Professional Pipe Services CITY OF RANCHO PALOS VERDES
MAINTENANCE AGREEMENT
THIS AGREEMENT ("Agreement") is made and entered this 1St day of June, 2015, by and
between the CITY OF RANCHO PALOS VERDES, a California municipal corporation ("City")
and Professional Pipe Services ("Contractor"). Contractor's license number is 761395 A, C36,
C42.
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
Abalone Cove Sewer Manhole Inspections and Sewer Lift Stations Cleaning &
Inspections ("Project"), as described in this Agreement and in the Bid Documents
(including the Scope of Work and Plan Sheet as prepared prior to submitting his/her
proposal setting forth any modifications or interpretations of any said documents), which
are attached hereto as Exhibit "A" 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 under written 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. Term. This Agreement shall commence on July 22, 2015 and shall remain in effect until
the tasks described herein are completed to the City's approval, but in no event later
than August 30, 2015, unless sooner terminated pursuant to Section 13 of this
Agreement.
4. Time. Time is of the essence in this Agreement.
5. 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.
6. Compensation. In consideration of the services rendered hereunder, City shall pay
Contractor a not to exceed amount of Sixteen Thousand Seven Hundred Ten Dollars
($16,710.00) in accordance with the prices as submitted in Contractor's Proposal,
attached hereto as Exhibit "B" and incorporated herein by this reference.
7. Payments. City shall make payments within thirty (30) days after receipt of an
undisputed and properly submitted payment request from Contractor. City shall return to
Contractor any payment 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.
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. Audit. The City or its representative shall have the option of inspecting and/or auditing all
records and other written materials used by Contractor in preparing its billings to the City
as a condition precedent to any payment to Contractor. Contractor will promptly furnish
documents requested by the City. Additionally, 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.
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 not be excused from any scheduled completion date
provided for by the Agreement, but shall proceed with all work to be performed under the
Agreement. Contractor shall retain any and all rights provided that pertain to the
resolution of disputes and protests between the parties. 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. Termination. This Agreement may be canceled by the City 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.
12. Indemnity.
a. Contractor's Duty. To the maximum extent permitted by law, Contractor shall
defend, indemnify, and hold the City, its elected officials, officers, employees,
volunteers, agents, and those City agents serving as independent contractors in
the role of City officials (collectively "Indemnitees") free and harmless from and
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R6876-0001\1348971 v1.doc Maintenance Agreement
against any and all claims (including, without limitation, claims for bodily injury,
death or damage to property), demands, obligations, damages, actions, causes
of action, suits, losses,judgments, fines, penalties, liabilities, costs and expenses
of every kind and nature whatsoever, in any manner arising out of or incident to
the performance 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. Civil Code Exception. Nothing in the paragraph above this one shall be
construed to encompass Indemnitees' sole negligence or willful misconduct or
the City's active negligence to the limited extent that the underlying Agreement is
subject to Civil Code section 2782.
c. 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.
d. Waiver of Right of Subrogation. Contractor, on behalf of itself and all parties
claiming under or through it, hereby waives all rights of subrogation against the
Indemnitees, while acting within the scope of their duties, from all Claims arising
out of or incident to the activities or operations performed by or on behalf of the
Contractor.
e. Survival. The provisions of this Indemnification and Hold Harmless Agreement
and Waiver of Subrogation and Contribution 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 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.
13. 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); and Additional Insured Endorsement (Excess
Liability).
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14. 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.
15. Prevailing Wages. City and Contractor acknowledge that this project is a public work to
which prevailing wages apply. The Agreement to Comply with California Labor Law
Requirements is attached hereto and incorporated herein by this reference. Eight hours
of labor constitutes a legal day's work.
16. 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."
17. Nondiscriminatory Employment. Contractor shall not unlawfully discriminate against any
individual based on race, color, religion, nationality, gender, sex, sexual orientation, age
or condition of disability. Contractor understands and agrees that it is bound by and will
comply with the nondiscrimination mandates of all statutes and local ordinances and
regulations.
18. Debarred, Suspended or Ineligible Contractors. Contractor shall not be debarred
throughout the duration of this Agreement. Contractor shall not perform work with
debarred subcontractor pursuant to California Labor Code Section 1777.1 or 1777.7.
19. 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.
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20. Bonds. Contractor shall obtain faithful payment bond 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 form entitled Payment Bond (Labor
and Materials) is attached hereto and incorporated herein by this reference.
21. 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.
22. Conflicts of Interest. 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.
23. 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.
24. 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.
25.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.
26.Attorneys' Fees. If any legal action or other proceeding, including action for declaratory
relief, is brought for the enforcement of this Agreement or because of an alleged dispute,
breach, default or misrepresentation in connection with this Agreement, the prevailing
party shall be entitled to recover reasonable attorneys' fees, experts' fees, and other
costs, in addition to any other relief to which the party may be entitled.
27. 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.
28. 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.
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29. 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. This Agreement may not be modified or amended, nor
any provision or breach waived, except in a writing signed by both parties which
expressly refers to this Agreement.
30. 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.
31. 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 Consultant 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 Consultant, 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.
32. 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 Blvd.
Rancho Palos Verdes, CA 90275
To CONTRACTOR:
The address listed in Exhibit"B."
33. 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.
34. 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.
[signatures on next page]
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R6876-0001\1348971v1.doc Maintenance Agreement
IN WITNESS WHEREOF,the parties hereto have executed the within Agreement the day and
year first above written.
CITY OF RANCHO PALOS VERDES
By: e4AA'
City Manager
ATTE • '
City Clerk
001/6,--
Dated:
(`CONTRACTOR")
By:
Printed Name: cal-6\i € VC)14)0A--
Title: VIAAPiksf:----teg----
By:
Printed Name:
Title:
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R8876-000111348971v1.doc Maintenance Agreement
EXHIBIT A
Scope of Work
Description: Provide 72 sewer manhole inspections and 4 sewer lift stations cleaning&inspections in
the Abalone Cove Sewer System(as shown on map attached).
Proposal includes the following:
*All labor, materials and equipment
* Confined space entry if required
* Combination Vactor truck for cleaning
* CCTV inspection truck
* Cleaning and removal of debris from 4 lift stations
* Includes pictures and written inspection reports including any recommendations for
corrective actions if needed
*Traffic control per the latest CAMUTCD edition
*Traffic control plans sealed by a P.E.will need to be submitted by the contractor and
approved by the City for lane closures longer than 30 minutes on major/principal roads and
arterials
* Disposal of debris removed from lift stations
* Construction water meter for cleaning
* Insurance
* Payment Bond
* City Business License
Exhibit A
_____
ABALONE COVE SEWER MANHOLE INSPECTIONSAND
SEWER LIFT STATION CLEANING & INSPECTIONSPROJECT
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LEGEND
O Sewer Manhole
RANCHO LOS ERDES
8" Sewer Pipeline
L.414.
30940 HAWTHORNE BOULEVARD RANCHO PALOS VERDES,CA 90275 --*-- Force Main
s
EXHIBIT B
Hoffman Southwest Corp.dba
Professional Pipe Services fPro-Pipe]
CA License#761395(A,C36,C42) .40 249 S Paseo Tesoro,Walnut CA 91799
0:909 598 9746 I F'909 598 9756
Quote a to: Jeff Garcia I M:626-893-9543
Page 1 of 1 CA Registration 1000000081 Jearcia@hswcorp.com I oro-Dioe.com
PROPOSAL SUBMITTED TO: DATE PHONE
Rancho Palos Verdes 5/20/2015 310-544-5333
STREET(Business address) JOB/PROJECT NAME
30940 Hawthorne Blvd. Sewer Manholes and Lift Station Inspections
CITY,STATE AND ZIP CODE JOB LOCATION
Rancho Palos Verdes,CA 90275 Abalone Cove,Rancho Palos Verdes,CA
CONTACT NAME EMAIL Prices Reflect Prevailing Wage Rates
Nadia Carrasco nadiactorpvca.aov
ITEM DESCRIPTION QTY UNIT PRICE TOTAL
1 Use IBAK Panoramo SI Unit to inspect 72 manholes 72 EA $105.00 $7,560.00
in Abalone Cove.City will receive digital inspection
of entire manhole from rim to invert along with
MACP reports.
2 Use combo truck to vacuum out lift stations and
spray down walls with high pressure gun.Use 4 EA $2,200.00 $8,800.00
CCTV camera to inspect lift station and note
defects.
3 Cost of Bonds/Business License 1 LS $350.00 $350.00
Liquid will be decanted back into MH and solid
debris will be disposed of offsite. If debris exceeds
one full load(10 cubic yards)a charge of$1,200.00
for each additional load will apply.
GRAND TOTAL: $16.710.00
EXCLUSIONS (any qualifications to exclusions are in earenthesis
1 Bypass pumping and operating pump stations
2 Environmental/erosion control
3 Permits,licenses and performance bonds
4 Excavation of any kind
5 Access-(Owner shall provide adequate access)
6 Additional mobilizations-(proposal is based upon 1 instance of mobilization for the above services)
7 Cleaning of manholes
8 Locating buried manholes
9 Repairing lift stations
10 Off-site disposal of debris from lift stations in excess of one full load(10 cubic yards)
WE PROPOSE hereby to furnish material and labor--complete in accordance with above specifications,for the sum of
Payment terms: Dollars: $16,710.00
30 Days of Invoice This proposal shall be incorporated into the service contract when
Pro Pipe is listed as a subcontractor.
AH material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from
above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements
are contingent upon strikes,accidents,or delays beyond our control.Owner&Professional Pipe Services to carry general liability,workman's compensation fund
and other necessary insurance.Maximum allowable interest charge on overdue invoices.
Professional Pipe Services Authorized Signature:
This proposal may be withdrawn by us if not accepted within 30 days.
ACCEPTANCE OF PROPOSAL:
The above prices,specifications and conditions are satisfactory and are hereby acceptedYou are authorized to do the work as specified.
Requests for additional services beyond the above outlined scooewill be submitted by written chanae order and payment thereof made accordinalv.
Date Customer Signature
BONDS ISSUED IN DUPLICATE ORIGINALS
Bond N o. 106226892
PAYMENT BOND Premium: $133.00
(LABOR AND MATERIALS) Premium based on final contract amount.
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the City of Rancho Palos Verdes, California ("Public Agency"), has awarded to_
Hoffman Southwest Corp., DBA Professional Pipe Services, 23311 Madero, Mission Viejo, CA 92691
(Name and address of Contractor)
("Principal"), a contract (the "Contract"), which is incorporated herein by this reference, for the work
described as follows:
Abalone Cove Sewer Manhole Inspections and Sewer Lift Stations Cleaning& Inspections
WHEREAS, Principal is required under the terms of the Contract and the California Civil Code to file a
good and sufficient payment bond with the Public Agency to secure the payment of claims of laborers,
mechanics, material persons, and other persons as provided by law.
NOW, THEREFORE, we, the undersigned Principal, and
Travelers Casualty and Surety Company of America, 21688 Gateway Center Drive Diamond Bar, CA 91765 ,
(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 subcontractors, laborers, material persons, and other
persons employed in the performance of the Contract in the penal sum of
Sixteen Thousand Seven Hundred Ten Dollars and 00/100ths
Dollars ($16,710.00 ) (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
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, his, her or
its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the
persons named in Section 9100 of the California CMI Code, or any amounts due under the
Unemployment Insurance Code with respect to work or labor performed under the Contract, or for any
amounts required to be deducted, withheld, and paid over to the Employment Development Department
from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the
Unemployment Insurance Code, with respect to work or labor performed under the Contract, the Surety
will pay for the same in an amount not exceeding the Penal Sum specified in this bond; otherwise, this
obligation shall become null and void.
This bond shall inure to the benefit of any of the persons named in Section 9100 of the California Civil
Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond.
In case suit is brought upon this bond, Surety further agrees to pay, in addition to the Penal Sum, all
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.
R68 76-00011168 2 8 2 2v 2.doc
C- 1
Further, the Surety, for value received, hereby stipulates and agrees that no change, extension of time,
alteration, addition or modification to the terms of the Contract, or of the work to be performed there
under, or the specifications for the same, shall in any way affect its obligations under this bond, and it
does hereby waive notice of any such change, extension of time, alteration, addition, or modification to
the terms of the Contract or to the work or to the specifications there under. 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: June 2, 2015
"Principal" "Surety"
Hoffman Southwest Corp., DBA Professional Pipe Services Travelers Casualty and Surety Company of America
By: By: yi
Its Monte . Yoder, VP of Fi ance Its 2eo &F
a
By: By:
Its Its
(Seal) (Seal)
APPROVED AS TO SURETY AND PRINCIPAL APPROVED AS TO FORM:
AMOUNT
RICHARDS, WATSON &GERSHON
A Professional Corporation
By: By:
Insurance Administrator Public Age cy Attorney
R6876-0001\1682822v2.doc
C-2
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.
R68 76-000111682 822v2.doc
C-3
k. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy,or validity of that document.
STATE OF CALIFORNIA
County of San Diego
On JUN 0 2 2015 before me, Aireanna Mannerud Brown , Notary Public,
Date Insert Name of Notary exactly as it appears on the official seal
personally appeared Margie Wager
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they
2'��` "�"�`��.;�..�a.��` r„� executed the same in his/her/their authorized ca aci les ,
REANiAMANNEBROWN''' and that by his/her/their signature(s) on the instrument the
:•��.� Commission# 1961280
,�~ person(s), or the entityupon behalf of which the person(s)
a 6-4�:�:•,;+�)o, Notary Pub{ic-California z p p ( )
z tz . a acted, executed the instrument.
,,, San Diego County
L ::
My Comm.Expires Nov 20,2015 I certify under PENALTY OF PERJURY under the laws of
the State of California that the foregoing paragraph is true
and correct.
Witness my ,nd and fficia seal. a I'
Signature 0
Place Notary Seal Above Si. .ture of Notary Public
OPTIONAL
Though the information below is not required by law it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of the form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies)Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer Title(s): ❑ Corporate Officer-Title(s):
❑ Partner ❑Limited ❑General ❑ Partner ❑Limited❑ General
® Attorney in Fact RIGHT THUMBPRINT ❑ Attorney in Fact RIGHT THUr.lBPR'NT
❑ Trustee OF SIGNER El Trustee OF Si GNER
❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here
❑ Other: El Other
Signer is Representing: Signer is Representing:
WARNI HIS POWER OF ATTORNEY IS INVALID WITHOUT THE BORDER
. , 410k POWER OF ATTORNEY
TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company
y
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company
224302
Attorney-In Fact No. Certificate No. 005 9
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company,St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the
laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint
Margie Wager
of the City of Escondido ,State of California ,their true and lawful Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 10th
day of July 2014
Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company
G 1 S V�/� 411‘.1111 . 1'111•,,
(tarz.,,,,,x�� ,y ��NIks P�NSq, Jp�,ZY ANpY0 O�t'~I��� 1�WR�,Iw��Ny�� fJ i_¢ fLORP°RSI>F �`J'.RPOR47...t'. - �'110 �+4. ��t 19SZ O t 1977 t �n�►1 ,TED • 4 7 Rf= Vr; "'4 T' iC:Cw� C:C,: R �AR FORD. L a tYVirFoRD.�+\ 4, 96 �1VgtvE*cfp4). - 1951 - , Ilt' 1 ,%SEAL�o`'s It'',SE�i. p
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State of Connecticut By: / '
I
City of Hartford ss. Robert L.Raney, enior Vice President
On this the 10th day of July , 2014 ,before me personally appeared Robert L.Raney,who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul
Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers
Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
G•'M
In Witness Whereof,I hereunto set my hand and official seal. ' c . .-/J4letAARd+
My Commission expires the 30th day of June,2016. * / `�G v* Marie C.Tetreault,Notary Public
C
58440-8-12 Printed in U.S.A.
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
WARN!' 'HIS POWER OF ATTORNEY IS INVALID WITHOUT THE r BORDER
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,,rid;lity
and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance
Company, St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows:
RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice
President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf
of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is
FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary;and it is
FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking
shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice
President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,
any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds
and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance
Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and
Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing
is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked.
JUN 022015
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of ,20
Kevin E.Hughes,Assistant Sec tary
'►SU �����'�►.� FIRE �� 1 NS, PttY AN, �.p�fY'Y
G 4,�, s '' ~ 'fir 0\�.......�G9 4,951747›. gJ dG it � �t�
fit% �xltpRP01iA�Ftl'f �: poa,vrf°r+
t 19 8 2 0 a. _ ORATED.� �.�•w — :e �, 1896
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gyp'1•.....•vat d••.......... �D �� 4s % A�
1�' S'•A ' F 1 w 0,
To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the
above-named individuals and the details of the bond to which the power is attached.
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County ofMirifse_,,
On • 1 before me, ..Q
(1- re insert name and title o the 7j'>,a'n
officer)
personally appeared6• �� .�-
who proved to me on the basis of satisfactory evidence to be the person whose name(s/is/arisubscribed to
the within instrument and acknowledged to me that Ise/sWe/thiy executed the same in his/br/thr authorized !'
capacity(is4), and that by leis/liIr/tVir signatures on the instrument the person,or the entity upon behalf of
which the person acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
,,..,. KIM L. SCOTT59757
Commission # 9
WITNES my han s d official seal. Q lie California• z
Notary Pub D
z
Orange County
a r� trnkyd
deff/64t
My Comm.Expires Dec 6,2015
.
irna r t Notary Publ
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exact!;' as
DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notany section or a separate acknowledgment form must be
elki-427411—#A0
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of C alifvr nia. In such instances.ant'alternative
acknowled ment v rg e hruge us rrru�•be printed urs strclt a dvcurrrerrt co loss as the
or dcscri tion of attached document) R_Ma
• verbiage does not require the frowsy to do something that is illegal for a notary in ids 1104fi
California(i.e. certifiing the authorized capacity of the signer). Please check the
('Title or description o attached document continued)
document carefully for proper notarial wording and attach this form if required.
�• ��
• State and County information must be the State and County where the document
Number of Pages 5Document Date
signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
must also be the same date the acknowledgment is completed.
(Additional information) • The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title(notary public).
• Print the 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/eFe)or circling the correct forms.Failure to correctly indicate this
❑ Individual(s) information may lead to rejection of document recording.
g
0 Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges,re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
❑ Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
0 Attorney-in-Fact •: Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
❑ Other + Indicate title or type of attached document,number of pages and date.
a� Indicate the capacity claimed by the signer. if the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
• Securely attach this document to the signed document
2008 Version CAPA v 12.10.07 800-873-9865 www.NotaryClasses.com
Form W.9Request for Taxpayer Give Form to the
(Rev.December 2014) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
HOFFMAN SOUTHWEST CORP
c‘i 2 Business name/disregarded entity name,if different from above
g PROFESSIONAL PIPE SERVICES
Q 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to
certain entities,not individuals;see
❑Individual/sole proprietor or ❑ C Corporation Q S Corporation ❑ Partnership ❑Trust/estate instructions on page 3):
d E single-member LLC Exempt payee code(if any)
o ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)►
• 3 Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for
Exemption from FATCA reporting
E the tax classification of the single-member owner. code(if any)
ac r--1Other(see instructions)0. (I�ppMes tor accounts nwine.in•d ovts'dtM U S.)
V
E5 Address(number,street,and apt.or suite no.) Requester's name and address(optional)
& 23311 MADERO
6 City,state,and ZIP code
cn MISSION VIEJO,CA 92691
7 List account number(s)here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid [Social security number
backup withholding.For individuals,this is generally your social security number(SSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other -
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN on page 3. or
Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter.
9 5 - 2 8 0 0 6 8 0
Part II Certification
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3. I am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage
interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and
generally,payments other than Interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
instructions on page 3. -�
'/
Sign Signature of �,/ y.
Here U.S.person► �G•�. ' �� �'lr�G4 44 t, Date► /. /,�
General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release it)is at www.irs.gov/fw9.
Use Form W-9 only if you are a U.S.person(including a resident alien),to
Purpose of Form provide your correct TIN.
An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2.
which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you:
number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number
identification number(EIN),to report on an information return the amount paid to to be issued),
you,or other amount reportable on an information return.Examples of information
returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If
•Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of
any partnership income from a U.S.trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-B(stock or mutual fund safes and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are
brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat.No.10231X Form W-9(Rev.12-2014)
AlACCIR '' DATE(MMIDDNYYY)
46,.....,46,.....,---
,. CERTIFICATE OF LIABILITY INSURANCE06/03r15
THIS CERTIFICATE IS ISSUED AS A NATTER OF'INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT'AFFIRMATIVELY OR.NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE-POLICIES ,
BELOW. THIS CERTIFICATE•OF'INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the poicy, certain policies may require an endorsement: ..N statement on this certificate does not confer rights to the
- F holder In lieu of such ',J1.2.. • - •
PRODUCER Phone:.949453-9800 '
The Woocitch Company insurance FAX
- Inc. Fax:949-553-067Ck. o.Exe; , i FAX No):
Park.Plaza,Sults 400 .�---.
Inc,CA 9261.4 ' + `
curio/ER ID r:HOFFM63 .
INSURERS).AFFORDIVG,CONERAGE NAIC S
INSURED Hoffman Southwest Corp., INSURER A:Landmark American insurance Co 33138
dbe Professional Pipe Services INSURER B:Liberty Mutual Fire Ins.Co. 23035
23311 Madero. INSURER C:Sentry Casual:Co. 284$0
Mission Viejo,CA 92691
INSURER D:
INSURER E:
INSLIBER F! y
• A • . I g L. ; I k ,. : .Z. ► 4.,i.-L,1 k ,_ - qt
THIS 1S TO CERTIFY THAT THE.POLICIES OF INSURANCE LISTED BELOW HAVE.BEEN ISSUED TO THE INSURED'NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT', TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
i; TYPE OF INSURANCE % •1.-Ly ►: �: „I.i,�!:IFtA t.: 11•.:•�t�! •LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,1 1 1
.7,,,.N • -.., 2
A X 'CC*J ERCIAL GENERAL LrAeILmr X LHA137966 '12131/14 12131115 --,, isEs Ea oc u 100,1 i l
CLAIMS-MADE [K]OCCUR ; MED EXP(MY one person) $ 5,•1.
PERSONAL•KUV INJURY $ 1,000,1 1 1
GFiERAI AGGREGATE 3 2,00%,1 1 1
Galt A6GREGAIE LIMIT APPLIES PE 1 PRODUCTS-co c,oP AGG $ 2,000,001
•
Orn tr:Y n PRa- III I r,r: • $
AUTOMOBILE LABILITYCOMBINED SINGLE LIMIT
X (Ea accident) ?.,0001 1
B .X ANY O ' 2-Z61-065426-014 12131114 1213'1/15 BODILY Y.(Per person) $
ALL OWNED AUTOS. BODILY INJURY(Per accident) $
9GI DULED AUTOS PROPERTY WAGE
X HIRED AUTOS ('Per accident)
X NON-OWNED.AIJTOS $
$ .
UMBRELLA LIAR OCCUR EACH.00CU t
'EXCESS LMB CLAIMS-MADE I AGGREGATE $
DmL1CTIDLC
t
•
',3L�1 •
WORKERS COMPENSATION X •• ' , .
AND•EMPLOYERB'LIABILITY EWA t` �;
C A PROPR ETA T CLIME Y I R N, '= 20147-01 12131114. 12141115: a t.�ACCIDENT' $ 1,000,1 11
OFF(Mandatory In NH) E.L.DISEASE-EA LOYEE $ 1,000,0
11
' =-.describe.under EL DISEASE-POLICY LIMIT 1 000 Ott
111
DESCRIPTJON•OF OPERATIONS/LOCATIONS/VEHICLES/Midi ACOR)101,Addition Remarks 8ct sdWe It moI*spdee Is rrqtdreedd� •
Except 10 Days Notice of Cancellation .for.Nan-Payment-oto Premium (B#63)
'4 : Abalone eve Manhole/Lift Stations Cl ''ng & �Inspeetions/CCTV. City of
.
• 0 Palos Verdes s 4.ngluded.as.Additional Insured as- respects General
f 'ability and Auto Lability per attached endo sements
*SCE NOTES** .lai wv/auaiwv/.wcwvfwet
r2 _ .• I . : • _ ,•.,
RANCI-It)P
SSD.ANY OF'THE ABOVEDESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREO', NOTICE tVILL 8E DELIVERED 8I
ACCORDANCE WITH THE POLICY PRCVISIONB.
City of Rancho Palos Verdes
30940 Hawthorne Blvd. AUTrIORJZEb REPRESENTATIVE
Rancho Palos Verdes,CA 90275
W. i
S -4.41...:A A
-
*1990-20Q9 ACORD CORPORATION. All right.reserved.
ACORD 25(2009109) The ACORD name-and logo are registered medal-of ACORD
•
HOFFM63 PAGE 2
NOTEPAD resutuars mut Hoffman Southwest Corp., OP ID:Edi. UAIk 06103/15
he General Aggregate Limits applies separately to each project away from
e premises owned or rented by the Insured.
Should this policy be cancelled before the expiration date, The Wooditch
• Iti._ y will mail 30 (thirty) days written notice to those Certificate
elders which require such action per contract or agreement.*
- i
NOTEPAD: HOLDER CODE RANCHOP HC?F.FNS PAGE 3
IN
NAM Hoffman Southwest Corp., OP ID:EL t 06,03115
aiver of Sub tion for General Liability,'Auto Liability and Workers'
• pensation Attached Endorsements.
•
•
•
•
•
This Endorsement Changes The.Policy. Please Read It Carefully.
ADDITIONAL INSURED
BLANKET-
PRIMARY AND YOUR WORK
- F
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL.LIABILITY COVERAGE FORM
w_ • ,..••...«.....w. .•.«-•.w.•.•,w «•-•.•.,••I.w•••..w ... ..•.•... ..t•rI••w«•••.•••w.t•N«•••r•••w••.••••••••ww_•••,•w«.••,I•••w.•.N«.••r•1,••.\•M•I,••.wN••••.
SCHEDULE
Name of Person or Organization: iikny person or organization to whom or to which you are obligated by virtue
iota written contract or by the issuance or existence of.a Written permit,to
provide insurance.such as Is afforded by this policy,
A. SECTION 1l - 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", 'property
damage".or"personal.and.advettising injury'caused,in whole or in part,by:
1. Your acts or omissions;or
2. The acts or omissions-of those acting On your behalf;
in the performance of your ongoing operations; andior 'your work" idefine0 for the additional insured(s)
designated above included in the'products-completed operations hazard".
B. If'you are required by.a written contract to provide primary insurance, this policy shall be primary and
SECTION IV—COMMERCIAL GENERAL WABIL.ITY CONDITIONS,4,-Other-Insurance does not apply,but
only with.respect to coverage.provided by this policy.
•
This endorsement effective i2/31114
forms pan of Policy Number LHA137966
issued to *Hoffman Southwest Corporation
by .Landmark American Insurance Company
RSG 16017 1207 I nrludes•copyrig hied material of insurance Services Office,Inc.1984
(1185) with its permission
POLICY NUMBER: LHA137966 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT::CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - AGGREGATE LIMITS OF INSURANCE
(PER PROJECT)
This endotsenient modifies insurance provided under-the following:.
COMMERCIAL GENERAL LIABILITY COVERAGE.PART.
The General Aggregate Limit under LIMITS OF INSURANCE (SECTION III) applies separately to each of your
projects away from premises owned by.or.rented to you.
CG 25 03 11 85 Copyright; insurance Services Office, Inc., 1.984 Page 'I of 1 0
This.Endorsement'Changes The Policy.. Please-Read It Carefully:
WAIVER OF TRANSFER OF RIGHTS GF RECOVERY AGAINST
OTHERS TO US
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization:
Any Person or Organization As Required By Written Contract
The following 1$ added to SECTION IV-CONDITIONS, 8.TRANSFER OF RIGHTS.OF RECOVERY AGAINST
OTHERS TO US:
We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above
because of payment we make for injury or damage arising out of.your.ongoing operations, "your product"-or"your
work" done under a written *contract with that person or organization and included in the "product-completed
operations hazard'. This waiver applies only to the person or organization'shown:in the SCHEDULE above.
This.endorsement effective 1 P/31/14
forms.partof:Poliby-Number LHA137906
Issued to Hoffman Southwest Corporation
by_ landmark American Insurance Company
Ree 14045 1006. includes copyr.ighted material of Insurance Services Office, Inc. 1992
with its permission.
•
•
THIS ENDORSEMENT CHANGES-THE POLICit. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided.under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
. s
MOTOR CARRIER COVIlltAGP.FORM
TRUCKERS COVERAGE FORM
With.respect to coverage-.provided by this.endi rsenitnt,-the provisions of the Coverage Porn apply unless modified by this
cndomelncnt.
This endorsement identities person(s)or organizations)who are insureds"-under the Who Is An Insured provision of the Coverage
Fc , This endorsement dors.nor alter coverage provided in the Covezige Funs.
This endorsement change the policy effective on the inception date of the policy unless another date is indicated below_ •
i
•SCHEDUI.E
1
Name of Person(s)or Orgarni ation(s):
Any prrsnvn or yn».11:44gfroyl in writing')ro add as Sn addil nn Sl inmrerl,
but only to coverage and minimum limits of insurance.required by the written agreement,and in
event to exceed either the scope of covcragc ur•the limxtk of iftsuratoce provided in this:)OhCy.
(lfno entry appears abov=e,information required to complete:this cndorsemcnt will lac shown in the Dcdatat ons as applicable-to this
.cndotscrnent)
Each prison or organization:uidicated aben c.is an.•rinsurc d"fnt.I abili ty Coverage,but Only to the citcnt that person:or organization
qualifies as an"insured"under the Who is An Insured provision contained in-Sl:CTIPN II of the Coverage Form.
This endorsement is executed by the company below designated by en entry in the.bos opposite its name.
Policy*No: A82261-065426-014 rued By: Liberty Mutual Fire Insurance Company
Effective Date: 128112014
Expiration Date: 12/31/2015
Sales Office: Endt Serial No:
CA 2048 07 97 Copy light,Insurance Services t,�,r'rirc,Inc.,1996
POLICY NUMBER: AS2=Z61-065426-014 COMMERCIAL AUTO
CA 04 44 03 10
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
31
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST.OTHERS TO U.S (WAIVER OF SUBROGATiON)
This endorsement modiifies.insurante provided underthS.following:
{
BUSINESS AUTO COVERAGE FORM
BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM
-GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement,the provisions-of the.Coverage Form apply unless.rnodi-
fied by the endorsement.
SCHEDULE
Name(s)Of Person(s)Or Organization(s):. :
Bhztnkrt dl requitd bymitten ontrivt(jr 4 7wPJent.
InTormation required to complete this-Schedule,if not shown above,Will be Shown in the Declarations.- -
The Transfer. Of Rights. Of Recovery Against
Others To 4is Condition does not apply to the
person(s) Of' organization(s).shown in the Schedule,
but only to the extent that subrogation is waived prior
to the "accident" or the loss" under a contract with
that person or organization.
CA 04 44 0310 Chi Insurance Services Office,Inc.;2009 Page 1 of 1
SENTRY CASUALTY COMPANY
Carrier Code No. 37877
WORKERSo COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
POLICY NUMBER: 90-20147-01 00 141
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for
an injurycovered b - th.is olio . We will not enforce our right
against he person or or ani 7ation named i n the Schedule. (This
!� O �
agreement applies only to the extent that ,ou perform work under
a written contract that requires you to obtain this agreement
from us.)
This agreement shall not operate directly or indirectly to benefit
any one not named in the Schedule.
Schedule
MALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS"
WC 00 03 13 (Ed. 04-84)
Copyright 1983 National Council on Compensation Insurance,
IfO.F 90-20147-01 00 141 HOFFMAN SOUTHWEST CORP
12.12-14
PAGE 001