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Dash Construction Company Inc .nECORDING REQUESTED BY: City of Rancho Palos Verdes WHEN RECORDED MAIL TO: 05I20/206 1 rCity Clerk 11111111111111111111 111111 Name City of Rancho Palos Verses Street 30940 Hawthorne Blvd. Address *20160580576* Rancho Palos Verdes City State CA Zip 90275 1. J Space above this line for recorder's use WOLCOTTS FORMS INC. Stn+cE 1893 NOTICE OF COMPLETION Notice pursuant to Civil Code Section 3093,must be filed within 10 days after completion.(See reverse side for complete requirements.) Notice is hereby given that: 1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the property hereinafter described. 2. The full name of the owner is City of Rancho Palos Verdes 3. The full address of the owner is 30940 Hawthorne Blvd. , Rancho Palos Terde s, CA 90275 4. The nature of the interest or estate of the owner is:In fee. (If other than Fee,strike in fee'and insert,for example.'purchaser under contract of purchase.'or'Lessee') 5. The lull names and full addresses of all persons,if any,who hold title with the undersigned as joint tenants or as tenants in common are: NAMES ADDRESSES 6. The full names and full addresses of the predecessors in interest of the undersigned, if the property was transferred subsequent to the commencement of the work or improvements herein referred to: NAMES ADDRESSES 7. A work of improvement on the property hereinafter described was completed on 3r2571-6 .The work done was: AnA Ar_ceSS and Sidewalk Improvements on PVDW 8. The names of the contractor,if any,for such work of improvement was Dash Construction Company, nc. (II no contractor for work of improvement as a whole,insert'None') (Date of Contract) 9. The property on which said work of improvement was completed is in the City of Rancho Palos Verdes County of Los Angeles-- ,State of C A ,and is described as follows: R 10. The street address of said property is Hawthorne Blvd. to Rue Beaupre on Palos Verdes Dr. West (If no street address has been officially assigned,insert'none'.) Dated (4-(f c, (Signature of Owner or corporate officer of Owner named in paragraph 2,or his agent) -- ty_a Rancho Palos Verdes rVERIFICATION I,the undersigned,say:I am the City C 1 e ,the Declarant of the foregoing Notice of Completion; (President of,Manager of,Partner of.Owner of.etc.) I have read said Notice of Completion and know the contents thereof;the same is!rue to my own knowledge.I declare under penalty of perjury that the fore oing is true and correct. Rancho Palos Verdes CA Executed on_ ,2 _ . (Personal signature of the indivi• who is swearing that the••-ents of the '• •:of Completion are true) Before you use this form fill in all blanks,and make whatever chanes are appropriate and necessary ;111111 to your particular transact ion.Consult a lawyer if you doubt the forms fitness for your purpose and use 11 'LI Wolcotts makes no representation or warranty, express or implied,with respect to the merchantability 7 67775 01114 12 or fitness of this form for an intended use or purpose. ©2005 WOLCOTTS FORMS,INC. FORM 1114 Rev.10-05 e • DO NOT RECORD THIS PAGE REQUIREMENTS AS TO NOTICE OF COMPLETION - Notice of completion must be filed for record WITHIN 10 DAYS after the cov pletion of the work of improvement (to be computed exclusive of the day of completion) a . provided in Civil Code Section 3093. The "owner" who must file for record a notice of completion of •uilding or other work of improvement means the owner (or his successor in interest at th- date the notice is filed) on whose behalf the work was done, though his ownership is less an the fee title. For example, if A is the owner in fee, and B, lessee under a lease, causes . building to be constructed, then B, or whoever has succeeded to his interest at the date the notice is filed, must file the notice. If the ownership is in two or more persons as .'int tenants or tenants in common, the notice may be signed by any one of the co-owners in fact, the e •: -: e at is designed for giving of the notice by only one co-tenant), bu he names and addresses • the other co- owners must be stated in paragraph 5 of the f• m. �..- Note that any Notice of Completion igned by a succes-• -terest shat-recite the names and addresses of his transferor or transferors. In paragraphs 3, 5 and 6, the ull address called for should include street number, city, county, and state. As to paragraphs 7 and , this form should be used only where the notice of completion covers the work of improve ent as a whole. If the notice is to be given only of completion of a particular contract, whey the work of improvement is made pursuant to two or more original contracts, then this f -rm must be modified as follows: (1) Strike the words "A work of improvement" from aragraph 7 and insert a general statement of the kind of work done or materials furnishesi pursuant to such contract (e.g., "The foundation for the improvements"); (2) Insert the na a of the contractor under the particular contract in paragraph 8. In paragr ph 8 of the notice, insert the name of the contractor for the work of improvement as a whole. No contractor's name need to given if there is no general contractor, e.g. on so- called "o ner-builder jobs." In paragraph 9, insert the full, legal description, not merely a street address or tax description. Refer to deed or policy of title insurance. If the space provided for description is not sufficient, a rider may be attached. In paragraph 10, show the street address, if any, assigned to the property by any competent public or governmental authority. STATE COMPENSATION INSURANCE FUND IN REPLY REFER TO: JULY 10 , 2017 CITY OF RANCHO PALOS VERDES CITY HALL 30940 HAWTHORNE BLVD RANCHO PALOS VERDES CA 90275-5351 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE CANCELLATION NOTICE RE: CERTIFICATE DATED MARCH 1, 2017 THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW WILL BE CANCELLED EFFECTIVE AUGUST 15, 2017 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: DASH CONSTRUCTION COMPANY INC PO BOX 261321 ENCINO, CA 91426 POLICY 9047242-17 CUSTOMER SERVICE REPRESENTATIVE CUSTOMER SERVICE CENTER (888) 782-8338 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 SCIF 19102 STATE COMPENSATION INSURANCE FUND IN REPLY REFER TO: JULY 10, 2017 CITY OF RANCHO PALOS VERDE CITY HALL 30940 HAWTHORNE BLVD RANCHO PALOS VERDES CA 90275-5351 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE CANCELLATION NOTICE RE: CERTIFICATE DATED MARCH 1, 2017 THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW WILL BE CANCELLED EFFECTIVE AUGUST 15, 2017 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: DASH CONSTRUCTION COMPANY INC PO BOX 261321 ENCINO, CA 91426 POLICY 9047242-17 CUSTOMER SERVICE REPRESENTATIVE CUSTOMER SERVICE CENTER (888) 782-8338. 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 SCIF 19102 A This page is part of your document-DO NOT DISCARD ,y020160580576 InzitYPP* IIUIIIOHI III IIIII I I IIII IIII II P��Oz: Recorded/Filetl In ficial Records Recorders Office,Los Angeles County, t{ j 1"'"I 1��+ California "11,0114*' 05/20/16 AT 11:35AM FEES: 0.00 TAXES: 0.00 OTHER: 0.00 PAID: 0.00 III II I I I III II I VIII II I II I I I II III I I I II II I III I II I I III II I I III III LEADSHEET III I I iii I I II VIII I I I II VIII nii IIII I I III III II I III 1111 201605203330006 00012117166 YII IQ uu�N III III IIII �� I�III 0075661d7 SEQ: 01 DAR - Counter (Upfront Scan) IIIHI I YIIlulyl11yIVIuY 1101111II'IAY1,ll11011110�I�IW pII�IWIIII'I liiiY�IIIpII� I�I�IIIlA1�lY��I1I,lu 11111I0111II�IY�WIn - - THIS FORM IS NOT TO BE DUPLICATED CITY OF RANCHO PALOS VERDES AGREEMENT FOR ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (Community Development Block Grant Project#601659-14) THIS AGREEMENTg (the "Agreement") is made and entered this 1 1 S ) 16 , by and between the CITY OF RANCHO PALOS VERDES, a California municipal corporation ("City") and 5vi (oar)*ro oev ("Contractor"). Contractor's license number is 61S-0 ivcrri t i c.. In consideration of the mutual covenants hereinafter set forth,the parties hereto agree as follows: 1. Scope of Services. Contractor shall perform the work and provide all labor, materials, equipment and services in a good and workmanlike manner for the project identified as ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW ("Project"), as described in this Agreement and in the Bid Documents(including the Notice Inviting Sealed Bids,the Instructions to Bidders,the General Provisions, the Special Provisions, the Proposal, Appendices I through V, and all addenda as prepared prior to the date of bid opening setting forth any modifications or interpretations of any said documents), which are on file with the Department of Public Works and incorporated herein by this reference, including miscellaneous appurtenant work. All work shall be performed in accordance with the latest edition of the Standard Specifications for Public Works Construction (commonly known as the"Greenbook"), including supplements, prepared and promulgated by the Southern California Chapter of the American Public Works Association and the Associated General Contractors of California (collectively "Standard Specifications"), which is incorporated herein by this reference. In the event of any conflict between the terms of this Agreement and incorporated documents, the terms of this Agreement shall control. 2. Extra Work. Extra work,when ordered in writing by the Director of Public Works and accepted by the Contractor, shall be paid for underwritten work order in accordance with the terms therein provided. Payment for extra work will be made at the unit price or lump sum previously agreed upon in writing between the Contractor and the Director of Public Works. All extra work shall be adjusted daily upon report sheet furnished by the Contractor, prepared by the Director of Public Works, and signed by both parties, and said daily report shall be considered thereafter the true records of extra work done. 3. Effective Date. This Agreement is effective as of the date listed above, and shall remain in full force and effect until Contractor has rendered the services required by this Agreement. 4. Force Majeure. Neither the City nor Contractor shall be responsible for delays in performance under this Agreement due to causes beyond its control, including but not limited to acts of God, acts of the public enemy, acts of the Government, fires, floods or other casualty, epidemics, earthquakes, labor stoppages or slowdowns, freight embargoes, unusually severe weather, and supplier delays due to such causes. Neither economic nor market conditions nor the financial condition of either party shall be considered a cause to excuse delay pursuant to this Section. Each party shall notify the other promptly in writing of each such excusable delay, its cause and its expected delay, and shall upon request update such notice. 5. Compensation. In consideration of the services ren ered her urldej , i s ay Contractor a not to exceed amount of DnikurreJ O'tQ. �7°''1 �e i � - � doll s $ JI, $43.o0) in accordance with the as submitted in ontractorp's Pro osal, attached hereto as xhibit "A" and prices incorporated herein by this reference. 6. Payments. City shall make payments within thirty (30) days after receipt of undisputed and properly submitted payment requests from Contractor. City shall return to Contractor any payment C- 1 R6876-0010\1817323v2.doc request determined not to be a proper payment request as soon as practicable, but not later than seven (7) days, after receipt and shall explain in writing the reasons why the payment request is not proper. A payment shall be made as the City Council of the City prescribes upon estimates approved by the City Council. However, progress payments shall not be made in excess of ninety-five percent(95%) of the percentage of actual work completed plus a like percentage of the value of material delivered on the ground or stored subject to, or under the control of, the City, and unused. The City shall withhold not less than five percent (5%) of the Agreement price until final completion and acceptance of the Project. However, at any time after fifty percent (50%) of the work has been completed, if the City Council of the City finds that satisfactory progress is being made, it may, at its discretion, make any of the remaining progress payments in full for actual work completed. 7. Substitute Security. a. At the written request and expense of Contractor, securities equivalent to any moneys withheld by the City to ensure performance under this Agreement shall be deposited with the City, or with a state or federally chartered bank in the State of California as the escrow agent,that shall then pay those moneys to Contractor. Upon satisfactory completion of the Agreement, the securities shall be returned to Contractor. b. Alternatively, Contractor may request that the City shall make payment of retentions earned directly to the escrow agent at the expense of Contractor. At the expense of Contractor, Contractor may direct the investment of the payments into securities, and Contractor shall receive the interest earned on the investments upon the same terms provided for securities deposited by Contractor. Upon satisfactory completion of the Agreement, Contractor shall receive from the escrow agent all securities, interest, and payments received by the escrow agent from the City, pursuant to the terms of this Section. c. Securities eligible for investment shall include those listed in California Government Code Section 16430, bank or savings and loan certificates of deposit, interest-bearing demand deposit accounts, standby letters of credit, or any other security to which Contractor and the City mutually agree in writing. Contractor shall be the beneficial owner of any securities substituted for moneys withheld and shall receive any interest thereon. d. If Contractor elects to receive interest on moneys withheld in retention by the City, it shall, at the request of any subcontractor performing more than five percent(5%)of Contractor's total bid, make that option available to the subcontractor regarding any moneys withheld in retention by Contractor from the subcontractor. Further mandatory details are provided in Public Contract Code Section 22300(d), which is incorporated herein by this reference. e. The escrow agreement for security deposits in lieu of retention shall be substantially similar to the form provided in Public Contract Code Section 22300(f), which is incorporated herein by this reference. 8. Taxes. Contractor shall calculate payment for all sales, unemployment, old age pension and other taxes imposed by local, State of California and federal law. These payments are included in the total amounts in Exhibit "B." 9. Time. Upon receipt of written Notice to Proceed from the City, Contractor shall perform with due diligence the services requested by the City as specified in the Bid Documents. Time is of the essence C-2 R6876-0010\1817323v2.doc in this Agreement. 10. Unresolved Disputes. In the event that a dispute arises between the City and Contractor regarding whether the conditions materially differ, involve hazardous waste, or cause a decrease or increase in Contractor's cost of or time required for performance of any part of the work, Contractor shall notify City promptly of its intention to submit a claim. If the dispute arises before performance of the related work, the written notice shall be submitted prior to commencing such work. In any event, the Contractor shall proceed with such work in compliance with the instructions of the City; such compliance shall not be a waiver of the Contractor's rights to make a claim, provided they have notified the City in writing as above stipulated. In the event of any dispute or controversy with the City over any matter whatsoever, Contractor shall not cause any delay or cessation in or of work, but shall proceed with the performance of the work in dispute. This includes disputed time extension requests and prices for changes. The disputed work will be categorized as an "unresolved dispute" and payment, if any, shall be as later determined by mutual agreement or a court of law. Contractor shall keep accurate, detailed records of all disputed work, claims and other disputed matters. Public Contract Code Sections 20104 et seq. and Rancho Palos Verdes Municipal Code chapter 3.24 ("Claims Against the City") shall govern the procedures of the claim process, and these provisions are incorporated herein by this reference. 11. Default and Remedies. a. Default shall consist of any failure by the Contractor to perform under this Agreement or written amendments thereto or any breach of any covenant, agreement, provision or warranty provided by the Contractor as a part of this Agreement. Actions which constitute a default include, but are not limited to: (1) failure to submit to the City reports which are required pursuant to this Agreement or the submission of required reports that are incorrect or incomplete; (2) submission of requests for payment or reimbursement of amounts that are incorrect or incomplete; (3) the failure of Contractor to accept any additional conditions which may be required by law, by executive order, by regulation or by other policy announced by the City, the state or any federal agency; or (4) failure to perform any activity required by this Agreement. b. Upon occurrence of any default, the City shall advise Contractor in writing of the action constituting the default, and specify the actions that must be taken to cure the default. The City may suspend payment under the Agreement. If Contractor does not cure the default within thirty(30) days of receipt of written notice from the City, the City may continue the suspension or, by written notice of termination, may terminate this Agreement. c. Notwithstanding the above, Contractor shall not be relieved of liability to the City for damage sustained by the City by virtue of any default or breach of the Agreement, and the City may deduct the amount of damages from any outstanding payments to Contractor or may withhold payments until such time as the exact amount of the damages is determined. 12. Termination. a. The City may cancel this Agreement at any time with or without cause without penalty upon thirty (30) days'written notice. In the event of termination without fault of Contractor, City shall pay Contractor for all services satisfactorily rendered prior to date of termination, and such payment shall be in full satisfaction of all services rendered hereunder. b. If federal funding for this Agreement is terminated and no other funding is available for continuation of this project, the City will not be obligated to continue funding for the services contained in this Agreement and may terminate the Agreement. C-3 R6876-001O\1817323v2.d o c c. In the event of termination, all property and finished or unfinished documents, data, studies, surveys, drawings, maps, models, photographs and reports prepared by or purchased with CDBG/HOME funds by the Contractor under this Agreement shall, at the option of the City, become the City's property, and Contractor shall be entitled to receive just and equitable compensation, as determined by the City, for any work satisfactorily completed hereunder. 13. Indemnity. a. Contractor's Duty. To the maximum extent permitted by law, Contractor shall defend, indemnify, and hold harmless the City, its elected officials, officers, employees, volunteers, agents, successors, assigns, and those City agents serving as independent contractors in the role of City officials (collectively "Indemnitees") from and against any and all claims (including, without limitation, claims for bodily injury, death or damage to property), demands, obligations, damages, actions, causes of action, proceedings, suits, losses, bid protests, stop notices, judgments, fines, liens, penalties, liabilities, costs and expenses of every kind and nature whatsoever, in any manner arising out of or incident to any act, failure to act, error or omission of Contractor or any of its officers, agents, servants, employees, subcontractors, materialmen, suppliers or their officers, agents, servants or employees, arising out of the Agreement, including without limitation, the payment of all consequential damages, attorneys' fees, experts' fees, and other related costs and expenses (individually, a "Claim," or collectively, "Claims"). Further, Contractor shall appoint competent defense counsel approved by the City Attorney at Contractor's own cost, expense and risk, to defend any and all such Claims that may be brought or instituted against Indemnitees. Contractor shall pay and satisfy any judgment, award or decree that may be rendered against Indemnitees in any such Claim. Contractor shall reimburse Indemnitees for any and all legal expenses and costs incurred by each of them in connection therewith or in enforcing the indemnity herein provided. Contractor's obligation to indemnify shall not be restricted to insurance proceeds, if any, received by Contractor or Indemnitees. This indemnity shall apply to all Claims regardless of whether any insurance policies are applicable. b. Bid Protests. In addition to its obligations pursuant to Section 13(a), Contractor shall reimburse the City for all attorneys' fees and costs incurred by City in connection with, arising out of or incident to any bid protest. c. Civil Code Exception. Nothing in Section 13(a) shall be construed to encompass Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code section 2782(a) or the City's active negligence to the limited extent that the underlying Agreement is subject to Civil Code section 2782(b). d. Nonwaiver of Rights. Indemnitees do not and shall not waive any rights that they may possess against Contractor because the acceptance by City, or the deposit with City, of any insurance policy or certificate required pursuant to this Agreement. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence. e. Waiver of Right of Subrogation. Contractor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all Claims arising outof or incident to the activities or operations performed by or on behalf of the Contractor regardless of any prior, concurrent or subsequent active or passive negligence by Indemnitees. f. Survival. The provisions of this Section 13 shall survive the termination of this Agreement and are in addition to any other rights or remedies that Indemnitees may have under the law. Payment C-4 R6876-0010\1817323v2.doc is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against a Contractor shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. 14. Incorporation by Reference. All of the following documents are attached hereto and incorporated herein by this reference: City of Rancho Palos Verdes Instructions for Execution of Instruments; Insurance Requirements for the City of Rancho Palos Verdes Public Works Contract; Workers' Compensation Certificate of Insurance; Additional Insured Endorsement (Comprehensive General Liability); Additional Insured Endorsement (Automobile Liability); Additional Insured Endorsement (Excess Liability); Non-Segregated Facilities Certification; Equal Employment Opportunity Commitment; U.S. Department of Housing and Urban Development Report of Additional Classification and Rate (HUD Form 4230A); U.S. Department of Labor Employment Standards Administration Wage and Hour Division Payroll; Contracting with Small Business Minority Firms, Women's Business Enterprise and Labor Surplus Area Firms; Federal Equal Employment Opportunity/Affirmative Action Requirements; Past Performance Certification; and Fringe Benefit Payment Certification. 15. Record-Keeping and Reporting. a. Records to be Kept. Records shall be maintained in accordance with the requirements prescribed by the Secretary of Housing and Urban Development ("HUD") or the County of Los Angeles (the"County")with respect to all matters covered by this Agreement. Except as otherwise authorized by HUD, such records shall be maintained for a period of five (5) years after receipt of the final payment under this Agreement. Additionally, pursuant to Government Code Section 8546.7, Contractor shall be subject to State Auditor examination and audit at the request of the City or as part of any audit of the City, for a period of three (3) years after final payment under this Agreement. b. Documentation of Costs. All costs shall be supported by properly executed payrolls, time records, invoices, contracts, vouchers, orders or other accounting documents. All documents pertaining in whole or in part to this Agreement shall be clearly identified and readily accessible. c. Inspection of Records. At any time during normal business hours and as often as City, County, HUD and/or the Comptroller General of the United States may deem necessary, the Contractor shall make available to any of these entities for examination all of its records, with respect to all matters covered by this Agreement, and will permit any of these entities to audit, examine and make excerpts or transcripts from such records, including contracts, invoices, materials, payrolls, records of personnel, conditions of employment and any other data relating to matters covered by this Agreement. 16. Lobbying Certifications. The Los Angeles County Lobbyist Code Chapter 2.160 County Ordinance No. 93-0031 Certification and the Federal Lobbyist Requirements Certification are attached hereto and incorporated herein by this reference. Consultant shall complete and file these Certifications as required by the City or the County. 17. Utilities. The City acknowledges its responsibilities under Government Code section 4215 and incorporates that section herein by this reference. 18. Location of Existing Elements. The methods used and costs involved to locate existing elements, points of connection and all construction methods are the Contractor's sole responsibility. Accuracy of information furnished, as to existing conditions, is not guaranteed by the City. Contractor, at its sole expense, must make all investigations necessary to determine locations of existing elements, which may include, without limitation, contacting U.S.A. Alert and other private underground locating firm(s), utilizing specialized locating equipment and/or hand trenching. C-5 R6876-0010\1817323v2.doc 19. Antitrust Claims. Pursuant to Public Contract Code Section 7103.5, Contractor offers and agrees to assign to the 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. Section 15) or under the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part 2 of Division 7 of the California Business and Professions Code) arising from purchases of goods, services, or materials pursuant to the Agreement. This assignment shall be made and become effective at the time the City tenders final payment to Contractor without further acknowledgment by the parties. 20. Independent Contractor. Contractor is and shall at all times remain, as to the City, a wholly independent contractor. Neither the City nor any of its agents shall have control over the conduct of Contractor or any of the Contractor's employees, except as herein set forth, and Contractor is free to dispose of all portions of its time and activities which it is not obligated to devote to the City in such a manner and to such persons,firms, or corporations at the Contractor wishes except as expressly provided in this Agreement. Contractor shall have no power to incur any debt, obligation, or liability on behalf of the City, bind the City in any manner, or otherwise act on behalf of the City as an agent. Contractor shall not, at any time or in any manner, represent that it or any of its agents, servants or employees, are in any manner agents, servants or employees of City. Contractor agrees to pay all required taxes on amounts paid to Contractor under this Agreement, and to indemnify and hold the City harmless from any and all taxes, assessments, penalties, and interest asserted against the City by reason of the independent contractor relationship created by this Agreement. Contractor shall fully comply with the workers' compensation law regarding Contractor and its employees. Contractor further agrees to indemnify and hold the City harmless from any failure of Contractor to comply with applicable workers' compensation laws. The City shall have the right to offset against the amount of any compensation due to Contractor under this Agreement any amount due to the City from Contractor as a result of its failure to promptly pay to the City any reimbursement or indemnification arising under this Section. 21. Workers' Compensation Insurance. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861, the Contractor hereby certifies as follows: "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 under take 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." 22. Subcontracting. Contractor shall adhere to all provisions of the Subletting and Subcontracting Fair Practices Act, Public Contract Code Section 4100 et seq., which is incorporated herein by this reference. 23. Excluded Contractors. -In an effort to eliminate unfair competitive advantage, contractors who develop or draft specifications, requirements, statements of work, invitations for bids, and/or requests for proposals will be excluded from competing for such procurement(24 CFR 84.43). Contractor shall not be, and shall ensure all subcontractors are not, debarred, suspended or placed in eligibility status under the provisions of 24 C.F.R. Part 24 throughout the duration of this Agreement. Contractor shall not perform work with debarred subcontractor pursuant to California Labor Code sections 1777.1 or 1777.7. 24. Anti-Discrimination. Contractor shall adhere to all federal discrimination requirements, including Executive Order 11246, as listed in the Federal Discrimination Provisions, which is attached hereto and incorporated herein by this reference. Contractor shall also adhere to the Equal Employment Opportunity C-6 R6876-0010\1817323v2.doc Regulations for Federally Assisted Construction Contracts, which is attached hereto and incorporated herein by this reference. Contractor shall ensure equal opportunity to all persons without regard to race, color, gender, sexual orientation, religion, national origin, ancestry, age, marital status, or disability. 25. Conflicts of Interest. a. Contractor agrees not to accept any employment or representation during the term of this Agreement or within twelve (12) months after completion of the work under this Agreement which is or may likely make Contractor "financially interested," as provided in Government Code Section 1090 and 87100, in any decisions made by City on any matter in connection with which Contractor has been retained pursuant to this Agreement. b. No official, officer, employee, or agent of the City or Contractor shall have any financial interest,direct or indirect, in any contract or subcontract, or the proceeds thereof,for work to be performed in connection with the program assisted under this Agreement. Immediate family members of said officials, officers, employees, and agents are similarly barred from having any financial interest in the program. c. No person who exercises, or has exercised any function or responsibilities with respect to CDBG activities, or who is in a position to participate in a decision making process or gain inside information with regards to such activities, may obtain a financial interest or benefit from a CDBG-assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a CDBG- assisted activity, or with respect to the proceeds of the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. d. Contractor shall take appropriate steps to assure compliance with paragraph (b) of this Section and will incorporate the following provision into every subcontract: "Interest of Subcontractor and Employees. The Subcontractor covenants that no person who presently exercises any functions or responsibilities in connection with the Community Development Block Grant Program has any personal financial interest, direct or indirect, in this Contract. Any interest on the part of the Subcontractor or his employees must be disclosed to the Recipient and the City, provided, however,that this paragraph shall be interpreted in such a manner so as not to unreasonably impede the statutory requirement that maximum opportunity be provided for employment of and participation by residents of the area." 26. Third Party Claims. City shall have full authority to compromise or otherwise settle any claim relating to the Agreement at any time. City shall timely notify Contractor of the receipt of any third-party claim relating to the Agreement. City shall be entitled to recover its reasonable costs incurred in providing this notice. 27. Davis-Bacon Act, Copeland Anti-Kickback Act, and Prevailing Wages. City and Contractor acknowledge that this project is a public work to which prevailing wages apply. City and Contractor acknowledge that this is a federally assisted construction contract and that federal labor standards provisions, including prevailing wage requirements of the Davis-Bacon Act ((40 U.S.C. 276 a to a.7) as supplemented by Department of Labor Regulations (29 CFR Part 5)) and related acts, are incorporated by this reference and will be enforced. Contractor understands that in the event of a conflict between the Federal General Wage Decision as established by the United States Department of Labor (available at www.access.gpo.gov/davisbacon/ca.html) and the State General Prevailing Wage Determination as established by the California Department of Industrial Relations (available at C-7 R6876-0010\1817323v2.doc http://www.dir.ca.gov/DLSR/PWD/index.htm), the higher of the two will prevail. The rates per diem for each type of worker are on file with the Public Works Director at City Hall at the address listed below, and are available to anyone upon request. The documents titled U.S. Department of Housing and Urban Development Office of Labor Relations Federal Labor Standards Provisions and Agreement to Comply with California Labor Law Requirements are attached hereto and incorporated herein by this reference. Eight hours of labor constitutes a legal day's work. The Copeland "Anti-Kick Back Act" (18 U.S.C. 876), as supplemented in Department of Labor regulations (29 CFR Part 3), shall apply, and Contractor shall not induce, by any means, any person employed in this Project to give up any part of the compensation to which he or she is otherwise entitled. 28. Contract Work Hours and Safety Standards Act. In employing mechanics or laborers, Contractor shall comply with the Contract Work Hours and Safety Standards Act (40 USC §§ 327 et seq.), as supplemented by Department of Labor Regulations contained in 29 C.F.R. Parts 3, 5 and 5a. Contractor shall not require or permit any laborer or mechanic, in any workweek in which the laborer or mechanic is employed on that work, to work more than forty (40) hours in that workweek, except as provided in the Contract Work Hours and Safety Standards Act. When a violation occurs, Contractor is liable to the affected employee for the employee's unpaid wages and to the City for liquidated damages equal to ten dollars ($10) for each calendar day on which the individual was required or permitted to work in excess of the standard workweek without payment of the overtime wages required by this chapter. 29. Compliance with Laws. Contractor shall comply with all applicable federal, state and local laws, ordinances, codes and regulations in force at the time Contractor performs pursuant to this Agreement, including those governing the funds provided under this Agreement. 30. Bonds. Contractor shall obtain faithful performance and payment bonds, each in an amount that is not less than the total compensation amount of this Agreement, and nothing in this Agreement shall be read to excuse this requirement. The required forms entitled Payment Bond (Labor and Materials) and Performance Bond are attached hereto and incorporated herein by this reference. Contractor shall also obtain a one-year warranty bond in an amount that is not less than the total compensation amount of this Agreement and in a form approved by the City Attorney and shall deliver this bond to the City before the City's acceptance of the project; alternatively,the Contractor shall submit written evidence from the surety of an extension to its performance bond, to be effective for a year after acceptance by the City, and shall submit this extension before the City's acceptance of the Project. 31. Ownership of Documents and Work Product. a. All final documents, plans, specifications, reports, information, data, exhibits, photographs, images, video files and media created or developed by CONSULTANT pursuant to this Agreement ("Written Products") shall be and remain the property of the CITY without restriction or limitation upon its use, duplication or dissemination by the CITY. All Written Products shall be considered "works made for hire," and all Written Products and any and all intellectual property rights arising from their creation, including, but not limited to, all copyrights and other proprietary rights, shall be and remain the property of the CITY without restriction or limitation upon their use, duplication or dissemination by the CITY. CONSULTANT shall not obtain or attempt to obtain copyright protection as to any Written Products. CONSULTANT hereby assigns to the CITY all ownership and any and all intellectual property rights to the Written Products that are not otherwise vested in the CITY pursuant to this paragraph. b. CONSULTANT warrants and represents that it has secured all necessary licenses, consents or approvals to use any instrumentality,thing or component as to which any intellectual property right exists, including computer software, used in the rendering of the services and the production of all Written Products produced under this Agreement, and that the CITY has full legal title to and the right to C-8 R6876-0010\1817323v2.doc reproduce the Written Products. CONSULTANT shall defend, indemnify and hold the CITY, and its elected officials, officers, employees, servants, attorneys, designated volunteers, and agents serving as independent contractors in the role of CITY officials, harmless from any loss, claim or liability in any way related to a claim that CITY's use of any of the Written Products is violating federal, state or local laws, or any contractual provisions, or any laws relating to trade names, licenses, franchises, copyrights, patents or other means of protecting intellectual property rights and/or interests in products or inventions. CONSULTANT shall bear all costs arising from the use of patented, copyrighted, trade secret or trademarked documents, materials, equipment, devices or processes in connection with its provision of the services and Written Products produced under this Agreement. In the event the use of any of the Written Products or other deliverables hereunder by the CITY is held to constitute an infringement and the use of any of the same is enjoined, CONSULTANT, at its expense, shall: (a) secure for CITY the right to continue using the Written Products and other deliverables by suspension of any injunction, or by procuring a license or licenses for CITY; or(b) modify the Written Products and other deliverables so that they become non-infringing while remaining in compliance with the requirements of this Agreement. This covenant shall survive the termination of this Agreement. c. Upon termination, abandonment or suspension of the Project, the CONSULTANT shall deliver to the CITY all Written Products and other deliverables related to the Project without additional cost or expense to the CITY. If CONSULTANT prepares a document on a computer, CONSULTANT shall provide CITY with said document both in a printed format and in an electronic format that is acceptable to the CITY. 32. Contractor's Representations. Contractor represents, covenants and agrees that: a) Contractor is licensed, qualified, and capable of furnishing the labor, materials, and expertise necessary to perform the services in accordance with the terms and conditions set forth in this Agreement; b) there are no obligations, commitments, or impediments of any kind that will limit or prevent its full performance under this Agreement; c) there is no litigation pending against Contractor, and Contractor is not the subject of any criminal investigation or proceeding; and d)to Contractor's actual knowledge, neither Contractor nor its personnel have been convicted of a felony. 33. Non-Assignability; Subcontracting. Contractor shall not assign or transfer any interest in this Agreement nor any part thereof, whether by assignment or novation, without the City's prior written consent. Any purported assignment without written consent shall be null, void, and of no effect, and Contractor shall hold harmless, defend and indemnify the City and its officers, officials, employees, agents and representatives with respect to any claim, demand or action arising from or relating to any unauthorized assignment. 34. Applicable Law. The validity, interpretation, and performance of this Agreement shall be controlled by and construed under the laws of the State of California, excluding California's choice of law rules. Venue for any such action relating to this Agreement shall be in the Los Angeles County Superior Court. 35. Titles. The titles used in this Agreement are for convenience only and shall in no way define, limit or describe the scope or intent of this Agreement or any part of it. 36. Authority. The person executing this Agreement on behalf of Contractor warrants and represents that he or she has the authority to execute this Agreement on behalf of Contractor and has the authority to bind Contractor to the performance of its obligations hereunder. 37. Entire Agreement. This Agreement, including any other documents incorporated herein by specific reference, represents the entire and integrated agreement between City and Contractor. This Agreement supersedes all prior oral or written negotiations, representations or agreements. C-9 R6876-0010\1817323v2.doc 38. Amendment. The City or Contractor may only modify or amend this Agreement or any provision herein in a writing signed by both parties which expressly refers to this Agreement. The City may, at its discretion, amend this Agreement to conform with federal, state or local governmental guidelines, policies and available funding amount, or for other reasons. If such amendments result in a change in the funding, the scope of services, or schedule of the activities to be undertaken as a part of this Agreement, such modifications will be incorporated only by written amendments signed by both the City and Contractor. 39. Construction. In the event of any asserted ambiguity in, or dispute regarding the interpretation of any matter herein, the interpretation of this Agreement shall not be resolved by any rules of interpretation providing for interpretation against the party who causes the uncertainty to exist or against the party who drafted the Agreement or who drafted that portion of the Agreement. 40. Non-waiver of Terms, Rights and Remedies. Waiver by either party of any one or more of the conditions of performance under this Agreement shall not be a waiver of any other condition of performance under this Agreement. In no event shall the making by the City of any payment to Contractor constitute or be construed as a waiver by the City of any breach of covenant, or any default which may then exist on the part of Contractor, and the making of any such payment by the City shall in no way impair or prejudice any right or remedy available to the City with regard to such breach or default. 41. Notice. Except as otherwise required by law, any notice or other communication authorized or required by this Agreement shall be in writing and shall be deemed received on (a) the day of delivery if delivered by hand or overnight courier service during Contractor's or City's regular business hours or(b) on the third business day following deposit in the United States mail, postage prepaid, to the addresses listed below, or at such other address as one party may notify the other: To CITY: Mr. Michael Throne, Director of Public Works City of Rancho Palos Verdes 30940 Hawthorne Boulevard Rancho Palos Verdes, CA 90275 To CONTRACTOR: The address listed in Exhibit"A." 42. Counterparts. This Agreement may be executed in counterpart originals, duplicate originals, or both, each of which is deemed to be an original for all purposes. 43. Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed the within Agreement the day and year first above written. CITY OF RANCHO PA OS VE- 'ES 4S° By: %e( Mayor C- 10 R6876-0010\1817323v2.doc ATT EST• � 6j By: City Clerk CONTRACTOR: Printed Nam- Ilk _ - t (/ C1 11(t Date. 1 / 4/2 c LC APPROVED AS TO FORM: 10:! _ e By: ALE S H IRE & WYDNER, LLP � viOk C Printed Name: �`' Date: S ZOt - et OFcertificate David J. A ire, City Attorney LOURDES LARA Commission#2084980 Q •`� -�'�,�► Notary Public-California ILosAngelecntys ou M Comm.Ex fires Oct 25,2018 C-11 R6876-0010\1817323v2.doc 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 ore me, •ere rose name an• lie o e• icer personally appeared Thar \ �1CA \ !�2 , who proved to me on the basis of satisfactory evidence to be the person{ 7 whose nameffris/subscribed to the within instrument and acknowledged to me that he/s4erithertxecuted the same in hisaterMliett authorized capacity(iest, and that by his/ 1thsignature(?;ron the instrument the person{ey, or the entity upon behalf of which the persoksericted, 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. NESS my handmd official seal. 410if LOURDES LARA I :��F Commission#2084980 �_ g" �'� �� Notary Public-California z 4:10Lcipm....... 4.4.4pwwwwwwwilos Angeles County Yrlli ll� A M Comm.Expires Oct 25,20 Not,7n;• is Si•"lure N~ (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION ThisINSTRUCTIONS FOR COMPLETING THIS FORM 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 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 document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages 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/aye)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • 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). 201 5 Version www.NotaryClasses.corn 800-871-9865 • Securely attach this document to the signed document with a staple. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 c c. ..-. .-t, c.-4.— ._ c^ c. -c=c - c 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 ) Los Angeles County of ) Narciso Meza Jr., Notary Public Ybefore On3UYLA ' me, Date Here Insert Name and Title of the Officer appeared SMIYOGI- 5VCYcA'JCIZ. personally pp Name($} of Signer(4 whop roved to me on the basis of satisfactory evidence to be the person(, whose name() is/#e subscribed to the within instrument and acknowledged to me that he/sp(e/thO executed the same in his/her/their authorized capacity(i46), and that by his/hWr/thetfr signature( on the instrument the person( j, or the entity upon behalf of which the persons) 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. 1 �,� WITNESS my hand and official seal. 41.2_JLA - • NARCISO MEZA JR. COMM.#1974135 t,-1044),---1 Public-California-{Notaryeti1CM4' LOS ANGELES COUNTY.4 Signature My Cop. mm. Ex Apr.2,2016 Signature of ota Public p 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 unintend2C.)aIk d document. c mentd Description of Attached Do u GYM • �„ �� SSS �--� • Title or Type of Document: i Document Date: Number of Pages: 3(o Sitner(s) Other Than Named Above: • Capacity(ie) Clqiipecl by Signe*); Signer's Name. 'OQZ ��GnV1Z Signer'sner's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): D Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited E eneral individual ❑Attorney in Fact ❑ Individual P • orney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Sig - s Representing: x,-0<rascc,,0<: - :ea :fid' �'fi e',.- ,,E." ^ch.` �' ." `` .``t%C,er. -. "_ e' - -`Cf- 0(: `` CITY OF RANCHO PALOS VERDES INSTRUCTIONS FOR EXECUTION OF INSTRUMENTS THIS IS INSTRUCTION ONLY— IT IS NOT TO BE SIGNED OR USED IN CONJUNCTION WITH THE AGREEMENT OR ANY OTHER FORMS THAT MUST BE TURNED INTO THE CITY OF RANCHO PALOS VERDES— IT IS SIMPLY A FORMAT TO USE WHEN FILLING OUT DOCUMENTS. 1. By an Individual. The individual must sign the instrument, and if he/she is doing business under a fictitious name, the fictitious name must be set forth. The signature must be acknowledged before a Notary Public, using the proper form of acknowledgment. 2. By a Partnership. The name of the partnership must be set forth followed by the signatures of all of the partners. The signatures must be acknowledged before a Notary Public, using the proper form of acknowledgment. 3. By an LLC. The name of the LLC must be set forth, followed by the signatures of two corporate officers: one signature must be from the Chairperson of the Board, the President or any Vice President, and the other signature must be from the Secretary, any Assistant Secretary, the Chief Financial Officer, or any Assistant Treasurer of the LLC. Alternatively, the name of the LLC must be set forth, followed by the signature(s) of a member, manager or two managers with authority to bind the LLC if he, she or they submit a copy of the articles of organization and highlight the provision stating who manages the LLC or otherwise has authority to bind the LLC. In either case, all signatures must be acknowledged before a Notary Public, using in substance the following form of acknowledgment. 4. By a Corporation. The name of the corporation must be set forth, followed by the signatures of two corporate officers: one signature must be from the Chairperson of the Board, the President or any Vice President, and the other signature must be from the Secretary, any Assistant Secretary,the Chief Financial Officer, or any Assistant Treasurer of the corporation. All signatures must be acknowledged before a Notary Public, using in substance the following form of acknowledgment. If any person or entity wishes to sign the Agreement or any other forms that must be signed in a manner other than as required above,that person or entity must first submit to the City for approval documentation evidencing the authority to bind the individual, partnership or corporation in the alternative manner proposed. C- 12 R6876-0010\1817323v2.doc INSURANCE REQUIREMENTS FOR CITY OF RANCHO PALOS VERDES PUBLIC WORKS CONTRACT The Contractor shall at all times, during the term of this contract, carry, maintain and keep in full force and effect, a policy or policies of comprehensive public liability insurance with an insurance company admitted to write insurance in California, or carriers with a rating of, or equivalent to, A:VII by A. M. Best & Company to, and approved by, the Director of Public Works and City Attorney, within minimum limits of one Million Dollars ($1,000,000.00) combined single limit coverage with an aggregate of Two Million Dollars($2,000,000.00) against any injury, death, loss or damage as a result of wrongful or negligent acts or omissions by the Contractor, its officers, employees, agents, and independent contractors in performance of services under this agreement; (2)Automotive liability insurance with a minimum combined single limits coverage of One Million Dollars ($1,000,000.00) with an aggregate of Two Million Dollars ($2,000.000.00); and (3) workers' compensation insurance as required by law. The contractor shall at all times during the term of this contract carry, maintain and keep in full force and effect a policy or policies of workers' compensation insurance and shall provide to the City evidence of such coverage in the form set forth herein. The City, its officers, employees, attorneys, and volunteers shall be named as additional insured on the policy(ies) as to comprehensive general liability, automotive liability, and worker's compensation coverages. a) All insurance policies shall provide that the insurance coverage shall not be non-renewed, canceled, reduced, or otherwise modified (except through the addition of additional insured to the policy) by the insurance carrier without the insurance carrier giving the City thirty (30) day's prior written notice thereof. The Contractor agrees that it will not cancel, reduce, or otherwise modify said insurance coverage. b) The Contractor agrees that if it does not keep the aforesaid insurance in full force and effect, and such insurance is available at a reasonable cost, the City may take out the necessary insurance and the pay the premium thereon, and the repayment thereof shall be deemed an obligation of the Contractor and the cost of such insurance may be deducted, at the option of the City, from payments due to the Contractor. c) The Contractor shall submit to the City(1) insurance certificate indicating compliance with the minimum worker's compensation insurance requirements above, and (2) insurance policy endorsements above, not less than one (1) day prior to beginning of performance under this Agreement. Endorsements must be executed on the City's appropriate standard forms entitled "Additional Insured Endorsement," copies of which are attached hereto. C- 13 R6876-0010\1817323v2.doc Bond No. 1001053153 . _.. __._.. } .� BOND :Premiwn: ..3,1:63.-00 . _.... . WHEREAS the City of Rancho Palos Verdes,California("Public Agency')has awarded to Dash Construction Company, Inc. 20501 Ventura Blvd. , Suite 225, Woodland Hills___ A 91364 • (Name and address of Contractor) ("Principal"),a contract(the"Contract`)for the work described as follows: ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (Community Development Block Grant Project#601659-14) WHEREAS, Pr•incipal is req•uire•d un•der the terms of the Contract to furnish a bond for the faithful performance•of the Contract. NOW, THEREFORE,we, the undersigned Principal, and American Contractors Indemnity Company, 601 South Figueroa St., Suite 1600, Los Angelesy CA 90017 (Name and address of Surety) ("Surety")a duly admitted surety insurer under the laws of the State of California,as Surety,are held and firmly bound unto the Public Agency in the penal sum of * . Dollars($ 161,843.00 ) in lawful money of the United States of America, this amount being not less than the total Contract price,for the payment of which sum well and truly to be made,we bind ourselves,our heirs,executors,administrators,successors,and assigns,jointly and severally,firmly by these presents. *One Hundred Sixty-One Thousand, Eight Hundred Forty-Three and no/100 -- THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal, his, her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings,terms,covenants, conditions and provisions in the Contract and any alteration thereof made as therein.provided, on the Principal's part to be kept and performed, all within the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers,agents, and employees, as therein stipulated, then this obligation shall become null and void;otherwise, it shall be and remain in full force and effect. As a part of the obligation secured hereby and in addition to the face amount specified therefor, there shall be included costs and reasonable expenses and fees,including reasonable attorneys'fees,incurred by the Public Agency in successfully enforcing such obligation,all to be taxed as costs and included in any judgment rendered. The Surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the agreement or to the work to be performed thereunder or the specifications accompanying the same shall in anywise 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 agreement or to the work or to the specifications. Surety hereby waives the provisions of California Civil Code sections 2845 and 2849. The City is the principal beneficiary of this bond and has all rights of a party hereto. C-16 86876-001011817323x2.d oc r s a IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed_ m an original hereof, have been duly executed_by Principal and_Surety, on the date . . . . set forth below, the nae of each corporate party being hereto affixed-and(these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated. December 30th, 2015 "Pnncipar "Surety" ?ash co;stjuctj.on Company, Inc. Aerican Contractors Tndemni ty Company CBy . .. .. . By: . a7°C)—(' Its its Attorn- •-in- acid, Patric ,, Z- izo By. By: Its Its (Seal) (Seal) APPROVED AS TO SURETY AND APPROVED AS TO FORM: PRINCIPAL AMOUNT RICHARDS,WATSON&GERSHON A Professional Corporation By: By: • Insurance Administrator Public Agency Attorney Note: This bond must be executed in duplicate and dated,all signatures must be notarized,and evidence of the authority of any person signing as attorney-in-fact must be attached C-17 R6876-001 OO1817323v2.doc 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 Los Angeles On before me, Trina Lee Vega, Notary Public Date Here Insert Name and Title of the Officer personally appeared Patricia Zenizo Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s} is/Fide subscribed to the within instrument and acknowledged to me that Kb/she/014y executed the same in Nis/her/tridir authorized capacity(iis),and that by IM /her/t))r signature($on the instrument the persons), or the entity upon behalf of which the persons)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. TRINA LEE VEGA ,•s WITNESS my hand • official seal. .� - 'a. Commission #2056669 '4111M Notary Public•California z c Los Angeles County D Signat - All WWI" My Comm. Expires Feb 1,2018 . _...� S gn- ure 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: Corporate Officer -- Title(s): .:.l Corporate Officer -- Title(s): 0 Partner — Ei LimitedE l General 0 Partner -- 0 Limited El General El Individual s Attorney in Fact 0 Individual 0 Attorney in Fact 111 Trustee El Guardian or Conservator D Trustee El Guardian or Conservator [I Other: 0 Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association• _ •, www.NationalNotary.org•1-800-US NOTARY{1-800-876-6827} Item#5907 Bond No. 1001053L53 PAYMENT BOND Premium Included in (LABORAND MATERIALS) Performance Bond. WHEREAS the City of Rancho Palos Verdes,California("Public Agency')has awarded to Dash Construction Company, Inc. , 20501 Ventura Blvd. , Suite 225, Woodland Hills, CA 91364 (Name and address of Contractor) ("Principal"), a contract (the "Contract'), which is incorporated herein by this reference, for the work described as follows: ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (Community Development Block Grant Project#601659-14) WHEREAS, Principal is required under the terms of the Contract and the California Civil Code before entering upon the performance of the work to file a good and sufficient payment bond with the Public Agency to secure the claims to which reference is made in Title 3 (commencing with Section 9000) of Part a of Division 4 of the Civil Code. NOW,THEREFORE,we,the undersigned Principal, and American Contractors Indemnity Company, 601 South Figueroa St. , Suite 1600, Los Angeles, CA 90017 (Name and address of Surety) ("Surety")a duly admitted surety insurer under the laws of the State of California,as Surety, are held and firmly bound unto the Public Agency and all contractors,subcontractors, laborers, material suppliers, and other persons employed in the performance of the Contract and referred to in Title 3(commencing with Section 9000)of Part 6 of Division 4 of the Civil Code in the sum of One Hundred Sixty-One Thousand, Eight Hundred Forty-Three and no/100 • Dollars($ 161,843.00 ) (the "Penal Sum"), this amount being not less than one hundred percent(100%)of the total Contract price, in lawful money of the United States of America,for materials furnished or labor thereon of any kind,or for amounts due under the Unemployment Insurance Act with respect to this work or labor, that the surety will pay the same in an amount not exceeding the amount hereinabove set forth, and also in case suit is brought upon this bond,will pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by the Public Agency in successfully enforcing this obligation, to be awarded and fixed by the court, and to be taxed as costs and to be included in the judgment therein rendered. It is herebyexpressly stipulated and agreed that this bond shall inure to the benefit of any and all persons, � y � companies, and corporations entitled to file claims under Title 3(commencing with Section 9000)of Part 6 of Division 4 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. Should the condition of this bond be fully performed, then this obligation shall become null and void, otherwise it shall be and remain in full force and effect. C-14 R6876-001011817323v2.doc The surety hereby stipulates and agrees that no change, extension of time, alteration,or addition to the terms of the agreement_or the_specifications accompanying,the same s�ha!! in any_.manner affect its abli g atioris on this+bond and it does hereb waive notice of'any such charge, extensors, alteiration,`or addition. Surety hereby waives the provisions of California Civil Code sections 2845 and 2849. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety,on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: December 30th, 2015 "Principal "Surety' Dash Construction Company, Inc. American Contractors Indemnity Company B : By: / Its I Attorne in-:- Patrici: Ze•izo By: By: Its Its (Seal) (Seal) APPROVED AS TO SURETY AND PRINCIPAL APPROVED AS TO FORM: AMOUNT RICHARDS,WATSON&GERSHON A Professional Corporation By: Insurance Administrator By: Public Agency Attorney Note: This bond must be executed in duplicate and dated, all signatures must be notarized,and evidence of the authority of any person signing as attorney-in-fact must be attached. C-15 R6876-4010\1817323v2.doc CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CML 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 Los Angeles On before me, Trina Lee Vega, Notary Public Date Here Insert Name and Title of the Officer personally appeared Patricia Zenizo Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name() is/de subscribed to the within instrument and acknowledged to me that b//she/tfi y executed the same in Ills/her/Mk authorized capacityQ s),and that by p/her/t r 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 TBWA LEE VEGA is true and correct. Commission # 2050669 tzWITNESS my official seal. hand 7 V(` ` ;�;1� Notary Public -C Int 1'in t7, Los AngeIc County E . , My Comm Expires Feb 1, 2.018' , :v Sign re Sign; re 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: 0 Corporate Officer -- Title(s): L...Corporate Officer — Title(s): El Partner — L Limited {i General 0 Partner — Lw.J Limited 0 General El Individual i Attorney in Fact 0 Individual El Attorney in Fact L1 Trustee ❑Guardian or Conservator 0 Trustee 0 Guardian or Conservator El Other: D Other: Signer Is Representing: Signer Is Representing: �. -./, �. .-i , . / ./ 1, �" .. • •, 02014 National Notary Association•www.NationalNotary.org•1-800-US NOTARY(1-800-876-6827) Item#5907 * r POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY —- Y THESE P1 E TSThat American Contractor n - a California corporation, Texas • 1,.,,i Cnri ` • �'actors Indernnitr� --__ -- � =mates Surety Com, a-Maryland an assumed n corporation and U.S. Specialty Insurance Company,a Texas corporation(co&ctively,the"Companies"),do by these presents make, constitute and appoint: Patricia Zenizo,Elisabete Salazar or Pietro Micciche of Los Angeles California its e and l Attorney(s)-in-f eack in theimicapacity if more than one is named above,with full - - ami at. st er-ettyn eclin its name,place t „ e ute acknowledge and del ver any and all bonds,recognizan u ki s=- --_ or other instruments or contracts of suretyship to include riders, amendments, and consents of surety, providing the bond penalty does not exceed *****Three Million***** Dollars ($ **3,000,000.00** ). This Power of Attorney shall expire without further action on December 20,2017. This Power of Attorney is granted under and by authority o win resolutions adopted y the Boards of Directors of the Companies:- g P � m��nie� Air4?e: M.Ixdresident,any Vice 'resit any Assistant Vic*President,any S tar$'04—inyssiTitancriaUry shall be and is hereby vested with full - tl oint anyone or more suitable sons as Attorne sin-Fact to re act o f of the Company _ tothe following lam' Y(}-� P� ---- - �� g n.ova Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts,and any and all notices and documents canceling or terminating the Company's liability thereunder,and any such instruments so executed by any such Attor -Fact shall be binding upon the Company as if signed by the President and sealed and effected-__ by the - porS Be itResoival=thattie signature of any atiwriMiceiumczathAtompany heretofore or hereafter affixed to any power of attorney ov4nOtarfficateleWin = Thereto_by facsimileaid any power of attorn e g mile signature or facsimile seal shall be valid and binding upon the p - - any bond or undertaking to which it is attached: IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 1st day of December,2014. AMERICAN C ,, OR L NITY COMPANY - OI I MPANY UNITED'' ATES SUVTV'CO "ANY U.S.SP PANY , �, •'' ml S, N,,,...ie,,�� NActo i ,,,,,: 'stot r 1,we fi{in'Mimo�j"ri ,�� wn .� ,�''? f°ate V '..-. .t�• ....,get 4'�!- en .. ..3 Hipp 1,,y a..11 pat w.. :�►.st �s s'�a, B -H”' .1:1c2- I R 1 r , i Imo, 'zg: _, z /r�`�' i ;�. ��.�...�0► 40.4 _ � y ,., � - s �;� ri t s• s Daniel P.Aguilar,Vice President ''y ......'!w«. .�`�'k a.: ••'�'••.....••'`` yj►S +\2X «.•••`y.44- V-moi �r'S `•• -- - A nary pulAk 01-0thei officer comple- -ertelenly the identity of the individual who signed the t to WhielyAhis certificate is atta a -13itzmffriess,accuracy,or validity of that document. State of California County of Los Angeles SS: On this 1st dater of December,2014, before me,Maria G.Rodriguez-Wong,a notary public, personally appeare -_Dan P.Aguilar,Vice President of American Contwters_-_ Weitlompany,Texas Bonding Company,United States Surety Company S S ranee Company who wovvd to nie on is=-sitisfWevidence to be ti 'Ipersort whowhcilo panC is snh cribed to the wil•- = er l w ed to me that he executed-the same in ------ Wws4ualumiteand that by his sifiriihire on the ingrunient the person,or the enti n h f I Verson acted,executed the instrument I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. c-.,,� MARIA G.RODRIGUEZ-WOMB Commission#2049771 -_ ( __ Public-California l - _ i , r Notary iivrnia Los Angeles County Comet.', Dsc 2017 I,Michael Chalekson,Assistant Secretary of American Contractors Indemnity Company,Texas Bonding Company,United States Surety Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Companies,which is still in full force and effect;furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are in &Ilan — - Mhtnem IMimcCI have hereunt0$et iviy I i'af cl '"i t d the seals of s = ars a eles,California 311th day lemendte, , 2015 Corporate Seals ,"��rr�"„, ,,,�,rrr.«,,. 44irtirrr`nl"rfh, ,,,Nrinn%, Mat-- -ee- `t �.,,;.�ri�' ,``**E�N� A/�y►�'! ``*`y*� �� Q, 1�y �t�vt 1nsurB,,,,,i 7:-...-a ../ --.....-. ',pi ...c..: ...,,., ,,, ....... ,, .14' .ar. •'e_ _0i — , 'A - i = Michael Chalekson,Ass _ 4 _ _ - Bones o 1 3153 . _ — • _• _- ,-,- : v.TIC y. u}c 3057 ' �k -.tel. .y. �ttf`t��li.•... �� Nit.,:*; � .. [rEr� — _ —aims _- rin rrfrtt:►�'''' kV�"� 100 • Kan't Kopy Ki Kan't Kopy• K1 Security Paper Security Paper • Hidden Pantograph • Hidden Pantograph • Color Match • Color Match • Artificial Watermark Artificial Watermark • Anti-Copy Coin Rub • Anti-Copy Coin Rub • Erasure Protection • Erasure Protection • Security Features Box • Security Features Box • Microprint Protection • Microprint Protection • Acid Free • Acid Free Kan't Kopy K1 Kan't Kopy K1 Security Paper Security Paper • Hidden Pantograph • Hidden Pantograph • Color Match • Color Match • Artificial Watermark. • Artificial Watermark • Anti-Copy Coin Hub • Anti-Copy Coin Rub • Erasure Protection • tr Erasure F ratt_:�,Ioi, • Security features Rex • Security Features i, • • Microprint Protection • Microprint Protect.;i • Acid Free • Acid Free WORKERS' COMPENSATION Certificate of Insurance WHEREAS, the City of Rancho Palos Verdes has required certain insurance to be provided by: 12)IA-c 4-k 69-wi.i `ori Co-vv,10. 14.(� , NOW THEREFORE,the undersigned insurance company does hereby certify that it has issued the policy or policies described below to the following named insured and that the same are in force at this time: 1. This certificate is issued to: City of Rancho Palos Verdes City Hall 30940 Hawthorne Boulevard Rancho Palos Verdes, California 90275 2. The insured under such policy or policies are: sea-Caa,,•e Jrsv ,�/� .i/✓� __ , � . _ �C ek/4 rD I'� tu--eb7o/clepe, 1Jr9.41 49v►11. 3. Workers' Compensation Policy or Policies in a form approved by the Insurance Commissioner of California covering all operations of the named insured as follows: Policy Number Effective Date Expiration Date fO7229/c :S /l/iS" Eji//6. ., 4. Said policy or policies shall not be canceled, nor shall there be any reduction in coverage or limits of liability, unless and until thirty days'written notice thereof has been served upon the City Clerk of the City of Rancho Palos Verdes Un. 1/La(W-?--- By: Its Authorized Representative C- 18 R6876-0010\1817323v2.doc AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS 1. Contractor acknowledges that the project as defined in this Agreement between Contractor and the City, to which this Agreement to Comply with California Labor Law Requirements is attached and incorporated by reference, is a"public work"as defined in Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code ("Chapter 1"), and that this Agreement is subject to (a) Chapter 1, including without limitation Labor Code Section 1771 and (b) the rules and regulations established by the Director of Industrial Relations ("DIR") implementing such statutes. Contractor shall - perform all work on the project as a public work. Contractor shall comply with and be bound by all the terms, rules and regulations described in 1(a) and 1(b) as though set forth in full herein. 2. California law requires the inclusion of specific Labor Code provisions in certain contracts. The inclusion of such specific provisions below, whether or not required by California law, does not alter the meaning or scope of Section 1 above. 3. Pursuant to Labor Code Section 1773.2, copies of the prevailing rate of per diem wages for each craft, classification, or type of worker needed to perform the Agreement are on file at City Hall and will be made available to any interested party on request. Contractor acknowledges receipt of a copy of the DIR determination of such prevailing rate of per diem wages, and Contractor shall post such rates at each job site covered by this Agreement. 4. Contractor shall comply with and be bound by the provisions of Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the City, forfeit two hundred dollars ($200) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the DIR for the work or craft in which the worker is employed for any public work done pursuant to this Agreement by Contractor or by any subcontractor. 5. Contractor shall comply with and be bound by the provisions of Labor Code Section 1776, which among other things requires Contractor and each subcontractor to (1) keep accurate payroll records and verify such records in writing under penalty of perjury, as specified in Section 1776, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the City of the location of the records. 6. Contractor shall comply with and be bound by the provisions of Labor Code Sections 1777.5, 1777.6 and 1777.7 and California Administrative Code title 8, section 200 et seq. concerning the employment of apprentices on public works projects. Contractor shall be responsible for compliance with these aforementioned Sections for all apprenticeable occupations. Prior to commencing work under this Agreement, Contractor shall provide City with a copy of the information submitted to any applicable apprenticeship program. Within sixty (60) days after concluding work pursuant to this Agreement, Contractor and each of its subcontractors shall submit to the City a verified statement of the journeyman and apprentice hours performed under this Agreement. 7. Contractor acknowledges that eight (8) hours labor constitutes a legal day's work. Contractor shall comply with and be bound by Labor Code Section 1810. Contractor shall comply with and be bound by the provisions of Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the City, forfeit twenty-five dollars ($25) for each worker employed in the performance of this Agreement by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than eight (8) hours in any one (1) calendar day and forty (40) hours in any one calendar week in violation of the provisions of Division 2, C- 19 R6876-0010\1817323v2.doc Part 7, Chapter 1, Article 3 of the Labor Code. Pursuant to Labor Code section 1815, work performed by employees of Contractor in excess of eight (8) hours per day, and forty(40) hours during any one (1) week shall be permitted upon public work upon compensation for all hours worked in excess of eight (8) hours per day at not less than one and one-half(1-1/2) times the basic rate of pay. 8. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861, Contractor hereby certifies as follows: "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." 9. For every subcontractor who will perform work on the project, Contractor shall be responsible for such subcontractor's compliance with Chapter 1 and Labor Code Sections 1860 and 3700, and Contractor shall include in the written contract between it and each subcontractor a copy of those statutory provisions and a requirement that each subcontractor shall comply with those statutory provisions. Contractor shall be required to take all actions necessary to enforce such contractual provisions and ensure subcontractor's compliance, including without limitation, conducting a periodic review of the certified payroll records of the subcontractor and upon becoming aware of the failure of the subcontractor to pay his or her workers the specified prevailing rate of wages. Contractor shall diligently take corrective action to halt or rectify any failure. 10. To the maximum extent permitted by law, Contractor shall indemnify, hold harmless and defend (at Contractor's expense with counsel reasonably acceptable to the City) the City, its officials, officers, employees, agents and independent contractors serving in the role of City officials, and volunteers from and against any demand or claim for damages, compensation, fines, penalties or other amounts arising out of or incidental to any acts or omissions listed above by any person or entity (including Contractor, its subcontractors, and each of their officials, officers, employees and agents) in connection with any work undertaken or in connection with the Agreement, including without limitation the payment of all consequential damages, attorneys' fees, and other related costs and expenses. All duties of Contractor under this Section shall survive termination of the Agreement. Date: I Signature -1. 1‘,L__ : Signature 2: e. `• See attached certificate LOURDES LARA ,4 ,vs;_. Commission#2084980 Notary Public-California 7_ `-'0411#, Los Angeles County M Comm.Expires Oct 25,2018 C-20 R6876-0010\1817323v2.doc CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 C ] .'j':`SvC.`�-. ; i t .i t:4' :.vet, t. d�iSwi-.�•.�w`�i 1 - .- t.v,.- t. 4.- - 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 ) Los Angeles County of ) Narciso Meza Jr., Notary Public r On � ��Y `AY before me, Date Here Insert Name and Title of the Officer personally appeared5ct'rfOo1 SbcJi y�dVo�Z P Y PP Name(4 of Signer(4 who proved to me on the basis of satisfactory evidence to be the person( ) whose names) is/afe subscribed to the within instrument and acknowledged to me that he/sVe/thiy executed the same in his/h6r/th4ir authorized capacity(ie,), and that by his/her/the(r signatures)on the instrument the person(i), 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. WITNESS my hand and official seal. • ;;t. : s NARCISO MEZAJR. .Li%, COMM.#1974135 W '-' t4&.,&'1 Notary Public-California Signature m ,_ LOS ANGELES COUNTY Signature of otary Public ' My Comm.Exp.Apr.2,2016r Y Y - - i� -- Y Y Y - - Y Y 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 csitrfornio, Lacy Lau qff,04 kr0110145 • Title or Type of Document: Ao & i ' •�' At Col* Document Date: Number of Pages: 2- ner(s) Other Than Named Above: Capacity(j�e�) Cla' a by Sign r(,sT 9 Si ner's Name: YOOZ WITUVAL Signer's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited eneral Individual ❑Attorney in Fact ❑ Individual ■ = orney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: s 0 Other: Signer Is Representing: Sign- s Representing: INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND WAIVER OF SUBROGATION AND CONTRIBUTION Contract/Agreement/License/Permit No. or description: ' �,J„_/L /vs?g P � ��e:t',7 efr, s CIA _Dv) Indemnitor(s) (list all names): To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend, protect, indemnify, and hold harmless the City of Rancho Palos Verdes and its elected officials, officers, attorneys, agents, employees, volunteers, successors, and assigns(collectively"Indemnitees")from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses,judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys, or other professionals and all costs associated therewith (collectively "Liabilities"), arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act, error, or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors, material persons, suppliers or their officers, agents, servants or employees, arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to the above-referenced contract, agreement, license, or permit(the "Agreement")or the performance or failure to perform any term, provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorney's fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code 2782(a) or (b) the contracting public agency's active negligence to the limited extent that the underlying Agreement is subject to Civil Code 2782(b). This indemnity is effective without reference to the existence or applicability of any insurance coverage which may have been required under the Agreement or any additional insured endorsements which may extend to Indemnitees. Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor regardless of any prior, concurrent, or subsequent active or passive negligence by the Indemnitees. In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint and several. C-21 R6876-0010\1817323v2.doc "Indemnitor" Name: c �Gr---/ c,�.....Fi 2, Name: 1$(\ZikYC)Cri SRa1907> ----.) SMNJP,By' _ By: Its Its See attached certificate t,,. : LOURDES LARA 0 c \ Commission#2084980 Z -_ r, Notary Public-California z r�.'' Los Angeles County :::-:= My Comm.Expires Oct 25,2018 C-22 R6876-001O\1817323v2.d o c CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 - =c.- ,- .v,, t.- - . c. 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 ) Los Angeles County of ) 2015 • Narciso Meza Jr., Notary Public On5 before me, -- - , Date Here Insert Name and Title of the Officer personally appeared S"vih'i oOZ %Alma?. Name( of Signers whopwhoroved to me on the basis of satisfactory evidence to be the person() whose name() is/a/e roved subscribed to the within instrument and acknowledged to me that he/sfie/ttiy executed the same in his/hir/thdir authorized capacity(i's), and that by his/hAr/thir signature(s)on the instrument the person(, or the entity upon behalf of which the personM acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. • � , � NARCISO MEZA JR. COMM.#1974135 03 Signature 7. Notary Public-California Signature of No ary Public 0o(sLotr-',7 • LOS ANGELES COUNTY 41. 3My Comm. Exp.Apr.2,2016( r Y •f Y Y Y Y Y Y Y Y Y Y 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 Docum nt OctioNks5 feAKer • Title or Type of Document: -tvl l C�' �� - J14Document Date: Number of Pages: Signer(s) Other Than Named Above: - g Capacity(ie,srClOtne4 by Signer Signer's Name: YOO5}10<YVONS ZSigner's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited • General Individual ❑Attorney in Fact ❑ Individual P. A ttorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other Signer Is Representing: Si• - Is Representing: ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY I C .� /'6? .3'0-3c-26132( . .. � om.._ InC_. Name and address of named insured("Nam-d InsOcr): "C:.''�� CA k ?a 6 -74 rd ULAA, (A) 1--/i Li Name and address of Insurance Company("Company'): cle t al t "4 Pro kie-frvu-,3 01,1- VP t-‘) General description of agre#ment(s), permit(s), license(s), and/or activity(ies)insured: Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the"Policy") or in any endorseme t now or h reafter attached thereto, it is agreed as follows: 1. The�,�T ccU11 RkQ'J /2)-04,1-o 11.41/PLA-- Pvofficers attome s a ents employees, avolunteers are ("Public Agency"), its effected officials, y , g additional insured (the above named additional insured are hereafter referred to as the "Additional Insured") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insured have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverage afforded the Additional Insured under the Policy shall be primary insurance,and no other insurance maintained by the Additional Insured shall be called upon to contribute with the insurance coverage provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall be covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insured. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereof. In the event of Company's failure to comply with this notice provision,the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insured, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insured. C-23 R6876-001011817323v2.doc 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation, and enforcement of this contract of insurance. 9. This endorsement and all notices given hereunder shall be sent to Public Agency at: City of Rancho Palos Verdes 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROMITO LIABILITY 6p_Arke2,1"-ed q/pam-1l4/i(a k 000/0o0 ��..��,( �.al �, +'tilt.c,ra k c e- � gg Z r?enO dog E'rc 4 4A,,t , (f000, vow eerr(3,9 h�,� v 11. Scheduled items or locations are to be identified on an attached sheet. The following tV inclusions relate to the above coverage. Includes: ❑ Contractual Liability ❑ Explosion Hazard ❑ Owners/Landlords/Tenants El Collapse Hazard ❑ Manufacturers/Contractors ❑ Underground Property Damage Products/Completed Operations ❑ Pollution Liability ❑ Broad Form Property Damage ❑ Liquor Liability vExtended Bodily Injury tik k/ c7c, o( oco QGCu-Yr Broad Form Comprehensive k �o e��o d),am.") � � r.Q�.-�L P�,�,1,,tGeneral Liability Endorsement �r r- o o� 12. A ❑ deductible or❑ self-insured retention (check one) of$ applies to all coverage(s) except: IV(4 (if none, so state). The deductible is applicable ❑ per claim or❑ per occurrence (check one). 13. This is ank7occurrence or❑ claims made policy (check one). 14. This endorsement is effective on ef/7/ at 12:01 a.m. and forms a part of Policy Number ;�� c��-Z ��I I, a)421---x,\ALSAA (3k4AdvAliWet /L- (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof, I do so bind the Company. Executed )��C'�w,,l-�e,v Z � , 20_ty' Mil_lt-e%4&. Signature of Authorized Represen a ive (Original signature only rro facsimile signatureor initialed signature accepted) Telephone No.: (AT )(b2 ,p— C-24 R6876-0010\1817323v2.doc ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY 7.1-&k1 fl tij, 1 n C ., e C9 - 0a 'k- ZC0 Is 2,1 Name and address of named insured("Named Insure '): 7"77-)1 C1'vvc9 , Ak (41-4 Name and address of Insurance Company("Company'): General description of agreement(s), permit(s), license(s), and/or activity(ies) insured: Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the"Policy") or in any endorsement now or hereafter attached thereto, it is agreed as follows: 1. The C ("Public Agency"), its elected officials, officers, attorneys, agents, employees, and volunteers are additional insured (the above named additional insured are hereafter referred to as the "Additional Insured") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insured have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverage afforded the Additional Insured under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insured shall be called upon to contribute with the insurance coverage provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall be covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insured. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this notice provision,the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insured, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insured. C-25 R6876-0010\1817323v2.doc 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation, and enforcement of this contract of insurance. 9. This endorsement and all notices given hereunder shall be sent to Public Agency at: City Manager City of Rancho Palos Verdes 30940 Hawthorne Boulevard Rancho Palos Verdes, California 90275 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverage. Includes: • Any Automobiles ❑ Truckers Coverage ❑ All Owned Automobiles ❑ Motor Carrier Act ❑ Non-owned Automobiles ❑ Bus Regulatory Reform Act ❑ Hired Automobiles ❑ Public Livery Coverage ❑ Scheduled Automobiles ❑ Garage Coverage 12. A ❑ deductible or❑ self-insured retention (check one) of$ applies to all coverage(s) except: _(if none, so state). The deductible is applicable G per claim or G per occurrence (check one). 13. This is an ❑ occurrence or❑ claims made policy (check one). 14. This endorsement is effective on at 12:01 a.m. and forms a part of Policy Number I, j:Dczt-,', +.t,s4, tlAct-LINAeaA/ e:?- (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof, I do so bind the Company. Executed Z(A , 20 11 • Signature of Authorized Representative (Original signature only;no facsimile signature Telephone No.: (6l� ) e20.-7,s---Y-9- or initialed signature accepted) C-26 R6876-0010\1817323v2.doc STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS [Business & Professions Code 7028.15] [Public Contract Code 20103.5] I, the undersigned, certify that I am aware of the following provisions of California law and that I, or the entity on whose behalf this certification is given, hold a currently valid California contractor's license as set forth below: Business &Professions Code 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefore, except in any of the following cases: (1) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104 [now' 20103.5] of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section,the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months, or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract"for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect, land surveyor, or registered professional engineer to form joint ventures with licensed contractor to render services within the scope of their respective practices. (f) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non- responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order, verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13 inclusive. Any contract awarded to, or any purchase order issued to, a contractor who is not licensed pursuant to this chapter is void. C-29 R6876-0010\1817323v2.doc (fl Any compliance or noncompliance with subdivision (e) of this section, as added by Chapter 863 of the Statutes of 1989, shall not invalidate any contract or bid awarded by a public agency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if the public employee, officer, or employing agency made an inquiry to the board for the purposes of verifying the license status of any person or contractor and the board failed to respond to the inquiry within three business days. For purposes of this section, a telephone response by the board shall be deemed sufficient. Public Contract Code 20103.5: In all contracts subject to this part where federal funds are involved, no bid submitted shall be invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However, at the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material under any contract shall not be made unless and until the Registrar of Contractors verifies to the agency that the records of the Contractor's State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law including, but not limited to, any appropriate disciplinary action by the Contractor's State License Board. The agency shall include a statement to that effect in the standard form of prequalification questionnaire and financial statement. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. License No.: `A V Class: A � -2 I c...1 3 3 Expiration Date: 6 3 / 20 Date: 1 L / 2 g / —410 Signature: � =l� C-30 R6876-0010N 817323v2.doc FEDERAL LOBBYIST REQUIREMENTS CERTIFICATION Name of Firm: eg,vvir".„4„, Y, Date: 2/Lj / Address: . CD . 2- & I3 Z C , Zi Code: 2-C Phone No.: cgtg)Statea�� ,'1� � Acting on behalf of the above named firm, as its Authorized Official, I make the following Certification to the Department of Housing and Urban Development (HUD) and the Community Development Commission, County of Los Angeles: 1. No Federal appropriated funds have been paid, by or on behalf of the above named firm to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of and Federal grant, loan or cooperative agreement, and any extension, continuation, renewal, amendment, or modification thereof, and; 2. If any funds other than Federal appropriated funds have paid or will be paid to any person for influencing or attempting to influence an officer or employee or any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with this Federal contract, grant loan, or cooperative agreement, the above named firm shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions, and: 3. The above name firm shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreement) and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into the transaction imposed by Section 1352 Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Authorized Official: Name: ` -1-t 415 Signature j71_ Date: t 21241 !J_ Federal Lobbying Requirements Certification Form Revised 09/30/05 C-31 R6876-0010\1817323v2.doc FEDERAL DISCRIMINATION PROVISIONS Contractors shall comply with all relevant requirements of the following federal laws and regulations dealing with discrimination in federally assisted programs: A. Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 20000d), as amended by the Equal Employment Opportunity Act of 1972, which provide that no person shall, on the ground of race, color, national origin, or sex, be excluded from employment or participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. B. Section 109 of Title I of the Housing and Community Development Act of 1974, as amended (42 U.S.C. 5309) and regulations at CFR 570.602 which provide that no person shall on the grounds of race, color, national origin, or sex, be excluded from participation in, be denied the benefits of, be denied employment in, or be subjected to discrimination under any CDBG/HOME program or activity. C. Section 504 of the Rehabilitation Act of 1973, as amended, (29 U.S.C. 794) which provides that no otherwise qualified handicapped individual shall, solely by reason of his/her handicap, be excluded from the participation in, be denied the benefits of, be denied employment in, or be discriminated against under any program or activity receiving federal assistance, and Section 503 of the Rehabilitation Act of 1973, which provides for affirmative action to employ and advance qualified disabled people D. Age Discrimination Act of 1975, as amended (42 U.S.C. 6101)which provides that no person shall, on the basis of age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal assistance. E. Americans with Disabilities Act of 1990, as amended, (42 U.S.C. 12101) and regulations at 28 CFR Part 35 and 29 CFR Title 1630, which provides prohibits discrimination based on disability, and Architectural Barriers Act of 1968, which requires buildings assigned for public use to be designed, constructed and altered so as to be accessible to and usable by persons with physical disabilities. F. Executive Order 11246, as amended by Executive Order 12086,and regulations in 41 CFR 60,which provides that no person shall be discriminated against on the basis of race, color, religion, sex, or national origin in all phases of employment during the performance of federally-assisted construction contracts and subcontracts. Contractors and subcontractors shall take affirmative action to ensure fair treatment in employment, including recruitment, training, promotion, demotion, transfer, layoff, termination, and pay. 1. The Contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The Contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay of other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions in this nondiscrimination clause. 2. The Contractor will, in all solicitations or advertisement for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex or national origin. 3. The Contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice,to be provided by the agency contracting officer,advertising the labor union or worker's representative of the Contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. C-32 R6876-0010\1817323v2.doc 4. The Contractor will comply with all provisions of Executive Order No. 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Contractor will furnish all information and reports required by Executive Order No. 11246 of September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations and orders. 6. In the event of the Contractor's noncompliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, and orders, this contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. 7. The Contractor will include the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order No. 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The Contractor will take such action with respect to any subcontractor or purchase order as the contracting agency, and may direct the subcontractor or vendor as a means of enforcing such provisions including sanctions for noncompliance. Provided, however, that in the event the contract becomes involved in, or threatened with, litigation with a subcontractor or vendor as a result of such direction by the contracting agency, the Contractor may request the United States to enter into such litigation to protect the interest of the United States. C-33 R6876-0010\1817323v2.doc EQUAL EMPLOYMENT OPPORTUNITY REGULATIONS NONDISCRIMINATION: (Applicable to all Federal-aid construction contracts and to all related subcontracts of$10,000 or more) Equal employment opportunity(EEO)requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630 and 41 CFR 60) and orders of the Secretary of Labor as modified by the provisions prescribed herein,and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The Equal Opportunity Construction Contractor Specifications set forth under 41 CFR 60-4.3 and the provisions of the American Disabilities Act of 1990 (42 U.S.C. 12101 et seq.)set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. In the execution of this contract,the contractor agrees to comply with the following minimum specific requirement activities of EEO. The contractor will work with the awarding agency and the Federal Government in carrying out EEO obligations and in their review of his/her activities under the contract. The contractor will accept as his operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation;and selection for training, including apprenticeship, preapprenticeship, and/or on-the-job training." EEO OFFICER: The contractor will designate and make known to the awarding agency an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active contractor program of EEO and who must be assigned adequate authority and responsibility to do so. DISSEMINATION OF POLICY: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action,or who are substantially involved in such action,will be made fully cognizant of,and will implement,the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met,the following actions will be taken as a minimum: Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO officer. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer,covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minority employees. Notices and posters identifying the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings,employee handbooks, or other appropriate means. C-34 R6876-0010\1817323v2.d oc RECRUITMENT OF EMPLOYEES: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minority groups in the area from which the project work force would normally be derived. The contractor will, unless precluded by a valid bargaining agreement,conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minority group applicants. To meet this requirement,the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority group applicants may be referred to the contractor for employment consideration. In the event the contractor has a valid bargaining agreement providing for exclusive hall referrals, he is expected to observe the provisions of that agreement to the extent that the system permits the contractor's compliance with EEO contract provisions. (The DOL has held that where implementations of such agreements have the effect of discriminating against minorities or women, or obligates the contractor to do the same,such implementation violates Executive Order 11246,as amended.) The contractor will encourage his present employees to refer minority group applicants for employment. Information and procedures with regard to referring minority group applicants will be discussed with employees. SELECTION OF SUBCONTRACTORS, PROCUREMENT OF MATERIALS AND LEASING OF EQUIPMENT: The contractor shall not discriminate on the grounds of race,color, religion, sex, national origin,age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall notify all potential subcontractors and suppliers of his/her EEO obligations under this contract. Disadvantaged business enterprises(DBE)as defined in 49 CFR 23, shall have equal opportunity to compete for and perform subcontracts which the contractor enters into pursuant to this contract. The contractor will use his best efforts to solicit bids from and to utilize DBE subcontractors or subcontractors with meaningful minority group and female representation among their employees. The contractor will use his best efforts to ensure subcontractor compliance with their EEO obligations. EEO RECORDS AND REPORTS: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following completion of the contract work and shall be available at reasonable times and places for inspection by authorized representatives. The records kept by the contractor shall document the following: The number of minority and non-minority group members and women employed in each work classification on the project; The progress and efforts being made in cooperation with unions, when applicable, to increase employment opportunities for minorities and women; The progress and efforts being made in locating, hiring,training,qualifying, and upgrading minority and female employees; and The progress and efforts being made in securing the services of DBE subcontractors or subcontractors with meaningful minority and female representation among their employees. NONSEGREGATED FACILITIES: Applicable to all Federal-aid construction contracts and to all related subcontracts of$10,000 or more. By the execution of this contract or subcontract, or the consummation of this material supply agreement or purchase order, all parties certify that the firm does not maintain or provide for its employees any segregated facilities at any of its establishments, and that the firm does not permit its employees to perform their services at any location under its control, where segregated facilities are maintained. The contractor agrees that a breach of this certification is a violation of the EEO provisions of this contract. The contractor further certifies that no employee will be denied access to adequate facilities on the basis of sex or disability. C-35 R6876-0010\1817323v2.doc As used in this certification, the term "segregated facilities" refers to facilities provided for employees which are segregated by explicit directive, or on the basis of race, color, religion, national origin, age or disability, because of habit, local custom, or otherwise. The only exception will be for the disabled when the demands for accessibility override, (e.g.disabled parking). The contractor agrees that it has obtained or will obtain identical certification from proposed subcontractors or material suppliers prior to award of subcontracts or consummation of material supply agreements of$10,000 or more and that it will retain such certifications in its files. FALSIFICATION OF DOCUMENTS: The falsification of any of the above certifications may subject the contractor to civil or criminal prosecution under 18 U.S.C. 1001 and 31 U.S.C. 231. The contractor or subcontractor shall make the records required available for inspection,copying,or transcription by authorized representatives of the awarding agency or the DOL,and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available,the awarding agency, HUD or DOL, or all may, after written notice to the contractor, sponsor, applicant, or owner, take such actions as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds of debarment action pursuant to 29 CFR 5.12. C-36 R6876-0010\1817323v2.doc TE(MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE DA12/31/2015 PRODUCER 888-900-9989 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SKYLES INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SKYLES INSURANCE AGENCY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . 9840 BUSINESS PARK DRIVE 1 SACRAMENTO, CA 95827 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: AMTRUST INT'L UNDERWRITERS LTD DASH CONSTRUCTION COMPANY INC INSURER B: CENTURY-NATIONAL INSURANCE CO 126905 DARIUSH SHAHNAVAZ INSURER C: I 727 EAST CYPRESS AVE. UNIT#101 I INSURER D: BURBANK, CA 91501 I I INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JSR r`NDSCal I POLICY EFFECTIVE POUCYEXPIRATION I.TR TYPE OF INSURANCE POLICY NUMBER DATE IMMIDD/YYl DATE IMMIDD/YYl umITS I '• GENERAL LIABILITY i EACH OCCURRENCE I$ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY XN104289701 9/9/15 9/9/16 DAMAGE TO RENTED PREMISES(Ea occurence) S 100,000 1 CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY i$ 1,000,000 i GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: j PRODUCTS)COMP/OPAGG 1 S 2,000,000 X I POLICY I PRO' I LOC i JECT ,7 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT !$ 1,000,000 B X I ANY AUTO BAP0183523 12/22/15 12/22/16 (Ea accident) ALL OWNED AUTOS BODILY INJURY i S i X SCHEDULED AUTOS (Per person) I HIRED AUTOS BODILY INJURY ' $ (Per accident) � NON)OWNED AUTOS PROPERTY DAMAGE • (Per accident) GARAGE LIABILITY ! AUTO ONLY,EA ACCIDENT S ANY AUTO OTHER THAN EA ACC j$ AUTO ONLY: AGG!$ I EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ,$ OCCUR I CLAIMS MADE I I AGGREGATE i$ Is DEDUCTIBLE i RETENTION $ $ — WC STATUS OTH� WORKERS COMPENSATION AND I TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE)EA EMPLOYEE_$ If yes,describe under E.L.DISEASE POLICY LIMIT $ SPECIAL PROVISIONS below OTHER I I 1 ESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS 'ITY OF RANCHO PALOS VERDES, ITS OFFICIALS,OFFICERS,AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED ON 3ENERAL LIABILITY AND AUTO POLICIES PER CONDITIONS OF THE ATTACHED FORMS NX GL 189 0511,CG 20 37 07 04, CN 613 37/11), CN 613A(07/11) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CITY MANAGER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL CITY OF RANCHO PALOS VERDES IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 30940 HAWTHORNE RD. REPRESENTATIVES. RANCHO PALOS VERDES, CA 90275 AUTHO7 IZEDRE RESENTATIV MMm CM e/6e't--- • CORD 25(2001/08) 'ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. .CORD 25(2001/08) POLICY NUMBER: XN104289701 COMMERCIAL GENERAL LIABILITY NX GL 189 05 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number:XN104289701 Endorsement Effective: 12/30/2015 12:01 a.m. •Named Insured: DASH CONSTRUCTION Counter Signed By: COMPANY INC "N.\,..J\ SCHEDULE Name of Person or Organization: CITY OF RANCHO PALOS VERDES, ITS OFFICIALS,OFFICERS, AGENTS,AND EMPLOYEES 30940 HAWTHORNE BLVD. RANCHO PALOS VERDES CA 90275 Location: VARIOUS LOCATIONS THROUGHOUT RANCHO PALOS VERDES,CA (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) A. Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds,the following exclusion is added: 2. Exclusions This insurance does not apply to"bodily injury"or"property damage"occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work,on the project(other than services, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed: or (2) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The words"you" and"your"refer to the Named Insured shown in the Declarations. NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission D. The following are added to SECTION v-DEFINITIONS:_._.__._._ "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement 1. Primary Wording With respect to the Third Party shown above,this insurance is primary and non-contributing.Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy,shall in no instance be considered as primary, co-insurance,or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2. Waiver of Su brogatio n If required by written contract or agreement:We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"you work"done under a contract with that person or organization. NX G1. 189 45 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy#: XN104289701 Insured Name: DASH CONSTRUCTION COMPANY INC 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 SCHEDULE Name of Additional Insured Person(s)or Location and Description of Completed Organization(s): Operations CITY OF RANCHO PALOS VERDES ITS INSURED WILL BE INSTALLING A SIDEWALK AS OFFICIALS, OFFICERS, AGENTS, AND PART OF A SERVICE FOR THE CITY OF EMPLOYEES RANCHO PALOS VERDES, VARIOUS LOCATIONS VARIOUS LOCATIONS THROUGHOUT RANCHO PALOS VERDES, CA 30940 HAWTHORNE BLVD. RANCHO PALOS VERDES CA 90275 Information required to complete this Schedule, if not shown above, will be shown in the declarations Section II Who is an Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury"or"Property damage"caused, in whole or in part, by"your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the°products • - completed operations hazard". CG 20 37 07 04 Copyright Iso Properties, inc.,2004 Page 1 of 1 Insured oak CENTURY-NATIONAL INSURANCE COMPANY (P.) P.O. Box 3999 •North Hollywood, CA 91609-0599 YW , For Service Call Your Broker. For Claims Call:800-733-1980 SKYLES INSURANCE AGENCY DASH CONSTRUCTION COMPANY INC 9840 BUSINESS PARK DR 727 EAST CYPRESS AVE UNIT#10 SACRAMENTO CA 95827-1704 BURBANK CA 91501 (916) 361-9585 Name of Insured: Endorsement Effective Date and Time: DASH CONSTRUCTION COMPANY INC 12/22/2015 at 12:01 AM Policy Number: Policy Term Covers from: Endorsement Number: BAP0183523 12:01 AM on 12/22/2015 to 12/22/2016 at 12:01AM 000 Name of Agency: SKYLES INSURANCE AGENCY 224300 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured Endorsement IT IS AGREED THAT INSURANCE AFFORDED BY THE ABOVE POLICY SHALL APPLY TO THE PARTY(S) NAMED BELOW, AS THEIR INTEREST MAY APPEAR BUT SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY. ANY ADDITIONAL INSURED LANGUAGE ON A CERTIFICATE OF INSURANCE IS VOID. The additional insured named below is only an insured for liability which is the result of an act or omission of the "NAMED INSURED"of the policy and shall have no coverage under this endorsement or the policy for its own acts or omissions, those of its agents or employees, or those of any other person or entity for which it is vicariously liable, save for acts of omissions of the"NAMED INSURED"of the policy. Further, any insurance provided by this endorsement shall be excess to all other insurance available to any person or entity who becomes an insured by reason of this endorsement whether the other insurance is primary or excess and whether or not the other insurance is collectible. In the event the other insurer has a duty to defend any person or entity added to our policy by reason of this endorsement,we will have no duty to defend that person or entity however,we may elect to do so, and, if we do,we will be entitled to the rights of any person or entity we do defend against the other insurer. ADDITIONAL INSURED CITY OF RANCHO PALOS VERDES, ITS ELECTED OFFICIALS, OFFICERS,AGENTS, EMPLOYEES 30940 HAWTHORNE BLVD RANCHO PALOS VERDES CA 90275 JOB LOCATIONS:VARIOUS LOCATIONS THROUGHOUT THE CITY OF RANCHO PALOS VERDES ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Date Printed: 12/30/2015 GINA BAZAURE CN 613 (07/11) Page 1 't CENTURY-NATIONAL INSURANCE COMPANY %Mir P.O.Box 3999 •North Hollywood, CA 91609-0599 For Service Call Your Broker. For Claims Call:800-733-1980 Name dfinsured: .- _ R y9.� _. -- -—_ _-__ rsernent Effective-Date-and Time:—— - - DASH CONSTRUCTION COMPANY INC 12/22/2015 at 12:01 AM Policy Number: Policy Term Covers from: Endorsement Number: BAP0183523 12:01 AM on 12/22/2015 to 12/22/2016 at 12:01AM 000 Name of Agency: SKYLES INSURANCE AGENCY 224300 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Waiver of Subrogation "THE RIGHT TO SUBROGATE AGAINST THE ADDITIONAL INSURED NAMED BELOW IS WAIVED FOR LOSSES PAID WHICH ARISE OUT OF THE OPERATIONS OF THE NAMED INSURED", FOR WHICH THE NAMED ADDITIONAL INSURED HAS NO INDEPENDENT NEGLIGENCE. CERTIFICATE HOLDER $100 The insurance is Primary and Non-Contributory with respect to any insurance carried by the Additional Insured CITY OF RANCHO PALOS VERDES, ITS ELECTED OFFICIALS, OFFICERS,AGENTS, EMPLOYEES 30940 HAWTHORNE BLVD RANCHO PALOS VERDES CA 90275 JOB LOCATIONS: VARIOUS LOCATIONS THROUGHOUT THE CITY OF RANCHO PALOS VERDES ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Date Printed: 12/30/2015 G I NA BAZAU R E Page 1 rN F1 riA !t?7l111 I (MMIDD/YYYY) ACORDTM CERTIFiCATE OF LIABILITY INSURANCE DATE12123/2015 PRODUCER 888-900-9989 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SKYLES INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SKYLES INSURANCEAGENCY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 9840 BUSINESS PARK DRIVE SACRAMENTO, CA 95827 INSURERS AFFORDING COVERAGE NAM# INSURED INSURER A: AMTRUST TNTC UNDERWRITERS LTD DASH CONSTRUCTION COMPANY INC INSURER B: DARIUSH SHAHNAVAZ INSURER C: 727 EAST CYPRESS AVE. UNIT#101 INSURER D: , BURBANK, CA 91501 1 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VSR�ADD'L POLICY NUMBER DAUTEXIIM!!DDmj-POLICYATION LIMITS _TR NSIZD TYPE OF INSURANCE GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X )( COMMERCIAL GENERAL LIABILITY XN104289701 9/9/15 9/9/16 GE TO FTENTICV PREM{SES(Ea oa:urence) $ 100,000 CLAIMS MADE X OCCUR MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _PRODUCTS)COMP/OP AGG $ 2,000,000 PRO, - } X POLICY JECT LOC f AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident) S ANY AUTO (Ea ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY (Per accident) $ NON,OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY)EA ACCIDENT $ ANY AUTOOTHER THAN EA ACC S AUTO ONLY: AGG $ 1 EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE , $ 1 S DEDUCTIBLE $ -� RETENTION S S ' - WCSTATU' JOTH' WORKERS COMPENSATION AND TORY L[MITS_ ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE)EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS belowE.L.DISEASE)POLICY LIMIT $ f � OTHER I ESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS ;ITV OF RANCHO PALOS VERDES, CDC, COUNTY,THEIR OFFICERS,OFFICIALS, EMPLOYEES,AND AGENTS ARE NAMED AS \DDITIONAL INSURED PER CONDITIONS OF THE ATTACHED FORMS NX GL 189 05 11,CG 20 37 07 04. ( :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN CITY OF RANCHO PALOS VERDES NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 30940 HAWTHORNE RD. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR r RANCHO PALOS VERDES,CA 90275 REPRESEN1ATIVES. AUTHORIZE REP � T .'4 MMag . / 1 .CORD 25(2001/08) 'ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER • The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CORD 25(2001/08) COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy#: XN 104289701 Insured Name: DASH CONSTRUCTION COMPANY INC . . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies.insui"ance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Location and Description of Completed Organization(s): Operations i CITY OF RANCHO PALOS VERDES;CDC, INSURED WILL BE INSTALLING A SIDE WALK COUNTY, AND THEIR OFFICERS, OFFICIALS, • AS PART OF A SERVICE FOR THE CITY OF EMPLOYEES, AND AGENTS RANCHO PALOS VERDES. VARIOUS LOCATIONS THROUGHOUT RACHO PALOS VERDES, CA 30940 HAVV T HORNS BLVD. RANCHO PALOS VERDES CA 90275 information required to complete this Schedule, if not shown above, will be shown in the declarations Section II -Who is an Insured is amended to include as an additional insured the person(s)or organization(s)shown in the Schedule, but only with respect to liability for"bodily injury"or"Property damage"caused, in whole or in part, by"your work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products- completed operations hazard". OG 20 37 07 04 Copyright iso Properties, Inc.,2004 Page 1 of 1 insured POLICY NUMBER: XN104289701 COMMERCIAL GENERAL LIABILITY NX GL 189 05 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS OWNERSLESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: XN104289701 Endorsement Effective: 12/23/2015 12:01 a.m. Named Insured: DASH CONSTRUCTION Counter Signed By: COMPANY INC c - ... ‘7".',4,;\- -..ki, '.- -r.r;i0v:-.N*..... SCHEDULE Name of Person or Organization: CITY OF RANCHO PALOS VERDES,CDC, COUNTY, THEIR OFFICERS, OFFICIALS„ EMPLOYEES,AND AGENTS 30940 HAWTHORNE BLVD. RANCHO PALOS VERDES CA 90275 I Location: VARIOUS LOCATIONS THROUGHOUT RANCHO PALOS VERDES, CA i (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) A. Section II-Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded tc these additional insureds,the following exclusion is added: 1 Exclusions This insurance does not apply to"bodily injury' or"property damage"occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than services,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed: or (2) That portion of"your work'out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project C. The words"you" and"your" refer to the Named Insured shown in the Declarations. NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission 0. The follo tng are-added to SECTION V—DEFINITIONS: - ..- . - _._. "Your world'means work or operations performed by you or on your behalf;and materials, parts or equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement 1. Primary Wording With respect to the Third Party shown above,this insurance is primary and non-contributing.Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy,shall in no instance be considered as primary, co-insurance,or contributing insurance. Rather,any such other insurance shall be considered excess over and above the insurance provided by this policy. 2. Waiver of Subrogation If required by written contract or agreement We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"you work"done under a contract with that person or organization. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission CERTHOLDER COPY STATE P.O. BOX 8192, PLEASANTON, CA 94588 N LiPaNCE ------- FUND • • CERTIFICATE OF WORKERS` COMPENSATION INSURANCE ISSUE DATE: 12-18-2015 GROUP: POLICY NUMBER: 9047242-2015 CERTIFICATE ID: 16 CERTIFICATE EXPIRES: 03-01-2016 03-01-2015/03-01-2016 CITY OF RANCHO PALOS VERDES NF CITY HALL 30940 HAWTHORNE BLVD RANCHO PALOS VERDES CA 90275-5351 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner.to the, employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of sucholio . P Y Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - SHAI+IAVAZ, DARIUS PRESIDENT - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2013 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER DASH CONSTRUCTION COMPANY, INC NF PO BOX 261321 ENCINO CA 91426 [LFR,CNJ 'REV. -`°' ) PRINTED : 12-18-2015 ♦♦wvv •.....iiN.:..::::u:.:iv.w.♦♦..♦♦..Mhiu.:w:.:..n. n .:. .. ...: .. :t.: v.: ... .. ... .. ..... ♦...4..w.wn...wx.vv.w♦rn (..... v ♦ ♦r ...n .. ... .......:.:. :..... PROPOSAL CITY OF RANCHO PALOS VERDES ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (Community Development Block Grant Project#601659-14) TO THE DIRECTQR QF PUBLIC WORK$CITY OF RANCHO PALOS VERDES d as bidder, declares that: (1) this proposal is made without collusion with any' other The unders�gne corporation, and that the onlypersons or parties interested as principals are those named person,firm or rp • r (2) bidder has carefullyexamined the project plans, specifications, instructions to bidders, herein; proposal, notice to contractors and all other information furnished therefore and the site of the proposed bidder has investi ate and is satisfied as to the conditions to be encountered, the character, work (3) g bidder agrees quality and quantities of work to be performed and materials to be furnished. Furthermore, g � this � examinationand investigation that submission of proposal shall be conclusive evidence that such g have been made and agrees, in the event this contract be awarded to bidder,to enter into a contract with RANCHO PALOS VERDES, to perform said proposed work in accordance with the plans, the CITY OF if any, and the terms of the specifications, in the time and manner therein prescribed, and to furnish or labor, tools, equipment, apparatus and other means necessary to do, except provide all materials, . otherwise be furnished or provided under the terms of said specifications, for the such. thereof.as may following stated unit prices or lump-sum price as submitted on the Schedule attached hereto: shall submit aspart of this proposal a completed copy of the Contractor's Industrial Safety The bidder Record. ' is �`'��` �� :��M d (Insert)" ` sh," "Cashier's Accompanying this proposal Check," "certified check," or"Bid Bond," as the case may be) in the amount equal to at least ten percent (10%) of the total aggregate bid price hereof based on the quantities shown and the unit prices quoted g in the Bid Sheets. The undersigned further agrees that should he/she be awarded the contract on the basis hereof and in executingthe required contract, with necessary bonds and documents, within ten thereafter, defaults q (10) days, not including Sundayslegal and le al holidays, after having received notice that the contract has been awarded signature,andis readyfor si nature,the proceeds of the security accompanying his bid shall become the property of the CITY TY OF RANCHO PALOS VERDES and this proposal and the acceptance thereof may be considered null and void. • accordance with an act providingfor the registration of contractors, California Contractor's Licensed in License No. RC:.q5'cS ,` , Ex.' tion Date 2.V / 9 Class Sig nature(s) of bidder: . ' e If a firm or co-partnership, state the firm name and give the names of all If an individual, so state. individual co-partners composing the firm. If a corporation, state legal name of corporation, also names p 9 • treasurer, and manager thereof. Two notarized officer's signatures and the of president, secretary, g corporate seal are required for corporations. Business Name: 94 .4 4411:" C 4 t C Legal Address: P2 0$. A . Telephone: A 2.. P- 1 R6876-001011817323V2.doc Contact: Proosals which do not show the number and date of the Bidder's License under the provisions of Chapter 9-of Divisiarr3 of the Susiness-&.Professional Code-wilt be rejected:--Y------ ... To be submitted with each bid to contract for the ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (Community Development Block Grant Project#601659-14) Bid Date: k 4? This information must include all construction work undertaken in the State of California by the bidder andartnershi joint venture or corporation that any principal of the bidder participated in as a principal p p or owner for the last five calendar years and the current calendar year prior to the date of bid submittal. Separate information shall be submitted for each particular partnership, joint venture, corporate or individual bidder. The bidder may attach any additional information or explanation of data which bidder would like to be taken into consideration in evaluating the safety record. An explanation must be attached of the circumstances surrounding any and all fatalities. P-2 R6876-001011817323v2.doc CITY OF RANCHO PALOS VERDES BID SHEET ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (CommunityDevelopment Block Grant Project#601659-14) NAME OF COMPANY. zitAAtAtt ' A (2 1.,44c 14 • Tote h Honorable Mayor and Members of the City Council: . is withNotice InvitingSeated Bids, the undersigned hereby agrees to enter into a In compliance the contract..act to furnish all labor, materials, equipment and supplies for the project identified as ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW in accordance with the specifications and plans for demolition, g construction and installation in the ContractDocumentswhich areon file in the office of the Director of Public WorksCity . . of the of Rancho Palos Verdes to the satisfaction and under the direction of the Director of Public Works at the following prices: Estimated E Unit Unit Extended Item Description �„� Meas. Price ; Amount nt No. �. 1 TRAFFIC CONTROL/MOBILIZATION/BMPs E 1 LS 000 o0o. 2 UNCLASSIFIED EXCAVATION 150 CY 3 2-01 10 0, CON000 I STRUCT TEMPORARY SLOPE AND BLOCK WALLQ Qo0 3 ARY REMOVALS 1 LS to SUPPORT STRUCTURE OR NECESSARY Option A ..., 4 CONSTRUCT PCC OR CMU RETAINING WALL, HE GHT=3` f or B LF 5 CONSTRUCT 4"PCC SIDEWALK 440 SF kt 0 6 CONSTRUCT BUS SHELTER 1 LS 0 000 0 060. SUB-TOTAL BID PRICE Contractor shall propose on one construction material (PCC or CMU), Option A or B, listed below: OPTION A--PCC RETAINING WALL CONSTRUCT PCC RETAINING WALL, 451 LF $ �'" $ 4A H :I T= ' OR. OPTION B CMU RETAINING WALL CONSTRUCT CMU RETAINING WALL, F $ 53 ' $ 6 O 451 L 4B HEIGHT=3' th• TOTAL BID = $ G 46 TOTAL BID PRICE IN'WORDS: 9 R Gt-, 4 a vvAA extort - +0[ .01 ,. • • r : The contract shall be awarded to he!owes responsible onsible bidder based on the TOTAL BID. 01203.0005/273304.1 P-3R R6876-001011817323v2.d0c INFORMATION REQUIRED OF BIDDER The bidder is required to supply the following information: (Additional sheets may be attached if necessary.) 6 (1) Address: ► t „...•.....x....... . . ,.m. .:...:.44 m'..ww:.. •::...v.4•:..•w...:.....x....4xx.NMwvx.wwvM v.wv...wrv.•...w....... .......•...4.....v...:..,...:.., ., .. ::w..... ......,...:r. , ....... (2) Telephone: .? 0 6 aOP - . - (3) Type of firm - Individual, Partnership, or Corporation: 11:: g (4) Corporation organized under the laws of the State of Coe I f (5) Contractor's license number and class: g641,c'ee7 ,r- ' ` ' 3 (6) DIR Contractor Registration Number: ,_ (7) List the names and addresses of all members of the firm or names and titles of all officers of the corporation: 4 4 e Y -7z.-7 c— 0 ,e,4„, 4 42, P 1 A 1 , t** .A. SII a 44 ...,, 0 .R.• et- - - ' cA 'ks.... (8) Number of years experience as a contractor in construction work .. (9) List at least three similar projects completed as of recent date: Contract Amount Class of Work Date Corn•leted Name Address of Owner and Tele•hone No. A qi 3 '10- C., , AL I ;,, ' a fdliOt * ' )Vt 4 'Sr'. IS C '/V 4'' I° Igit 0 33 1 3'6+ 1 ar-s" . t --4-,. 14„ ..ii q s-..- , (fit, i,, 1--GA. f'1r1 )r&. 626 ii 121 ((co.---• &tole it ,i is- Z.. 4 SP CA' g ) q tv - _ v, .ig 39 — ay (10) List the name of the pees n who inspected the site of the proposed work for your firm: (4, ..-.. .....41ote' , _IA ' .4 -/ Ai...01 A .... - (11) NOTE: Uponrequest of the City, the bidder shall furnish evidence showing a notarized financial statement, financial data, construction experience, or other information. P-4 R6876-001011817323v2.doc STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS .. ..v. :x.::.xrx..wn+•r:xwx+xw::wx:rYvAv:r.1.•.4•.4-M 9f:rcw4.N41t ynw:x.. .: ;..•: •... .. [Business. Professions ...: C4e 7028.15] wiw vM aw r..•1a. .rrw....w....-..... ..vx xvv...rr.:.. - [Public Contract Code 20103.5] I, the undersigned, certify that I am aware of the following provisions of California law and that I, or the entity on whose behalf this certification is given, hold a currently valid California contractor's license as set forth below: Business &Professions Code 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefore, except in any of the following cases: (1) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104 [now 20103.5] of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section,the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months, or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis,"the price of the contract"for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect, land surveyor, or registered professional engineer to form joint ventures with licensed contractor to render services within the scope of their respective practices. (e) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non- responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order, verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law, unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13 inclusive. Any contract awarded to, or any purchase order issued to, a contractor who is not licensed pursuant to this chapter is void. P-5 R6876-041011817323v2.doc (f) Any compliance or noncompliance with subdivision (e) of this section, as added by Chapter 863 ofthe Statutes of 1989, shall not invalidate any contract or bid awarded by a publicagency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if the public employee, officer, or employing agency made an inquiry to the board for the purposes of verifying the license status of any person or contractor and the board failed to respond to the inquiry within three business days. For purposes of this section, a telephone response by the board shall be deemed sufficient. Public Contract Code 20103.5: In all contracts subject to this part where federal funds are involved, no bid submitted shall be invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However, at the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material under any contract shall not be made unless and until the Registrar of Contractors verifies to the agency that the records of the Contractor's State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law including, but not limited to, any appropriate disciplinary action by the Contractor's State License Board. The agency shall include a statement to that effect in the standard form of prequalification questionnaire and financial statement. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. License No.: AClass: C .. .: Expiration Date: 3 2.0 Date: 1tZ fT .. :71„„„.„...20,,..)rt Sig nature: P-6 R6876-001011817323v2.doc DESIGNATION OF SUBCONTRACTORS [Public Contract Code Section 4104] List all Subcontractors who will perform Work or labor or render service to the Contractor in or about the construction of the Mirk or improvement,or a Subcontractor licensed by the State of California who, under subcontract to the Contractor, specially fabricates and installs a portion of the Work or improvement according to detailed drawings contained in the Plans and Specifications, in an amount in excess of one-half percent (0.5%) of the Contractor's total Bid or, in the case of bids or offers for the construction of streets or highways, incl(jding bridges, in excess of one-half percent(0.5%)of the Contractor's total Bid or$10,000, whichever is greater. If all Subcontractors do nottfit on this page, attach another page listing all information for all other Subcontractors. Name under which Subcontractor is CSLB License DIR Contractor Type of Work Percentage of Total Number(s)and Registration Address and Phone Number Electrical) Bid (e.g., 10%)* Licensed Number (e.g., and Registered Class(es) 11J� • P *The percentage of the total Bid shall represent the"portion of the work"for the purposes of Public Contract Code Section 4104(b). T p g p P-7 R6876-001011817323v2.doc CONTRACTOR LIST OF PROPOSED SUBCONTRACTORS .. w11, sf- .. 4's 1 L.J t > t" c birL'0 Wiiret-#141.0 ..". F r 4_,),Ii „iim%-, CC:, ' . , 40_ .,...._..J --;:".: kiNI°. 4).1 " '"'C'P Vehnev444- _dr , - . Locatmcv 4 Re:Lk:3, 4 .4.--fek,„Ltiej v:2„,e; Prv;ec, s 1 Cif- .. war► t4rnber C_016_, fl, i} Employer .�ik��Y mated E bma� i t SUBCONTRACTORS: Start rt Cele n TRADES To BE usED Name,Address,and TeLpcne Number Amount Date Date Number urnbr , s z i i • IaIIMIIINIMMIMMIIIIIIIIIIIIIIIIMIMIMIIIIIMIIIIIIIIIIIIII.1111110 . } illIllMIMIIMIIallhIMMIIIIIII III all.11111111111111111.11ali IIIIMIIIIIIIIIIIIIIIMIIIIIIIINIIIIIEMIIIIMIIIIIIIIIIIIIIIMII i I 11111.11111111111.111111..1 ..aaileir' a4k., ' L , 4, . .,„,, Ar I 40* ' *,'" , . rr� Sig nature Name and Tie -I Zs/2.'( I....,S7 . r .2D 4 4."W ..a.a.., ' T Company Name Date e... 7 INDUSTRIAL SAFETY RECORD FORM Bidder's Name . }.. j (2d?,,,i4 A_ - .+ .�.,,,., .�:�'j rC..., Current Year of 2014 2013 2012 2011 2010 Total Record Jr Number of contracts 2.. 1 2.... - -3 2._ 7 1 2-- Total dollar amount of 2t6 contracts(in thousands of 368u VA$j1... 3�, 14- 33C� k Ss-Li- t4- Lt.ZZ 3 dollars) Number of fatalities Q 0 (D Q 0 0 C.) Number of lost workday cases 0 C 0 0 Q 0 a Number of lost workday cases � C ccp.involving permanent transfer 0 to another job or termination of employment The above information was compiled from the records that are available to me at this time and I declare under penalty of perjury that the information is true and accurate within the limitations of those records. t , Signature: a.!•.�....irr.:-a�_ -. Signature: Title: CmilraMVI. "'�r , Title: Date: y Z ' ç Date: P-8 R6876-0010‘1817323v2.doC Bond No.N/A :,..•:.«.•,.. , e ;.....; t.n...s t .w..;•v.rw.w.ww....w.w,,,.....A,,,. ..... «:.. ........ a,.. _ ........ .. .• ..,. BIOBOND ' KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the Cit of Rancho Palos Verdes ("Public Agency"), has issued an invitation for bids for the work described as follows: ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW (Community Development Block Grant Project#601659-14) WHEREAS Dash Construction Compan Inc. 20501 Ventura Blvd. , #255, Woodland Hills, CA 91364 (Name and address of Bidder) ("Principal"), desires to submit a bid to Public Agency for the work. WHEREAS,bidders are required under the provisions of the California Public Contract Code to furnish a form of bidder's security with their bid. NOW, THEREFORE, we, the undersigned Principal, and American Contractors Indemnity Company, 601 South Fi:ueroa St. , #1600, Los Angeles, CA 90017 (Name and address of Surety) ("Surety")a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Ten Percent of the total Amount of the Bid in Dollars($ 107 , being not less than ten percent (10%) of the total bid price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal is awarded a contract for the work by the Public Agency and,within the time and in the manner required by the bidding specifications, enters into the written form of contract included with bidding specifications,furnishes the required bonds, one to guarantee faithful performance and the other to guarantee payment for labor and materials, and furnishes the required insurance coverage,then this obligation shall become null and void; otherwise, it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay ail court costs incurred by the Public Agency in the suit and reasonable attorneys'fees in an amount fixed by the court. Surety hereby waives the provisions of California Civil Code 2845. P-9 R6876-009 011817323v2.doc IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety, on the date -set-forth-below-the-name-of each-corporate party being hereto affixed.and:these presents-duly igned- by its undersigned representative(s)pursuant to authority of its governing body. Dated: December 1st, 2015. "Principal" "Surety" Dash Construe, ion Company, Inc. American Contractors Indemnity Company C:4; 4-73,, s* a: r; - :r.rn•aF,M..W.•'t.YikK.M^"n••:F.wY:naa. 4........ By: Its Its Attorney—in—Fact, Elisabete Salazar By: By: Its its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized,and evidence of the authority of any person signing as attorney- In-fact must be attached P 10 R6876-001011817323v2.doc .. 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 Los Angeles ) On December 1st, 201.5 before me, Trine Lee W.a Note Public E Date Here insert Name and Title of the Officer personally appeared Ossa Sal a Name(s)of Signer(s) • who proved to me on the basis of satisfactory evidence to be the person(s) whose name($ is/die subscribed to the within instrument and acknowledged to me that l /she/tfi y executed the same in I-a/her/Mir authorised capacity(Ufis),and that by Ws/her/00)r signature()on the instrument the person(), or the entity upon behalf of which the person(t)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. . i *(£A i..1µ1.VEGA 4hwilwairml WITNESS my hand and tial seal. dila 3 s : 1056669 1 E'O 4 S 4F .ot'. - ' d..33 Y`.tf4r;t?i6alft'£ iia -441141 11!.4t •t•S¢ ttR � ¢a � g,Ar,,.!ti :�2 •J7 Signature :.:. .. .:.`,,77 _.—.... • ize �, � iT x; lF r R� ia `' i J„.F 0. j .t � ( Os :. 7psSignature o N o tary 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(les)Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer -- Title(s): 0 Corporate Officer — Title(s): ❑Partner-- 0 Limited 0 General 0 Partner-- 0 Limited 0 General 0 Individual bil Attorney in Fact 0 Individual 0 Attorney in Fact Li Trustee ❑Guardian or Conservator 0 Trustee 0 Guardian or Conservator ❑Other:_ 0 Other: Signer Is Representing: Signer is Representing: .ia -..`.. f, i i... 1\x. �, f/; s>r. r:,. :: .,'S > ;>f:* .1> e, } (- ♦. .,a. f. si.,f4'._ar: i: ' " f' 02014 National Notary Association•www.NationalNotary.org•1-800-US NOTARY(1-800-876-8827) Item#5907 --. .""""'.' """"-••' - .:,::::::::: :•,:iii:ii•:.:-•:,, '',,,,,,i ::::,::::::: ,,,,i:::.... .' --::-: ••••••• ••••••••• -....--- ....----- ss......• • ,,,,,,,,,, ::,,,,,,,,,-.: :: ,,,,:::::::,. ,,,,,,,, .,::::::::: ::.::- , -s':,.'.!''•, . -H''' - '-'' '''.'-'• ; . --•' i''"' ' ,„„,„..i„,„„:„,. ...:.„ ..„,„„„,. .„„„„:.„,,„„„,„,„,.,.,....••.: ::H .•.:';-'f,- -I- _,...:,,,,,,,,,,,,,. :::i!!!!!•,:•-,,,,,,,,,,,,,,,,-. ,:.:„„,.„,„•„. .....::,:::::::„:. ...::::. ....... POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY TEXAS BONDING COMPANY UNITED STATES SURETY COMPANY U.S.SPECIALTY INSURANCE COMPANY .....'" -:::::::...::.--. ..'.-1:"H."::ii'"":"'••••••":':'•• --. ••-:::''''''•.'-'::'''''',.i'''''' "'-',',••i':•:H '•:::::-': :'-'. •.'' 0Y '''''''' • • • • • •:•': •-• '-' '''.'.''•'-•.:•..L":••••• •:::.'''''i'.i.: .,'...:;•- '!--. Z.H.'...--•,-;,,'H'''''t. i""" : •.!!!!E .:''' :".I.1111111. KNOWIIIA,L4 MEN BY MESE..'!!e..13,g$gN717.$ 1-71-10::American: Contractor0....-Indemnity qpinp0Oyi, a California- Corp.Oratiori', Te*aS.7 H. 1111,,'Diiii.Oint:-,COt.#0011y.,:,:an:itisiurte-4.nOt.t*,:-,61-:•A001004,,Con*ta4tor$:.Indoreirtity:0,C0iii0*y114ited111!Stitoti Surety Cortiii.any,'.-a M.141-ylAnd.:-!-iiii!:!.. • . .... ... - - ..,..,--,:,': '....:H...--•;.., ,..-:-. •-..=-::-'• •: • . . • .....,.. ii: . ..-.....:.......• .:.,s • corporation and U.S.Specialty insurance a Texas corporation (Ctillettively-,.the "Companies"),do by these presents make, constitute and appoint: Patricia Zenizo,Elisabete Salazar or Pietro Micciche of Los Angeles California •,,,,,,,, ,,,,,,,,,..:•:::.,..-.. -..,...., ::,,,,,,,,, ,,,,,,,,,• ::: . :• .. :, .• . ; : . itgltud:-.,-Arid,,liwftil.::AttOrttOy(s)-in-faot eatitiiii•theirs,s0pailitttapaqi.V.if..r.note...thall...0tte:.'ilv#40100:above,with full power ittitlititity:• •:......-,-,- :...••••::::...,---, • .y•„t„i:,:!.-„.!:-::.,. -- separate capacity .. deliver any .--..,:,.:•,... --. • - .,•• • : . :„.,1,„:_.•...„,„.:: .:...: •.,:,,,i.„:.,.,.„E , •••i•!!,:•:'::.'liet.e.h.r-,OnfOttedin.!its.nairie,places,4ndt*.ead,.,40..,exeOute;i.,acknowledge.-and;Oiver.'iipyandall bonds,retOgiiitaiiOes .tintlertiiklOg.C,...:. •„•:„..,..,,„:.:•::,::,. ..:::::::...,:,...:•::. ...........• •: • .:•...:...:.::: .... . Or other instruments or contracts Orsuret-yship to include riders,Ameitdinents.1..and.:totitehtt:Of surety,providing the bond penalty does not exceed.. __ ****srfhte...—.0EMillieri***** Dollars ($ :**3,000,000..00 ' ). This Power of Attorney shall expire without further action on December 20,2017. This Power of Attorney is granted under and by authority ofthtfollo*ingteStiltititint.:radopted oy:_t.40..-..Bofttd .Of Directoit.!of the.Companies: '..... :::•'•:"-:-......... --.... - • ' • --. ---..---i- . :- •: ok/(;:**0004,i!#013110•let000tot,-..:**..yi0.04.p.00.000.t. 1.0t Assisar*yoorotudon‘..„;,,ty.-.$#goto,rt,*t-*Iy-.,:-.:,'40041.4;:--iac,q.etont..ititill-r be and iS.her4.1...VeSted*itItcull.. :iioWeeitndatithoritiiiisitipoint any one or ritOritt.Stiitabletiersonias'iAttortieY(SY.iii,Tact to,represent att4attfOr:ood'on:.-ibohor of the CompanyaubjeCt40.4he'..-:.folloWing •.:•:..,:' :, ::..:,,,.. :,,,.••,: ,,,,,,,:,. :,,,,,,,, ::•,—,,,,,. • •• - .. ;,-,,,'• .,:•-•,• •-•,.....----..- .. • •,iiiii;,iii,„:,- :i•,•,g!„:„•-•-•-• „•ii-,---..• ,,,ii, ,:••,• provisions: •.:::-,,::.,• .:..--. .„„i....... •.:.:..„.... Artoett.ey4nareicrmay.be given full.power and:authority.for and in the name Of and-on:.behalf Of the Company,:to exectite...ackno*ledgeand:deliVer,any and alt-bonds,. recogni*OSS, contracts,!goo!** ot,:.:indoaltilty...,-and.-•Oter conditional or obligatory undertakings, including any and all. consents for the release of retained percentages and/or finat:estiMateS..tnicogioaoot:and•000isotion-comsos,.40.00.9'tiods.aii notices and documents canceling or terminating the Company's liability thereunder,and:any such instruments:sOitxeCtita by stithAttorney,ineFact Shall:bd.:binding upon the Company 0$if*igoed oy.the.Pre$14elit:Orid-tea)44-01.0.-effecte4„....::H 0,,...its.:i.007..0Orate::Setretaty.,.. ,,,,,,.,:••,.. ,,,:,!„„.„.,.,,,,:... Ill'ilill:,:'. iiii•W•::• :!:.,.,,„ . . :::: "":""--"'------:.-. .,:":::::::: --",:: 'Th.'. -..---.. • ' ''''''.''- ..::'• ' ..;-- ''--": •''' ::-..:.-±;. • '-'":-:H, :".... .-.:!i:;""f" ''''•i' '''--Iii• •• "'"' 'i•-•,-,!: Belt Resolved, thti:!:Signatte0:0(.any.aiithokiottal000n*tt:0".?of the Company heretofOre.or•hereofter..tiffiked-te::•ariyipp*Or Of attorney.47,.r!-0:•*..,-!ettifiettte;,irelating• .,...,, ,•:... . • • .H::.:.••Atereto-•.:by?,.-.,ftlesintileAnd'itily.:ipot:of.tiopook!orotitio**0.00#0t facsimile signature or facsimile se0.......shaltbealid'arilbinding upon the CotriOny.i k.fittreSpect,tO1H.:.:i, •:::,:-.f.any kiondOrundartakingto which it attached.::,.':;:;:ii: '''"'"."'•••••'-'• ..:--- •-,. :: --::::* IN WITNESS WHEREOF,The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 1st day of December,2014. •••••••• •- '- i;:-,• •'T'''':!:•':.:il:=,'P,. CONTRACTORSAMERICANINDEMNITY BONDING:TEXASCOMPANY ..:: ,...„„ii„.H.,.gi-:.::::•:-::: „. .„0.„„„-•: -1i:i.„i„.•-•.,,,•-•:-.:„,,,•,:r:,:,. - --• - .• ,. . - . • ....:.:.,.„.:• : . -'i!":.!',:. •:'""'"'i,i'i::::iiii. ."'''"!':!;'0•;, •"',!4•!:: '•P:IP,, ''''"':-,,•,' '1311ITED:.,:$TATItS!$1.)RET.Y:'CQ114rANY-1- U.S.SPECIALTY INSURANCE COMPANY .C.orgrItt6:::SOlikl.i.!!i!:!'..:..111.,Y • . .. •• •:,..,•'.:.•::',-f-.'-•:i'-':.-:' ..-:.-.':••!:::.-- .::'h]':.i'..-.''': .,•!..:::'• " -...i.H.H•!:::...: .'-'H. .iii!:-ii!F- Fiiii-L.. --.-;::',4,:: ,,,iiii:,h•. :,.':,':..,.:,,,'00404. ....,00.• ..:-.,!..,.. ::. i...,40.:t!0411014,.-,:.;:::.:: I::• .•••oiOntot,N, :.:,„„„,„.,:::: :„,. .:::„„„„ ,„„,„, .-.••- .- .. . : • . .::,-., .: • Oft..:. .-.. :, . -00::• .• . •... -,•-:'...004.4t9 /tiekliTIAN-H, : hOltt,rei •. :01if...4 j,.,.,4. :•.'..!,/:••• . i' ....,4,t<1::.;.;; :4i.: irpt ' '-...'"•.t").••• ...:0:-.-+;«:.:,•;4-;4.'•-••;.•. .. • .= __. ,......a..b1 :2.......01,,___.• ,.-.,._..1..H: ,. .... • . -1(:‘,.,,..,ocoapooulea A.'-..•ri :.:21, '7'1'):...:J,..1.0: 1.:..( • ytti: :..-4:.:• ....,..„,),....,; .so:. By: .•...::::.: -.W.:.: .:.:.,,,,k;•,:.:,- ,.• -<,! .-......;,*,:. .itel•.... . . ....,,,,. .., ,.ii,:':.t....,,,,...:,.1..,.. :....r. • .....:..::....;. .: • ,...,...,... . : •:..- .,.::,. ....• • -• • •.'1,........... /...g:•. :::.- 11.‘...• :. -.4/ 4:,:41',..\,. . .:4.,.- :...:-....,..:,. s../.•-•.•-• (0,,, ) Daniel'F.Aguilar,Vice Pretident:. ,.......• „ .... •.41”.,..,,,:..,,.,,....-v.....:. .1„,..4.i.„...,,,,,A.,;:,,•.„..;,,,,.. .:: .... ,,....,,,. ._ . 7,*.. :.-4... . ..1,....,-.. t-1,,, - . ......::!......-..:• :......,,-..., .•:4,•• ..,0.::.•:,,, .::::::::::::,:•;;;,••••$411,iivo, •• •:,:::-:,:, :••••:••!•••• 001. ::,';; ,, :,,,,::;;:•••:::•.:•!,•••,.•" -- . , :....::: ...,,:,,::::, : „i„ .,:::,::: :;:‘ . 7'7.•••"::.::::.... ,.. •:•,•,•,:::, : • . •:•:. ::::,•• ••this•. ••••• •••••.,•,.• .::••••, ...•.;••••.: • ,•: individual::. :• :: • - A notary public or,other officereoroidonti ,:cettifiookyocip4.„Only the identity•,:oft4 :Who signed the - •_,,,:.:.,, ::::::: •::!::,:r:,.,• :,'::,:-- :1::.: . n: ,:::::::!!!, •..•• that document. • , '-:-.-- document which certificate is attiOte4;:A44:001he.$:troll*110es4 accuracy,or valtdity:ofthat document.• --• - •State of California.:. County of Los Angeles SS: 00:01.1*istdity..of'DeccMbe4,20:144,beforeinei,'Matia..a-•RodrigUe4Wongi•a,notary-publie, personally appeared Dan P.Aguilar,Vice President of American .ContrtietOrS:'•In4e*ityiOii,.itiariy.i TeXati:.)3.1.000.ingotnpatty.,i,VO.i*ktateS:-Surety-Cotnpanyr::,Tian4:1• 4: 4#0#1alty.•••kisprance Companywho..proved to ine.;.-,on...:••.... . :tho:6asit.-4t.-SatiSfat(otY:1-0idttitt•t0..be the'..,:potion,*hoto:.tollso is subscribed to the Wit4i.#:-instrutneni.,:atid;a61.r.nOw.10ge4 to me that he-exeCUted,the..0.amein:::...: i•::,..,. ..- . •::- -..--:•-::: :-:,•• .... . i!!!!:.•:•!!..h.ii4iiihOtii.i:(1.:':*.aoaoloa*od:that oy...hii signature-#.4:011-iiiti.,00)-e*:..tk*-kiiiiott,or the enti**Offi.:tOhOr017.0iok•O*.:::0641'00 acted.executed the -.D.,,H.::•!,T,. •:,,.ii,:,,, •:,,::Jir,i,,,:,,,.:•:.:. - • '.......1:certify under-PENALTY0FPERIURY•undertheia*S of-theState.:Of.california,that.theforegoint paragraph is true and correct. WITNESS my hand and official seal. i: ....:-,..:!..,,......;',-,. MARIA(3, -. --------- '....:.:::..;...-,,„.„, • commlision:#2049771 . : Signature..... •:Z.:•:-::::.,-!•ii-'111iZ::!:I:.:..:, . .....44..,... -J.:'':,,,,::::..:,..: ilLin.,.. :(P#0,1).;i1111,!,[i!.:-:.!-:-:'::.:.:. :i, •.=.,;-,,i . , ---- .•..:: : z iik...Ti.,,,,..f,...# :.:..:Notary,•Pubtle hi,:California ...• - -•-•: •.''"'""'""":- '''::-.1 . -- i 1 :::::i: : : :•., ... ..,::....„ : .:.,.,,,..: .:,•Hi .!::::::::....7:::l::::',: :•:".t. .. :;:!.:,:li.ty::::::: --n::' Iv ':'I,!,1111;111..• ':ill:: ''' ' ::I;113: z' "'.'"€"1?::::::: Los:• Angeles county . ---,iiiii :,::H-:;.•:-:.. -',-:m ::i:!,, :„,: - ...,., ,,.... •••• •.,.,.:.... •: ...... ,„.:•.,• ..„ ••••• • . .,;.:::T:. .::.,.,::..,„:::,,i,!,:,:. J;!:i::,,,:,::, .,:;:,i.i;,:i::: :',:':,-,...,:,„;;;:,,n.". :.. i!!!,:!iiT...,:ip::,...-i-:iE,,‘,.; ..:-,:.,::::-i-!!,, I;iiiiiR,:'!,,,HE,,i:iiIii,.,,:. . .:.i.;.::,......,:li-•.::,:::,:;:: .::COntni, :. 111020.10.17 i: ,.7:.„„,„,. „is,.: __ :..:. ,..„„,„„ :„„„,„„,„,. -:':-.,,',,,:',,,--.':.:!:!:!;:!:,:, .,:c,i:.. ,,:y,1•:;•!:!:!,:! :w:::::::41:!..i!•:.,,,,,- .-• ..•:- ii.iii.;!iii:iiii,i,i, .•:iiiiiE:. ..Ei!::z;•;,::: -,::::::!,::,,!i .4ii;Hii,:ip,... :.,.::...:,.. • .,: •.:..••.•• . . . . :::-.„:.„i ---:::„7::,:„',„:!„-.,,,:' ,-:-: :: • — :.• 7N„:::iiiiii -,,,::,:;„1..„-,;.i.,,,,., I,Michael Michael Chalekson,Assistant Secretary of American Contractors Indemnity Company,Texas Bonding Company,United States Surety Company and U.S.Specialty Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Companies,which is still in full force and effect;furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are in fttit'fOrc.e.andt1T.-06t- ,,,, • . ., .. ......:.... i:i: ,:::: .,....,.: ------... .•-•-•'''..... -"" "t,:f.i:"" :,::. •:""".: i'l.i'"Iri:ii.:.';''..!.P:'-'-'':.'"11.'.HIlillli!i•_ '!:!fiiiiiii lilt._71', '••'..":--- '"""''''''''''''''""' '''''''' '.""""-""' ''.'"'"". 4 ..:' .:..:.:•' Ii'Vlitnot•'WhOtecill have heiti),fito4et.:*'htintt4n4:tiffigod-thefsSealS-of Companiessaid L.00--,Angeles.California :,-,••:,.' .15ft':,' .l'tity----..:-..., •:.:ss ,' .. . . ... ..... ... .. ... . , . . . . 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NON-COLLUSION DECLARATION . .._ ___..__._..........._.__......:..._..____:.___.. -__._..__.-TO BE.-EXECUTED BY BIDDER.ANaSuBM TTEu t1TH.sif._._----._._.__ [Public Contract Code § 7106] State of C I or ia. } County of Ul ) ss. City of E„, «gkt 0 The undersigned declares: I am the 141,syy Jj,theof1) a party making the foregoing bid. 4, The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or.sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation,partnership,joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on s date], at city], riil://p43,44,..4 [state]. yh •.wlM.vMw Signature 4,4, w. Subscribed and sworn to before me on / '27 #fir (Date) (Notary Seal) q e, r FRED K.JACOBSONSignature7:7;k: . ,e19Vrd:, CommIgsion 0 2130201 Notary Public s I Notary Public-California Z �.. , Los Angeles County "1 A' Comniwirwirmr44,444040wevilorwelNov rSS 1� 01� P- 11 R6876-0010\1817323v2.doc ADDENDA ACKNOWLEDGMENT FORM Bidder's Name jb/4„,n‘A 0 0441,04/1,,-7 a/461- The Bidder shall signify receipt of all Addenda here, if any: Addendum Number Date Received 4 Sign ure 1 1 Z 5 / s- � l (1:54 .v. If there are more Addenda than there is room in the chart above, attach another page acknowledging receipt of the Addenda. P- 12 R6876-001011817323v2.doc pluxEcru__ w_AgrJVM115'ffEr (Make copies of`blank sheet as needed) of the Questionnaire): as designated XIII Contract No.( �ted in Question 3 of Section Contract Date: -• 2. 1 Final Contract Amount adjusted): / x Z..o • ,14t,' t,. Project Name: °+ - ��.. `�., { r .. •lam " ; Project Address: r' 4mr , ► ; (Project Owner): ____ Cop t Contact Name: , t Contact Telephone Number. Design Professional(i.e.,Architect or,if none,Engineer): �onal Design Professional Contact Name:. . Design Professional Telephone Number Construction Manager(insert mNjA"ifnone or if Contractor acted as the CM): Construction Manager Contact Name: Construction Manager Telephone Number Prime Contractor(if Contractor acted as a Subcontractor): Prime Contractor Contact Name: Prime Contractor Telephone Number: of Project and Contractor's Scope of Work: General Description c../t Originally-Scheduled . Completion Date: ' ' Contract Time Extensions(number of days): Actual Completion Date: PROJU IRA' L4 (Make copiesofblankshams as needed) . .. _____ ,.02......2....------- Contract No.(as designated in Question 3 of Section Xill of the Questionnaire): Contract Date:_;5_,/,...7 2— — Final Contract Amount(as adjusted): 4. ..- . A. 6 ' - :,.. . ' 4ii i , 4. ,_,-/-k Project Name..,i r F ��.. Ar . Project Address: :, t I V ' SwE,,(Proms Owner): ,M,,,., �4. V.:ContactName: - ~Contact Telep hone Number. '"" Design Professional(i.e.,Architect or,if none,Engineer): � Design Professional Contact Name: • Design Professional Telephone Number: Construction Manager(insert''N/A"if none� or if Contractor acted as the CM): I ' .0.4______Ji Construction Manager Contact Name: Construction Manager Telephone Number Prime Contractor(ifContractor acted as a Subcontractor): Prime Contractor Contact Name: Prime Cofactor Telephone Number 't, AL' '' 40"i-r-iff . PTO and Contractor's Scope of Work: d �I A +i` General Description of � � � � ,�,,, ,,� * ::10:` 4z, p �,. GMS "'.4,- . . 4, 1 itifif '� ... - .#„ .t . ,„ . A . -, , .4 -,,, 1*.. . 1 err / . , ,, .. , ier- ,- , * i _... , ( R r � � jsiiii , t a rpt Originally-Scheduled Completion Date: .. I .!;«-- 2-0 i Contract Time Extensions(number of days):_ 0 —................&S.........--...........--...... r Actual Completion Date: R______--2--E—L---gr%1PROJECT IN RNA çJUONSHE . (Make copies of blank sheet.as needed) 1 . - of the Questionnaire):(as °-- designated in Question 3 of Section XIII - ' ..` Contract No. � Corer, tae: .» Cap,If Anal Contract Amount(as adjusted): _ C A ' Project Name: '" ,M.•� in0. Address: ` a j y C • Pro Owner): ) 3 te . Contact Name:. it d 4n%(A: a A & .# 41 Contact Telephone Number= Design Professional(i.e.,Architect or,if none,Engineer) Design Professional Contact Name: .. . .: Design Professional Telephone Number: .� � _____,A(/. Construction Manager(insert N/A if none or if Contractor acted as the CM): Construction Manager Contact Name: Construction Manager Telephone Number. Prime Contractor(if Contractor acted as a Subcontractor): Prime Contractor Contact Name: Prime Contractor Telephone Number: Project and Contractor's General Description of � Scope of Work: 41 /0 ...c-,.....• - . ........ " . i 41 Ilr c ' 1 41.. M r' 0 ..rt. .a '� .MIS .a f. .. 0 -- ort 11 4 ES fil ik .4 fir! y i. -(. J Originally-Scheduled Completion Date: Contract Time Extensions(number of days):........._(.7141...------ Actual ' Actual Completion Date: 4111, MRNIATION SH (Make copies of blank sheet as needed) Contract Ido:Jas designated in Question 3 of Section Xlli of the Questionnaire): 4_1242.4..... Contract Date: Final Contract Amount(as adjusted): r Project Name: q , Project Address � ♦ y School District(Project owner): School District Contact Name: ,, r School District Contact Telephone Number: Design Professional(i.e.,Architect or,if none,Engineer): Design Professional Contact Name: Design Professional Telephone Number: . •• �ifacted as the CM): •� - --- . Construction Manager(insert N/A none or if Contractor Construction Manager Contact Name: Construction Manager Telephone Number: Prime Contractor(if Contractor acted as a Subcontractor): Prime Contractor Contact Name: , , Prime Contractor Telephone Number: General Description of Project and Contractor's Scope of Work: 40, ,,,, .» y. r , (j f err- _ K Completion Date: k #•..,.,, mow `" Originally-Scheduled ""� j) Contract Time Extensions(number of days): Q Actual Completion Date: "�" PROJCTim o H EET (Make es of blank sheet as needed) ' All of the Questionnaire): • ' na�te�in(question 3 of Section Contact l�tc�-_�aS�� :.. :. ... . a K Contract Date: gr: Final Contract Amount(as adjusted): '0' - - '.._Mrs ... .,...^A!- 3 w ..a Project Name= .�"•' Project Address: :... x Y,,, . ,04.-ty-100Q c A A°4-.., \c---.7 I ,---,E ( k;4 —C-e wy4e._ .A ay._ , 4-to-a • School District(Project Owner)- :. �•-->- 4 1. r ..> Cid Name: .� 'j.=' School Distr K School District Contact Telephone Number: - , Architect or,if none,Engineer):professional{+.e.,Arch Design Professional Contact Name: - Design Professional Telephone Number: •-c#none or Contractor acted as the CM): Construction Manager(insert.,NIA Construction Manager Contact Name: Construction Manager Telephone Number: Prime Contractor(if Contractor acted as a Subcontractor): Prime Contractor Contact Name: Prime Contactor Telephone Number. GeneralDescription of Project and Contractor's Scope of Work: a '� r 'r / '�640.0 , * w. i�r Fair. : ,,mi A. C e' , ,.. ' ....,, '• ..,.. , ,„,.. . • d ofeLA , k. * —.0 •• �•.0. �. � • Ilii :':.ri 4• ''0,...' Ir ,...1k originally-Scheduled Completion Date: .- ate: ;M: Contract lime Extensions(number of days):___ 0 Actual Completion Date: PROJECT INFORMATION 5 EET (Make copies of blank sheet as needed) . .. .._............ ....._ . ....._. . . XIII of the Questionnaire): ` Contract No.(as designated in Question 3 of Section R w k Contract Date: ` - Final Contract Amount(as adjusted): .I4 .ii , ' * ' de. I ' .g 04,, _ , 1 „Lt.%4::,..... ..., ::: ct Name: . .I "1 Project ,� ��-��. vMMYM�� 4.,� � � r , Project Address: �. g (Project �"` {P e ' Contact Name: I ... 4 M 4 .,..Contact Telephone Number: Design Professional{�.e.,Architect or,if none,Engineer): Design Professional Contact Name: 4 Design Professional Telephone Number: Construction Manager(insert N/A ifnone or if Contractor acted as the CM): Construction Manager Contact Name: Construction Manager Telephone Number. Prime Contractor(if Contractor acted as a Subcontractor): Prime Contractor Contact Name: Prime Contractor Telephone Number: Project and Contractor's Scope of Work: , General Description of 0 . : , 1 `r� M ..d' Ali .. «.r 4, i .... „ AA . i .rtot 4' "r..:. f yy ," •fit .ate v .SUM „ rr' . ted CompletionD "'- .� Arg:. Originally-Schede Date: Contract Time Extensions(number of days): Q ... . _.__ct:;Ns_.____.— Actual Completion Date: t PRCYECrnWPL- ----aktlAnONESH (Make copies of blank sheet as needed) Conta.a149,1 as_designated in Question 3 of Section XIII of the Questionnaire): _ S2....t. ?________ ___ Contraa Date: 7.:b ,.... , .„.„, Final Contract Amount(as adjusted): . 4 Project Name: „.. ' 41 A Project Address: aii-- , , . - , i ; i/44 -- . r . ate?2.(co ......... .:... . . School District(Project Owner) L . „ . . 4an - -..„ •' - CI c 4 School District Contact Name: - - .• .0. I A - School District Contact Telephone Number: ' ".4 .' I......« Of it , Design Professional(i.e.,Architect or,if none,Engineer): Design Professional Contact Name: • . . Design Professional Telephone Construction Manager(insert"N/A'if none or if Contractor acted as the CM): Construction Manager Contact Name: ...........—...................—......................... Construction Manager Telephone Number. ______ ___,__--------._ Prime Contractor(if Contractor acted as a Subcontractor): Prime Contractor Contact Name: Prime Contractor Telephone Number: General Description of Project and Contractor's Scope of Work: 4 ti ...„ ... •,/, , '' . • , ...........N.PN4.........uar.m................se........m............. / LA'NMI 1 v _ - .' ... •••••..........................................NMI•••MN.OW....d....................• ••••• .••Y••• Nd•........••••••.•.....••••••.....••••••••........••• A1101.1.....1.1000.1.10...MIA..................................................... .11................................................... .............. Originally-Scheduled Completion Date: Contract Tune Extensions(number of days): C) . ..... —„............................................................ Actual Completion Date: ' , - OJT INF (Make copies of blank sheet as needed) 11 of the Questionnaire); Contract No.(as designated in Question 3 of Section __„psi.k,,,,I--efi"' .._.-......... Y Contract Date: ; Final Contract Amount(as adjusted): ....,. .... , 4 Project Name_ „.r, y ,,,r i r I. Project Address: �.. M, , i z Project Owner): Z. . A , ..:: :1, istrict Contact Name: •,,.11f: School D� � .' • . School District Contact Telephone Number_24,3_,...._ , Design Professional(i.e.,Architect or,if none,Engineer): Design Professional Contact Name: Design Professional Telephone Number: Construction Manager(insert"N/A”if none or if Contractor acted as the Cly): 4 -: u Construction Manager Contact Name: Construction Manager Telephone Number: Prime Contractor(if Contractor acted as a Subcontractor): Prune Contractor Contact Name: Prime Contractor Telephone Number: General Description of Project and Contractor's Scope of Work: ) .,,,A ". , 7"` l - ,� ,0 k C1'- F 11. i . OP wiwwr.+w-rw✓ 1. ,' F h .ww Originally-Scheduled Completion Date: ____,4....i/YIL "4% CContract Time Extensions(number of days): _ 0 -- o ....pessess...............ar:;1111rm......................“.....womiess........................................r Actual Completion Date: if ADDENDUM #1 ADA ACCESS RAMPS AND SIDEWALK IMPROVEMENTS ON PVDW PROJECT # 601659-14 Al CiTYOF 4' \\ RANCHO PALOS\AMES ADDENDUM NO. I. TO THE CONTRACT'DOCUMENTS,SPECIFICATIONS, & STANDARD DRAWINGS FOR THE ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW PROJECT#60165944 In accordance with "Addenda" on page I-) of the "Instructions to Bidders", the following changes (revisions, additions, and/or deletions) as noted below, are hereby incorporated and made a part of the subject plans, specifications and contract documents for this project. Portion S of the Contract, not specifically mentioned in the Addendum,remain in force.All trades affected shall be figly advised of these revisions,deletions,and additions. This Addendum forms a part of the Contract Documents for the above-identified project and modifies the original specifications and Contract Documents. Each bidder shall be responsible for ascertaining,prior to submitting a Bid,that it has received all issued Addenda and shall ACKNOWLEDGE RECEIPT OF THIS ADDENDUM IN THE SPACE PROVIDED BELOW. A bidder's failure to address the requirements of this addendum or failure to acknowledge the receipt of this addendum may result in that Bid being rejected as nonresponsive. The subject contract documents are hereby amended as follows: Item 1 .The latest Federal Wage Decision issued, dated November 6, 2015. The attached.Federal Wage Decision and CDBG forms shall supersede Appendix IV included in the specifications. Item 2-Reference Specification Page NC-I.The date for submittal of bids is revised. The updated Notice Inviting Bids,Page NC-IR, is attached. Item 3-RFT I,Question I &Answer , Q. Appendix V calls for professional liability insurance and pollution liability insurance. Does the bid require professional liability and pollution liability insurances? A. Yes, per Appendix V,insurance is needed for professional liability and pollution liability.Please see page C-24 of the contract section 11.Check the box for pollution Liability and,only if you are using professional services,add in Professional liability on a blank line. Item 4-RI/ I,Question 2&Answer Q. Page NC-I states that the bid date is Monday,December 1. December 1 is a Tuesday. Is Tuesday, December I the correct bid date? A. This is to be addressed in Addendum 1,Item 2.The bid opening is Tuesday December 1,2015 at 10:00 AM. Page 1 of 3 Item 5. RSI I,Question 3&Answer Q. Regarding concrete and masonry walls plan sheets SI and S2 show concrete retaining walls,and plan sheet S3 shows CMU retaining walls as an alternate. The AARCON report in the specs has info for both concrete and CM1J wads, a. Biditem 3 covers a block wall retention structure. i, What spec covers the scope(location,dimensions,etc.)of this block wall retention structure? ii. Is the block wall retention structure temporary? iii. Is the removal of the block wall retention structure a part of the bid? iv. Are the plans for the CMU retaining wall for the temporary block wall retention structure? v. Construction Note "D" on plan sheet 2 calls for `provide support or remove as needed". Can the City quantify how much wall is to be supported and how much is to be removed? b. Bid item 4 covers a concrete retaining wall, i. Does the City want a concrete or CMU retaining wall? ti. Is there an alternate bid for the CMU retaining wall? iii. Is it up to the bidder to decide which type of wall to bid? A. The structural plans are for the new construction only. a. This bid item covers dealing with the existing private walls or fences that are not stable and the effort it may take to protect the new work to be constructed. This effort is to include what is necessary depending on what is uncovered once the shrubs are trimmed up to providing a temporary support system to create a safe working area for the project. Also, if the existing wall is so unstable that removal is necessary,that removal is included in item no.3. See Section 12,page SP-5 i, There are no locations or dimensions available. ii. If support is needed,it will be temporary and removal is not part of this project. iii. No iv. No,there are no plans for any temporary support structure. The configuration will be up to the Contractor and communicated to the City with a shop drawing submittal. v. No,it will depend on what is uncovered following the trimming. b. See responses below,i,ii,iii: i. There is an alternate bid item for the wall. It is intended for the Contractor to bid on or the other. ii. Yes,see the bid sheet. iii. Yes Item 6-I I I,Question 4&Answer Q. In order to installed the new retaining wall,the existing vines and shrubs will probably have to be removed. If the vines are removed from the side of the wall facing PVDW,then the vines on the other side(the side facing the home)might die depending on which side the roots are on. a. Will the homeowners be OK with the vegetation dying? b. Will the Contractor be responsible for removing the vines from the homeowners'side of the wall? Page 2 of 3 c. Will the City coordinate with the homeowners for access to the backyards? Mr„wr..v+.•.w-r.:..+:..rr:... ..:.. ..v; i. .. r r. :...v.t...... ........nv A. All vegetation originating in the City Right of Way should be cleared and grubbed where R � appropriate. Said vegetation that has infiltrated private property shall be removed by the contractor and not left dead in private property. Contractor shall not go onto private property without consent of the private property owner.Coordination with Private Property owners will be conducted by the City,its officials,employees,or agents, Vegetation originating in private property that has encroached into City Right of Way should be trimmed back to the property line at the furthest and done so in a way to keep vegetation alive. Once again,coordination with private property owners will be conducted by the City,its officials, employees,or agents. BIDS MUST BE RECEIVED BY: 10:00 a.m.Tuesday,December 1,2015 End of Addendum No. I Any questions regarding this Addendum should be directed to the Project Managers James Flannigan at (310)5444277. r it°OW I S' iiyiHl.. MWM.. NprorveerN Ape Michael Tb e Date Director of Public Works acknowledge receipt of this, No. I. and accept the aforementioned. ..i ROM`:KN/frt!(K((WffMt'.tt4.pyM.K�a � '�WIOt•N:.. -7:5 2- S-1 Bidder's Signature Date Please sign above and include this signed addendum in the Bid package..Failure to do so may result In that wilduidmildammtrumix..,H; e Page 3 of 3 ADDENDUM #2 ADA ACCESS RAMPS AND SIDEWALK IMPROVEMENTS ON PVDW PROJECT # 601659-14 CITYOF RANCHO PALOS ADDENDUM NO.2 TO THE CONTRACT DOCUMENTS,SPECIFICATIONS, & STANDARD DRAWINGS FOR THE :.. ..•: .: v.•rw.vrw•:.w..w.v.::..:.r.:.r.r.:•:v•r:[:.r•..:.r.:.:r•rvr: :.nn..::•::.. ...::'rrv[.•n.::...r...r.f..:. .:. .....:.•....r.:rv:•...r[.•...rrn[4':.•...+vn.:r.r..r.::.n.r..<.•1.:.•:[:•.n.••rr...:N.f•N.:............. .........•..r........... ...r.. .... •. ..r...... ..r. Irvn•f•.•....f..r..r..., .....r..:...:.f....:.<:..f.y..r...r...:....n.....p.y..::.n:.nn..nvfr•rrrv.•te:.v.c[.ww.wrrv.Mui.r!•-:M.•r:rvr.wmrw.rrvrf[rvrrrvry wrv.ww.ww N N •[r ADA ACCESS AND SIDEWALK IMPROVEMENTS ON PVDW PROJECT#60165944 In accordance with "Addenda" on page I-1 of the "Instructions to Bidders", the following changes (revisions, additions, and/or deletions) as noted below, are hereby incorporated and made a part of the subject plans, specifications and contract documents for this project. Portions of the Contract, not specifically mentioned in the Addendum,remain in force.All trades affected shall be fully advised of these revisions,deletions,and additions. This Addendum forms a part of the Contract Documents for the above-identified project and modifies the original specifications and Contract Documents. Each bidder shall be responsible for ascertaining, prior to submitting a Bid, that it has received all issued Addenda and shall ACKNOWLEDGE RECEIPT OF THIS ADDENDUM IN THE SPACE PROVIDED BELOW. A bidder's failure to address the requirements of this addendum or failure to acknowledge the receipt of this addendum may result in that Bid being rejected as nonresponsive. The subject contract documents are hereby amended as follows: Item 1 - Reference Specification Page NC-1R from Addendum No. 1. The date for submittal of bids is revised. The updated Notice Inviting Bids,Page NC-1RR,is attached. Item 2 -Updated language has been added to"Prevailing Wage"located on page NC—2 of the original bid document specifications.The updated Notice Inviting Bids,Page NC-2R, is attached. Item 3 - Information for"Apprenticeship Program"has been added to Page NC-3R of the bid documents specifications and is attached. Item 4-Updated language has been added to"Bid Sheet"located on page P—3 of the original bid document specifications. The updated Bid Sheet,Page P-3R,is attached. Item 5-Updated language has been added to Special Provisions of the original bid document specifications. The updated Special Provision on Page SP-15R and SP-16R is attached. This change adds an item 17 "Construct Temporary Slope and Block Wall Support Structure." Item 6-RFI 2, Question 1 &Answer Q. Addendum 1 states that there is an alternate bid item for the CMU wall(as an alternate to bid item 4,the concrete wall). The bid proposal only has seven bid items and no alternate items; there is no bid item for a CMU wall. Is there an alternate bid item for the CMU wall? A. This is to be addressed in Addendum 1,item 4.There is an updated bid sheet. Page 1 of 2 Item 6-RFI 2,Question 2&Answer Q. Bid item 7 is for"traffic striping" but the plans don't show any striping work. What scope does ...,...: bid...item...7...cover' .........:.:...:.:.....:................ ::.... .. w ..w ._.µ ..:.wµ. .w.._.........µ...................... A. This is to be addressed in Addendum 1,item 4.There is an updated bid sheet. BIDS MUST BE RECEIVED BY: 11:00 a.m.Thursday, December 3,2015 End of Addendum No.2 Any questions regarding this Addendum should be directed to the Project Manager,James Flannigan at (310)544-5277. kiftWi i;, r 140V 3o 2.oI5 Michael Throne Date Director of Public Works tiels:___,,, I acknowledge receipt of this Ad nd 'o. 1 and accept the aforementioned. p .._1 jr7.744 - 's ',..:z tt 3e7( 2_0( Ss Bidder's Signature Date Please sign above and include this signed addendum in the Bid package.Failure to do so may result in that Bid! i.iire ected:. n. utres ons e. Page 2 of 2 Shahrooz Shahnavaz November 27, 2015 DASH Construction Company, Inc. P.O. Box 261321 Encino. CA 91426 Mr. James Flannigan,Assistant Engineer City of Rancho Palos Verdes Department of Public Works 30940 Hawthorne Blvd. Rancho Palos Verdes, CA 90275 Office Phone (310) 544-5277 RE: 4DA.CCESS.AND SIDEWALK IMPROVEMENTS Dear Mr. Flannigan, I am the Secretary for DASH Construction Company, Inc. I hereby authorize Dariush Shahnavaz to sign anydocuments on my behalf for the above referenced project. If you have anyquestion,please do not hesitate to contact me directly on my phone at(818) 400-3531 Best Regards cs, 4-k-r-cm64 (310-411?"-- Shahrooz R. Shahnavaz 1 Errors detected cannot file this statement 401174t-ei, ./,‘":40 t„, A 111PKI"- State of California;, Secretary STATEMENT OF INFORMATION (Domestic Stock Corporation) Fees $25.00. IMPORTANT - instvaiQnsRead .� before completing this S1-200-NC form. e-filed statements are not provided a t the time of filing. Therefore, you • Copies of� a flied copies • - for our records prior to submission.rent the com feted pages y nr�ay wtsh top pe �►rt�s..�3�'t��r usingour Ss�ness �ntitIeS.. :� ............ e documents may be requested �.. of filed [.[:..... form. _... CORPORATION N NUMBER, NAME AND ADDRESS CO C2914749 DASH CONSTRUCTION COMPANY, INC. 727 E CYPRESS AVENUE UNIT ## 101 BU RBAN K, CA 91501 ininformation conta;r1ed in the last Statement of IIf there has•been no change .any of the . 2.: � Information filed�with the CaliforniaCaSecretary of State, check the box and proceed to Item in the last Statement of have been any changes to the information containedusl If there � State, or no statement has been previously Information filed with the CaliforniaSecretaryof filed, this form must be completed In Its entirety. OFFICE (DO NOT USE PO BOX) STREET ADDRESS PRINCIPAL EXECUTIVE D D RS5 727 E CYPRESS AVENUE t.i..�..�y,,{•.:.:V..: 4.'.:::. I UNIT# 101 CITY STAT: ZIP CODE COUNTRY O1BURSNK vF5/77 �. . _ [-N.vA,.{A...4«W..-. • • NOT • OFFICE IN CALIFORNIA, IF ANY ADO STREET ADDRESS•OF PRINCIPAL�BUSINESS USE Po BOX) DDRESS CITY STATE ZIP CODE CA r"----; THE CORPORATION, IFDIFFERENT THAN ITEM 3 5�. MAILING ADDRESS N CARE OF/ATTENTION [.4 A.: v v.::Y••'wY 971:N:./._. [tv.Ay .DDRS httns://husinessfilings.sos.ca.gov/frm200:asp 1/21/2008 ITY stAIE ZIP CODE COUNTRY______________ r---1 'UNITED STATES , , ... • w s......., . • , .......,,,,, . . 1ST THE NAMES AND COMPLETE ADDRESSES OF THE OFFICERS(The corporation must have these three •fficers. 6. CHIEF-EXECUTIVE-OFFICER - , . , v FIRST MIDDLE LAST ' DARIUSH I---- SHAHNAVEP7r: ---- DDRESS 727 E CYPRESS AVENUE i UNIT#101 101 , , . ... . A.,/AA,...4....., ne.,A.,AN ,. , •• A. ••••AM .,X, ,1 ITY ILO. ZIP CODE COUNTRY BURBANK _....._,,..] 1:5777 Pc77:7: N1TED STATES1 . SECRETARY FIRST MIDDLE LAST SHAHROOZ , REZA 'SHAHNAVAZ . ADDRESS 727 E CYPRESS AVENUE ' UNIT# 101 ITY SIVE ZIP CODE COUNTRY___________ ...... ............. .................._ BURE3ANK,, ,, 915CF-71-- rtiNvITED STATES CHIEF FINANCIAL OFFICER FIRST MIDDLE LAST SHAHROOZ FEZI7*---SHAI-Wr-siKTZ---I A DDRESS , 727 E CYPRESS AVENUE ' UNIT# 101 . ITY sw.gZIP CODE COUNTRY BURBANKCA ' FEE- UNITED STATES ,47. .,• ...• .. • ... ,,,,,,thAr.,,A4 4 , A. AA...•. 0 Aw• ,MA,A..,./..,r.......4...`WA.A.,4, ,.4A•A A., , A+ ,Ar..A.A.., . , 1ST THE NAMES AND COMPLETE ADDRESSES OF ALL DIRECTORS, INCLUDING DIRECTORS WHO ARE A LSO OFFICERS he co ••ration must have at least one director. • FIRST DARIUSH MIDDLE--14*-----'AHNAVAZ DDRESS 727 E CYPRESS AVENUE , ... •...... UNIT#101 CITY ZIP CODE COUNTRY BURBANK ; lar- i07-7 kriNITED STATES 10. Duplicate director name found, FIRST MIDDLE LAST .__ ...... . _ SHAHROOZ , IREZik .,_. 11S,1-1, 1-INAVAZ A DDRESS htt-rtill/4%11 QinPgqfilii‘og.-sng-eaa...p.ovifrm200.aso - . ,.. 1/21/2008 , : ' 727.E CYPRESS AVENUE, UNIT# 101 i , ,..., ,... ..... •• . ........,..., IVSIETE ZIP CODE COUNTRY BURBANK I ci7:77 197.17-, UNI1E7*--)S1-1-sATES-----143 11. RST ' ' - MIDDLE , , -LAST , DDREss „. .s. •............„. . • ,....„....., , ary7ErATE ZIP CODE COUNTRY 1 -77STATES 12. NUMBER OF VACANCIES ON THE BOARD OF DIRECTORS, IF ANY: I-7 13. CHECK THE APPROPRIATE PROVISION BELOW AND NAME THE AGENT FOR i SERVICE OF PROCESS 1111N INDIVIDUAL RESIDING IN CALIFORNIA .GENTS FIRST • DARIUSH MIDDLE LAS [7"---"r SHAI1NiWA4 aCORPORATION WHICH HAS FILED A CERTIFICATE PURSUANT TO CALIFORNIA ORPORATIONS CODE SECTION 1505. AME OF CORPORATE AGENT AAA( List, 14. STREET ADDRESS OF THE AGENT FOR SERVICE OE PROCESS IN CALIFORNIA, IF AN INDIVIDUAL ADDRESS ... . pi27 E CYPRESS---- AVENUE----- ismw:vatullerilswiwavAlwywormsliMirsawrosarmellsioNfossuillinmeiNAwsattaiNalwatimws.....mtvarmawmamsAmMoslaWMAIIINNIsru,N IT#1 0 1,,..., ,w.,. , ,,,......,.....,,,,,,,,,,,,, CITY STATE ZIP CODE . . BURBANK CA Fri is. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION ONSTRUCnrOlr---- "----- 4,...„...,,, +,...,„„ ,... , ......,...........„",„. 16. ENTER THE NAME AND TITLE OF THE PERSON COMPLETING THIS STATEMENT. BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE CALIFORNIA SECRETARY OF STATE, THE CORPORATION CERTIFIES THE INFORMATION CONTAINED HEREIN, INCLUD ANY ATTACHMENTS, IS TRUE AND CORRECT. DATE TITLE FIRST MIDDLE LAST 1/21/2008 FFEF714A674 SHAI-tn :166rrn-E-zA---isHAi- ivNA2 cmlotk-,:tliTil lir*Pskt;',,,, ,:-':'''',':!:,..liiiiii-' . ... ....., ................._....., . ..........._,, ........,....,. ....._......._ .., ...,....... ... . ..... ,. .., ........• _..............•.•.. ____ v... .. 1,44,...•//kileiliAcc.SUtierc ena na anv/frm/.00.asn 1/21/2008