PCI (2007-2013) -
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SECOND AMENDMENT TO AGREEMENT BETWEEN
4; THE CITY OF RANCHO PALOS VERDES AND PCI
This agreement is the second amendment to the pavement striping maintenance
agreement between the City of Rancho Palos Verdes ("City") and PCI ("Contractor"),
dated April 3, 2007 ("Agreement"). This amendment to Agreement is effective as of
May 17, 2011 and is being made to extend the term of the Agreement for one year.
Section 1. Section 2 of the Agreement is hereby amended to read as follows:
2. Term: The Contract shall commence on May 17, 2011, and shall continue in
full force and effect through and including May 16, 2012, unless earlier terminated as
provided in section 6 herein. This Contract may be extended for up to one (1) additional
one-year term by mutual consent of both parties.
Section 2. Except as expressly amended by this second amendment to
Agreement, all of the other provisions of the Agreement shall remain in full force and
effect as written in the Agreement.
IN WITNESS WHEREOF, City and Contractor have executed this amendment to
the Agreement as of the day and year first above written.
CITY OF RANCHO PALOS VERDES
("City„)
By:
Mayor
ATTEST:
By: ,f
City Clerk
PCI
("Contractor") ,
Signature:
Printed Name: /Q' - 14
Title: es/ 'i-
RECEIVED
City of Rancho Palos Verdes
FIRST AMENDMENT TO AGREEMENT BETWEEN
THE CITY OF RANCHO PALOS VERDES AND PCI APR a - 2r)
This agreement is an amendment to the pavement striping maintenanceWORKS
DEPARTMENT
agreement between the City of Rancho Palos Verdes ( City ) and
PCI ( Contractor ).
dated April 3, 2007 ("the Agreement"). This amendment to Agreement is effective as of
April 3, 2010 and is being made to extend the term of the Agreement for one year.
Section 1. Section 2 of the Agreement is hereby amended to read as follows:
2. Term: The Contract shall commence on April 3, 2010, and shall continue in
full force and effect through and including April 2, 2011, unless earlier terminated as
provided in section 6 herein. This Contract may be extended for up to two (2) additional
one-year terms by mutual consent of both parties.
Section 2. Except as expressly amended by this first amendment to
Agreement, all of the other provisions of the Agreement shall remain in full force and
effect as written in the Agreement.
IN WITNESS WHEREOF, City and Contractor have executed this amendment to
the Agreement as of the day and year first above written.
CITY OF RANCHO PALOS VERDES
("City")
By4IIIPL r 16
ATTEST:
t) ,
B :
YLI/Aet.C71Ated&
City Clerk
PCI
("Contractor") _.__M�
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Signature:
r
Printed Name: (1)1//lam Jc46
Title: PreSiaen''
R6876-000111212381 v1.doc
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CITY OF RANCHO PALOS VERDES
CONTRACT FOR:
FISCAL YEAR FY 2006-2007, 2007-2008, 2008-2009
Pavement Striping maintenance contract
THIS AGREEMENT is made and entered this 3 dayAPgIL0 of 20 7
,
by and between the CITY OF RANCHO PALOS VERDES, hereinafter referred to as
"City", and PCI hereinafter referred to "Contractor".
as Contractor .
WITNESSETH:
WHEREAS, Contractor and Contractor's Surety are providing the bonds attached hereto
and incorporated by this reference, and
WHEREAS, City desires to contract with Contractor top erform the services detailed in
this contract, including the Proposal, 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. City hereby employs Contractor to perform the work and provide
the services and materials for the project identified as: Pavement Striping
(maintenance contract 2006-2007, 2007-2008, 2008-2009, as described in these
Plans and Specifications, attached hereto and incorporated herein by this reference,
including miscellaneous appurtenant work. Such work shall be performed in a good
and workmanlike manner, under the terms as stated herein and in these Plans and
Specifications, and in accordance with the latest edition of the Joint Cooperative
Committee, Southern California Chapters of the American Public Works Association
and the Associated General Contractors of America, document entitled "Standard
Specifications". In the event of any conflict between the terms of this agreement and
any of the above-referenced documents, the terms of this agreement shall be
controlling.
2. Term: The Contract shall commence on April 3, 2007, and shall continue in full force
and effect through and including April 2, 2010, unless earlier termination as provided in
the section 6 herein. This contract may be extended for up to three (3) additional one-
year terms by mutual consent of both parties.
3. Compensation. In consideration of the services rendered hereunder, Contractor shall
be paid according to the prices as submitted on the Bid Sheet of the Proposal,
attached hereto as a part of these Plans and Specifications and in accordance with
the Special Provisions.
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4. Independent Contractor. It is specifically understood and agreed by all parties hereto
that Contractor is an independent contractor and not an employee of the City.
Accordingly, Contractor shall not be deemed the City's employee for any pur
whatsoever. Contractor shall not incur or have the power to incur any debt,
obligation or liability whatever for or against City.
5. Assignment. This agreement may not be assigned by Contractor, in whole or in part,
without the prior written consent of City.
6. Termination. This Agreement may be canceled by the City at any time without
penalty upon thirty (30) days' written notice. In the event of termination without fault
of Contractor, the City shall pay Contractor for all services rendered prior to date of
termination, and such payment shall be in full satisfaction of all services rendered
hereunder.
7. Worker's 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 worker's
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."
8. General Rate of Per Diem Wages. Pursuant to the Labor Code of the State of
California, the Director of Industrial Relations has determined the general prevailing
rate of wages and employer payments for health and welfare, vacation, pension and
similar purposes applicable to the work to be done. This rate and scale are on file
with the Director of Public Works and copies will be made available to any interested
party on request. The Contractor to whom the contract is awarded, and the
subcontractors under him must pay not less than these rates for this area to all
workers employed in the execution of this contract.
This contract is subject to the provision of Article 1.5 (commencing at Section 20104)
of Division 2, Part 3 of the California Public Contract Code regarding the resolution of
public works claims of less than $375,000. Article 1.5 mandates certain procedures
for the filing of claims and supporting documentation by the contractor, for the
response to such claims by the contracting public agency, for a mandatory meet and
confer conference upon the request of the contractor, for mandatory non-binding
mediation in the event of litigation is commenced, and for mandatory judicial
arbitration upon the failure to resolve the dispute through mediation. This contract
hereby incorporates the provisions of Article 1.5 as though fully set forth herein.
9. Suit; Recovery of Attorney Fees & Costs. Should either party bring any action to
protect or enforce its rights hereunder, the prevailing party in such action shall be
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entitled to recover, in addition to all other relief, its reasonable attorneys fees and
court costs.
10. Insurance Requirements. The Contractor shall at all time during the term of this
Agreement carry, maintain, and keep in full force and effect, with an insurance company
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admitted to do business in California and approved by the City (1) a policy or policies of
broad-form comprehensive general liability insurance with minimum limits of
$3,000,000.00 combined single limit coverage against anyinjury, death loss or damage
as a result of wrongful or negligent acts by the Contractor, its officers, employees,
agents, and independent contractors in performance of services under this Agreement;
(2) property damage insurance with a minimum limit of $1,000,000.00; (3) automotive
liability insurance with a minimum combined single limits coverage of $1,000,000.00;
and (4) worker's compensation insurance with a minimum limit of $1,000,000.00 or the
amount required by law, whichever is greater. The City, its officers, employees,
attorneys, and volunteers shall be named as additional insured on the policy (ies) as to
comprehensive general liability, property damage, and worker's compensation
coverage's.
1. All insurance policies shall provide that the insurance coverage shall not be non-
renewed, canceled, reduced, or otherwise modified (except through addition of
additional insured to the policy) by the insurance carrier without the insurance
carrier giving the City thirty (30) day's prior written notice thereof. The Contractor
agrees that it will not cancel, reduce or otherwise modify said insurance coverage.
2. The Contractor agrees that if it does not keep the aforesaid insurance in full force
and effect, and such insurance is available at a reasonable cost, the City may take
out the necessary insurance and pay the premium thereon, and the repayment
thereof shall be deemed an obligation of the Contractor and the cost of such
insurance may be deducted, at the option of the City, from payments due the
Contractor.
3. The Contractor shall submit to the City (1) insurance certificates indicating
compliance with the minimum worker's compensation insurance requirements
above, and (2) insurance policy endorsements above, not less than one (1) day
prior to beginning of performance under this Agreement. Endorsements must be
executed on the City's appropriate standard forms entitled "Additional Insured
Endorsement," copies of which are attached hereto.
IN WITNESS WHEREOF, the parties hereto have executed the within Agreement the
day and year first above written.
CITY OF RA 2 PALOS VERDE
By: wrrP
or
ATTEST:
By: / /
'
City Cler
CONTRACTOR: PC i
By:
Wh4ry & Jcob- Pesiiirrt-
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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State ofCalifornia �'
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g County of LOS ANGELES :,
Ag ?"
I On Celeste A. Graham ?'
, before me, Notary Public
(' Date Name and Title of Officer(e.g.,"Jane Doe,Notary Public") '
g personally appeared WILLIAM G. JACOB PRESIDENT, PCI , 'o,
I Name(s)of Signer(s) I
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❑ proved to me on the basis of satisfactory evidence �,
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_ _ to be the person(s) whose name(s) is/are �!
� ._ ' CELESTE A. GRAHAM subscribed to the within instrument and
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acknowledged to me that he/she/they executed ��
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ac .t �y'.'�}`.��t f. - `tel . . . . ��
.4. : NU iARY PUBLIC-CALIPORNIA the same in his/her/their authorized
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ANS�LES C4UNTY�• capacity(ies), and that byhis/her/their
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signature(s)on the instrument the person(s), or
the entity upon behalf of which the person(s)
4 acted, executed the instrument.
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• i WIT SS my hand and official seal.
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4 Place Notary Seal Above - S•nature of Notary Public ����---
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Description of Attached Document 1
4 Title or Type of Document: 9j
Document Date: Number of Pages: 9�
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Signer(s) Other Than Named Above:
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r• Capacity(ies) Claimed by Signer hj
Signer's Name: RIGHT THUMBPRINT g
❑ Individual OF SIGNER .4
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❑ Corporate Officer—Title(s): i
(: ❑ Partner—❑Limited ❑General
�• ❑ Attorney in Fact .
❑ Trustee >>
(. ❑ Guardian or Conservator >>
❑ Other:
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0 1999 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationalnotary.org Prod.No.5907 Reorder.Call Toil-Free 1-800-876-6827
CITY OF RANCHO PALOS VERDES
INSTRUCTIONS FOR EXECUTION OF INSTRUMENTS
THIS IS INSTRUCTION ONLY - IT IS NOT TO BE SIGNED OR USED IN CONJUNCTION WITH
THE AGREEMENT OR ANY OTHER FORMS THAT MUST BE TURNED INTO THE CITY OF
RANCHO PALOS VERDES - IT IS SIMPLY A FORMAT TO USE WHEN FILLING OUT
DOCUMENTS.
1. By an Individual. The individual must sign the instrument, and if he/she is doing business under
a fictitious name, the fictitious name must be set forth. The signature must be acknowledged
before a Notary Public,using the proper form of acknowledgment.
2. By a Partnership. The name of the partnership must be set forth followed by the signatures of
less than all of the partners will be acceptable only if submitted with evidence of authority to act
on behalf of the partnership. The signatures must be acknowledged before a Notary Public,using
the proper form of acknowledgment.
3. By a Corporation. The name of the corporation must be set forth, followed by the signatures of
the President or Vice President and Secretary or Assistant Secretary. The signatures must be
acknowledged before a Notary Public,using in substance the following form of acknowledgment.
4. By a Surety. The name of the surety must be set forth, followed by an authorized signature. The
signatures must be acknowledged before a Notary Public, using the proper form of
acknowledgment.
STATE OF )
) SS.
COUNTY OF )
On ,20 ,before me,the undersigned,appeared
known to me to be the President or Vice President and known to be to be the Secretary or Assistant
Secretary of the corporation that executed the within instrument, and acknowledged to me that such
corporation executed the within instrument pursuant to its by-laws or a resolution of its City Council.
WITNESS my signature and seal.
Notary Public
(Seal)
SPC06-12
C-5
INSURANCE REQUIREMENTS FOR CITY OF RANCHO PALOS VERDES
PUBLIC WORKS CONTRACT
The Contractor shall at all time during the term of this Agreement carry, maintain, and keep in full force
and effect, with an insurance company admitted to do business in California and approved by the City(1)
a policy or policies of broad-form comprehensive general liability insurance with minimum limits of
$5,000,000.00 combined single limit coverage against any injury, death, lose, or damage as a result of
wrongful or negligent acts by the Contractor, its officers, employees, agents, and independent contractors
in performance of services under this Agreement; (2)property damage insurance with a minimum limit of
$1,000,000.00; (3) automotive liability insurance with a minimum combined single limits coverage of
$5,000,000.00; and (4) workers' compensation insurance with a minimum limit of$1,000,000.00 or the
amount required by law,whichever is greater. The City, its officers,employees, attorneys, and volunteers
shall be named as additional insured on the policy(ies) as to comprehensive general liability, property
damage, and workers' compensation coverages.
1. Acceptable insurance coverage shall be placed with carriers admitted to write insurance
in California, or carriers with a rating of, or equivalent to, A:VII by A.M. Best &
Company. Any deviation from this rule shall require specific approval, in writing, from
the City.
2. All insurance policies shall provide that the insurance coverage shall not be non-renewed,
canceled, reduced, or otherwise modified (except through addition of additional insured
to the policy) by the insurance carrier without the insurance carrier giving the City thirty
(30) days prior written notice thereof. The Contractor agrees that it will not cancel,
reduce or otherwise modify said insurance coverage.
3. The Contractor agrees that if it does not keep the aforesaid insurance in full force and
effect, and such insurance is available at a reasonable cost, the City may take out the
necessary insurance and pay the premium thereon, and the repayment thereof shall be
deemed an obligation of the Contractor and the cost of such insurance may be deducted,
at the option of the City, from payments due the Contractor.
4. The Contractor shall submit to the City (1) insurance certificates indicating compliance
with the minimum workers' compensation insurance requirements above, and (2)
insurance policy endorsements above, not less than one (1) day prior to beginning of
performance under this Agreement. Endorsements must be executed on the City's
appropriate standard forms entitled "Additional Insured Endorsement," copies of which
are attached hereto.
SPC06-12
C- 6
i
Bond No. 25
$1,443.00
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS that
WHEREAS the CitY of Rwctri Palos Vaclas
(`Public Agency"),has awarded to FaT
1105 IiiS't.
--
(Namc and address of Contractor)
("Principal"),a contract(the"Contract")for the work described as follows: Pawment Striping
(maintenance contract 2006-2007,2007-2008,2008-2009)
WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful
performance of the Contract.
NOW,THEREFORE,we,the undersigned Principal,and
15 Martai.n View A3.
Warren, NI 07059(Nam and address of Surely)
("Surety') a duly admitted surety insurer under the laws of the State of California,as Surety,are
held and firmly bound unto the Public Agency in the penal sum of ane linktsd SAY
tEl and m/100
Dollars--..-...($ 160 410.00 j,this amount beinot less than 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.
TEE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal,his,her
or its heirs,executors,administrators,successors or assigns,shall in all things stand to and abide by,and
well and truly keep and perform all the undertakings,terms,covenants,conditions and agreements in the
Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and
performed, ail within the time and in the manner therein specified,and in all respects according to their
true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers,agents,
and others as therein provided,then this obligation shall become null and void;othavise,it shall be and
remain in full force and effect.
In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable
attorneys'fees in an amount fixed by the court.
SPCO6-12
C-9
theSurety,for value received,hereby stipulates and agrees that no change,extension of time,
FURTHER, of the work to be performed
tion addition or modification to the terms of the Contract, or
alteration,
specifications i ficat ions for the same, shall in any way affect its obligations under this bond,and
thereunder, or addition,or modification to
it does herebywaive notice of any such change,extension of time,
e tarns of the Contract or to the work or to the specifications . Surety hereby waives
the�`
provisions of California Civil Codc '2845 and 2849. The City is the principal beneficiay of this bond
and has all rights of a party hereto.
IN WITNESS two (2) identical counterparts of this instrument,each of which shall for all
deemed anoriginal hereof,have been duly executed by Principal and Surety,on the date set
purposes� beingbyits
below,the name of each party hereto axed and these duly signed
forth undersigned representative(s)pursuant to authority of its governing body.
Dated: ArZ-il 20, 2007
"Principal" "Surety"
VIANINIMPW 'GM"
By: By.,°It LAP
Its\fJ11l%6(jry C. Ja(.Dbrfres;d JnA.+ Darfias A. Itcp
AtbxrEyin Pact
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Its Its
(seal)
APPROVED AS TO suREnr AND APPROVED AS TO FORM:
PRINCIPAL AMOUNT
RI S,WATSON
A,Professional Corporation
By: _ By•
Insurance Administrator Public Agency Attorney
Note: Mb bond must be kited in duplicate and dated,all steres must be notarised and evidence of the authority of any
person sig as attorney-in-fact mat be attached
SPCO6-12
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
r te` &-`i •�y
State of '
gg Californiaa
g 1 ss. ',
g County of LOS ANGELES '?;
,g ?i
l On Celeste A. Graham Notary �'
, before me, Public :s„,
g. Date Name and Title of Officer(e.g.,"Jane Doe,Notary Public") '
personallyappearedWILLIAM G. JACOB PRESIDENT, PCI
g 'oJ
o,
(. Name(s)of Signer(s)
E ersonall known to me
personally oI
�.. ❑ proved to me on the basis of satisfactory si
i. evidence i),
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to be the person(s) whose name(s) is/are !
411. A. _ subscribed to the within instrument and ;$4
ti +,> , ry CELESTE _ acknowledged to me that he/she/theyexecuted
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the same in his/her/their authorized
[oki!.4-- !-�l,. NOTARY PUBLIC-'CALIFORNIA capacity(ies), and that by his/her/their
y nt��,� ANGELES �4UNTY� signature(s)on the instrument the person(s), or -
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the entity upon behalf of which the person(s)
f.
acted, executed the instrument.
WIT, my hand and official s-al. k
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Place Notary Seal Above Signature o Notary Public
. OPTIONAL
(` Though the information below is not required by law, it may prove valuable to persons relying on the document 'f
P and could prevent fraudulent removal and reattachment of this form to another document. >>
Description of Attached Document r
(. Title or Type of Document:
k
Document Date: Number of Pages: ti
Signer(s) Other Than Named Above:
ski
.)
Capacity(ies) Claimed by Signer ki
Signer's Name: RIGHT THUMBPRINT 4
l� ❑ Individual OF SIGNER sJ
Top of thumb here
❑ Corporate Officer—Title(s):
❑ Partner—❑ Limited ❑General
❑ Attorney in Fact .
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❑ Trustee >>
C. ❑ Guardian or Conservator
• ❑ Other:
Signer Is Representing:
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01999 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationalnotary.org Prod.No.5907 Reorder.Call Toll-Free 1-800-876-6827
ACKNOWLEDGMENT
State of California
County of Orange
OnApr. 20, 2007 before me, A.P.Coats,Notary Public
(here insert name and tifie of the officer)
personally appeared Douglas A.Rapp
personally known to me(or proved to me on the basis of satisfactory evidence) to be
the person(s)whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
normypuitzttgAR
6 —1 ORANGE COUNTY Ell
Signature &iiI1 L1 . , MY Tenn J+r zaIX
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(Seal)
POWNI FederalAttn:` IC Chubb Insurance Compan Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY .
Pacific Indemnity Company Warren, NJ 07059
,
Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation,VIGILANT INSURANCE COMPANY,a New York corporation,
and PACIFIC INDEMNITY COMPANY,a Wisconsin corporation,do each hereby constitute and appoint Douglas A A. Rapp or
Linda D. Coats of Laguna Hills, California
each as their true and lawful Attomey-in-Fad to execute under such designation in their names and to affix their corporate seals to and deliver for and on
their behalf as surety thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or
executed in the course of business,and any instruments amending or altering the same,and consents to the modification or alteration of any instrument
referred to in said bonds or obligations.
In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each
executed and attested these presents and affixed their corporate seals on this 2 2nd day of January, 2004
/ /
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-- 444114::8‘--"1-11-7
Kenneth C.Wendel,Assistant Secretary $1& 4
STATE OF NEW JERSEY
ss. .
County of Somerset
On this 2 2 ndlay of January, 2 0 0 4 ,before me,a Notary Public of New Jersey,personally cane Kenneth C.Wendel,to me known
to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the
foregoing Power of Attorney,and the said Kenneth C.Wendel being by me duly sworn,did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY,
VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the foregoing Power of Attorney are
such corporate seals and were thereto awed by authority of the By-Laws of said Companies;and that he signed said Power of
by like authority;and that he is acquainted with Frank E.Robertson,and knows him to be Vice President of said Attorney as Assistant Secretary of said Companies
subscribed to said Power of Attorney is in the genuine handwriting of Frank E.Robertson,and was thereto Companies;and that the signature of Frank E.Robertson,
n9subscribed by authority of said By-Laws and in deponent's presence.
Notarial Seal Karen A.Price
. ..
•Ric Notary Public State of New Jersey Rik LILILLVtei
(4, RY a• (ta4, lUo. 2 !•7
Notary Public
.. are \C, a- !,•,.....,•,,c.;,..1• ?w..„;, r.jam:. . er', ren
'0- 4, y'•.1,.II.,;t:: :: i ,CER�IFIcA N
Extras';,', '►i,,= =' - - of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY:
"Aliattorney for and on behalf of the Company may and shall be executed in the name and on behalf of the
Company,either by the
Chairman or the President or a Vice President or an Assistant Voce President,jointly with the Secretary or an Assistant Secretary, under their
respective designations. The signature of such officers may be engraved,printed or lithographed. The signature of each of the following officers:
Chairman,President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretaty and the seal of the Company may .
be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing 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 bang upon the Company and any such power so
executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or
undertaking to which it is attached.'
I,Kenneth C.Wendel,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY
(the ”)do hereby certify that
(I) the foregoing extract of the -Laws of the Companies mpanies is true and correct,
(iii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of
Columbia and are authorized by the U.S.Treasury Department further,Federal and Vigilant are licensed in Puerto Rico and the U.S. •
Virgin Islands,and Federal is licensed in American Samoa,Guam,and each of the Provinces of Canada except Prince Edward Island;and
(iii) the foregoing Power of Attorney is true,correct and in full force and effect.
Given under my hand and seals of said Companies at Warren,NJ this day of x]-11 .
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Kenneth C.Wendel,Assistant
-
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY,OF THIS BOND OR
NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE,OR BY
Telephone(908)903-3485 Fax (908)903-3656 e-mail: surety@chubb.com
Form 15-10-0225(Ed.499)CONSENT
Bond No. 820445--25
Pieniun
PAYMENT BOND
(LABOR AND MATERIALS)
KNOW ALL PERSONS BY THESE PRESENTS that:
WHEREAS the CitY cif h:'IElcs VecciEs
('Public Agency"),has awarded to Pa
1105 H St.
Ing Bead, CA9006
(Name and addre`s of Conunctor1.
MaillirWOjit*ttiti. .-Tiiiiii40.:.fisiii
X)07dIebt . . � '• rte••. .� � r .�y� •�r �.}• �• fn. S�:/r: ice.•. ,.,� � ._.
�•• 1 .I. •'I• YI
�. - --. • � --fir..
WHEREAS,Principal is required under the terms of the Contract and the California Civil Code to secure
the payment of claims of laborers,mechanics,material ,and other persons as provided by law.
NOW,ITIEREFORE,we,the undersigned Principal,and Ittimal Insware alIFErlY
NT 0059 ---
(Name and adcirag of Surety)
("Surety") a duly admitted surety insurer under the laws of the State of California,as Surety, are
held and firmly bound unto the Public Agency in the penal sum of Cne hnitEd *by ttrumg#
fair lurked tEl a i ra100
Dollars($ 160,410.00 ), this amount being not less than 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 subcontract=shall fail to pay any of the
persons named in Section 3181 of the California Civil 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 Jnsurance 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 3181 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 all court costs and reasonable attorneys'
fees in an amount fixed by the court.
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
thereunder,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
SPCO6-12
C-?
the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives
the
provisions of California Civil Code'2845 and 2849.
JN WITNESS WHEREOF,two (2) identical counterparts of this in.strument,each of which shall for all
purposes be deemed an original hereof,have been duly executed by Principal and Surety,on the date set
hereto affixed and these dulyby its
forth below,the name of each corporate party being signed
undersigned representative(s)pursuant to authority of its governing body.
Dated: 41 20, 200x7 _ .._.
"Surety"
Fa 143:132a InsmarrE attpxy
By: Imp I By: O '
Its Was ry GrJaD-Pr5iee -o1 'w ' A.
"I. - in Fact
By:
By:
Its Its
APPROVED AS TO SURETY AND APPROVED AS TO FORM:
PRINCIPAL AMOUNT
RICHARDS,WATSON&GERSHON
A Professional Corporation
By: BY:
Insurance Administrator Public
Note: This hand must be wed m duplicate and dated. all signatures,oust be notarized and evidence rethe authority of any
person signing as attorney-fn-,fact nayst be attached.
SPC6-t2
C-S
•
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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of California
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g County of LOS ANGELES '',
,g .?'
I. On Celeste A. GrahamLD1
,.. , before me, Notary Public
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g Date Name and Title of Officer(e.g.,"Jane Doe,Notary Public")
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g personally appeared WILLIAM G. JACOB PRESIDENT, PCI 'o,
IPiName(s)of Signer(s) 'I
personally known to me �'
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to be the person(s) whose name(s) is/are !
subscribed to the within instrument and
- CELESTE A GRAHAMacknowledged to me that he/she/they executed
COMM. # ,1 the same in his/her/their authorized
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(' 0", , ..„-OY NOTARY PUBLIC�-CALIFORNIA� capacity(ies), and that by his/her/their '$1
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c� � g ( ) a person(s), or ,�
.1 . Comm: EXP, AUS, 11, 2009 the entity upon behalf of which the person(s)
. acted, executed the instrument.
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Place Notary Seal Above gr Signature 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 this form to another document.
Description of Attached Document
9
(. Title or Type of Document: 9
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Document Date: Number of Pages: ti
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Signer(s) Other Than Named Above:
P
r; Capacity(ies) Claimed by Signer t
( Signer's Name: RIGHT THUMBPRINT
• OF SIGNER
❑ Individual
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❑ Corporate Officer—Title(s):
(: ❑ Partner—Cl Limited ❑ General >>
❑ Attorney in Fact .
` ❑ Trustee >>
❑ Guardian or Conservator
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Signer Is Representing:
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ACKNOWLEDGMENT
State of California
County of Orange
OnApr. 20, 2007 before me, A.P.Coats,Notary Public
(here insert name and tifie of the officer)
personally appeared Douglas A.Rapp
personally known to me(or proved to me on the basis of satisfactory evidence) to be
the person(s)whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand a • or�al seal.
r � m CQATS
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Signature I�►A
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(Seal)
f
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POWUI I Federal Insurance Co
Chubb mpa Attn.•
Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY • � •
Pacific Indemnity Company Warren, NJ 07059
Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation,VIGILANT INSURANCE COMPANY,a New York corporation,
and PACIFIC INDEMNITY COMPANY,a Wisconsin corporation,do each hereby constitute and appoint Douglas A. Rapp or
Linda D. Coats of Laguna Hills, California
each as their true and lawful Attomey-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on
their behalf as surety thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than ball bonds)given or
executed in the course of business,and any instruments amending or altering the same,and consents to the modification or alteration of any instrument
referred to in said bonds or obligations.
In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each
executed and attested these presents and affixed their corporate seals on this 2 2nd day of January, 2004
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41-1-7,--a----
Kenneth C.Wendel,Assistant Secretary - E.Robertson, •= - .
STATE OF NEW JERSEY
ss. .
County of Somerset
Ole* 22 ndday of January, 2004 ,before me,a Notary Public of New Jersey,personally came Kenneth C.Wendel,to me known
to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the
foregoing Power of Attorney,and the said Kenneth C.Wendel being by me duly sworn,did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY,
VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals afioed to the foregoing Power of Attorney are
such corporate seals and were thereto awed by authority of the By-Laws of said Companies;and that he signed said Power of Attorney as Assistant Secretary of said Companies
by Ike author;and that he is acquainted with Frank E.Robertson,and knows him to be Vice President of said Companies;and that the signature of Frank E.Robertson,
subscribed to said Power of Attorney is to the genuine handwriting of Frank E.Robertson,and was thereto subscribed
by authority of said By-Laws and in deponents presence.
Notarial Seal Karen A.Price -
. .. .
PR,� Notary Public State of New Jersey:«, ' rak
• ,a: ��, .,
No. 2231647
• G >- ,� Notary Public
' 1,51b‘' c': . '.. .,•:� ' ..cER`IIFICA'noN
Extract;,'►i,;= -- of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY:
"AI;• = - attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Co either edher by the
Chairman or the President or a Vice President or an Assistant Vice President,jointly with the Secretary or an Assistant Secretary, under their
respective designations. The signature of such officers may be engraved,printed or lithographed. The signature of each of the following officers:
Chairman,President,any Vice President,any Assistant Vice President,any, any and the seal of the Company may .
be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing 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 biding upon the Company and any such power so
executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or
undertaking to which it is attached.'
I,Kenneth C.Wendel,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY
(the"Companies")do hereby certify that
(I) the foregoing extract of the By-Laws of the Companies is true and correct,
(ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of
Columbia and are authorized by the U.S.Treasury further,Federal and Vigilant are licensed in Puerto Rico and the U.S.
Virgin Islands,and Federal is licensed in American Samoa,Guam,and each of the Provinces of Canada except Prince Edward Island;and
tai) the foregoing Power of Attorney is true,correct and in full force and effect
Given under my hand and seals of said Companies at Warren,NJ this day of April 201
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�►DIAl1 '' ". ENr Ypit .
Kenneth C.Wendel,Assistant Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY,OF THIS BOND OR
NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY
Telephone (908)903-3485 Fax (908)903-3656 e-mail: surety@chubb.com
Form 15-10-0225(Ed.499)CONSENT
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 insureds and that the same are in force at this time:
1. This certificate is issued to:
City of Rancho Palos Verdes
City Hall
30940 Hawthorne Boulevard
Rancho Palos Verdes,California 90275
2. The insureds 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 insureds as follows:
Policy Number Effective Date Expiration Date
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:
Its Authorized Representative
SPC06-12
C- 11
1
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 prevailing rates of wages to workers and the penalties for failure
to pay prevailing 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
prevailing 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 co en ing the performance of the
work of this contract."
Date 04)t�►-I J
l'�`� Signature illitieh6.Alicyb-Presiden-i-
SPC06-12
C- 12
.+
INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
AND WAIVER OF SUBROGATION AND CONTRIBUTION
Contract/Agreement/License/Permit eement/License/Permlt No. or description: pot��1M�°� ,�' p � y-
3
\lett' -1—e, n &
Indemnitor(s) (list all names):
To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend,
protect, indemnify, and hold harmless the City of Rancho Palos Verdes and its elected officials, officers,
attorneys, agents, employees, volunteers, successors, and assigns (collectively "Indemnitees") from and
against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings,
expenses,judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants,
attorneys, or other professionals and all costs associated therewith (collectively "Liabilities"), arising or
claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act,
failure to act, error, or omission of Indemnitor or any of its officers, agents, servants, employees,
subcontractors, 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 Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence.
This indemnity provision shall survive the termination of the Agreement and is in addition to any other
rights or remedies which Indemnitees may have under the law. Payment is not required as a condition
precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment
against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this
indemnity provision. Indemnitor shall pay Indemnitees for any attorney's fees and costs incurred in
enforcing this indemnification provision. Notwithstanding the foregoing,nothing in this instrument shall
be construed to encompass (a) Indemnitees' sole negligence or willful misconduct to the limited extent
that the underlying Agreement is subject to Civil Code 2782(a) or (b) the contracting public agency's
active negligence to the limited extent that the underlying Agreement is subject to Civil Code 2782(b).
This indemnity is effective without reference to the existence or applicability of any insurance coverages
which may have been required under the Agreement or any additional insured endorsements which may
extend to Indemnitees.
Indemnitor, on behalf of itself and all parties claiming under or through it, hereby waives all rights of
subrogation and contribution against the Indemnitees, while acting within the scope of their duties, from
all claims, losses and liabilities arising out of or incident to activities or operations performed by or on
behalf of the Indemnitor regardless of any prior, concurrent, or subsequent active or passive negligence
by the Indemnitees.
In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all
obligations, liabilities, covenants and conditions under this instrument shall be joint and several.
"Indemnitor"
Name Pal—
Name
By: By:
Its i1 & cb-Pres d e{' Its
SPC06-12
C- 13
i •
ADDITIONAL INSURED ENDORSEMENT
AUTOMOBILE LIABILITY
Name and address of named insured("Named Insured'):
Name and address of Insurance Company("Company'):
General description of agreement(s),permit(s), license(s), and/or activity(ies) insured:
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached
(the"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows:
1. The
("Public Agency"), its elected officials, officers, attorneys, agents, employees, and volunteers are
additional insureds (the above named additional insureds are hereafter referred to as the "Additional
Insureds") 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 Insureds have no liability for
the payment of any premiums or assessments under the Policy.
2. The insurance coverages afforded the Additional Insureds under the Policy shall be
primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to
contribute with the insurance coverages provided by the Policy.
3. Each insurance coverage under the Policy shall apply separately to each Additional
Insured against whom claim is made or suit is brought except with respect to the limits of the Company's
liability.
4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim
by one insured under the policy against another insured under the policy. All such claims shall be
covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each
insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of
liability as provided under the policy.
5. The insurance afforded by the Policy for contractual liability insurance (subject to the
terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named
Insured under the indemnification and/or hold harmless provision(s) contained or executed in conjunction
with the written agreement(s) or permit(s) designated above, between the Named Insured and the
Additional Insureds.
6. The policy to which this endorsement is attached shall not be subject to cancellation,
change in coverage, reduction of limits (except as the result of the payment of claims), or non-renewal
except after written notice to Public Agency, by certified mail, return receipt requested, not less than
thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this
notice provision, the policy as initially drafted will continue in full force and effect until compliance with
this notice requirement.
7. Company hereby waives all rights of subrogation and contribution against the Additional
Insureds, 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 Insureds.
SPC06-12
C- 16
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:
10. Except as stated above and not in conflict with this endorsement, nothing contained
herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to
which this endorsement is attached.
TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY
11. Scheduled items or locations are to be identified on an attached sheet. The following
inclusions relate to the above coverages. Includes:
o Contractual Liability o Explosion Hazard
o Owners/Landlords/Tenants o Collapse Hazard
o Manufacturers/Contractors o Underground Property Damage
o Products/Completed Operations o Pollution Liability
o Broad Form Property Damage o Liquor Liability
o Extended Bodily Injury o
o Broad Form Comprehensive o
General Liability Endorsement o
12. A o deductible or o self-insured retention(check one) of$
applies to all coverage(s)except:
(if none, so state). The deductible is applicable o per claim or o per occurrence (check one).
13. This is an o occurrence or o claims made policy(check one).
14. This endorsement is effective on at 12:01 a.m. and forms a
part of Policy Number
I, (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 ,20
Signature of Authorized Representative
(Original signature only; no facsimile signature
Telephone No.: ( ) or initialed signature accepted)
SPC06-12
C- 15
ADDITIONAL INSURED ENDORSEMENT
COMPREHENSIVE GENERAL LIABILITY
Name and address of named insured("Named Insured'):
Name and address of Insurance Company ("Company'):
General description of agreement(s),permit(s), license(s), and/or activity(ies) insured:
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached
(the"Policy")or in any endorsement now or hereafter attached thereto, it is agreed as follows:
1. The
("Public Agency"), its elected officials, officers, attorneys, agents, employees, and volunteers are
additional insureds (the above named additional insureds are hereafter referred to as the "Additional
Insureds") 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 Insureds have no liability for
the payment of any premiums or assessments under the Policy.
2. The insurance coverages afforded the Additional Insureds under the Policy shall be
primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to
contribute with the insurance coverages 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 Insureds.
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
Insureds, 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 Insureds.
SPC06-12
C - 14
r
8. It is hereby agreed that the laws of the State of California shall apply to and govern the
validity,construction,interpretation, and enforcement of this contract of insurance.
9. This endorsement and all notices given hereunder shall be sent to Public Agency at:
City Manager
City of Rancho Palos Verdes
30940 Hawthorne Boulevard
Rancho Palos Verdes, California 90275
10. Except as stated above and not in conflict with this endorsement, nothing contained
herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to
which this endorsement is attached.
TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY
11. Scheduled items or locations are to be identified on an attached sheet. The following
inclusions relate to the above coverages. Includes:
A• ny Automobiles i Truckers Coverage
A
i All Owned Automobiles M• otor Carrier Act
N• on-owned Automobiles i Bus Regulatory Reform Act
I Hired Automobiles P• ublic Livery Coverage
P A
S• cheduled Automobiles
G• arage Coverage
12. A o deductible or o self-insured retention(check one) of$
applies to all coverage(s)except: (if none, so state). The deductible is applicable G per claim or G
per occurrence (check one).
13. This is an o occurrence or o claims made policy(check one).
14. This endorsement is effective on at 12:01 a.m. and forms a part of Policy
Number
I, (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 , 20
Signature of Authorized Representative
(Original signature only; no facsimile signature
Telephone No.: ( ) or initialed signature accepted)
SPC06-12
C- 17
ADDITIONAL INSURED ENDORSEMENT
EXCESS LIABILITY
Name and address of named insured("Named Insured'):
Name and address of Insurance Company("Company'):
General description of agreement(s),permit(s), license(s), and/or activity(ies) insured:
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached
(the"Policy")or in any endorsement now or hereafter attached thereto, it is agreed as follows:
1. The
("Public Agency"), its elected officials, officers, attorneys, agents, employees, and volunteers are
additional insureds (the above named additional insureds are hereafter referred to as the "Additional
Insureds") 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 Insureds have no liability for
the payment of any premiums or assessments under the Policy.
2. The insurance coverages afforded the Additional Insureds under the Policy shall be
primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to
contribute with the insurance coverages 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 Insureds.
6. The policy to which this endorsement is attached shall not be subject to cancellation,
change in coverage, reduction of limits (except as the result of the payment of claims), or non-renewal
except after written notice to Public Agency, by certified mail, return receipt requested, not less than
thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this
notice provision, the policy as initially drafted will continue in full force and effect until compliance with
this notice requirement.
7. Company hereby waives all rights of subrogation and contribution against the Additional
Insureds, 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 Insureds.
SPC06-1 2
C- 18
8. It is hereby agreed that the laws of the State of California shall apply to and govern the
validity, construction,interpretation, and enforcement of this contract of insurance.
9. This endorsement and all notices given hereunder shall be sent to Public Agency at:
City Manager
City of Rancho Palos Verdes
30940 Hawthorne Boulevard
Rancho Palos Verdes, California 90275
10. Except as stated above and not in conflict with this endorsement, nothing contained
herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to
which this endorsement is attached.
TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF
THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY
❑ Following Form
❑ Umbrella Liability
11. Applicable underlying coverages:
INSURANCE COMPANY POLICY NO. AMOUNT
12. The following inclusions, exclusions, extensions or specific provisions relate to the above
coverages:
13. A o deductible or o self-insured retention(check one) of$
applies to all coverage(s)except:
(if none, so state). The deductible is applicable o per claim or o per occurrence (check one).
14. This is an o occurrence or o claims made policy(check one).
15. This endorsement is effective on at 12:01 a.m. and forms a part of Policy
Number
I, (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 , 20
Signature of Authorized Representative
(Original signature only; no facsimile signature
Telephone No.: ( ) or initialed signature accepted)
SPC06-12
C- 19
MUST BE DISPLAYED IN PLACE OF BUSINESS-NOT TRANSFERABLE
City of RPalos Verdes Finance Department
30940 Hawthorne Blvd
BUSINESS TAX REGISTRATION CERTIFICATE Rancho Palos Verdes, CA 90275
THIS CERTIFICATE IS EVIDENCE THAT THE PERSON OR FIRM
Business Name: PCI A CALIFORNIA LIMITED PRTNS NAMED HAS PAID A TAX TO CONDUCT AND OPERATE A BUSINESS
Business Number: 1889 AS INDICATED HEREON PURSUANT TO THE PROVISIONS OF
Location Address: OUT OF CITY BUSINESS enAPTFR IV(1F RANCN(1 PAI nc VFRI WQ MI TNICIPAI C(lEW
License Number/Class: 07 00001900. SUBCONTRACTORS&OTHER CONTRACTORS
. _ ... .._.ter„--•--••----••--•_•.r-••r--.--• ,
LIMITED PRTNS .. . ::. . .. .. :. -.
PCI 4 CALIFORNIA .� • .
POBOX161
LONG BEACH 90806 `,,Y ,.�i - :▪. .. •
•
Issue Date: 1/16/07 Expiration Date: 12/31/07 ISSUING OFFICERS
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