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Contract 1650
6 cqb 6 f gfr6 SECTION 1300 ' g) CONTRACT THIS CONTRACT, by and between the CITY OF CATHEDRAL CITY, a municipal corporation, herein referred to as"City,and CT&T CONCRETE PAVING,INC,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 SAN JOAQUIN DRIVE SIDEWALK IMPROVEMENTS, BID NO. B15-05E, CITY PROJECT NO. 2517 (the "Work") in the City of Cathedral City, California. The Work shall be done in strict conformity with this Contract, approved Change Orders, the Invitation to Bid dated April 28, 2016, Instructions to Bidders,permits issued by the City or other agencies, the General and Specific Project Requirements, Standard Specifications, Plans, Referenced Specifications,the General Conditions,Supplementary Conditions the Contractor's Bid dated May 18,2016,and any addenda thereto(the"Contract Documents")all of which shall be considered a part hereof as though fully set herein. 2. Contractor will comply with all Federal, State, County, and City of Cathedral City laws, regulations and policies,which are,as amended from time to time,incorporated herein by reference. 3. All work shall be done in a workman like manner and to the satisfaction of the City Engineer. 4. Time is of the essence in Contractor's performance of the Work for this Contract. Contractor agrees to diligently pursue the performance and completion of the Work in every detail to the satisfaction of the City. Contractor shall commence work after the issuance of a written Notice to Proceed and agrees to have all work completed within 20 working days from the date of Notification to Proceed. 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 total compensation to Contractor for all Work shall not exceed One hundred Forty Three Thousand One Hundred dollars ($143,100.00). 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 Contract Documents. 6. The Contractor, and any subcontractor engaged by Contractor, shall not pay less than 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 up to Two Hundred Dollars($200.00)for each calendar day, or fraction thereof, for every workman paid by Contractor or by any subcontractor engaged by Contractor, 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 the Contract Documents,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 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 the Contract Agreement 1300-1 Documents. 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 as an 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 disability, mental disability, medical condition,genetic information, marital status, sex,gender,gender identity, gender expression,age,sexual orientation,or military and veteran status 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 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 Work. Contractor must, at Contractor's sole expense, obtain all necessary permits and licenses required for the Work, and give all necessary notices and pay all fees and taxes required by law, including, without limitation, any business license tax imposed by City. Contractor represents and declares to Agency that it has all licenses, permits, qualifications and approvals of whatever nature which are legally required to practice its profession. 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 three 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. In entering into this Contract or a contract with a subcontractor to supply goods, services, or materials pursuant to this Contract, Contractor and any or subcontractor is deemed to have offered and agreed to assign to City all rights,title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter 2, commencing with Section 16700 of Part 2 of Agreement 1300-2 Division 7 of the California Business and Professions Code),arising from purchases of goods,services,or materials for the Contract. This assignment will be deemed made and will become effective at the time City tenders final payment to Contractor,without further acknowledgement by the Parties. IN WITNESS WHEREOF,the parties have executed this Contract as of the dates stated below. "CITY" CITY OF CATHEDRAL CITY, a California municipal corporation 4/ /. / 11/ ' WI LP C l rtes McClendon,City Manager ATTEST: PAIL 1 , Dated: Ca.--7f -70/ e)p ary Howell,City C 7 rk APPROVED AS 0 F fOr Dated: CG 06 7..0/6 Eric Vail,City Attorney "CONTRACTOR" Dated: ) tP By: Name: \„J USe �VI I Title: %rL°S[ Dated: CD I 2-3 i (P By Ii_ /. Name: Joni/Fe CGr\fa1 Title: 1 YeQsCJ' 'es- [CONTRACTOR SIGNATURES MUST BE NOTARIZED. IF CONTRACTOR IS A CORPORATION OR LIMITED LIABILITY COMPANY,TWO SIGNATURES MUST BE PROVIDED.] Agreement 1300-3 BOND NO RCB0003632 BOND PREMIUM $3,578.00 WI-HCH IS SUBJECT TO CHANGE BASED ON THE FINAL CONTRACT AMOUNT SECTION 1310 FAITHFUL PERFORMANCE BOND KNUW ALL MEN BY THESE PRESENTS: THAT the City of Cathedral City,a municipal corporation, hereinafter designated the City,has, on June 8, 20l6^ awarded to CT&T Concrete Paving, Inc, hereinafter designated as the Principal, a Contract for SAN JOAQUIN DRIVE SIDEWALK IMPROVEMENTS,BID NO. B15-05E,CITY PROJECT NO. 2517,and WHEREAS, said Principal is required under the terms of said Contract to furnish a bond for the faithful per!U'rnance of said Contract: NOW, THEREFORE, we,the Principal,and Contractors Bonding and insurance Company , as Surety, are held and fizm}ybound unto the City in the just and full amount of Øa43,Ioo.00 lawful money of the United States, for the 'payment of which sum well and truly to be made, we hind ouroclvrn, our heirs, cxccnmo, a4miniuc,u1urs, and suc°osymo.jointly and severally,finnhyby these presents T!{E CONDITION OF THIS OBLIGATION IS SUCH, that if said Principal, his of is heirs, exocutors, adnlnistrators,successors,or assigns,assigns,shall in all things stand to and abide by, and well and truly keep and faithfully perk,rm 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 perform d, 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 tbor^io shpulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and yin uc. lt is acknowledged that the Contract provides for one-year guarantee period, during which time this bond remains in fell 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 accoi»puoying the same shall, in any way,affect its obligations on this bond,and it does hereby waive notice of any scd` 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 ColifOnniu. THE REMAINDER OF THIS PAGE INT1.NTIONALLY LEFT BLANK Faithful Performance Bond 1310-1 IN WITNESS WHEREOF,the Principai and Surety hae executed this instrument under their seals this 21 day of June ____, 2016 , 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. o CT6�T[^n� toPu,io Inc. � � .___-_-__________ Prinuipu| • (Sca|) �iii Title of Signatory Contractors Bonding and |n�umnccCvm �,� » Company Surety (Si)ra Signature for Surety / / Yung T. M»| .ck,Attorney-In-Fact-_-_____-__-______ Title of Signatory |\| Pacifica,Suite 35o. Irvine,(x92u)V Address of Surety 949-341'9110 Phone of Surety Julie Contact Person For Surety Faithful Performance Bond 1310-2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA County of Orange 1 . On June 21, 2016 before me, Terah Johnston . Notary Public, Date Insert Name of Notary exactly as it appears on the official sea; personally appeared Yung T. Mullick Name(s)of Signer(s) II r; t 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 TERAH JOHNSTON person(s), or the entity upon behalf of which the person(s) i r Commission # 2004865 acted, executed the instrument. z .!j Notary Public - California Z Z ' ' Orange County I certify under PENALTY OF PERJURY under the laws of Ii! PAy Comm.Expires Jan 2t,2017 the State of California that the foregoing paragraph is true and correct. Witness my hand and o • iallseal. Signatur Place Notary Seal Above S, tore Notary Terah ii OPTIONAL ii 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 the form to another document, !i' Description of Attached Document Title or Type of Document: Performance Bond RCB0003632 Document Date: June 21, 2016 — Number of Pages: 2 Signer(s) Other Than Named Above: None Capacity(ies)Claimed by Signer(s) Signer's Name: Yung T. Mullick Signer's Name: ❑ Individual ❑ Individual C! ❑ Corporate Officer—Title(s): ❑ Corporate Officer —Title(s): ❑ Partner ❑Limited ❑General ❑ Partner ❑Limited❑General , Attorney in Fact RIGHT THUMBPRINT ❑ Attorney in Fact RIGHT THUMBPRINT ❑ Trustee OF SIGNER ❑ Trustee OF SIGNER ❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here ❑ Other ❑ Other: ! Signer is Representing: Signer is Representing Contractors Bonding and _ I Insurance Company _ _– CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of WS 1V 1K } On 1;64, 11/1111 101 4 before me, Aryl t l I ce,� M OVII NU G�►�y Fbt IC' , Here insert nam and title of the officer personally appeared CJO5� O tW AVt I) ' COIYV� I Pr 1--v who proved to me on the basis of satisfactory evidenc be the person(') whose name(V) is/a, subscribed to the within instrument and acknowledged to me that he/site/tt3 y executed the same in his/tyer/their authorized capacity(i s), and that by his/I r/thOr 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. AMY ELISE MOODY l WITNESS my hand and official seal. _ ,.,*r� Commission No.2149616• 2 -'�.1 NOTARY PUBLIC-CALIFORNIA 12 Z " LOS ANGELES COUNTY : Meow My Comm.ANGELES APRIL U TY Notary Public Signature ( / (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long I Re�Io r /r l(/'l`�� �+�^, as the wording does not require the California notary to violate California notary (Title or description of attached ocument) V' V r • State and County information must be the State and County where the document Cast Y e�{v� / signer(s)personally appeared before the notary public for acknowledgment. (� v I ent • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document must also be the same date the acknowledgment is completed. �1 4)12-411(e • The notary public must print his or her name as it appears within his or her Number of Pages 2- Document Date 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. he/she/they, is/are)or circling the correct forms.Failure to correctly indicate this ...���❑I Individual (s) information may lead to rejection of document recording. Cor orate fflce� •• The notary seal impression must be clear and photographically reproducible. r - 4/, Impression must not cover text or lines. If seal impression smudges,re-seal if a u Y 1 I sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) 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. Indicate title or type of attached document,number of pages and date. Other ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). www ;r;' r ff less Loy:S,•;"_;`:;98 • Securely attach this document to the signed document with a staple. RLI chic POWER OF ATTORNEY an RU Company RLI Insurance Company 9025 N.Lindbergh Dr.1 Peoria,IL 61615 Contractors Bonding and Insurance Company g nce om P an y Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed,but may be detached by the approving officer if desired. That this Power of Attorney may be effective and given to either or both of RLI Insurance Company and Contractors Bonding and Insurance Company,required for the applicable bond. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each Illinois corporations (as applicable), each authorized and licensed to do business in all states and the District of Columbia do hereby make,constitute and appoint: James W.Moilanen,Yung T.Mullick,Christine T.Hoang,Terah Johnston,Kat Jorgensen,jointly or severally in the City of Mission Viejo , State of California ,as Attorney in Fact,with full power and authority hereby conferred upon him/her to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds, undertakings,and recognizances in an amount not to exceed Ten Million Dollars ( $10,000,000.00 )for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company. RLI Insurance Company and Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of the Resolution adopted by the Board of Directors of each such corporation,and now in force,to-wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation shall be executed in the corporate name of the Corporation by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Corporation. The corporate seal is not necessary for the validity of any bonds, policies, undertakings,Powers of Attorney or other obligations of the Corporation. The signature of any such officer and the corporate seal may be printed by facsimile or other electronic image." IN WITNESS WHEREOF,RLI Insurance Company and/or Contractors Bonding and Insurance Company,as applicable,have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 26th day of April,2016. o�o �'AN'NS, ,"P "E'� RLI Insurance Company•o¢o•• poxi4rFA°- ;;`�S�oAPOR;°'ts;:. Contractors Bonding and Insurance Company =3-' SEAL .I. SEAL = 4'J .-0- •<2 - Barton W.Davis Vice President State of Illinois ) •i...i• 1 SS •'L LINOlS ,•••••••',41.I'N 0V County of Peoria CERTIFICATE On this 26th day of April , 2016 , I, the undersigned officer of RLI Insurance Company, and/or before me, a Notary Public, personally appeared Barton W. Davis Contractors Bonding and Insurance Company, each Illinois who being by me duly sworn,acknowledged that he signed the above Power corporations, do hereby certify that the attached Power of Attorney is of Attorney as the aforesaid officer of the RLI Insurance Company and/or in full force and effect and is irrevocable; and furthermore, that the Contractors Bonding and Insurance Company, and acknowledged said Resolution of the Company as set forth in the Power of Attorney, is instrument to be the voluntary act and deed of said corporation. now in force. In testimony whereof,I have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding and Insurance Company this orgy day of w..e_ o0(b . �f• Q�' Q RLI Insurance Company Jacqu ire M.Bockler Notary Public Contractors on ing and Ins rance Company . ..L1 "OFFICIAL SEAL" . ► Barton W.Davis Vice President 1NOTARV 52-'' JACQUELINE M.BOCKLER 1 'WNW' COMMISSION EXPIRES 01/14118 1 I.■ lu� i 0475412020212 A0059115 • BON Dw0KCH00V@2 BOND PREMIUM INCLUDED IN PERFORMANCE BOND SECTION 1320 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: THAT the City of Cathedral City,a municipal corporation, hoeiouftrrdcoiaou<ed the City, has,on June 8, 2816, awarded to CT&T Concrete Paving, Inc., hereinafter designated as the Principal, a Contract for SAN jWAQ0IN DRIVE SIDEWALK IMPROVEMENTS, BID NO. Bl5-08E,CITY PROJECT NO.2517, 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 donc, 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 Contractors Bonding and Insurance Company , as Surety, are held and firmly bound unto the City in the just and full amount of( ** ) , executors, administrators, and successors, joio�\y and severally,firmlyby these presents. ~~S143,100.00 THE CONDITION OF THIS OBLIGATION IS SUCH, that if said Principal, it or its heirs, executors, adniinistrators, 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 fotth,and also will pay in case suit is brough upon this bond, such reasonable attorney's fees to the City as shall be flxed by the court. This bond shall insure tn the h*oofi*o[any and all persons, companies, and corporations named in Section 2l8 of the Civil Code nfthe State ofCalifornia 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 ohuogm, 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,affec its obligations of this bond, and it does hereby waive notice of any ckrige, extension of time,alteration, or addition to the terms of the contract or to the work or to the specifications. Said furetv 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 321)-} IN WITNESS WHEREOF,the Principal and Surety have executed this instrument under their seals this 21 day of June , 2016, 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. CT&T Concrete Paving,Inc. Principal --- __—_ (Seal) • ]gn. cipa; fre-s S Title of Signatory Contractors Bonding and Insurance Company Surety (Sea:) / Signature for Surety Yun_T.Mug k,Attorney-In-Fact Title of S:.,natory 11 Pacifica,Suite 350.Irvine,CA 92618 Address of Surety 949-341-9110 Phone;r of Surety Julie Durkin Contact Person For Surety r'fdyinent Bond 1329-2 , _ _.... CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 11 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. 'd: STATE OF CALIFORNIA 1; County of Orange On June 21, 2016 before me, Terah Johnston . Notary Public, tj Date Insert Name of Notary exactly as t appears on the official seal ;l. 11' personally appeared Yung T. Mullick _ Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they TERAH JOHNSTON executed the same in his/her/their authorized capacity(ies), .\ Commission #2004865 and that by his/her/their signature(s) on the instrument the y z person(s); or the entity upon behalf of which the person(s) Notary Public - California z z D acted, executed the instrument. z +t � Orange County My Comm. Expires Jan 21,tot I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true i and correct. Witness my hand and o .iai .eal. Signature A., , Place Notary Seal Above Signature of Notary' :is Tera on i`! 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 the form to another document. Description of Attached Document Title or Type of Document: Payment Bond RCB0003632 Ill Document Date: June 21, 2016 Number of Pages: 2 Signer(s) Other Than Named Above: None III Capacity(ies)Claimed by Signer(s) Signer's Name: Yung T. Mullick Signer's Name: ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑ Corporate Officer —Title(s): ❑ Partner ❑Limited ❑General ❑ Partner ❑Limited❑ General ( g Attorney in Fact RIGHT THUMBPRINT ❑ Attorney in Fact RIGHT THUMBPRINT ❑ Trustee OF SIGNER ❑ Trustee OF SIGNER ❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here ❑ Other: ❑ Other Signer is Representing: Signer is Representing: I Contractors Bonding and Insurance Company _ - CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of On 1-tw Z-I'k+ 201 1/4) before me, Pm I y N. IVloody, Notary pool it/ (Here insert name an title of the officer personally appeared 'D5C' Clued oi IVY d rva i\ WIWIcW who proved to me on the basis of satisfactory evidence to t e personV) whose nameV is/af€ subscribed to the within instrument and acknowledged to me that he/s a/tt)ey executed the same in his/t r/tl; it authorized capacity(i s), and that by his/hftr/th¢ir signature on the instrument the person(x), or the entity upon behalf of which the person( e) 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. AMY ELISE MOODY 1 WITNESS my hand and official seal. _ _ Commission No.2149616 g NOTARY PUBLIC-CALIFORNIA LOS ANGELES COUNTY MooV V My Comm.Expires APRIL 14,2020 Notary Pu lic ignature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document Ci1A-0-cci x611 Gi+ • signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached docum t continued) must also be the same date the acknowledgment is completed. +/� (e • The notary public must print his or her name as it appears within his or her Number of Pages 2- Document Date Y N I I`C 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. lie/she/they, is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. l�( Cor orate Qfficer • The notary seal impression must be clear and photographically reproducible. VY(c le PAn Impression must not cover text or lines. If seal impression smudges, re-seal if a (((( !I sufficient area permits,otherwise complete a different acknowledgment form.e • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) 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. Indicate title or type of attached document,number of pages and date. Other ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). "'.(.01.Verson • Securely attach this document to the signed document with a staple. • RLI® c bic POWER OF ATTORNEY in RU Company RLI Insurance Company 9025 N.Lindbergh Dr.I Peoria,IL 61615 Contractors Bonding and Insurance Company Phone:(800)645-2402 I Fax:(309)689-2036 Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed,but may be detached by the approving officer if desired. That this Power of Attorney may be effective and given to either or both of RLI Insurance Company and Contractors Bonding and Insurance Company,required for the applicable bond. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each Illinois corporations (as applicable), each authorized and licensed to do business in all states and the District of Columbia do hereby make,constitute and appoint: James W.Moilanen,Yung T.Mullick,Christine T.Hoang,Terah Johnston,Kat Jorgensen,jointly or severally in the City of Mission Viejo , State of California ,as Attorney in Fact,with full power and authority hereby conferred upon him/her to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds, undertakings,and recognizances in an amount not to exceed Ten Million Dollars ( $10,000,000.00 )for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company. RLI Insurance Company and Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of the Resolution adopted by the Board of Directors of each such corporation,and now in force,to-wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation shall be executed in the corporate name of the Corporation by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Corporation. The corporate seal is not necessary for the validity of any bonds, policies, undertakings,Powers of Attorney or other obligations of the Corporation. The signature of any such officer and the corporate seal may be printed by facsimile or other electronic image." IN WITNESS WHEREOF,RLI Insurance Company and/or Contractors Bonding and Insurance Company,as applicable,have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 26th day of April,2016. ,..`•„,GAND14,S'•,,/ `,"`).NCE'�o, RLI Insurance Company ''0e,• ' •.°q . :may,.• ••.44"-, Contractors Bonding and Insurance Company Fg••Gc OR4Ti<`;Zm=: ..GDpPDR4TP : SEAL ••,a' SEAL ll/'• State of Illinois y0° , Barton W.Davis Vice President• County of Peoria } SS •4LL:8o/S '. 41.1N0‘, ..,. CERTIFICATE On this 26th day of April 2016 , I, the undersigned officer of RLI Insurance Company, and/or before me, a Notary Public, personally appeared Barton W. Davis Contractors Bonding and Insurance Company, each Illinois who being by me duly sworn,acknowledged that he signed the above Power corporations, do hereby certify that the attached Power of Attorney is of Attorney as the aforesaid officer of the RLI Insurance Company and/or in full force and effect and is irrevocable; and furthermore, that the Contractors Bonding and Insurance Company, and acknowledged said ins solution of the Company as set forth in the Power of Attorney, is instrument to be the voluntary act and deed of said corporation. now in force. In testimony whereof,I have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding Bo and Insurance Company this �1 day of r,_e , �r - RLI Insurance Company ' Jacqu• ine M.Bockler Notaiy Public Contractors on ing and Ins ranee Company • O:�'� "OFFICIAL SEAL Barton W.Davis Vice President r ATE OFr JACQUELINE M. BOCKLER 1 ► NOIS COMMISSION EXPIRES 01/14/18 1 j 0475412020212 A0059115 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." nat.: Fresh 't+ Title Date Workers'Compensation Insurance 1330-1 SECTION 1340 LIABILITY AND INSURANCE REQUIREMENTS 1.0 INDEMNIFICATION Contractor shall defend,indemnify and hold harmless the City,City Council and each member thereof,and every officer,employee and agent of City,from any claim,demand,damage, liability, loss,cost or expense (including,without limitation,attorney's fees and costs)arising from any intentional,reckless,negligent,or otherwise wrongful acts,errors or omissions of the Contractor,or any of the Contractor" employees,or any of its subcontractors arising out of work under this Contract. The City does not, and shall not, waive any rights that it may have against Contractor, any of the Contractor's employees, or any of its subcontractors under this Section because of the acceptance by the City, or the deposit with the City, of any insurance policy or certificate required pursuant to this Contract. The hold harmless, indemnification and duty to defend provisions of this Section shall apply regardless of whether or not said insurance policies are determined to be applicable to the claim, demand, damage, liability, loss, cost or expense described herein. The City will not be liable for any accident, loss, or damage to the work prior to its completion and acceptance. 2.0 INSURANCE REQUIREMENTS 2.1 General After award of Contract,the Contractor shall promptly obtain,at its own expense,all the insurance required by Paragraph 1340-2.0, INSURANCE REQUIREMENTS, and shall submit coverage verification for review and approval by the City upon execution of the Contract. The Notice to Proceed with the Work under this Contract will not be issued, and the Contractor shall not commence work, until such insurance has been approved by the City. The Contractor shall not allow any subcontractors to commence work on its subcontract until all similar insurance required of the subcontractor has been obtained and verified by Contractor. Such insurance shall remain in full force and effect at all times during the prosecution of the Work and until the final completion and acceptance thereof. The Notice to Proceed does not relieve the Contractor of the duty to obtain such insurance as required by Paragraph 1340-2.0 INSURANCE REQUIREMENTS. 2.2 Commercial General Liability Policy The Contractor shall take out and maintain during the life of the Contract, a Commercial General Liability Policy, on an occurrence basis, with a minimum limit of not less than One Million Dollars ($1,000,000) combined single limit for bodily injury and property damage for any one occurrence and a Two Million Dollar($2,000,000)annual project aggregate,for all of the following: a. Premises Operations,including Explosion,Collapse and Underground(X,C,and U)Coverage. b. Completed Operations/Products,including X,C,and U Coverage. c. Independent Contractors. d. Blanket Contractual. e. Deductible shall not exceed One Thousand Dollars($1,000). Liability&Insurance Requirements 1340-1 2.3 Commercial Business Auto Policy The Contractor shall take out and maintain during the life of this Contract a Commercial Business Auto Policy,on an occurrence basis,with a minimum amount of not less than One Million Dollars($1,000,000) combined single limit for bodily injury and property damage, providing at least all of the following coverage: a. Coverage shall be applicable to any and all leased, owned, hired, or non-owned vehicles used in pursuit of any of the activities associated with this Contract. b. Any and all mobile equipment, including cranes, which is not covered under said Commercial Business Auto Policy shall have said coverage provided for under the Commercial General Liability Policy. c. Deductible shall not exceed One Thousand Dollars($1,000). 2.4 Workers' Compensation Insurance The Contractor shall take out and maintain during the life of the Contract, Worker's Compensation and Employers'Liability insurance providing coverage for any and all employees of Contractor: a. The required policy shall provide coverage for Workers'Compensation(Coverage A). b. This policy shall provide coverage for One Million Dollars ($1,000,000) Employers' Liability (Coverage B). 2.5 Endorsements All of the following endorsements are required to be made a part of the policies described in this Section hereof: a. "The City,City employees and officers,the City Engineer,its consultants,elected officials,agents, and sub-consultants are hereby added as additional insured insofar as Work done under this Contract is concerned." b. "This policy shall be considered primary insurance as respects any other valid and collectible insurance, including self-insured retention,the City may possess,and any other insurance the City does possess shall be considered excess insurance only." c. "This insurance shall act for each insured, and additional insured, as though a separate policy had been written for each. This, however, will not act to increase the limit of liability of the insuring company. d. "Thirty(30)days prior written notice of cancellation shall be given to the City. Such notice shall be sent to: City Manager City of Cathedral City 68-700 Avenida Lalo Guerrero Cathedral City,CA 92234 2.6 Change in Terms The Contractor shall provide immediate written notice to the City of any change in terms and conditions and/or reduction in the coverage of any nature to the insurance policies. The notice shall be sent to the location identified in Paragraph 1340-2.6.d, Endorsements. The Contractor shall be obligated to pay any extra premium for maintaining the insurance requirements specified herein. Liability&Insurance Requirements 1340-2 A 00 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/17/2016 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 LICENSE NO.0637431 CONTACT NAME: PATRICK MCRAE PATRICK MCRAE INSURANCE SERVICES (a/c No,Ext): (714)779-6999 FAX No): (714)779-6903 1290 N. HANCOCK ST., SUITE 210 E-MAIL sbc lobal.net ADDRESS: p mcrae g ANAHEIM HILLS, CA 92807 INSURER(S)AFFORDING COVERAGE ! NAIC# INSURER A: IRONSHORE SPECIALTY INSURANCE COMP 25445 INSURED INSURER B: CENTURY NATIONAL INSURANCE COMPAN126905 PERSONNEL STAFFING GROUP, LLC DBA KBS STAFFING INSURERC: NATIONAL UNION FIRE INSURANCE CO. OF 19445 CT&T CONCRETE PAVING INC. INSURER D:ZURICH AMERICAN INSURANCE COMPANY 16535 324 S DIAMOND BAR BLVD. PMB 275 INSURERS: GREAT AMERICAN INSURANCE CO. OF NY 22136 DIAMOND BAR CA 91765 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSRT IADDL SUBR1 POLICY EFF 1 POLICY EXP LTR, TYPE OF INSURANCE INgp ND/D POLICY NUMBER (MM/DD/YYYYLiMM/DD/YYYY) LIMITS A X 1 COMMERCIAL GENERAL LIABILITY X X AGS0098200 06/09/2016106/09/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE RENTED 50,000 I i PREMISES((Ea occurrence) $ X 1 XCU MED EXP(Any one person) $ 5,000 1 X I OCP PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY[ 1 JEC° LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I EBL $ $1,000,000 B AUTOMOBILE LIABILITY X BAP0180912 06/23/2015 06/23/2016 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ;AUTOS I AUTOS NON-OWNED PROPERTY DAMAGE J HIRED AUTOS ' X AUTOS I i der acc dent) $ C UMBRELLA LIAB X OCCUR EBU064589323 06/09/2016106/09/2017 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB— CLAIMS-MADE AGGREGATE $ 5,000,000 DED 1 RETENTION$ CRISIS RESPONSE $ 250,000 D j WORKERS COMPENSATION WC466477304 06/30/2015.06/30/2016 X 1 STATUTE I 1'2P - AND EMPLOYERS'LIABILITY Y/N -- --- -- ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/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 E INLAND IMP5021860 01126/2016101126/2017$61,386 SCHEDULED • MARINE/PROPERTY ! ! EQUIPMENT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) "THE CITY OF CATHEDRAL,CITY EMPLOYEES AND OFFICERS,THE CITY ENGINEER,ITS CONSULTANTS,ELECTED OFFICIALS,AGENTS,AND SUB-CONSULTANTS ARE HEREBY ADDED AS ADDITIONAL INSURED INSOFAR AS WORK DONE UNDER THIS CONTRACT IS CONCERNED." SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,A 30 DAY WRITTEN NOTICE WILL BE ISSUED. RE:ALL OPERATIONS CERTIFICATE HOLDER _CANCELLATION 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 68-700 AVENIDA LALO GUERRERO ACCORDANCE WITH THE POLICY PROVISIONS. CATHEDRAL CITY, CA 92234 AUTHORIZED REPRESENTATIVE ,� I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations As required by written contract. If required by your Any Location written contract or written agreement with such Additional Insured, this insurance is primary and non- contributory. If anyone, other than the Additional Insured, provides similar insurance for the Additional Insured, then this insurance will apply as outlined in SECTION IV— COMMERICAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The inclusion of one or more Insured(s) under the terms of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 2010 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 B. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following additional Insurance shown in the Declarations; exclusions apply: whichever is less. This insurance does not apply to "bodily injury" or This endorsement shall not increase the "property damage"occurring after: applicable Limits of Insurance shown in the 1. All work, including materials, parts or Declarations. 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 location 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 0413 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract. If required by your written contract or written agreement with such Any Location Additional Insured, this insurance is primary and non- contributory. If anyone, other than the Additional Insured, provides similar insurance for the Additional Insured, then this insurance will apply as outlined in SECTION IV— COMMERICAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The inclusion of one or more Insured(s) under the terms of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage"caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 Page 1 of 2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 CG 20 37 0413 ❑ COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required by Written Contract Information required to complete the Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard".This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 COMMERCIAL GENERAL LIABILITY CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: As Required by Written Contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally 4. The limits shown in the Declarations for Each obligated to pay as damages caused by Occurrence, Fire Damage and Medical "occurrences" under COVERAGE A (SECTION Expense continue to apply. However, instead I), and for all medical expenses caused by of being subject to the General Aggregate accidents under COVERAGE C (SECTION I), Limit shown in the Declarations, such limits which can be attributed only to ongoing will be subject to the applicable Designated operations at a single designated construction Construction Project General Aggregate Limit. project shown in the Schedule above: B. For all sums which the insured becomes legally 1. A separate Designated Construction Project obligated to pay as damages caused by General Aggregate Limit applies to each "occurrences" under COVERAGE A (SECTION designated construction project, and that limit I), and for all medical expenses caused by is equal to the amount of the General accidents under COVERAGE C (SECTION I), Aggregate Limit shown in the Declarations. which cannot be attributed only to ongoing 2. The Designated Construction Project General operations at a single designated construction Aggregate Limit is the most we will pay for the project shown in the Schedule above: sum of all damages under COVERAGE A, 1. Any payments made under COVERAGE A for except damages because of"bodily injury" or damages or under COVERAGE C for medical "property damage" included in the "products- expenses shall reduce the amount available completed operations hazard", and for under the General Aggregate Limit or the medical expenses under COVERAGE C Products-Completed Operations Aggregate regardless of the number of: Limit,whichever is applicable; and a. Insureds; 2. Such payments shall not reduce any b. Claims made or"suits" brought; or Designated Construction Project General Aggregate Limit. c. Persons or organizations making claims or C. When coverage for liability arising out of the bringing"suits". made under COVERAGE A for "products-completed operations hazard" is 3. Any payments provided, any payments for damages because of damages or under COVERAGE C for medical "bodily injury" or "property damage" included in expenses shall reduce the Designated the "products-completed operations hazard" will Construction Project General Aggregate Limit reduce the Products-Completed Operations for that designated construction project. Such Aggregate Limit, and not reduce the General payments shall not reduce the General Aggregate Limit nor the Designated Construction Aggregate Limit shown in the Declarations Project General Aggregate Limit. nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Page 1 of 2 ❑ D. If the applicable designated construction project E. The provisions of Limits Of Insurance (SECTION has been abandoned, delayed, or abandoned III) not otherwise modified by this endorsement and then restarted, or if the authorized shall continue to apply as stipulated. contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 CG 25 03 03 97 ❑ CEN RY-NATIO C, box Non' ".aV. Fcw.`.‘Azms 3 ..; Ac3a flStd Endosameni T ,NSURE: 2,-, 0, .:. ' • ..• :::•.::L.-v.:N.; i ii-FR‘!---4:•'.:-TIONAL ,!,-',,°..., - :z-,.-.''',,' -,...........,. .....„,... ,,..:, t-s,-....„;:„ 3.9•:,-,9 -;,-4::,.1h..,,PiziPeA,-. 41.j.,-.' 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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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN CONTRACT PRIOR TO LOSS . 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 06-30-15 Policy No. we 4664773-04 Endorsement No, Insured PERSONNEL STAFFING GROUP LLC D/B/A KBS STAFFING Premium$ INCL Insurance Company ZURICH AMERICAN INSURANCE COMPANY Countersigned By WC 00 03 13 (Ed. 4-84) To 2 Q C) o co •t., -o c w m M o c r ! j o _Fs ti co a E CC $ O d c Q a o o R. o c o 0 m o m .. 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