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HomeMy WebLinkAboutThe Don Chapin Company - Sixth Street Improvement Project efT)' . . SECTION 00500 ~Opi AGREEMENT Sixth Street Improvement Project (Eigleberry Street to Railroad Street), Federal Project No. CML-5034(017), Project No. 09-CDD-167 THIS AGREEMENT, made thi~ /3 dayof..:rO/.J.l ~~d between the Citv of Gilrov , hereinafter called the "City," am171/€ iJdAlt!H1J,r7~ Co ._mafter called the "Contractor. " WITNE~~ETH: WHEREAS, the City has caused the Contract Documents to be prepared comprised of bidding and contract requirements and technical specifications and drawings for the construction of the Sixth Street Improvement Project (Eigleberry Street to Railroad Street), Federal Project No. CML-5034(017), Project No. 09-CDD-167, as described therein, and WHEREAS, the Contractor has offered to perform the proposed work in accordance with the terms of the Contract Documents. NOW, THEREFORE, in consideration of the mutual covenants and agreements of the parties herein contained and to be performed, the City and Contractor agree as follows: Article 1. Work. Contractor shall complete the W oi'k as specified or indicated in the Contract Documents. Article 2. Contract Time. The Work shall be completed by the Contractor in accordance with the Contract Documents within the time period required by Paragraph 00810-2.0, Time Allowed for Completion, subject to extension as expressly provided in the Contract Documents. Article 3. Liquidated Damages. THE CITY AND THE CONTRACTOR RECOGNIZE THAT THE CITY WILL SUFFER SUBSTANTIAL DAMAGES AND SIGNIFICANT FINANCIAL LOSS AS A RESULT OF THE CONTRACTOR'S DELAYS IN PERFORMANCE OF THE WORK DESCRIBED IN THE CONTRACT DOCUMENTS. THE CITY AND THE CONTRACTOR HEREBY ACKNOWLEDGE AND AGREE THAT THE DAMAGES AND FINANCIAL ,LOSS Sixth Street Improvement Project (Eigleberry Street to Railroad Street) SECTION 00500-1 Federal Project No. CML-5034(OI7) Project No. 09-CDD-167 \ . SUSTAINED AS A RESULT OF ANY SUCH DELAYS IN PERFORMANCE WILL BE EXTREMELY DIFFICULT AND IMPRACTICAL TO ASCERTAIN. THEREFORE, THE CITY AND CONTRACTOR HEREBY AGREE THAT IN THE EVENT OF SUCH DELAYS IN PERFORMANCE, THE CITY SHALL BE ENTITLED TO COMPENSATION BY WAY OF LIQUIDATED DAMAGES (AND NOT PENALTY) FOR THE DETRIMENT RESULTING THEREFROM IN ACCORDANCE WITH PARAGRAPH 00700-6.5, LIOillDATED DAMAGES, OF THE CONTRACT DOCUMENTS. THE CITY AND THE CONTRACTOR FURTHER AGREE THAT THE AMOUNTS DESIGNATED AS LIQUIDATED DAMAGES ARE A REASONABLE ESTIMATE OF THE CITY'S DAMAGES AND FINANCIAL LOSS IN THE EVENT OF ANY SUCH DELAYS IN PERFORMANCE CONSIDERING ALL OF THE cmCUMSTANCES EXISTING AS OF THE DATE OF Tms AGREEMENT, INCLUDING THE RELATIONSHIP OF SUCH AMOUNTS TO THE RANGE OF HARM TO THE CITY WIDCH REASONABLY COULD BE ANTICIPATED AS OF THE DATE OF TmS AGREEMENT AND THE EXPECTATION THAT PROOF OF ACTUAL DAMAGES WOULD BE EXTREMELY DIFFICULT AND IMPRACTICAL. BY INITIALING Tms PARAGRAPH BELOW, THE PARTIES HERETO SIGNIFY THEm APPROVAL AND CONSENT TO THE TERMS OF Tms ARTICLE 3. ~ ~ City's Initials Contractors Initials Article 4. Contract Price. In consideration of the Contractors performance of the Work in accordance with the Contract Documents, the City shall pay the Contract Price set forth in the Contract Documents. Article 5. Contract Documents. The Contract Documents which comprise the entire agreement between City and Contractor concerning the Work consist of this Agreement (Section 00500 of the Contract Documents) and the following, all of which are hereby incorporated into this Agreement by reference with the same force and effect as if set forth in full. Invitation to Bid Instructions to BiddersBid Documents Designation of Subcontractors Bid Guaranty Bond Agreement Acknowledgements Performance Bond Sixth Street Improvement Project (Eiglcbeny Street to Railroad Street) Federal Project No. CML-S034(OJ 7) Project No. 09-CDD- I 67 SECTION 00500-2 Payment Bond General Conditions Supplementary Conditions General Requirements Standard Specifications Technical Specifications Drawings Addenda, if any Executed Change Orders, if any Notice of Award Notice to Proceed Article 6. Miscellaneous. Capitalized terms us~d in this Agreement which are defmed in Section 01090, References, of the Contract Documents will have the meanings set forth in Section 01090, References. Contractor shall not assign any rights, obligations, duties or responsibilities under or interest in the Contract Documents without the prior written consent of the City, which consent may be withheld by the City in its sole discretion. No assignment by the Contractor of any rights, obligations, duties or responsibilities under or interests in the Contract Documents will be binding on the City without the prior written consent of the City (which consent may be withheld in City's sole discretion); and specifically but without limitation monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, executed by the City, no assignment will release or discharge the assignor from any liability, duty, obligation, or responsibility under the Contract Documents. Subject to the foregoing, the Contract Documents shall be binding upon and shall inure to the benefit of the parties hereto and their respective successors and assigns. Nothing contained in the Contract Documents shall in any way constitute a personal obligation of or impose any personal liability on any employees, officers, directors, agents or representatives of the City or its successor and assigns. In accordance with California Business and Professions Code Section 7030, the Contractor is required by law to be licensed and regulated by the Contractors' State License Board which has jurisdiction to investigate complaints against Contractors if a complaint regarding a latent act or omission is filed within four years of the date of the alleged violation. A complaint regarding a latent act or omission pertaining to structural defects must be filed within 10 years of the date of the alleged violation. Any questions concerning the Contractor may be referred to the Registrar, Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(OI7) Project No. 09-CDD-167 SECTION 00500-3 Contractors' State License Board, P.O. Box 26000, Sacramento, California 95826. IN WITNESS WHEREOF, this agreement has been executed on this /3 day. of :r VU{ , 1.IJIO . 71fC0dJV~""a. ~ Name of Contractor ~ Signature of City ,7hV(flQ S r; I-wO/Llnd ())t~ Title of Signator /kJ,10fflr Title of Signator ,;f~b. /I., W~ ~ignature .\ lA ~ck C Q lIon Signature e i~1 A-Ho rN '-j J Title of Signator Cl'-hj (Jfr ~ Title 01 Signator ***END OF SECTION*** Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(O 17) Project No. 09-CDD-167 SECTION 00500-4 SECTION 00650 WORKERS' COMPENSATION INSURANCE CERTIFICATE In accordance with California Labor Code Section 1861, prior to commencement of work on the Contract, the Contractor shall sign and file with the City the following certification: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of ork 0 .s contr t." 71ft: {)()~C#1tPI^~ ~ Name of Contractor ~/~Ir , Title 7"/3-/0 Date **** END OF SECTION **** Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(OI7) Project No. 09-CDD-167 SECTION 00650-1 SECTION 00670 NOTICE OF NONDISCRIMINATION IN EMPLOYMENT The undersigned contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, age, marital status or national origin. The Contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, age, marital status or national origin. Such action shall include, but not be limited to, the following: Employment, upgrading, demotion, or transfer, recruitment advertising; layoff or termination; rates of pay, or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment notice to be provided by the municipality setting forth the provisions of this nondiscrimination clause. 7#"{3-/0 ~()ft:JSI2- Licensed General Contractor Date TIIG OdAl ~/~ & ~ Company License # ***POST IN CONSPICUOUS PLACE OF EMPLOYMENT*** ***END OF SECTION*** Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(0 17) Project No. 09-CDD-167 SECTION 00670-1 SECTION 00620 Bond II 105443937 Premium included with Performance Bond PAYMENT BOND KNOW ALL PERSONS BY THESE PRESENTS, THAT, WHEREAS, Citv of Gilrov . hereinafter designated as the "City," has, on July 13 , 2010. awarded to/The Don Chapin hereinafter designated as the "Principal," a Contract for the construction of the Sixtrmierr, Inc. Improvement Project (Eigleberry Street to Railroad Street), Federal Project No. CML- 5034(017), Project No. 09-CDD-167 WHEREAS, said Principal is required to furnish a bond in connection and with said Contract, providing that if said Principal, or any of it or its subcontractors shall fail to pay for any materials, provisions, or other supplies used in, upon, for, or about the performance of the work contracted to be done, or for any work or labor done thereon of any kind, the Surety of this bond will pay the same to the extent hereinafter set forth: NOW, THEREFORE, we, the Principal, and, as Surety, are held and firmly bound t th C'tyth al of One Million Twenty-Four Thousand, Four Hundred un 0 e 1 e pen sum Seveat) Four NO,' 1 00 Dollars ($ 1.024.474.00 ) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors jointly and severally, fIrmly by these presents. The Payment Bond for which this Section provides shall secure the payment of those persons or entities to whom the Principal, its Subcontractors or its heirs, executors, administrators, successors, or assigns, shall be become legally indebted for labor, materials, tools, equipment or services of any kind used or employed by the bidder in performing the work, or taxes or amounts to be withheld thereon. The Surety or Sureties will pay the following amounts should the Principal or a Subcontractor fail to pay the same, plus reasonable attorneys' fees to be fixed by the court if suit is brought upon the bond: (1) amounts due to any of the persons named in California Civil Code Section 3181; (2) amounts due under the Unemployment Insurance Code with respect to work contracted to be done or any work or labor thereon of any kin; and (3) any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the Principal and Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to the work and labor. This Payment Bond shall inure to the benefit of any of the persons named in Civil Code Section 3181 so as to give a right of action to those persons or their assigns in any suit brought upon this bond. Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(017) Project No. 09-CDD-167 SECTION 00620-1 Page 2 of Payment Bond # 105443937 And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition of the terms of the Contract or to the work to be performed thereunder or the specifications accompanying the same shall, in any way, affect its obligations of this bond, and it does hereby waive notice of any change, extension of time, alteration, or addition to the terms of the contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2819 and 2845 of the Civil Code of the State of California. IN WITNESS WHEREOF, the above bounded parties have executed this instrument under their seals this 13th day of July . 2010. the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. The Don Chapin Company, Inc. Principal (Seal) Signature for Principal ~~r Travelers Casualty and Surety Company of America Surety (Seal) &~"/..:/dd~ Detorah L. Tablak Signature for Surety Attorney-in-Fact Title **** END OF SECTION **** Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(017) Project No. 09-CDD-167 SECTION 00620-2 WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER , Thi~ Power 'of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kori M. Johanson, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand this 13th d f ay 0 July ,20 10 Kori M. Johans fa ~~ '~.:f ~ o ~ ~.~~~'~"...... .' ''';' ,Y". .,....., T~\ .~ Ill:" - m ;~UJ;^ NC~ cPO IIIIIHI"l\\\\II1 ~-.... fd:~q.~,'~'~'!~:9'f11;-'" <I..... -":"'('1\ ~::(<O~~~:Ari'\ ';" t..SEAL,/l \)r..... ....<fIi o{$'....;...'t-~ To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-In-Fact number, the above-named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVAliD WITHOUT THE RED BORDER POWER OF ATTORNEY WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER ! , ~ TRAVELERSJ Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. Seaboard Surety Company St. Paul Fire and Marine Insurance Company Attorney-In Fact No. 219995 St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company Certificate No. 0 0 2 4 9 8 8 9 2 KNOW ALL MEN BY THESE PRESENTS: That Seaboard Surety Company is a corporation duly organized under the laws of the State of New York. that St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut. that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa. and that Fidelity and Guaranty Insurance Underwriters, Inc. is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"). and that the Companies do hereby make, constitute and appoint Dennis M. Carney, Catherine Gustavson, F. R. Hudson III, Deborah L. Tablak, Jeanette M. Mazzarino, David J. Bachan, Matthew Reade, and John R. Ullmer of the City of Watsonville , State of California , their true and lawful Attorney(s)-in-Fact. each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in thei)' business of guaranteemg the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or pyrmjtted in any actions QrprQceedings allowed by law. !N WITNESS WHEREOF, the Companies have caused this day of July , 2008 . their corporate seals to be hereto affixed, this 15th Farmington Casualty ~o~piUty Fidelity and Guaranty Jnsu~ll;~C'~;0ompan~ Fidelity and Guaranty Insurance Underwriters, Inc. Seaboard Surety Company St. Paul Fire and Marine Insurance Company State of Connecticut City of Hartford ss. St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company (~~f~:;;~\ i.t..SEAL"!.?,l '\..O'~' "4b ~s'."'~""'~~.Y "...:.-" ~........, ~ ~ WIlt,s- y~ .!ill\m~~ ~~~OONJ}J ~~ By: 15th July 2008 . On this the day of , before me personally appeared George W. Thompson, who acknowledged hImself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2011. 58440-5-07 Printed in U.S.A. '\f\w, c. j~ "- Marie C. Tetreault Notary Puhlic " . CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT State of California County of Santa Cruz On July 13,2010 before me, Guadalupe Aboytes Jimenez, Notary Public, personally appeared Deborah L. Tablak, who proved to me on the basis of satisfactory evidence to be the personfsj whose namefsj istaFe subscribed to the within instrument and acknowledged to me that ~she~ executed the same in msA1er~ authorized capacity~ and that by msA1er~ signaturefsj on the instrument the personfsj, or the entity upon behalf of which the personfsj acted, executed the instrument I certify under PENALTY OF PERJURY under the laws of the State of Cali fomi a that the foregoing paragraph is true and correct. r~. GJADALUPE ABOYTES JIMENEZ i M / .....; . . COMM. # 1889432 -< ~ ~.., Notary Public-Calrtornia 0; t ~. . , County of Santa Cruz r ~ _ My Comm. Exp, May 15, 2014 WITNESS my hand and official seal. _____________________________________________________()PTI()NA~---------------------------------------------- D()CUMENT AND SIGNER Type: Payment Bond # 105443937 Principal: The Don Chapin Company, Inc. Obligee: City of Gilroy Description: Sixth Street Improvement Project (Eigleberry to Railroad) Deborah L. Tablak is Attorney-in-Fact for Travelers Casualty and Surety Company of America I I SECTION 00610 Bond # 105443937 Premium: $5,378.00 FMTHFULPERFORMANCEBOND KNOW ALL PERSONS BY THESE PRESENTS, THAT, WHEREAS, Citv of Gilrov. hereinafter designated the "City," has; on July 13 , ~ awarded to, The Don Chapin _hereinafter designated as the "Principal," a Contract for the construction of the Sixth Street Improvement Project (Eigleberry Street to Railroad Street), Federal Project No. CML- 5034(017), Project No. 09-CDD-167 Company, Inc. . WHEREAS, said Principal is required und~r the terms of said Contract to furnish a bond for the faithful performance of said Contract: Travelers Casualty and Surety Company of America NOW, THEREFORE, WE, the Principal, and I, as Surety, are held and frrmly bound unto the City the penal sum of One Million Twenty-Four Thousand, Four Hundred Seventy-Four NO/100------------ dollars ($1,024,474.00 ) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if the above bounden Principal, it or its heirs, executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep and faithfully perform the covenants, conditions, and ~.greements in the said contract and any alterations made as therein provided, on it or their part to be kept and perfonned, at.the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall indemnify and save harmless, the City, its officers and agents as therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and virtue. It is acknowledged that the Contract provides for a one-year warranty period, during which time this bond remains in full force and effect. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the tenns of the Contract or to the work to be performed thereunder or the specifications accompanying the same shall, in any way, affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration, or addition to the tenns of the Contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2819 and 2845 of the Civil Code of the State of California Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(017) Project No. 09-CDD-167 SECTION 00610-} Page 2 of Performance Bond # 105443937 IN WITNESS WHEREOF, the above bounden parties have executed this instrument under their seals this 13th day of July ,2010 . the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. (Seal) The Don Chapin Company, Inc. Principal Signature for Principal ~()#/7' Title of Signator (Seal) Travelers Casualty and Surety Company of America Surety ~.~;(.1>>~ Signature for Sufe Deborah L. Tabl-;k Attorney-in-Fact Title of Signator **** END OF SECTION**** Sixth Street Improvement Project (Eigleberry Street to Railroad Street) Federal Project No. CML-5034(017) Project No. 0~-CDD-167 SECTION 00610-2 WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER , This' Power 'of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company. Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company. St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kori M. Johanson, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand this 13th July ,201~. Kori M. Johans o ~ .....-;~;--.. /r~q;...,........-f",-""" ~f !(~~~~~~A;i\~\ ..I: io .,........~EA.~/f o-;..$:....;.....~~~ .- To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-In-Fact number, the above-named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER ~ TRAVELERSJ Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. Seaboard Surety Company St. Paul Fire and Marine Insurance Company Attorney-In Fact No. 219995 St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company Certificate No. 0 0 2 4 9 8 8 91 KNOW ALL MEN BY THESE PRESENTS: That Seaboard Surety Company is a corporation duly organized under the laws of the State of New York. that St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company. and Travelers Casualty and Surety Company of America arc corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa. and that Fidelity and Guaranty Insurance Underwriters, Inc. is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"). and that the Companies do hereby make, constitute and appoint Dennis M. Carney, Catherine Gustavson, F. R. Hudson III, Deborah L. Tablak, Jeanette M. Mazzarino, David J. Bachan, Matthew Reade, and John R. Ullmer of the City of WM~()nvill.. . State of r>)lif()rni>) , their true and lawful Attorney(s)-in-Fact. each in their separate capacity if more than one is named above, to sign. execute, seal and acknowledge any and all bonds, recognizances. conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or p~rmittedCin any actions or pf<lceedings allowed by law. 11\ WITNESS WHEREOF, the Companies have caused this day of July 2008 signed and Farmington Casualty ~Q~PllJlY Fidelity and GuarantYJnsu~a}lceCoritpan~ Fidelity and Guaranty Insurapce Underwriters, Inc. Seaboard Surety Company St. Paul Fire and Marine Insurance Company State of Connecticut City of Hartford ss. seals to be hereto affixed. this 15th St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company (ttr::;s;~~\ i .I: ;0: \ ?6;;:.~.E.A~1 j ~S"""""'t'-~"/ ,,,,-~.., "....~ P!!tJfiJ-c ~~~&J~\ ~~COHN.), 'iI ~,( ...__.~<-I. . . By: On this the 15th day of July 200~ before me personally appeared George W. Thompson, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company. Fidelity and Guaranty Insurance Underwriters. Inc.. Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company. and that he. as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2011. 58440-5-07 Printed in U.S.A. '\f\a.W C. j~ '- Marie C. Tetreault. Notary Public WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT State of California County of Santa Cruz On July 13,2010 before me, Guadalupe Aboytes Jimenez, Notary Public, personally appeared Deborah L. Tablak, who proved to me on the basis of satisfactory evidence to be the person~ whose nam~ iskfe subscribed to the within instrument and acknowledged to me that ~she~ executed the same in m&her~ authorized capacity~ and that by ~her~ signature~ on the instrument the person~, or the entity upon behalf of which the person~ acted, executed the instrument I certify under PENALTY OF PERJURY under the laws of the State of Cali fomi a that the foregoing paragraph is true and correct. . .~...........~....(.t.~./.., .....,.. GJADAL:.,?E AaoYrES JIMeNEZ I '/ ....... '-! lie COMM. # 1889432 <:: :': h:~ Notary Public.California ~ -:':;;;':<-:"",; County of Santa Cruz T ":';:'~:~".SoTT' Exp. May_1S. 2014 WITNESS my hand and official seal. _____________________________________________________()PllI()NA~---------------------------------------------- D()CUMENll AND SIGNER Type: Performance Bond # 105443937 Principal: llhe Don Chapin Company, Inc. Obligee: City of Gilroy Description: Sixth Street Improvement Project (Eigleberry to Railroad) Deborah L. Tablak is Attorney-in-Fact for llravelers Casualty and Surety Company of America I I ~ ACORD<>> CERTIFICATE OF LIABILITY INSURANCE r DATE (MM/DDIYYYY) ~ 09/30/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #0056172 1-831-724-3841 CONTACT NAME: McSherry & Hudson . rllgNJ COv": I FAX i ;A/C No\: 575 Auto Center Drive E-MAIL ADDRESS: P. O. Box 2690 PRODUCER Watsonvi11e, CA 95076 INSURERrs\ AFFORDING COVERAGE NAIC# INSURED INSURER A : ZURICH AMERICAN INS CO 16535 THE DON CHAPIN COMPANY INC. INSURER B : 560 CRAZY HORSE CANYON ROAD INSURER C : SALINAS, CA 93907 INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 23390023 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 TYPE OF INSURANCE I~.~..o.!- ~.'!.~! ,:gMg~ (:g~Jg~\ LIMITS LTR POLICY NUMBER A GENERAL LIABILITY X X GLO 9674277-01 10/01/1 10/01/12 EACH OCCURRENCE $ 1,000,000 f-- X :3MMERCIAL GENERAL LIABILITY ~~~~~il9E~~~J~~nce\ $ 300,000 - CLAIMS-MADE 0 OCCUR - MED EXP (Anyone person) $ 5,000 X Contractual Liability PERSONAL & ADV INJURY $ 1,000,000 - - GENERAL AGGREGATE $ 2,000,000 ~'L AGGREAE LIMIT AP~t PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY ~~.9,: LOC $ A AUTOMOBILE LIABILITY X X BAP 9674279-01 10/01/1 10/01/12 COMBINED SINGLE LIMIT $ 1,000,000 - (Ea accident) X ANY AUTO - BODILY INJURY (Per person) $ - ALL OWNED AUTOS BODILY INJURY (Per accident) $ - SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ - NON-OWNED AUTOS $ f-- X Contractual Liab. $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ I-- EXCESS L1AB CLAIMS-MADE AGGREGATE $ f-- DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION X WC 9674280-03 10/01/1 10/01/12 X IlXg.9T f'J#;" I IOlbl- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ~ E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 g~~'Mrtirg~ '8'~'6PERATIONS below EL DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) AS RESPECTS PROJECT NO. 09-CDD-167, FEDERAL PROJECT NO. CML-5034 (017) SIXTH ST. IMPROVEMENTS PROJECT (EIGLEBERRY ST. TO RAILROAD ST.) THE CITY OF GILROY AND CITY'S EMPLOYEES, OFFICERS, DESIGN CONSULTANTS, ELECTED OFFICIALS, CONSTRUCTION MANAGER, AGENTS, AND SUB CONSULTANTS ARE HEREBY ADDED AS ADDITIONAL INSUREDS PER ATTACHED ENDORSEMENTS. GL PER ISO FORM CGOO01 12/07; AL PER ISO FORM CA0001 03/06 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ENGINEERING DIVISION 7351 ROSANA STREET AUTHORIZED REPRESENTATIVE GILROY, CA 95020 ~ 1 USA yrivera ACORD 25 (2009/09) 23390023 @1988-2009ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 09/30/2011 NAME OF INSURED: THE DON CHAPIN COMPANY INC. SUPP (10/00) POLICY NUMBER: GLO 9674277-01 ZURICH AMERICAN INS. CO. COMMERCIAL GENERAL LIABILITY CG 24 04 10/93 / Modified THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: Any person or organization that requires you to waive your rights of recovery, in a written contract or agreement with the named insured that is executed prior to the accident or loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) THE TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24041093 Copyright, Insurance Services Office, Inc., Page 1 of 1 Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance g ZURICH Policy No. Eft. Date of Pol. Exp. Date of Pol. Eft. Date of End. Producer No. Add'!. Prem Return Premo GL09674277-01 10-1-2011 10-1-2012 10-1-2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A. If we cancel or non-renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Number of Days Notice: Oraanization(s): Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non-renewal, and/or reduction in coverage All other terms and conditions of this policy remain unchanged. U-GL-1447-A CW (05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Additional Insured - Automatic - Owners, Lessees Or Contractors @ ZURICH Policy No. Eft. Date of Pol. Exp. Date of Pol. Agency Add!. Return Premo Premo GLO 9674277-01 10/01/2011 10/01/2012 McSherry & Hudson THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II - Who Is An Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agree- ment. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or "personal and advertising injury" covered under SECTION I - Coverage A - Bodily Injury And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, but only with respect to liability for "bodily injury", "property damage" or "personal and advertis- ing injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; and resulting directly from: a. Your ongoing operations performed for the additional insured, which is the subject of the written contract or written agreement; or b. "Your work" completed as included in the "products-completed operations hazard", performed for the additional insured, which is the subject of the written contract or written agreement. C. However, regardless of the provisions of paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or fail- ure to render any professional architectural, engineering or surveying services including: Includes copyrighted material of Insurance Services Office, Inc., with its permission U-GL-1175-B CW (3/2007) Page 1 of 2 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. E. The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the writ- ten contract or written agreement requires that this coverage be primary and non-contributory. F. For the coverage provided by this endorsement: The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV - Commercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the ad- ditional insured person or organization is a Named Insured. 1. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV - Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional in- sured by attachment of an endorsement to another policy providing coverage for the same "occur- rence", claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an en- dorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as written. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1175 B CW (3/2007) Page 2 of 2 @ ZURIC WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Policy No. Eft. Date of Pol. Exp. Date of Pol. Eft. Date of End BAP 9674279-01 10/1/2011 10/1/2012 10/1/2011 This endorsement modifies insurance provided by the following: Business Auto Coverage Part Truckers Coverage Part Garage Coverage Part SCHEDULE Name of Person or Organization: ALL PERSONS AND/OR ORGANIZATIONS THAT REQUIRE BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY. We waive any right of recovery we may have against the designated person or organization shown in the schedule because of payment we make for injury or damage caused by an "accident" or "loss" resulting from the ownership, maintenance, or use of a covered "auto" for which a Waiver of Subrogation is required in conjunction with work performed by you for the designated person or organization. The waiver applies only to the designated person or organization shown in the schedule. U-CA-320-A (CW) (4/92) POLICY NO.: BAP 9674279-81 ZURICH AMERICAN INS. CO. COMMERCIAL AUTO CA 2048 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions ofthe Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are 'insureds" under the Who Is an Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 10/01/11 Countersigned By: "......---. l /~ <,,# ('~0. ~ _____ ~ I ~ , Authorized ReDresentative SCHEDULE Name of Person(s) or Organization(s): Any person or organization to whom or to which you are required to provide additional insured status or additional insured status on a primary, non-contributory basis, in a written contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by law. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is an Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc. 1998 Page 1 of 1 Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance g ZURICH '" Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'!. Prem Return Premo BAP 9674279-01 10-1-2011 10-1-2012 10-1-2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Number of Days Notice: Organization(s): Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non-renewal, and/or reduction in coverage All other terms and conditions of this policy remain unchanged. U-CA-811-A CW (05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This Endorsement is effective on 10/112011 at 12:01 A.M. standard time, forms a part Policy No. WC 9674280-03 Endorsement No. of the ZURICH AMERICAN INSURANCE COMPANY ~~ Premium (if any) $ Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS AND/OR ORGANIZATIONS THAT REQUIRE BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND / OR ORGANIZATION. ALL CALIFORNIA OPERATIONS WC 252 (4-84) WC 04 03 06 (Ed. 484) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR REDUCTION OF INSURANCE ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS A. If we cancel or non-renew this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or non- renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Number of Days Notice: Oraanization(s): Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non-renewal, and/or reduction in coverage All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/1/2011 Insured Policy No. WC 9674280-03 Endorsement No. Premium $ Insurance Company: Zurich American Ins. Co. WC 99 06 34 (Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission. Page 1 of 1