That_American Fire 8 Casualty Company and-The Ohio"Casualty Insurance Company are;corporations duly organized under-the laws of the state of New Hampshire,that LibertyMutual Insurance Company is a corporation duly organized-under the laws of the of Massachusetts,and West American Insurance Company ' ' -- is a corporation.duly organized.underthe lawss,of the State of Indiana(herein collectively called the"Companies"),pursuant to and'by authority-herein set forth;does hereby name,constitute and appoint; Frank Morones;Lynn A:Reimer;Richard-L-'.-Wells -- _ _- all of the city of BREA - • - ,state of CA " - each individuallif there be more than one named,its true y and lawful attomey-in-fact to make,execute,seal,acknowledge• - -and deliver,-for and otilts behalf as surety and as its act and deed,any and all undertakings;bonds,recognizances and other surety obligations,in pursuance of these presents and shall -- -be as binding upon the Companies.as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. •- - . IN WITNESS WHEREOF,this Power of Attorney has beers subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed - thereto this 13th day of- April , 2015- . - Ap1D C.4sG - , '1 INS0 - \ NSUR a,NSUq - American-Fire-and Casualty Company -- - �,.oreaAr9li hJ1 alT€9y' - ',,J,p�oe'U�'F ,�e��%�o� yrF - - The Ohio Casualty.Insurance Company - -y z_° _ r,=, n c o Liberty Mutual Insurance Company-_ d a- -1906. 0 0 1919 n - r 1912 ° ` - 1991' r..1- ' C 3 Y d a (� - a - West merican_ Insurance Company_ - Vl b��Ld N4A6asr baa� .> 'havaS`'�"4 _ vim"y"-r �` a ?i 44,7-`1, 2 fA 4,4 ACM1� T PNh �' _i!f-� 0 = STATE OF PENNSYLVANIA :SS _ David M.Care ;Assistant Secretary C to COUNTY OF-MONTGOMERY - - a- en On this 13th day of April ' , 2015, before me personally appeared David M. Carey,who acknowledged-himself to be the Assistant Secretary of-American Fire and- v 1-0- . 0 3 Casualty Company,Liberty Mutual Insurance Company,-The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as-such,being authorized so to do, m W• O�o execute the foregoing iristrurnent for the purposes therein contained by signing on behalf of the corporations-by himself as a duly authorized officer. _E IN WIT NESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on-the day and year first above written. - - O 0. d a) - - Pq COMMONWEALTH OF PENNSYLVANIA - _ Q e-)0 10 _ - '- - Q� S oNwkl-_„ .- Notarial Seal C"y - - ti u° - y y Teresa Pastella,Notary Public-_ - By: 71�� "`� -Z att l itp. • 0 d RI.d "— _ OF - Plymouth Twp.:Montgomery County. - - Te:ene P_astclia,-Noto r y.Pubilc---- --- - -- _ L - _ �P My Commission Expires March 28,2017 I . �• rO - - - _ 4ti Member,Pennsylvania Association of Notaries . - 0 a• m - a C a This.Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty Insurance m a ai..., Company,Liberty Mutual Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows:-- - - r c 0)N • : • - - �0) to ARTICLE IV-OFFICERS-Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman O an or the President,and subject c .2 a). to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact;as-may be-necessary to act in behalf of the Corporation to make,execute,seal, , m 0 E acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective . E ai powers of attorney,shall have full power to bind the Corporation by their signature•and execution of any such instruments and to attach thereto the seal:of the Corporation. When so 1-a): p co executed,such instruments shall beas"binding as if signed-by the President'and attested to:by the Secretary:Any power.orrauthoritY:ggrantedto any representative or attomey=in-fact under >-a a the provisions of this article may he revoked at any time by_the Board,the'Chairrnan;the President or bythe_officer or offcers:granting=such:power or authority. t o E N 3 C ARTICLE XIII-Execution of Contracts SECTION 5.SuretyBond"s•and Undertakings.Any_offrcer of the:Company authorized for that purpose inn writing by the chairman or the-president; E 0o. > L and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys=in=fact,asmaybe necessary to:act in-behalf of the Company-to make,execute, L M O 0 seal,.acknowledge and-deliver-as suretyanyand all undertakings,_bonds;recognizances-and other-surety,obligations,;_Such attorneys-in fact'subject to the.limitations set forth in their =0' rs z t? respective powe of attorney,shall have-full power to-bit-id-the Company by their signature and'execution of arty such instruments and to attach"thereto the seal of the Company. When so 0 o executed such.instruments shall,be as binding:as if signed by the president and attested by thesec etary. 0 r Certificate of Designation-The President of the acting:pursuant to the Bylaws of the;Company,:authorizes-David M.Carey,Assistant Secretary to appoint such attorneys-in- -fact as may he-necessary to act on behalf of-of to make,-execute;.seal,acknowledge and deliver as surety any and.all"undertakings,bonds,recognizances and other surety - - -obligations.- - - - .- - - ' - _ - = - Authorization_By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the - - - = Company,wherever appearing upon a certified-copy of any power of attorney issued by the-Company in connection with surety bonds,shall be valid and binding upon the Company with- = _ the same force and effect as though manually affixed. _ I,Gregory W:Davenport,the undersigned,Assistant-Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance.Company,and- - - -West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and,correct copy of the Power of Attorney executed by said - = Companies,is in full force and effect and has not been revoked. -. - - .. - - - - IN TESTIMONY WHEREOF,I have hereunto set my hand-and affixed the seals of said Companies-this 6th day of July- - 20 15 - PtiO CASL - `:o INSp 1,1NsuR - iy1N5U,9 - - --3oa0iwr�1,-- -.:_- o4-_0.2;r 92_ T J3,ef0R.r•vl n �+oP\T4ovrogA%'r'r.^ . _ _ - _ a= 1906 0 0 1919 n' a 1912 ° ` 1991 By: s b _o a°1 W a' - _ Gregory W.Davenport,Assistant Secretary - -' - - - - - 233 of 500. •- 1 LMS.12873 122013 • - ' ' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189 Si z.<i a.1<in.a <r••raa"ZTt A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document, State of California County of Orange �� ) On July 6, 2015 before me, Lynn A. Beimer, Notary Public Date Here Insert Name and Title of the Officer personally appeared _._ Richard L. Wells —_ Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(( whose name((t is/are subscribed to the within instrument and acknowledged to me that he/she/444y executed the same in his /their authorized capacity(ies),and that by his/her/their signature(on the instrument the person(, or the entity upon behalf of which the person(!acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. LYNN A. BEIMER Commission # 1960927 WITNESS my hand and official seal. a!=°",4 : Notary Public-California z z � � ?�� Orange County My Comm.Expires Dec 6,205 Signature_ /Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended 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: U Corporate Officer— Title(s): f..-1 Corporate Officer — Title(s): ❑ Partner — Lii Limited .l General [I] Partner — 0 Limited El General El Individual ^I Attorney in Fact l._:.i Individual (=:1 Attorney in Fact El Trustee -i Guardian or Conservator ❑Trustee El Guardian or Conservator El Other: Li Other: Signer Is Representing: Signer Is Representing: k %Ei T.SC vca,g ' i L{: G °.? 4. .4.• .• '.: '� 4e• _..• 02014 National Notary Association•www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 Bond No. 024060045 Premium included in Performance Bond SECTION 1320 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: THAT the City of Cathedral City,a municipal corporation,hereinafter designated the City,has,on June 22, 2015, awarded Pavement Coatings Co.,hereinafter designated as the Principal, a Contract for the EAST PALM CANYON DRIVE PREVENTIVE MAINTENANCE NO.B13-153E,CITY PROJECT NO.8901,and WHEREAS, said Principal is required to furnish a bond in connection and with said Contract,providing that if said Principal,or any of it or its subcontractors shall fail to pay for any materials,provisions,or other supplies used in, upon, for, or about the performance of the work contracted to be done, or for any work or labor done thereon of any kind,the Surety of this bond will pay the same to the extent hereinafter set forth: NOW, THEREFORE, we, the Principal, and The Ohio Casualty Insurance Company as Surety, are held and firmly bound unto the City in the just and full amount of ONE HUNDRED SIXTY-FIVE THOUSAND FOUR HUNDRED DOLLARS($165,400.00) 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 said Principal, it or its heirs, executors, administrators, successors, or assigns, shall fail to pay for any materials, provisions, or other supplies used in,upon,for,or about the performance of the work contracted to be done,or for any work or labor thereon of any kind or for amount due under the Unemployment Insurance Act with respect to such work or labor, or for any amounts due, or to be withheld pursuant to Sections 18806 of the Revenue and Taxation Code of the State of California with respect to such work or labor, then said surety will pay the same in or to an amount not exceeding the amount hereinabove set forth, and also will pay in case suit is brought upon this bond,such reasonable attorney's fees to the City as shall be fixed by the court. This bond shall insure to the benefit of any and all persons,companies,and corporations named in Section 3181 of the Civil Code of the State of California so as to give a right of action to them or their assigns in any suit brought upon this bond. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition of the terms of the Contract or to the work to be performed thereunder or the specifications accompanying the same shall,in any way,affect its obligations of this bond,and it does hereby waive notice of any change,extension of time,alteration,or addition to the terms of the contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2819 and 2845 of the Civil Code of the State of California. THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Payment Bond 13204 IN WITNESS WHEREOF,the Principal and Surety have executed this instrument under their seals this 6th day of July ,20 15 the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative,pursuant to authority of its governing body. Pavement Coatings Co. Principal (Seal) Signature for Principal ba✓& FORD PRESIDE//Y Title of Signatory The Ohio Casualty Insurance Company Surety (Seal) .‘-1;74/4 I /:(":1/7 Signature for Surety Richard L. Wells (Attorney-In-Fact) Title of Signatory 625 Maple Avenue, Keene, NH 03431 Address of Surety 800-763-9268 Phone#of Surety Contact Person for Surety Payment Bond 1320-2 CALIFORNIA:ALL-PURPOSE ACKNOWLE CIVIEN4 CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document State of California County of (Q W 6251 OF On ti&Lam/ ( mot Zc i c before me, :v 4 J IP• aJC 'o pOK L.c Date Here Insert Name and .Title of the Officer personally appeared. .. .. 0(9 6— FD2.,0 Name('of Signer(a') who proved to me on the basis of satisfactory evidence to be the person(g) whose name( is/are subscribed to the within instrument and acknowledged to me that he/sbe executed the same in his/ber their authorized ca aci. p ty(+es},and that by his/trier-,weir signature on the instrument the person, or the entity.upon behalf of which the personl,�) 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. VAN P DUNCAN WITNESS my hand and official seal. Commission*2084795 z Notary Public•California z Z `r'►/ Riverside County ' Signature --r Comm. 1res:Oct 30 2018 L Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document VA"(MCnai 101%-1 V3 Document 7- 1_I c iocument:Date: Number of Pages: Signer(s) Other Than Named Above:: Cap aci p ty(ies) Claimed by Signer(s) Signer's Name Signer's Name: ❑Corporate Officer — Titles O: Corporate Officer=Title(s): ❑ Partner — ❑ Limited 0 General ❑ Partner Limited ❑General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑Other: .. ❑ t her: igner Is Representing: Signer Is Representing: G<�.tis'.vti✓% .`:a =Kati< <`.1✓s\'✓\�✓.=�'•%a"tia'sti�s�w%�'�.titic�5<✓,'✓. .'.i ✓ v.--✓ ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 -- THIS-POWER--OF:ATTORNEY.IS NOT VALID-UNLESS IT IS PRINTED-ON BACKGROUND. :_ : _ r.-:.-- - - „This P,owe�of Attorney limits the acts-of those named herein_;and they have no authority to bind"the Company except-iin the mannerand to_the extent herein.stated.-_ -- _ . 1 - - _ -_ - _ Certificate No:6944927 - - - -- . : American Fire and Casualty Company Liberty Mutual Insurance Company - -: = - - - __- _ ---.1.-:_- _ - _ - - • - The.Ohio.Casualty Insurance Company: West American Insurance Company--. . - - = _ _• _ • -• = . = : _ _ : : - _ _ = - -POWER OFfATTORNEY - - =--=KNOWN ALL PERSON_S BY THESE PRESENTS:=ThatAm_encan-Fire 8 Casualty Company The Ohio:Casualty,.Insurance Companyare corporations duly organized under the laws of" - .--- .3 the State of New Hampshire,that Libe p rty^Mutual Insurance Company is a corporation dulyorganized.under3he laws of the State of Massachuseits;:and West Insurance-Company -- -- --is a corporation duly organized under the laws of theState of Indiana(herein collectively calledthe"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute-: : -.and appoint,= Frank Morones;Lyn -Beimer; Richard.Li:Wells - �- _- _'all of the:city of BREA-'• - - - ,state'of CA - . -each individually ifthere be more than one named,its true and"lawfulettomey-in-fact.to make,execute,seal,:acknowledge - and deliver,for and,on its behalf as surety and as:its act and-deed,any and-all undertakings;bonds,recognizances and other surety obligations,in pursuance of these-presents-end shall=- = _- be as binding upon the Companies as if they have been duly signed_by-the president and attested by the-secretary-of the Companies in their own:proper persons. - - - - - -lN WITNESS WHEREOF,this Power of-Attorney"has been:subscribed by-an authorized officer or official of the Companies and the corporate seals of the Companies.have.been.affixed - - th_ereto this -13th. :_':day --April - :. _ : ,- 2015:_ - _ - _ = v lws �NSU ,NSU - =American Fire and Casualty Company - : -0 .. - =- ` ;� °_�r�l:A'- ?P<-oao",,eogvy�- "e.sc-or8..%,; _ 4��zp�°R41:C The Ohio Casualty Insurance Company N m n _ c - Liberty Mutual Insurance Company '- - m = a 1906: 0, o _1919 - n : r 1912 "_ 2 - 1991 3 •_ Vilest American Insurance Company d�eF °`.as O -_ _F _ ;.: # By:- %/ r a• c -STATE;OF-PENNSYLVANIA'_-_ -- ss:-• -- - - _ -- David M.Care ;Assistant;Secretary = C m_1- COUNTY OF MONTGOMERY.- - - -- - - - - - _ -d of On this_13th_•day of April = . .,-2015 before_me.personally appeared David-M. Carey,who acknowledged.himself to be the Assistant Secretary_of American Fire--and- 3 N" v O 'Casualty Company,:Liberty Mutual Insura_nce Company,The Ohio Casualty Insurance Company,and WestAmerican Insurance Company,and that he as such;_being-authorized so to do,- 5- :execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations byhimself as a duly authorized officer.-- - - - - -- - • . 6: aa.> _IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,-Pennsylvania,on th_e.dayand yyear first above written:_= O .•w c PQS COMMONWEALTH OF PENNSYLVANIA- - _ _ - - �'O - _ - - - , ,„..,„,,, e,.... ._.. . _Notarial Seal . :. a �'N _ =" _ _ i u . .•y r - _ Teresa Pastella,-Notary Public-;" .,By 24�_ "� n 4 1,-.) _ O -� - - - - - - - - _ - - OF :- - PI mouth-R 7vlunt-me Count -- - "'�" O L. -- - - - - y r" gO ry y Teresa Pastella,Notary Public _ - yrL-, - My Commission Expires March 28,2017 -- - - _- 3 1a ac O' �� = Member,Pennsylvania Assoc a8on of Notaries -," - - : 0 E.CL -C This Power of Attorney is-made and executed pursuant to-and by authority of the following By:laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty Insurance v_i a- ai., .Company,Liberty Mutual Insurance Company,and West American Insurance Company which resolutions are now in full force and effect leading as follows:- _ - r o" of cots ` =ARTICLE IV-OFFICERS-Section 12.Power ofAttorney.Any officer or other_official of the Corporation.authorized for that purpose in"writing by the Chairman or the President,and.subject O c . 4; ,to such limitation as the Chairman or the President may prescribe;shall appoint-such attorneys-in-fact,as may be necessary to actin behalf ofthe Corporation to make;execute,seal, -y" O:E -acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in.their respective_ '13 E ai_powers of attorney shall have_full power to bind the Corporation by their signature and-execution of.any such instruments and to attach thereto the seal of the_Corporation..=When so 1 u. ".6_ -executed,such instruments shall be'as binding asif signed_by-the President and attested.to-by.the Secretary.Any power or_authority granted to any representative or attorney-in-fact under >-CI- the provisions of this article_may be revoked at any_timeby the Board-the Chairman the President or by the officeror.officers granting such.power or authority. ":_ - . _ - t�_ T-c ARTICLE XIII-Execution of Contracts=SECTION 5 Surety Bonds:and Undertakings Any officer of the:Company authorized for that purpose in.writing by the chairman or the president, -E _> L _and subject to such:limitations as the.chairrman or the'president may prescribe,shall appoint such attorneys-in.fact;as may be necessary to_actin behalf of the Company-to_make,execute, _M: O O seal,-acknowledge and:deliver as surety any and-all undertakings_tionds,recognizances and other`surety obligations,Such attorneys in feat"subject to the limitations set forth.in their c o? Z v respective powers.of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and-to attach thereto the seal of the Company.;When so, -0 Co executed such instruments shall-be as binding as if_signed-by the president and attested by the secretary - _ - T :Certificate_of.Designation-_The President of the:Company;acting;pursuant to the Bylaws of the Company,authorizes-David M.Carey,A'ssista`nt Secretary to appoint such attorneys-in- _ - . -fact as may be necessary to act on behalf of the,Company to make;execute seat acknowledge and-deliver as suretyany;and all undertakings,bonds;recognizances and other-surety := - = 'Obligations:- - _ _- '_ Authorization-,By.unanimous consent of the Company's Board of Directors,the consents that facsimile or mechanically reproduced signature-of any assistant -y of the:. _ - . - ;Company,wherever a`ppee�ing.upon a certified copy of any power of attorney issued by the.Company in.connection with surety bonds;shall-be valid binding upon-the Company With - =-- • - the same force and effect as though manually affixed:. _ _ : _ - _ -,l,Gregory W.Davenport,the undersigned,Assistant Secretary,of American:Fire and Casualty Company,:The Ohio,-Casualty Insurance Company,Liberty Mutual Insurance Company,and-'- _ .- := West American Insurance Company do herebyceitify-that the originafpower of attorney of which the foregoing is a full,true-and correct copyof,the Power of Attorney executed,by said,_,- ' :Companies,is infull force and-effect and.has not been revoked.- = --- - . : - "- - -- - -:-.IN TESTIMONY WHEREOF,I have set my hand and affixed the seals of said Companies this 6-1-1-, _day of -= :Th 1 y - _ - ,20 1 5- .- == - - \QF/�w o'er 9‹j, yJ Rsl 9y J�J pock,1,,-, ; �,\s oppeR,4 cF _ - a l 1906 0 • 0 1919= n . > -1912 ° ;Z," - 1991,. By: " _- y���.-y k. b o wqo`. - - ,1' _ =}`,' a y : _ Gregory W.Davenport;Assistant Secretary �_yb\HAIJ-'bra : J ti,..p��aaD - -? '4ISACMIS" ,. �j 7,:,,:n T - _ _ - : - -_ : - - _ - - - - _ .: 232 of:500 _ -'LMS 12873'122013- -' - - - _ - - CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of Orange On _July 6 2015 before me, Lynn A. Beimer, Notary Public Date Here Insert Name and Title of the Officer personally appeared Richard L.Wells__—____� Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(% whose name( 'j is/are subscribed to the within instrument and acknowledged to me that hereke/.t# ey executed the same in hisAteritheir authorized capacity(ies),and that by his/het*reir signatureM on the instrument the personN, or the entity upon behalf of which the personN 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. .m.o: .�.N.z..l...i. ..d .•L_.a,,.J.t .t.«d...b.._A...n.. LYNN A. BEIMER ` WITNESS my hand and official seai. Commission # 1960927 f. d / Q!:reb Notary Public California Orange County z — z � �' �%' � �;.�, 9 Y Signature__ � _/L My Comm.Expires Dec 16,2015 Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. • Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signers) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: El Corporate Officer --• Title(s): I::::I Corporate Officer — Title(s): Partner — L i Limited E General El Partner — i:- Limited El General El Individual {.__I Attorney in Fact El Individual El Attorney in Fact L_l Trustee El Guardian or Conservator IJ Trustee El Guardian or Conservator 1111 Other: I:l Other: Signer Is Representing: Is Representing: ..y s.X,G'" J:•L_'v.'. _s:.. -ar a...f .. er: _: ::?` .. . _ ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 SECTION 1330 WORKERS'COMPENSATION INSURANCE CERTIFICATE In accordance with California Labor Code Section 1861, prior to commencement of work on the Contract, the Contractor shall sign and file with the City the following certification: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers'compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract." Signature DOUG, FORD , PRES/d ENT Title 7—/O Date Worker's Compensation Insurance Certificate 1330-1 -J. 282954 A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D I W) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. 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). PRODUCER CONTACT Jacqueline Madera Commercial Lines-(310)543-9995 PHONE FAX (A/C.No,Ext):213 253-6529 (A/C,No):310-543-9175 Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 E-MAIL Jac ueline.Madera wellsfar o.com ADDRESS: q � g 21250 Hawthorne Boulevard,Suite 600 INSURER(S)AFFORDING COVERAGE NAIC u Torrance,CA 90503-5519 INSURER A: American Guarantee and Liability Insurance Corn 26247 INSURED INSURER B: Pavement Coatings Company,Inc.dba:Paveguard INSURER C: 10240 San Sevaine Way INSURER D: INSURER E: Jurupa Valley,CA 91752 INSURER F: COVERAGES CERTIFICATE NUMBER: 9337784 REVISION NUMBER: See below THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JERT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) $ A UMBRELLA LIAR X OCCUR AUC9459631-01 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project No.8901-East Palm Canyon Drive Preventative Maintenance-within Cathedral City FOR EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION Charles P.McClendon,City Manager SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cathedral City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 68-700 Avenida Laic Guerrero Cathedral City CA 92234 AUTHORIZED REPRESENTATIVE 961,4,4 The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) • +� ® YYY) ACG o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Y 7/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: • MMA- Minneapolis PHONE 763-746-8000 FAX 763-746-8337 7225 Northland Dr N#300 (A/C., No): Minneapolis MN 55428 AE-MAIL donovanj @rjfagencies.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arch Insurance Company 11150 INSURED PAVEREC INSURER B: Pavement Coatings Co INSURER C: 10240 San Sevaine Way Jurupa Valley,CA 91752 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2020631039 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL UABILITY ZAGLB9191000 10/1/2014 10/1/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $100,000 MED EXP(My one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $2,000,000 POLICY X To, LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY ZACAT9214400 10/1/2014 10/1/2015 COMBINED SINGLE LIMIT $ (Ea accident) 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ A WORKERS COMPENSATION ZAWCI9329900 10/1/2014 10/1/2015 X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project No.8901-East Palm Canyon Drive Preventative Maintenance-within Cathedral City. The City,City employees and officers,the City Engineer, its consultants,elected officials,agents,County of Riverside and sub-consultants are hereby added as additional insured insofar as Work done under this Contract is concerned.Additional Insured(s)is included on the General Liability and Automobile Liability coverage with respect to work performed by the named insured for specifically referenced jobs or as required by written contract or agreement,and applies to the liability policies only when written contract is in force/effect. Additional Insured(s)is included for ongoing operations only. A Waiver of Subrogation applies in favor of the certificate holder for Workers Compensation with respect to work performed by the named See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Charles P.McClendon,City Manager ACCORDANCE WITH THE POLICY PROVISIONS. City of Cathedral City 68-700 Avenida Lab Guerrero AUTHORIZED REPRESENTATIVE Cathedral City CA 92234 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PAVEREC LOC#: A o ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED MMA- Minneapolis Pavement Coatings Co 10240 San Sevaine Way POLICY NUMBER Jurupa Valley,CA 91752 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE insured for specifically referenced jobs or as required by written contract. RE:Project No.8901-East Palm Canyon Drive Preventative Maintenance-within Cathedral City ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement is effective on the inception date of the policy unless another date is indicated below. SECTION II —LIABILITY COVERAGE, 1. WHO IS AN INSURED is amended to include as an "insured"the person(s) or organization(s) named in the Schedule below, but only with respect to their legal liability for acts or omissions of a person for whom Liability Coverage is afforded under this policy. You are authorized to act for the additional insured named in the Schedule in all matters pertaining to this insurance. SCHEDULE Name and Address of Additional Insured: ANY PERSON OR ORGANIZATION FROM WHOM YOU HAVE SPECIFICALLY AGREED IN WRITING TO PROVIDE ADDITIONAL INSURED STATUS UNDER THIS POLICY All other terns and conditions of this Policy remain unchanged. Endorsement Number: Policy Number: ZACAT9214400 Named Insured: Pavement Coatings Co dba Paveguard Endorsement Effective Date:10/01/2014 local Standard Time at the First Named Insured's address. 00 CA0070 00 09 06 ENSURED COPY Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 POLICY NUMBER: ZAWCI9329900 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFOR NIA 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) 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 INCL % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ALL PERSONS OR ORGANIZATIONS, AS REQUIRED PRE WRITTEN CONTRACT OR AGREEMENT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/01/2014 Policy No. ZAWCI9329900 Endorsement No. Insured Pavement Coatings Company Inc Premium $ INCL. Insurance Company ARCH INSURANCE COMPANY Countersigned By DATE OF ISSUE: 0 1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual O 1999. INSURED COPY COMMERCIAL GENERAL LIABILITY CG 20330704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sions apply: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organization be added as an 1. "Bodily injury", "property damage" or "personal additional insured on your policy. Such person or and advertising injury" arising out of the organization is an additional insured only with re- rendering of, or the failure to render, any spect to liability for "bodily injury", "property dam- professional architectural, engineering or age"or"personal and advertising injury"caused, in surveying services, including: whole or in part, by: a The preparing, approving, or failing to pre- 1. Your acts or omissions;or pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and specifica- behalf; tions;or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an addi- 2. "Bodily injury" or "property damage" occurring tional insured under this endorsement ends when after: your operations for that additional insured are completed. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed;or b. 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 subcon- tractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ INSURED COPY POLICY NUMBER:ZAGLB9191000 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READITCAREFULLY. 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 Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations ALL PARTIES WHERE REQUIRED BY PROJECTS OR LOCATIONS AS SPECIFIED IN THE A WRITTEN CONTRACT. THIS WRITTEN CONTRACT BETWEEN PARTIES INSURANCE IS PRIMARY AND NON— OF WHICH THIS ENDORSEMENT SHALL CONTRIBUTORY WITH ANY OTHER APPLY. INSURANCE WHERE THE WRITTEN CONTRACT REQUIRES THAT THIS INSURANCE BE PRIMARY AND NON- CONTRIBUTORY. WHEN THE INSURANCE PROVIDED BY THIS ENDORSEMENT IS PRIMARY AND NON—CONTRIBUTORY, WE WILL NOT SEEK ANY CONTRIBUTION FROM ANY OTHER INSURANCE POLICY AVAILABLE TO THE ADDITIONAL INSURED ON WHICH THE ADDITIONAL INSURED IS A NAMED INSURED. A. Section II---- Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", °property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. • CG 2010 0704 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ INSUREDCOPY