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Fire Grazers Inc (2010) • AGREEMENT FOR FUEL MODIFICATION SERVICES BY GRAZING This Agreement("Agreement")is made and entered this 1$ day of q'ut ,2010,by and between the City of Rancho Palos Verdes(hereinafter referred to as the"City,")and Fire Grazers,Inc. (hereinafter referred to as"Contractor"). WHEREAS,City desires to clear brush at various locations throughout the City by grazing of goats;and WHEREAS,Contractor has represented that it is fully qualified to assume and discharge such responsibility. NOW,THEREFORE.the parties hereto do agree as follows: 1. Scope of Services. Contractor shall perform the work and provide the services and materials for the project identified as Fuel Modification Services by Grazing(the"Project")as described in these Plans and Specifications,attached hereto as Exhibit"A"and incorporated herein by this reference,including miscellaneous appurtenant work. Contractor shall perform the work and provide the services and materials for the Project only between April 15th and November 14th of each year that the Agreement is in effect.In the event of any conflict between the terms of this Agreement and any attached exhibit,the terms of this Agreement shall be controlling. 2. Term. This Agreement shall commence on July 1,2010 and shall terminate on June 30,2013 (the "Initial Term"),unless sooner terminated pursuant to Section 7 of this Agreement. After the Initial Term,the Agreement may be renewed for three(3)one-year periods by mutual written agreement. 3. Compensation. In consideration of the services rendered hereunder,City shall pay Contractor according to the Prices in Contractor's Proposal,attached hereto and incorporated herein as Exhibit"B,"and in a manner as described in Exhibit"A." 4. Time. Upon receipt of written Notice to Proceed from the City,Contractor shall perform with due diligence the services requested by the City and agreed on by Contractor,Time is of the essence in this Agreement. 5. Use. The City grants access to Contractor to the premises as stated in each Notice to Proceed for the sole purpose of grazing goats. The premises shall be used for no other purpose by the Contractor without the prior written consent of the City. 6. 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,f ins,or corporations at the Contractor wishes except as expressly provided in this Agreement. Contractor shall take no power to incur any debt, obligation,or liability on behalf of the City 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. R6876-0001\1234380v2.doc ' 411) 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 fees 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. 7. Termination. The City may terminate this Agreement with cause upon thirty(30)days written notice,and either parts may terminate this Agreement without cause upon 120 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. 8. Prevailing Wages. Contractor has advised the City that is does not employ any employee(s)in performing the work and providing the services and materials for the Project pursuant to this Agreement. Thus,requirements regarding the payment of prevailing wages are not relevant to this Agreement. 9. 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 Pains Verdes Fuel Modification Services by Grazing Contract;Workers' Compensation Certificate of Insurance;Agreement to Comply with California Labor Law Requirements;Indemnification and Hold Harmless Agreement and Waiver of Subrogation and Contribution;Additional Insured Endorsement(Comprehensive General Liability);Additional Insured Endorsement(Automobile Liability);and Additional Insured Endorsement(Excess Liability). 10. Applicable Law. Should either party to this Agreement bring legal action against the other,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. 11. 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 he entitled to recover reasonable attorneys'fees,experts' fees,and other costs,in addition to any other relief to which the party may be entitled. 12. Titles. The titles used in this Agreement are for general reference only and are not part of the Agreement. 13. Entire Agreement. This Agreement,including any other documents incorporated herein by specific reference,represents the entire and integrated agreement between City and Contractor and supersedes all prior negotiations.representations or agreements,either written or oral. This Agreement may he modified or amended,or provisions or breach may he waived,only by subsequent written agreement signed by both parties. 14. 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. R6876-0001\12343 80v2.doc 2 11) 15. 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. 16. 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, hy2.010 .Dated: �("Contractor") BY: .5041-121,1 CiiA ibA2t sEe-gET1I y 41;cc-AsIXE-02 (mc- BY: mcBY: Dated: The City of Rancho Palos Verdes, A Municipal Corporation("City") B talrik 1 'OR ATTEST: c.....227,14Aiatec CITY CLERK R6876-000111234380v2.doc 3 1 1 . •, 0 0 . • , . . • - . - ALos vERDEs THE ciTy oF RANCHO p I- :. I • Notice to Contractors- Instructions to Bidders, -• • ' Proposal, and Contract for: 1114 • � .ec�a! Provisions, I . : . . . . . • . • FuEL mo . 1F I . !CATION . . yGING I - . . . . . rOR. . . . - . s vERDEs . . . . . . . . • . . ' -, - :--:- . ,. .. 1 . . . .. ii. . . Prepared by: •4 The City of Rancho Palos Verdes • r 30940 Hawthorne Blvd. • • Rancho Palos.Verdes, California 90275 4 ti (310) 544-5252 • t'.7...e,'.'-'4( w it. ti A , Il ; s !`„1.,...q.: 1,11,‘,,':1 ., s .. } ak.tt a, r- �:. c- J,,.-- tet.. ;*"•-•-t74.'''..-':'t tt. . *:,-44-4,,s77„;::-.,- ,,. ,. . tf. ,. -;-•,-; ' . ..,... ; .: .. t.:,--,- - .. -- - -- -. 0 . Approved:ty} • Date ! t-_ 11/otowicz Steve -I- ' - . --'• -• ---tiki '. *yoiPro Tern,Thomas D. Long ." .'. .eouncilmernber,.Anthony M. Misetich B . L l� 4(. -,. mah, Douglas W. Stern" ire or of Public W:rks A • ' nc man, Brian Campbell. Ra (Aland t }F, J •.3 / r., . :..::. . . . 1,•. :,.. :, . . (i) CHECKLIST FOR BIDDERS The following information is required of all Bidders: / Signed Proposal Completed Bid Sheet / Completed Information Required of Bidders Form r Designation of Subcontractors tactors Complete Contractors Industrial SafetyRecord p k/ Non Collusion Affidavit Addendum SP-11 1 PROPOSAL THE CITY OF RANCHO PALOS VERDES FUEL MODIFICATION SERVICES BY GRAZING FOR THE CITY OF RANCHO PALOS VERDES TO THE CITY COUNCIL OF THE CITY OF RANCHO PALOS VERDES The undersigned, as bidder, declares that: (1)this proposal is made without collusion with any other person, firm or corporation, and that the only persons or parties interested as principals are those named herein; (2) bidder has carefully examined the project plans, specifications, instructions to bidders, proposal, notice to contractors and all other information furnished therefore and the site of the proposed work; (3) bidder has investigated and is satisfied as to the conditions to be encountered, the character, quality and quantities of work to be performed and materials to be furnished. Furthermore, bidder agrees that submission of this proposal shall be conclusive evidence that such examination and investigation have been made and agrees, in the event this contract be awarded to bidder, to enter into a contract with the CITY COUNCIL of the CITY OF RANCHO PALOS VERDES, to perform said proposed work in accordance with the plans,if any,and the terms of the specifications, in the time and manner therein prescribed, and to furnish or provide all materials, labor, tools, equipment, apparatus and other means necessary so to do, except such thereof as may otherwise be furnished or provided under the terms of said specifications, for the following stated unit prices or lump-sum price as submitted on the Schedule attached hereto: The bidder shall submit as part of this proposal a completed copy of the Contractor's Industrial Safety Record. The undersigned further agrees that should he/she be awarded the contract on the basis hereof and thereafter, defaults in executing the required contract, with necessary documents, within ten (10) days, not including Saturdays, Sundays and legal holidays, after having received notice that the contract has been awarded -nd i eady for signature,this proposal and the acceptance thereof may be considered null and voib. Signature(s) of bidder: Alg4K Nol , paws,477Z7 SN4NLMR SEaETAe y If an individual, so state. If a firm or co-partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, also names of president, secretary, treasurer, and manager thereof. Two notarized officer's signatures and the corporate seal are required for corporations. Legal Business Name: F) f G4Z.E Address: 3200 LA 'oro,JM #513, Rpc,w P1zAc VEIZbES, fi4 9o215" Telephone: (3,0 ) 4 ,2— 3199 Contact: $Mi ,A S4b41I11 Bid Date f /'7/2DIV P - l THE CITY OF RANCHO PALOS VERDES BID SHEET I'►c NAME OF COMPANY: J ',iQE G ,4zE&�j . To the Honorable Mayor and Members of the City Council: In compliance with the Notice Inviting Sealed Bids, the undersigned hereby agrees to enter into a contract to furnish all labor, materials, equipment and supplies for the project identified as FUEL MODIFICATION SERVICES BY GRAZING FOR THE CITY OF RANCHO PALOS VERDES in accordance with the specifications and plans in the Contract Documents which are on file in the office of the Director of Public Works of the City of Rancho Palos Verdes to the satisfaction and under the direction of the Director of Public Works at the following prices: BID SCHEDULE ABATEMENT LUMP SUM ZONE LOCATION DESCRIPTION PRICE* NUMBER 1 Bordering residences on Via Capri $ 44)90 2 Bordering City Hall $ 4/ 3 Bordering residences on Calle Viento $ 6 4-. ,5.-. • 4 4 Borderingresidences on Avenida Anillo $ ' 5 Bordering residences on Tarragon and 13 Arrowroot Lane $ 4/750 _ 14 Bordering residences on Seacove Dr $ 3/440 — • Bordering residences on Admirable / l $ 3,785-- 15 Dauntless Dr 17 Borderingresidences on Pirate Dr $ ,'i • • 21 Bordering 3445 'residences on Narc�ssa Dr $ Bordering residences on Narcissa Dr, near $ 3 200 — 22 Vanderlip 1 25 Bordering residences on Amber Sky Dr C, 5o— P - 3 27 Bordering Vanderlip Dr $ 3;gib— 28 Bordering Vanderlip Dr $ 3, 110" 29 Bordering residences on Ocean Terrace, 1 2) 2p0 -- Searidge 34 Shoreline Park $ �r� 9'fO~ 35 Crestridge, near Indian Peak Rd $ 3,100 - . 36 Bordering Indian Peak Rd $ 31711-0— TOTAL BASE BID $ S9,64S Extra Work for any area added to contract $ I , 150"' per acre Total for Base Bid in Words: EL&1. vY NINE "1ivasAaD St A F4ctY E bDLLAa $- CONTRACT PRICING. Except as otherwise provided, prices given herein shall remain in effect through the term of this contract. The City does not pay surcharges of any type unless identified in the response to this Invitation to Bid and accepted in writing by the City. All of Contractor's costs are considered to be included in the pricing provided to the City on the Bid Sheet. `Please note that the City reserves the right to remove any of the above listed fuel modification zones from the scope of work as deemed necessary during the course of the project. The City will not provide payment to the Contractor for those zones not completed due to their removal from the scope of work. The City will not adjust lump sum prices for any of the zones remaining in the scope of work to accommodate claims of loss due to a reduction in overall scope. Prices given herein, including provisions for annual adjustment provided in the Contract, are considered to be the stand alone price for each individual zone regardless of the number of zones included in the final scope of work. • p - a I • INFORMATION REQUIRED OF BIDDER The bidder is required to supply the following information: (Additional sheets may be attached if necessary.) n7� . RA�cro Pis ilbEs (1) Address: 32.D0 Lk ROTbN1� �5�� � GA 90275 (2) Telephone: (3to) 46/-31919 (3) Type of firm - Individual, Partnership, or Corporation: Co4PD' frfl'N (4) Corporation organized under the laws of the State of CALIrOaNIA (5) NOT USED: (6) List the names and addresses of all members of the firm or names and titles of all officers of the corporation: /fl,4 C1ot _ PRESIbEkir I/4 SH4IIeI — SEci2VrAgY/TAEAtV�4 (7) Number of years experience for brush clearance work (8) List at least three similar projects completed as of recent date: Contract Amount Class of Work Date Completed Name. Address of Owner, & Telephone No. CAUFl,QN�,� �z�NG . Cam I/(E aJ JJ �NAf�� D� Ve&s.e. See aadthctrwc p _ 5 (9) List the name and address of such subcontractor who will perform work in or about the work and indicate what part of the work will be done by each such contractor (if there are more than two subcontractors, attach a separate sheet ): NAME ^1b1J( TYPE OF WORK ADDRESS NAME TYPE OF WORK IADDRESS (10) List the name of the person who inspected the site of the proposed work for your firm: 54Q4f114g SH4Z (310) 462-3199 (11) NOTE: Upon request of the City, the bidder shall furnish evidence showing a notarized financial statement, financial data, similar project experience, or other information. I (12) NOT USED (13) NOT USED • •I I ' P - 6 f . • DESIGNATION OF SUBCONTRACTORS [Public Contract Code 4104] Public Contract Code 4104 provides as follows: taking bids for the officer, department, board or commission construction of any public or improvement shall provide in the specifications prepared ared for the work or work p under which bids will be received from the doing improvement or in the general conditions makinga bid or incident to thepublic work or improvement that of any person of the work offer to perform the work, shall, in his or her bid or offer, set forth: place of business of each subcontractor who will The name and the location of the nor about the (a) render service to the prime contractor perform work or labor or i� construction of the work or improvement, or a subcontractor licensed by the State of California who, under subcontract to the prime contractor, specially fabricates and installs a portion of the work or improvement according to detailed drawings specifications, in an amount in excess of one-half of 1 contained in the plans and sp or offers for the prime contractor's total bid or, in the case of bids percent of the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the prime contractor's total bid or ten thousand dollars ($10,000), whichever is greater. (b) The portion of the workwhich will be done by each subcontractor under this act. , The prime contractor shall list only one subcontractor for each portion as is defined by the prime contractor in his or her bid. Portion of Work and Subcontractor's Name and Percent of Total Bid Contract Name Address and Telephone No. 1Q01.16 I P _ 7 CONTRACTOR'S INDUSTRIAL . SAFETY RECORD i Record Last Five (5) Full Years: Year of Record 20 20 20 20 20 Total Current Year , 1. No. of contracts Please See Adde•tels.4 A. - 2. Total dollar amount of contracts (in 0 thousands of$) *3. No. of fatalities . *4. No. of lost workday cases - *5. No. of lost workday cases involving permanent transfer to another job or termination of employment The information required for these items is the same as requiredforColumns 3 to 6,Code 10, Occupational Injuries, Summary-Occupational Injuries and Illnesses No. 102. v information was compiled from the records that are available to me at this time, and I declare under penalty of perjury that the The above p information is true and accurate within the limitations of those records. • Eike GRAzeks, ) c . ________41_,AL„, - 7.D Name of Bidder (print) Signature o 3200 Ror bA DQ. At3 3 WA Address State Contractor's Lic.# & Classification 7s (3io) ��- 3199 /2p,.JcifD l%us1�E2bEs 9 d2 City Zip Code Telephone P - 8 i I . * • NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID [Public Contract Code 7106] State of California ss. County of Los ArJGELOS SUAHtAIZ 5 K4AvI12.1 Aitk , being first duly sworn, deposes and says that he or she is coot) SEcizETMY AND �i4Emui2E4 of the party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price 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, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. J Signature Subscribed and sworn to before me on Chba D D-te) \.I.t . Q� tubua (Notary Seal) ignatu e Notary •.•lic rika.1.1"4"1"6"1"1. C.W0006 •,r +noun, 'California COMM. is SPCO2-16 Revised 2.9.04 P - 9 . . . 0 0 , POLICY NUMBER: LBA 0 8 0 8 2 6 0 0 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, E LESS ES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Rancho Palos Verdes 30940 Hawthorne Blvd. Rancho Palos Verdes, CA 90275 (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 (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions (2) That portion of"your work"out of which the injury or damage arises has been This insurance does not apply to "bodily in- put to its intended use by any person jury"or"property damage"occurring after: or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 ©ISO Properties, Inc., 2000 Page 1 of 1 0 MUST BE DISPLAYED IN PLACE OF BUSINESS - NOT TRANSFERABLE City of Rancho Palos Verdes Finance Department 30940 Hawthorne Blvd BUSINESS TAX REGISTRATION CERTIFICA TE Rancho Palo Verdes, CA 90275 Business Name: FIRE GRAZERS INC THIS CERTIFICATE,IS EVIDENCE THAT THE P Business Number: 48 ` NAMED PERSON OR FIRM 9 HAS PAID A TAX TO CONDUCT AN Location Address: 3200 LA AND OPERATE A BUSINESS ROTONDA DR 503 AS INDICA��ED HEREON PURSUANT TO THE License Number/Class: l 0 0000697 .PROVISIONS OF 9 PROFESSIONS & SPECIFIED SERVICES (HO) • • .S• '•11 .• •• -r� •►, FIRE GRAZERS INC 3200 LA ROTONDA DR _ • RNCHO PLS503 VRD CA 90275 • Issue Date: 6/30/10 Expiration Date: 12/31/10 (SSU11vGOf. F'ICERS • • STATE P.O. BOX 420807, SAN FRANCISCOCA 41 COMPENSATION v 9 42- 0807 INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE JUNE 29, 2010 1952647 - 10 POLICY NUMBER:6_1 CERTIFICATE EXPIRES: THERROFIVED CITY TY OF RANCHO F ALOS VERDES DES ='y ,f -tencho Palos Verden 30940 HAWTHORNE BLVD _' •1 1�_ f ,j RANCHO F'ALOS VERDES CA 9027 5 : ttj V../OFilc DEPARTMENT 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. 30 This policy is not subject to cancellation by the Fund except upon ten days advance written notice to the employer. We will also give you *N 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 such policy. , k it 4 14 , %Aft./ AUTHORIZED REPRESENTATIVE INTERIM PRESIDENT AND CEO EMPLOYER'S LIABILITY LIMIT INCLUDINr DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS'NO T I C E EFFECTIVE 06/29/10 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER FIRE GRAZERS, INC 5200 LA ROTUNDA DR #503 RANCHO HO 1-ALOS VERDES CA 90275 #596 10262(REV.01-10) 4111 • ACOREY DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/29/2010 PRODUCER (626)799-7813 FAX: (626)799-8784 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Shaw Moses Mendenhall & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 625 Fair Oaks ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 158 South Pasadena CA 91030 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.Landmark American Ins. Co. Fire Grazers, Inc. INSURER B. 3200 La Rotunda Drive INSURER C• Unit 503 INSURER D. Rancho Ia1os Verdes CA 90275 INSURER E: COVERAGES + THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYYL LIMITS _ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 A CLAIMS MADE X,OCCUR LBA080826 6/29/2010 6/29/2011 MED EXP(Any one person) _ $ 5 000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE - $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT • LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) • GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LABILITY Y/N TORY LIMITS_ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'? (Mandatory in NH) • E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS THE CITY OF RANCHO PALSO VERDES, ITS ELECTED OFFICIALS, OFFICERS, ATTORNEYS, AGENTS, EMPLOYEES, AND VOLUNTEERS ARE ADDITIONAL INSURED. WAIVER OF SUBROGATION WORDING IS INCLUDED. *EXCEPT 10 DAYS FOR NON PAYMENT OF PREMIUM • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE CITY OF RANCHO PALOS VERDE S DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *3 0 DAYS WRITTEN ATTN: CITY HALL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 30940 HAWTHORNE BLVD. RANCHO PALOS VERDES, CA 90275 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robin Paul/RSP 1? ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) • The ACORD name and logo are registered marks of ACORD i 0 0 ' • , C!�p� U � GATE{MM/DD!YYYY) �•f I iCERTIFICATELIABILITY06/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). i PRODUCER CONTACT Tom Kulikov Thomas R. Kulikov NAME: _-. --- HONE -F7NAME: 559-935-2024 FAx 559-935-5664 {AIC.Na.Cxt}_.-..---........... _. �(AICs No;.................. 395 E. Elm Ave. Ste.0 E-MAIL ADDRESS:tom;kulikov.b8hz@statefarm.com Coalinga, Ca. 93210 PRODUCER .... . _ .......-.... CUSTOMER Lp#: INSURER(S)AFFORDING COVERAGE i NAIL;/ INSURED INSURER A:State Farm Mutual Automobile Insurance Company . 25178 Mike& Janet Canada}/ INSURER B: •• 30444 Jayne Ave_ INSURER c: • C�32 1 0 INSURER D: , Coalinga, a_. • <._... • INSURER E: ' INSURER F: : COVERAGES CERTIFICATE NUMBER: .._ .- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD—'' INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR i AODL'SUBR POLICY EFF POLICY EXP i LTR: TYPE OF INSURANCE INSR WVD! POLICY NUMBER I(MM/DD!YYYY)°(RAM/DD/YYYY) I.iMITS GENERAL LIABILITY EACH OCCURRENCE: • [Ah1ACE-'fid ROOt) I ' COMMERCIAL GENERA.LIABILITY ;'---II r--- l'r1FI1�iSt~S(Ea oc�.,tt;-t,';:.i:� ' T' ... • ...1 ClAIMS-NIADE OCCUR ' ..1'�.._...� 'P(Anyerr arc,-.... i MED EXerx person) $ PERSONAL&ADV INJURY S • • • GENERAL AGGREGATE • f I::N'1 AGGREGATE l IMI r AP ruE S El R PRODLJC t S COMP/OP AGG _ • '•PRO- • • _______ : POLICY jECT .r :LOC --_-- • -___ AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT• ' : c i,DO��.Ot7C ANY AU I O -1.C`__ ...._..___.'....... (E' gr�'�CNI:1 • • ►: BODILY INJURY(Per i AL I.OINNED AUTOS " --- BODILY INJURY;Per a1:r�rJer�:# s X SCHEDULED: AU?-US . .........................-......... ..... .... .. 012 2845-F02-551 06/02/2010 ' 12/02/ 010 PROPERTY Y DAMAGE • y X HRH)AI/1 Oti • • (Per a'c;tlen;t 123 0725-819-55A 02/19/2010 08/19/2010 X NON•U1"JNLCI AUTOS • • UMBRELLA LIAB • OCCUR' EACH OCCURRENCE !S EXCESS LIAB f.1�- _.. I AGGREGATE............ _.. :.................. CL.A 1 M/('I~ 1, !$.• • ............ ULGUC I IBLE. .....__....;•i_....__.. • •• RETENTION S _rWORKERS COMPENSATION ~. _.._.........._.._.__......._....._ __.._ ___—...___. __......._.._..._ ......_._. __....-_.._........i •_._._._---......._ ;.y'C START- I 10TH- AND EMPLOYERS'LIABILITY {)HYI.IhI11TS: ................__.................' FR Y/i� ANY PROPR;ETORIPAR1 NER,'E?iLCUI!VI F L...C....,_."H_ 1. ACCIDENT OFFICER/MEMBER EXCLUDED, :N/A (Mandatory in NH) E L DISEASE--EA EMPLOYEE`: If ye, describe under • • : . .E.L.DISEASE-POLICY LIMIT $'Si=!'=hPROW:WINS%,,cn:�: • • • LJ[ii1 • • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101.Additional Remarks Schedule,if more space is required) Additional Insured,Fire Grazers Inc.3200 La Rotonda Dr St.503 Rancho Palos Verdes,CA.90275 • I CERTIFICATE HOLDER CANCELLATION 1 Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE City Manager POLICY PROVISIONS. The City of Rancho Palos Verdes 30940 Hawthorne BI AUTHORIZED REPRESENTATD}/.E___.-j , Rancho Palos VerdEs,CA.90275 --------Z:,..-7--- J • r'1986-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02-11-2010 • • • Workers' Compensation Certificate of Insurance WHEREAS, the City of Rancho Palos Verdes has required certain insurance to be provided by: 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: The City of Rancho Palos Verdes City Hall 30940 Hawthorne Boulevard Rancho Palos Verdes, California 90275 2. The insured under such policy or policies are: • 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 1`1261-17-10 06/2114IO 0602 /2o1I � -�0 • 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 By: -- -C.-4{s Au rized Representative • C - 5 . • • 06/2.9/2010 16:35 FAX STATE COMP INSURANCE 2001 STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 C.OM NLN.;ATlON INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE JUNE 2?, 2010 1952647 - 10 POLICY NUMBER:6_1_11 CERTIFICATE EXPIRES: THE CITY OF RANCHO PALOS VERDES 30944 HAWTHORNE BLVD RANCHO PALOS VERDES CA 90275 • L 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 subjq to cancellation by the Fund except upon ten days'advance written notice to the employer. We will also give you"T"EN 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 such policy. 11 , /./ kitelf,At • . , 444E4..1 AUTHORIZED REPRESENTATIVE INTERIM PRESIDENT AND CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 4;1,000,000 PER OCCURRENCE. • ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS'NOTICE EFFECTIVE 06/29/10 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. • EMPLOYER • FIRE GRAZERS., INC X200 LA ROTUNDA DR #503 RANCHO PALOS VERDES CA 90275 L $5 s 10262(REV.01-10) rrfeE Qeedizeese C CHECKLIST FOR EXECUTION OF FUEL MODIFICATION CONTRACT TO BE SUBMITTED BY SUCCESSFUL BIDDER: Two Executed Notarized Copies of the Contract (Attached) Workers Compensation Certificate (Attached) ile/ Liability Insurance Certificate in the Amount of $1 Million, Naming the City as a Co-insured 01/ Automobile Insurance Certificate in the Amount of $1 Million, Naming the City as a Co-insured General Aggregate Insurance Certificate in the Amount of $2 Million, Naming the City as a Co- insured I Agreement To Comply with California Labor Law Requirements (Attached) [ler Business License with the City of Rancho Palos Verdes Indemnification and Hold Harmless Agreement (Attached) Additional Insured Endorsement - Comprehensive General Liability (Attached) Additional Insured Endorsement - Automobile Liability (Attached) AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS [Labor Code 1720, 1773.8, 1775, 1776, 1777.5, 1813, 1860, 1861, 3700] The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the following provisions of California law: 1. Contractor acknowledges that this contract is subject to the provisions of Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code relating to public works and the awarding public agency ("Agency") and agrees to be bound by all the provisions thereof as though set forth in full herein. 2. Contractor agrees to comply with the provisions of California Labor Code Section 1773.8 which requires the payment of travel and subsistence payments to each worker needed to execute the work to the extent required by law. 3. Contractor agrees to comply with the provisions of California Labor Code Sections 1774 and 1775 concerning the payment of living rates of wages to workers and the penalties for failure to pay living wages. The Contractor shall, as a penalty to the Agency, forfeit not more than fifty dollars($50)for each calendar day,or portion thereof,for each worker paid less than the living rates as determined by the Director of Industrial Relations for the work or craft in which the worker is employed for any public work done under the contract by Contractor or by any subcontractor. 4. Contractor agrees to comply with the provisions of California Labor Code Section 1776 which require Contractor and each subcontractor to (1) keep accurate payroll records, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the Agency of the location of the records. The Contractor is responsible for compliance with Section 1776 by itself and all of its subcontractors. 5. Contractor agrees to comply with the provisions of California Labor Code Section 1777.5 concerning the employment of apprentices on public works projects, and further agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of California Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall,as a penalty to the Agency, forfeit twenty-five dollars($25)for each worker employed in the execution of the contract by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than 8 hours in any one calendar day and 40 hours in any one calendar week in violation of the provisions of Division 2, Part 7, Chapter 1, Article 3 of the California Labor Code. 7. 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." Date /5/2OfO Signature III 4111 6/29/2010 The City of Rancho Palos Verdes, Calif... `' JHL ( y Irak (-) 1:- RA . H .) PA .,..,\ .. - -. ,,t,,,;,--.. -, -',,,,,,.-, -:,,,,,,, -:-.-,:,,,..\,:,,,,, ,-. . ,, ------._.-1-:,- .,,,,.." i :-.. - ..-;:',' . .' %.,, ' _ 4. „ . \7,,,,u..,'',,,,..Avs\,,t,:-• ,,,.., 5 , $,..s •,•4 Jr. ,.. . .., .._. ...-1." .-,4 lTC \`. 4y\ �`�\ ,V.;',',-, � ` 41 'J 421.,-'1,-.' , ! \tom � : ..w� �- ' -, _ 4 i„ v o . �1. _' t t\X� • ,'�' e, ,,, \' .-•-•4-•-•4 ,K Pia\ +,�, ..•?' k, \ , , .i < ; • F,. lit.eyars 1 44 ' THANK YOU. You have successfully completed the online application for a Rancho Palos Verdes Business License. $53 00 has been charged to your MasterCard/Visa credit card. An e-mail confirmation will be sent to you shortly. We recommend that you print this page for your records. Transaction Number: 7354905 Transaction Date: 06/29/2010 Finance Staff will process your application and contact you if further information is required. If no additional information is required, a business license will be issued and mailed within three weeks. If you have any questions regarding your business license application, please e-mail us at or call 310-544-5391. Please include your name, contact information and transaction number with any business license inquiry. If you have any comments or suggestions regarding the City's online business license application process or website, please e-mail us at . Please include your name and contact information with any comments APPLICATION INFORMATION Business Name. FIRE GRAZERS INC Business Address 3200 LA ROTONDA DRIVE#503 Street Address RANCHO PA LOS VERDES,CA 90275 City Zip Mailing Address Street Address City,Zip Business Phone (310)462'3199 SS#or Tax ID# 01-0932561 Email Address SHAHRIAR©GOATSROCK COM Ow nership Class rt cation Corporation Business Owner Name MARK CHOI AND SHA HRIA R SHA RIA RI Business Description FIRE MITIGATION AND BRUSH CLEARANCE SERVICES USING GOATS Regulated Businesses. None Click to return to the business license page palosverdes.com/rpv/.../return.cfm 1/1 , INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND WAIVER OF SUBROGATION AND CONTRIBUTION Contract/Agreement/License/Permit No. or description: FUEL MODIFICATION SERVICES BY GRAZING FOR THE CITY OF RANCHO PALOS VERDES 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 "Indemnities") 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, materialmen, 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 Indemnities and shall operate to fully indemnify Indemnities 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 Indemnities may have under the law. Payment is not required as a condition precedent to an Indemnities' right to recover under this indemnity provision, and an entry of judgment against an Indemnities shall be conclusive in favor of the Indemnities'right to recover under this indemnity provision. Indemnitor shall pay Indemnities 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) Indemnities' 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's, which may have been required under the Agreement, or any additional insured endorsements, which may extend to Indemnities. Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnities, 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 Indemnities. 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. "Indemnitor" Name */�r- w4�i'4, I c- Name / / r By: I • By: Its �- ���� Its $$/A�,,€1 As i/4ij,Q N � .ac.rcieQT.4t V/ X 0e- . - 7 • •F writ IN 9 Request for Taxpayer Give form to the (13e. October 2007; Identification Number and Certification requester. Do not nit:r tint r;i at tint' send to the IRS. in+etmat nc venuf,Senr,c.e l'.enle(as s!iov::,n'n yoLa income tax return) a Business;Jame if ij ilerent lrom above c C'..vck aoprepriate:,ua' C! Individual/Sole proprietor Corporation U Par ie's►hip ?' ❑ t uniternisi ed iiabwiity cum�an Enter '.ne tax c'assificatimr:n r17pa y {� Y disrtaarced entity,C roc;rperation.P- rico ip►► Li payee o 2 Li t vier isr.P irioructicris; i e Aouress rn.imher,street.and az.or suite no.) _ Reairester'.5 name and address(nl:;io14 8'7 e ..'07-o&-) • Oe--5(>3 0 City state,and 7.IP code so 4)4/0 J(. '0 P41OJ _.. f4"---30)Cs; (4- 9c)2 75— . account nurnber(s)here(optional) -- (Pant l/ Taxpayer Identification Number STIN) 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. ror individuals, this is your social security number(SSN).However, for a resiceni 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 chart on page 4 for guidelines on whose Employer identification number number to enter_ • Di 0932.5.6 i Pa"r't �l: Certification • tinder penalties of perjury. I certify that 1 'The number shown on this form is my correct taxpayer icentification number(or I am waiting for a number to be issued to me).arid P. i am not subject to backup withholding because: (a; I am exempt from backup withholding, or (h)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 (r.)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) Certification instructions.You must cross out item 2 above if you have been notified by then IRS that you are currently subject to backup williholdirty 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 4 Sign Signature of ' Here U.S.person ► sate ` 7/13/2 t✓I v General Instructions Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: Section references are to the Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien, otherwise noted. • A partnership. corporation, company,or association created or Purpose of Form organized in the United States or under the laws of the United A person who is required to file art information return with the States, IRS must obtain your correct taxpayer identification number(TIN) • An estate (other titan a foreign estate), or to report, for example,income paid to you, real estate • A domestic trust (as defined in Reoulations section transactions, mortgage interest you paid, acquisition or 301.7701-7). abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Special rules for partnerships.Partnerships that conduct a trade or business in the United States are generally required to Use Form W-9 only if you are a U.S. person (including a resident alien), to provideyour correct TIN to theperson pay a withholding tax on any foreign partners'share of income p from such business. Further, in certain cases where a Form W-9 requesting it (the requester)and, when applicable,to: has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person,and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in 2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States. provide Form W-9 to the partnership to establish your U.S. 3 Claim exemption from backup withholding if you are a U.S status and avoid withholding on your share of partnership exempt payee. If applicable,you are also certifying that as a income. U.S. person, your allocable share of any partnership income from The person who gives Form bV-9 to the partnership for a U.S. trade or business is not subject to the withholding tax on purposes of estab'ishing its U.S. status and avoiding withholding foreign partners'share of effectively connected income. on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if t s following cases: substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and rot the entity, Cat No. 10731); Fo-m W-9 )Rev.10-2007) • 411/ J. ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY HE & TNC. 3Zoo lA Roroom vE, #503 RA,KHO PALesv�izbEs, W clo215 Name and address of named insured("Named Insured'): Lirt. "AR\cAN ) s. Co. Ct45 &or Thcts FES T .*Ioo Atjm G-A 3032.6- It6o Name and address df Insurance Company("Company'): FUEL MODIFICATION SERVICES BY GRAZING FOR THE CITY OF RANCHO PALOS VERDES 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 CITY OF RANCHO PALOS VERDES ("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's 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's 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-8 • 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 The 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 GENERAL LIA3IL1tj ItzvRANcE 06/21/200-20'1 1,000,000 occvv t,jcE. 2,000,000 CONE AL ART. 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverage's. Includes: o Contractual Liability o Explosion Hazard • o Owners/Landlords/Tenants o Collapse Hazard o Manufacturers/Contractors o Underground Property Damage ® Products/Completed Operations o Pollution Liability o Broad Form Property Damage o Liquor Liability o Extended Bodily Injury ❑ o Broad Form Comprehensive o General Liability Endorsement o 12. A ■ deductible or o self-insured retention (check one) of$ 500 applies to all coverage(s) except: NONE (if none, so state). The deductible is applicable ® per claim or o per occurrence (check one). 13. This is an i occurrence or claims made policy (check one). 14. This endorsement is effective on 06/21(2010 at 12:01 a.m. and forms a part of Policy Number LBA OgPi 26 . I, TAGS PzsopJ (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 'UNE 2.9 T1' , , 20 10 Sign. f Kt•• ized Representative Telephone No.:.( 626 ) rici9- r7�sl3 (Original signature only; no facsimile signature or initialed signature accepted) n