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2011/12/13 City Council Resolution 2011-117RESOLUTION NO. 2011 -117 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF ROHNERT PARK APPROVING AND ADOPTING PROJECT PLANS AND SPECIFICATIONS AND AWARDING THE CONTRACT FOR LADDER REPLACEMENT OF TANK #'S I & 2 TO PASO ROBLES TANK, INC. WHEREAS, Ladder Replacement of Tank #'s 1 & 2 including Cleaning of Tank #'s 1 through 7 ( "Project ") is a project in the Five -Year Capital Improvement Program adopted by the City Council on June 28, 2011; and WHEREAS, pursuant to a Task Order dated June 20, 2011, executed under a Master Agreement dated February 25th, 2011, Brelje and Race Consulting Engineers has designed and produced project plans and specifications for the Project; and WHEREAS, on August 26, 2011, the Project was publicly advertised in accordance with the requirements set forth in the State of California's Public Contract Code; and WHEREAS, two responsive bids were received and opened on September 22, 2011 and reviewed by the Department of Public Works and Community Services; and WHEREAS, California law requires that bids be awarded to the lowest responsive responsible bidders; and WHEREAS, Paso Robles Tank submitted the lowest responsive and responsible bid for the Ladder Replacement of Tank #'s 1 & 2 ( "Ladder Replacement "). NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Rohnert Park that it does hereby approve and adopt the plans and specifications for the Ladder Replacement, accept the bids for the Ladder Replacement, and approve the award of the contract for the Ladder Replacement ( "Ladder Replacement Contract ") to Paso Robles Tank, Inc. in the amount of $66,280.00. BE IT FURTHER RESOLVED that the City Manager is hereby authorized and directed to execute for and on behalf of the City of Rohnert Park the Ladder Replacement Contract in substantially similar form to the attached contract; is further authorized to approve cumulative contract change orders up to ten percent (10 %) of the value of the original contract; and is further authorized to delegate to his designee approval authority for cumulative project progress payments up to the contract amount, including the change orders authorized in this Resolution. DULY AND REGULARLY ADOPTED this 13th day of December, 2011. CITY OF ROHNERT PARK AHANOTU: AYE CALLINAN: AYE MACKENZIE: AYE STAFFORD: AYE BELFORTE: AYE AYES: (5) NOES: (0) ABSENT: (0) ABSTAIN: (0) CONTRACT Ladders Replacement for Tank #'s 1 and 2. PROJECT NO. PWCS 2010 -14 THIS AGREEMENT, made and entered into this day of 208_, by and between Paso Robles Tank, Inc., hereinafter called "Contractor ", an the City of Rohnert Park, hereinafter called "City ". WITNESSETH: WHEREAS, the City Council of said City has awarded a contract to Contractor for performing the work hereinafter mentioned in accordance with the sealed proposal of said Contractor. NOW, THEREFORE, IT IS AGREED, as follows: 1. Scope of Work:. The Contractor shall perform all the work and furnish all the labor, materials, equipment and all utility and transportation services required to complete all of the work of construction and installation of the improvements more particularly described in the bid documents submitted by Contractor for Ladder Replacement of Tank #'s 1 & 2 and approved by the Resolution adopted by the City Council of said City on December 13, 2011, the items and quantities of which are more particularly set forth in such bid documents on file in the office of the City Clerk, except work done or to be done by others. 2. Time of Performance and Liquidated Damages: The Contractor shall begin work within fifteen (15) calendar days after official notice by Director of Public Works to proceed with the work and shall diligently prosecute the same to completion within 185 calendar days of that Notice. In the event the Contractor does not complete the work within the time limit so specified or within such further time as said City Council shall have authorized, the Contractor shall pay to the City liquidated damages in the amount of $1000 per day for each and every day's delay in finishing the work beyond the completion date so specified. Additional provisions with regard to said time of completion and liquidated damages are set forth in the specifications, which provisions are hereby referred to and incorporated herein by reference. 3. Payments: Payments will be made by City to the Contractor for said work performed at the times and in the manner provided in the specifications and at the unit prices stated in Contractor's bid. The award of the contract is for a total amount of $66,280.00. OAK 44812 -1088 -2318 Q 4. Component Parts: This contract shall consist of the following documents, each of which is on file in the office of the City Clerk and all of which are incorporated herein and made a part hereof by reference thereto: a) This Agreement b) Notice Inviting Sealed Proposals C) Instruction and Information to Bidders d) Accepted Proposal e) Faithful Performance Bond f) Labor and Material Bond g) Special Provisions h) Standard Specifications i) Design Standards j) Plans, Profiles and Detailed Drawings 5, Wage Scale: Pursuant to Section 1773 of the Labor Code of the State of California, the City has obtained from the Director of the Department of Industrial Relations the general prevailing rate of per diem wages and the general prevailing rate for holidays and overtime work for each craft, classification, or type of workman required to execute the contract. A copy of said prevailing rate of per diem wages is on file in the office of the City Clerk, to which reference is hereby made for further particulars. Said prevailing rate of per diem wages will be made available to any interested party upon request, and a copy thereof shall be posted at the job site. The provisions of Article 2, Chapter 1, Part 7, Division 2 (commencing with Section 1770) of the Labor Code and particularly Section 1775 thereof, shall be complied with. Notice is hereby given that, pursuant to Section 1776(g) of the Labor Code of the State of California that the Contractor shall make available as required in this Section of the Labor Code certified payroll records and that penalties for violation of the section may be enforced. 6. Hours of Labor: The Contractor shall forfeit, as penalty to said City, Twenty -five Dollars ($25.00) for each workman employed in the execution of the contract by him or by any subcontractor, for each calendar day during which any workman is required or permitted to labor more than eight (8) hours in any one calendar day and forty (40) hours in any one calendar week, in violation of the provisions of Article 3, Chapter 1, Part 7, Division 2 (commencing with Section 18 10) of the Labor Code of the State of California. 7. Apprentices: In accordance with the provisions of Section 1777.5 of the Labor Code, and in accordance with the rules and procedures of the California Apprenticeship Council, properly indentured apprentices shall be employed in the prosecution of the work. The ratio of apprentices to journeymen who shall be employed in the respective crafts or trades may be the ratio stipulated in the apprenticeship standards under which the appropriate joint apprenticeship committee operates. In no event shall the ratio be less than one apprentice for each five journeymen unless a certificate of exemption has been issued by the Division of Apprenticeship Standards. Willful failure by the Contractor to comply with said Section 1777.5 shall result in his being denied the right to bid on a public works contract for a period of six months from the date the determination is made. OAK 44812- 1088 -2318 Q Information relative to number of apprentices, identifications, wages, hours of employment and standards of working conditions shall be obtained from the Director of the Department of Industrial Relations, who is the Administrative Officer of the California Apprenticeship Council. 8. Labor Discrimination: Attention is directed to Section 1735 of the Labor Code, which reads as follows: "A contractor shall not discriminate in the employment of persons upon public works on any basis listed in subdivision (a) of Section 12940 of the Government Code, as those bases are defined in Sections 12926 and 12926.1 of the Government Code, except as otherwise provided in Section 12940 of the Government Code. Every contractor for public works who violates this section is subject to all the penalties imposed for a violation of this chapter. " 9. Workmen's Compensation Insurance: In accordance with the provisions of Article 5, Chapter 1, Part 7, Division 2 (commencing with Section 1860) and Chapter 4, Part 1, Division 4 (commencing with Section 3700) of the Labor Code of the State of California, the Contractor is required to secure the payment of compensation to his employees and shall for that purpose obtain and keep in effect adequate Workmen's Compensation Insurance. The undersigned Contractor is aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for workmen's compensation or to undertake self - insurance in accordance with the provisions of that Code, and will comply with such provisions before commencing the performance of the work of this contract. 10. Indemnify: To the fullest extent permitted by law, Contractor shall indemnify, hold harmless, release and defend City, its officers, elected officials, employees, agents, volunteers, and consultants from and against any and all actions, claims, demands, damages, disability, losses, expenses including, but not limited to, attorney's fees and other defense costs and liabilities of any nature that may be asserted by any person or entity including Contractor, in whole or in part, arising out of Contractor's activities hereunder, including the activities of other persons employed or utilized by Contractor in the performance of this Agreement excepting liabilities due to the active negligence of the City. This indemnification obligation is not limited in any way by any limitation on the amount or type of damages or compensation payable by or for Contractor under Worker's Compensation, disability or other employee benefit acts or the terms, applicability or limitations of any insurance held or provided by Contractor and shall continue to bind the parties after termination/completion of this Agreement. 11. Insurance: Without limiting contractor's indemnification provided herein, Contractor shall comply with the requirements set forth in Exhibit A to this agreement. 12. Attorneys Fees: In the event either party hereto shall commence any legal action or procedure, including an action for declaratory relief, against the other, by reason of the alleged failure of the other to perform or keep any term, covenant, or condition of this contract by it to be performed or kept, the party prevailing in said action or proceeding shall be entitled to recover, in OAK #4812- 1088 -2318 v2 addition to its court costs, a reasonable attorneys fee to be fixed by the court, and such recovery shall include court costs and attorneys fees on appeal, if any. 13. Substitution of Securities for Withheld Amounts: Pursuant to California Public Contracts Code Section 22300, securities may be substituted for any moneys withheld by a public agency to ensure performance under a contract. At the request and sole expense of the Contractor, securities equivalent to the amount withheld shall be deposited with the public agency, or with a state or federally chartered bank as the escrow agent, who shall pay such moneys to the Contractor upon satisfactory completion of the contract. Securities eligible for substitution under this section shall include those listed in the California Public Contracts Code Section 22300 or bank or savings and loan certificates of deposit. The Contractor shall be the beneficial owner of any securities substituted for moneys withheld and shall receive any interest thereon. Any escrow agreement entered into pursuant to this section shall contain as a minimum the following provisions: a. The amount of securities to be deposited; b. The terms and conditions of conversion to cash in case of the default of the Contractor; and C. The termination of the escrow upon completion of the contract. IN WITNESS WHEREOF, the City of Rohnert Park has caused these presents to be executed by its officers, thereunto duly authorized, and Contractor has subscribed same, all on the day and year first above written. CITY OF ROHNERT PARK ank, Inc. 4 / \�✓ \' /� / / / /'per Q� / / /�/ .�.. City Manager Date Name /Title Date Per Resolution No. —xK-*x �� adopted by the Rohnert Park y� �� i t City Council at its meeting of�aea�. DeC eA be.(- \3 2a� �P�i � G t/m )okes 1 �lq1 W 12 ATTEST: �mI1L'L 1 City Clerk, i)qO ��A OAK 94812 - 1088 -2318 v2 P ROVE F ity Attorney CAI YORNIA ALL -PURL' SE CERTIFICATE OF ACKNOWLEDGMENT State of California County of V. Id e... Oni.,t�d �q ZD�Z before me, insert name a\md title of the personally appeared A y-4Y-e,C-e_ C� �larnb�es CED/��s ' DC-�/' (Y) RnQ Q__ who proved to me on the basis of satisfactory eviden a to be the person whose nar the within instrument and acknowledged to me tha he /y executed the samev capacity( , and that by is r /Iir signature( on the instrument the person, or which thrson(s) acted, executed the instrument. 5W subscribed to 119fr authorized entity upon behalf of I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. CARLA L. JOHNSON WITNESS my hand and official seal. NOTARY PUBLIC COMM. 1 1874712 z �J NOTARY PUBLIC - CALIFORNIA � RIVERSIDE COUNTY Ael Atiy Comm. Expires Jan. 22, 2014 Signature of N Public (Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT ro�rnenV 2- (Title or desc lion of attached document) (Title or description of attached document continued) Number of Pages L Document Date \ 0CI 2A l �— (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) 0t 7 Officer e) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other CAPA vl2.10.07 800- 873 -9865 www.NotaryClasses.com INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary irl California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personalty appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he /she /they,— is /afe ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document EXHIBIT A Insurance Requirements The following parties or entities shall be listed as additional insured by endorsement: A. The City of Rohnert Park, its officers, elected officials, employees, agents and volunteers Contractors shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Contractor, his agents, representatives, employees or subcontractors. The cost of such insurance shall be included in the Contractor's bid. The Notice To Proceed with the Work will not be issued, and the Contractor shall not commence work, until such insurance has been approved by the City. Such insurance shall remain in full force and effect at all times during the prosecution of the Work and until the final completion and acceptance thereof. In addition, the Commercial General Liability Insurance shall be maintained for a minimum of five (5) years" after final completion and acceptance of the Work. It shall be the Contractor's responsibility to ensure that proof of insurance is sent to the City during this time. The Notice to Proceed does not relieve the Contractor of the duty to obtain such insurance as required herein. A. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. Insurance Services Office Commercial General Liability coverage (Occurrence Form CG 0001). 2. Insurance Services Office form number CA 0001 (Ed. 1/87) covering Automobile Liability, Code 1 "any auto" or the exact equivalent. If Contractor owns no vehicles, this requirement may be satisfied by a non -owned auto endorsement to the general liability policy described above. If Contractor or Contractor's employee(s) will use personal autos in any way on this project, Contractor shall provide evidence of personal auto liability coverage for each such person. 3. Workers' Compensation and Employers Liability: Workers' Compensation on a state- approved policy form providing statutory benefits as required by law with employers liability insurance, with minimum limits of One Million Dollars ($1,000,000) per occurrence. 4. Course of Construction insurance coverage shall provide "all risk" coverage for the completed value of the project. Policies shall contain the following provisions: a. The City shall be named as loss payee, and b. The insurer shall waive all rights of subrogation against the City. Coverage shall not extend to any indemnity coverage for the active negligence of the additional insured in any case where an agreement to indemnify the additional insured would be invalid under Subsection (b) of Section 2782 of the Civil Code. B. Minimum Limits of Insurance Contractor shall maintain limits no less than: 1. Commercial General Liability: $2,000,000 per occurrence for bodily injury, personal injury and property damage and $2,000,000 general aggregate. It is permissible to use excess /umbrella coverage to meet limit requirements provided the umbrella policies are appropriately endorsed and meet all other requirements. Additionally, a letter clearly identifying the primary policy or policies to which the excess umbrella coverage applies shall be submitted attesting to the following: "Umbrella or excess liability policies shall provide coverage at least as broad as specified for underlying coverages and covering those insured in the underlying policies. Coverage shall be `pay on beha�f", with defense costs payable in addition to policy limits. There shall be no cross liability exclusion of claims or suits by one insured against another. " 2. Automobile Liability: $2,000,000 combined single limit per accident for bodily injury and property damage. 3. Workers' Compensation and Employers Liability: Workers' Compensation providing statutory benefits as required by the Labor Code of the State of California with employers liability insurance, with minimum limits of $1,000,000 per accident or disease. 4. Course of Construction insurance coverage shall provide "all risk" coverage for the completed value of the project. Policies shall contain the following provisions: a. The City shall be named as loss payee, and b. The insurer shall waive all rights of subrogation against the City. C. Deductibles and Self- Insured Retentions Any deductibles or self - insured retentions must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self - insured retentions as respects the City, its officers, elected officials, employees, agents, and volunteers; or the Contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. D. Other Insurance Provisions The policies are to contain, or be endorsed to contain, the following provisions: 1. General Liability and Automobile Liability Coverages a. The City, its officers, elected officials, employees, agents and volunteers are to be covered as insureds as respects: liability arising out of activities performed by or on behalf of the Contractor, including the insured's general supervision of the Contractor; products and completed operations of the Contractor, premises owned, occupied or used by the Contractor, or automobiles owned, leased, hired or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its officers, elected officials, employees, agents or volunteers. b. The Contractor's insurance coverage shall be primary insurance as respects the City, its officers, elected officials, employees, agents and volunteers. Any insurance or self - insurance maintained by the City, its officers, elected officials, employees, agents or volunteers shall be in excess of Contractor's insurance and shall not contribute with it. C. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its officers, elected officials, employees, agents or volunteers. d. The Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 2. Workers' Compensation and Employers Liability Coverage The insurer shall agree to waive all rights of subrogation against the City, its officers, elected officials, employees, agents and volunteers for losses arising from work performed by Contractor for the City. 3. All Coverages a. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, cancelled by either party, reduced in coverage or in limits except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City. b. Coverage shall not extend to any indemnity coverage for the active negligence of the additional insured in any case where an agreement to indemnify the additional insured would be invalid under Subsection (b) of Section 2782 of the Civil Code. 4. Course of Construction policies shall contain the following provisions: a. The City shall be named as loss payee. The insurer shall waive all rights of subrogation against the City. PREMIUM IS FOR CONTRACT TERM This bond was executed in two(2) AND IS SUBJECT TO ADJUSTMENT identical counterparts. 1ASED ON FINAL CONTRACT PRICE FAITHFUL PERFORMANCE BOND Bond PUBLIC WORK (The premium charged on this bond is $ 598.00 , being at the rate of $ 9.02 per thousand of the contract price) KNOW ALL MEN BY THESE PRESENTS: THAT, WHEREAS the City of Rohnert Park 7627338 State of California, entered into a contract dated December 13th 2011 with Paso Robles Tank, Inc. 825 26th Street, Paso Robles, CA 93446 hereinafter designated as the "Principal," for the work described as follows: Ladders Replacement for Tank #'s 1 and 2 - Project No. PWCS 2010 -14 ; and WHEREAS, the said Principal is required under the terms of said contract to furnish a bond for the faithful performance of said contract. NOW, THEREFORE, We, the Principal, and Fidelity and Deposit Company of Maryland a corporation organized and existing under the laws of the State of Maryland , and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto City of Rohnert Park in the penal sum of Sixty Six Thousand Two Hundred Eighty and 00 /100 Dollars ($ 66,280.00 ), 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, his or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the said contract and any alteration thereof made as therein provided, on his or their part, to be kept and performed 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 of Rohnert Park 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. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed thereunder or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. IN WITNESS WHEREOF, We have hereunto set our hands and seals this 16th day of January 2012 By: 5 yic wi, j ?yv ern-s }lia r I PRF71001 CA0201 f =s��N Principal B rY,�1e5 , Cl=b Fidelity and ryland By —4A Ayala Attorney -in -Fact CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of Orange On 1/16/12 before me, Susan Pugh, Notary Public , Date Here Insert Name and Title of the Officer personally appeared Arturo Ayala Name(s) of Signer(s) SUSAN PUGH COMM. #1934229 N ,;. ,�- Notary Public- CaUfomla � ORANGE COUNTY My Ccmm. Expires 1 9., 2015 who proved to me on the basis of satisfactory evidence to be the person(x) whose name( is/Rm subscribed to the within instrument and acknowledged to me that he /steyi executed the same in his /koddwft authorized capacity(), and that by his/keTAhz* signature(x) on the instrument the person(), or the entity upon behalf of which the per-son(x) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature t ' _ Place Notary Seal Above Signature of Notary Public SL6an Put 1" A& , ! 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 Title or Type of Document: Faithful Performance Bond Document Date: 1/16/12 Signer(s) Other Than Named Above Capacity(ies) Claimed by Signer(s) Signer's Name: Arturo Ayala ❑ Individual ❑ Corporate OfficerTitle(s):___.__ ❑ Partner — ` Limited 0 General V Attorney in Fact U Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: None Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer -- Title(s): ❑ Partner -- ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: One 02007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313 -2402 - www.NationalNotary.org Item 4i5907 Reorder: Call Toll -Free 1 -800- 876 -6827 CAL. 17 ORNIA ALL -PURP SE CERTIFICATE OF ACKNOWLEDGMENT State of California County of ��1� �� e, On \�AtJe.� 2 i�1Z before me, L Ar—� L J ran n to ok c C���� C� — ► -- (here insert name and title •f the icer) personally appeared � recr��e C wt> Worms CE yy 10Y1CA e� who proved to eon the basis of satisfactory evide e to be the person whose nor the within instrument and cknowledged to me th h 'sye/dVy executed the same ii capacity), and that b his r/Wir signature on the instrument the person, or which the person(s) acte , executed the instrument. M is subscribed to r/t authorized entity upon behalf of I certify under PENALTY OF PERJURY under the laws of the St to of California that the fore oing paragraph is true and correct. CARLA L. JOHNSON COMM. # 1874712 Z WITN SS my hand and official seal. Z 'o��e NOTARY PUBLIC - CALIFORNIA % RIVERSIDE COUNTY My Comm. Expires Jan. 22, 2014 Signature of Notary Public (Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT ,e i 0 o'ce M"'Oir (Title or description of attached document) (Title or description of attached document continued) Number of Pages 7— Document Date 0 ' �— —� (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other CAPA vl2.10.07 800 - 873 -9865 www.NotaryClasses.com INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary ;rt California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. lie /she4ey, is /ere ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if & sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is q corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document PREMIUM IS FOR CONTRACT TERM AND IS SUBJECT TO ADJUSTMENT BASED ON FINAL CONTRACT PRICE Bond No. 7627338 This bond was executed in two(2) identical counterparts. PAYMENT BOND PUBLIC WORK Section 3247 -3252 inclusive, Civil code) (Premium included in Faithful Performance Bond) KNOW ALL MEN BY THESE PRESENT: That, Whereas City of Rohnert Park has awarded to Paso Robles Tank, Inc. as Principal, a contract for the work described as follows: Ladders Replacement for Tank #'s I and 2 ect No. PWCS 2010 -14 AND WHEREAS, said Principal is required ad to furnish a bond in connection with said contract, to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law: NOW, THEREFORE, We the undersigned Principal and Surety are held and firmly bound unto the of Rohnert Park in the amount required by law, the sum of Sixty Six Thousand Two Hundred Eighty and 00 /100 Dollars ($ 66,280.00 ) for which payment well and truly be made we bind ourselves, our heirs, executors and administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, That if said Principal, his or its heirs, executors, administrators, successors or assigns, or subcontractors, shall fail to pay any of the persons named in Civil Code Section 3181, or amounts due under the Unemployment's Insurance Act with respect to work or labor performed by any such claimant, or for any amounts required to be deducted, withheld, and paid over the Employment Development Department from the wages of employees of the principals and his subcontractors pursuant to section 13020 of the Unemployment Insurance Code, with respect to such work and labor, that the Surety or Sureties herein will pay for the same in the amount not exceeding the sum specified in this bond, otherwise the above obligation shall be void. In case suit is brought upon this bond, the said surety will pay a reasonable attorney's fee to be fixed by the court. PAY71001CA0202f In witness Whereof, We have hereunto set our hand and seals this 16th day of January 2012 Paso Robles Tank, Inc. al By- Fidelity and Depo aryland By• Arturo Ayala Attorney -In -Fact CAL. YORNIA ALL -PURP SE CERTIFICATE OF ACKNOWLEDGMENT State of California County of a� y8('5i d'e- Oq__\G 40,r4 JCj,2bI2— before me, insert naive and title personally appeared-- �t���� NO C. who proved to mj on the basis of satisfacto 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. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. CARLA L. JOHNSON ��..... COMM. # 1874712 Z WITNESS my hand and official seal. z NOTARY PUBLIC - CALIFORNIA RIVERSIDE COUNTY 1 ... My Comm. Expires Jan. 22, 2014 Cicmal„rn Nnrary public (Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or desc ption of attached document) �dcscrfiption hed docu ment continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) • Corporate Officer (Title) • Partner(s) • Attomey -in -Fact ❑ Trustee(s) ❑ Other CAPA vl2.10.07 800- 873 -9865 www.Notaryclasses.com INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if q document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the documeq) signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he /she /they ;- is /sre ) or circling the correct forms. Failure to correctly indicate tpis information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document CALIFORNIA ALL- PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of Orange On 1/16/12 before me, Susan Pugh, Notary Public Date Here Insert Name and Title of the Officer personally appeared Arturo Ayala Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(x) whose name( is/xm subscribed to the within instrument and acknowledged to me that he /stw executed the same in his/l%iacAixk authorized capacity(), and that by his/1TaTfthz9r signature(x) on the instrument the person(), or the entity upon behalf of which the person(x) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature'. Place Notary Seal Above g azure of Notary Public Su n Ij — #PTIONAL 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 Title or Type of Document: _ Payment Bond Document Date: 1/16/12 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Arturo Ayala ❑ Individual ❑ Corporate Officer— Title(s): ❑ Partner Limited ❑ General V Attorney in Fact L7 Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: None Number of Pages: Two Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s);_ ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: (q) 2007 National Notary Association • 9350 De Soto Avc., P.O. Sox 2402 • Chatsworth, CA 91313 -2402 • www.NationalNotary.org Item 45907 Reorder: Call Toll -Free 1- 800 -876 -6827 SUSAN PUGH It COMM. #1034229 N ; Notary Publir- Californis ` ORANGE COUNTY My Comm. Expires Apr 29, 2015 who proved to me on the basis of satisfactory evidence to be the person(x) whose name( is/xm subscribed to the within instrument and acknowledged to me that he /stw executed the same in his/l%iacAixk authorized capacity(), and that by his/1TaTfthz9r signature(x) on the instrument the person(), or the entity upon behalf of which the person(x) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature'. Place Notary Seal Above g azure of Notary Public Su n Ij — #PTIONAL 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 Title or Type of Document: _ Payment Bond Document Date: 1/16/12 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Arturo Ayala ❑ Individual ❑ Corporate Officer— Title(s): ❑ Partner Limited ❑ General V Attorney in Fact L7 Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: None Number of Pages: Two Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s);_ ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: (q) 2007 National Notary Association • 9350 De Soto Avc., P.O. Sox 2402 • Chatsworth, CA 91313 -2402 • www.NationalNotary.org Item 45907 Reorder: Call Toll -Free 1- 800 -876 -6827 Bond No. 7627338 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by THEODORE G. MARTINEZ, Vice President, and ERIC D. BARNES, Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By -Laws of said ny, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the d �ereby, nominate, constitute and appoint Daniel HUCKABAY, Dwight REILLY, Allison ro gA, all of Orange, California, EACH its true and lawful agent and Attorney -in- a it ort Q ,for, and on its behalf as surety, and as its act and deed: any and all bon G „ alu�igs� o such bonds or undertakings in pursuance of these presents, shall be as b U om }a ` ply, to all intents and purposes, as if they had been duly executed and ac e a re ( i ers of the Company at its office in Baltimore, Md., in their own proper peso i , p�fAo issued on behalf of Daniel HUCKABAY, Arturo AYALA, dated July 19, 2007.\ The said Assistant 0es�Iie eby certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2, of the By -Laid Company, and is now in force. IN WITNESS WHEREOF, the said Vice - President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 28th day of January, A.D. 2011. ATTEST: DEP' � O O W �wy D W 1Y^ State of Maryland 1 ss: City of Baltimore f FIDELITY AND DEPOSIT COMPANY OF MARYLAND Eric D. Barnes Assistant Secretary • Theodore G. Martinez I y On this 28th day of January, A.D. 2011, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Maria D. Adamski Notary Public My Commission Expires: July 8, 2015 POA -F 012 -0079A OP ID: IP CERTIFICATE OF LIABILITY INSURANCE DAT0112 011266DIYYYY) !12 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 909 -593 -7776 - United Agencies, Inc. (H) CA License 90252636 909- 593 -5477 2911 Bonita Ave. Ste. A La Verne CA91Y50 Kevin W. Hardy CONTACT PHo� Lisa T. Perrault, CISR FAX A/C No Ext : 909 -593 -7776 (AIC No); 909 -593 -5477 EMAIL I errault uniteda encies.com ADDRESS: p g CUSTOMER ID f: PASOR -1 INSURER(S) AFFORDING COVERAGE NAIC f INSURED Paso Robles Tank, Inc. PO Box 3229 Paso Robles, CA 93447 -3229 " INSURERA:Old Republic General Ins Corp 24139 INSURER B: National Union Fire Insurance 19445 -INSURER C: Evanston Ins Co /Markel 35378 INSURER 0: EACH OCCURRENCE. INSURER E C INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE g POLICY NUMBER MMIDDIYYYY MMILDI DIYYYY - LIMITS GENERAL LIABILITY EACH OCCURRENCE. $ 1,000,00 C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 11 PKG02603 11/01/11 11/01/12 AMA E TO ENTED PREMISES Ea occurrence $ - 30,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 $5,000 CGL DED PER OCC GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 3,000,00 POLICY X PRO- JECT LOC $ A AUTOMOBILE X LIABILITY ANY AUTO AlCA96411101 11/01/11 11101/12 COMBINED SINGLE LIMIT (Eaacddent) $ 1,000,00 BODILY INJURY (Perperson) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIREDAUTOS PROPERTYDAMAGE (Peraccident) $ X NON -OWNED AUTOS $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 B JX EXCESS LIAB CLAIMS -MADE BE042833951 11/01/11 11/01!12 DEDUCTIBLE Over CGL, $ Vkuto & WC $ RETENTION $ NIL A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR�PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? N/A Al CW96411102 11/01/11 11/01/12 X WC STAT U- OTH- TORY LIMITS ER E.L. EACH ACCIDENT _ $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 C CONTRACTORS 11PKG02603 11/01/11 11/01/12 PER OCC 2,000,00 POLLUTION LIAB OCCURRENCE FORM AGGREGATE 2,000,00 DESCRIPTION OF OPERATIONS/ LOCATIONS ]VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: LADDERS REPLACEMENT FOR TANKS # 1 AND 2, PROJECT #PWCS2010 -1. CERTIFICATE HOLDER IS AMENDED PE((R ATTACHED ADDENDUM AND ARE NAMED AS PER MEGL1543 INCLUDING PRIMARY & CG2037 G/L & W/C WAIVER OF SUBROGATION APPLIES PER CG2404 (05109) & WC9903 `15 104). 01/07. *30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS FOR NONPAYMENT. CITYOFR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ROHNERT PARK ACCORDANCE WITH THE POLICY PROVISIONS. DEPARTMENT OF PUBLIC WORKS & COMMUNITY SERVICES AUTHORIZED REPRESENTATIVE 3900 MAIN STREET � `-4'""5"� A RIVERSIDE, CA 92522 ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD MARKEL` COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 11PKG02603 Evanston Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED WITH PRIMARY AND NON - CONTRIBUTORY WORDING OWNERS, LESSEES OR CONTRACTORS (FORM C) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Any person(s) or organization(s) to whom the insured agrees to provide Additional Insured with Primary and Non - Contributory status in a written contract signed by both parties and executed prior to the commencement of operations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) scheduled above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury", "property damage ", or "personal and advertising injury" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. It is further agreed that coverage provided for the Additional Insured shown above shall be primary insurance and any other insurance maintained by the Additional Insured shall be excess and non - contributory, but only as respects any claim, loss or liability arising out of your operations, and only if such claim, loss or liability is determined to be solely your negligence or responsibility. All other terms and conditions remain the same. MEGL 1543 04 11 Includes copyrighted material of Insurance Services Office, Page 1 of 1 Inc., with its permission. POLICY NUMBER: # 11PKG02603 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anixation s : Location And Description Of Completed Operations ALL CONSTRUCTION OPERATIONS EXCEPT BLANKET AS REQUIRED BY WRITTEN CONTRACT WORK ON OR RELATED TO SINGLE - FAMILY PRIOR TO AN "OCCURRENCE" OR LOSS DWELLINGS, CONDOMINIUMS, TOWNHOUSE, CO- OPS, TOWN HOMES, RESIDENTIAL CARE FACILITIES. Information required to comp-fete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: 11 PKG02603 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL. LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. I Information required to complete this Schedule, if not shown above will be shown in the Declarations. j The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 OLD REPUBLIC GENERAL INSURANCE CORPORATION WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0,00 Named Insured PASO ROBLES TANK INC Policy Number AlCW96411102 Policy Period 11/01/11 to 11/01/12 Endorsement Effective Date: 11/01111 Producer's Name: United Agencies -La Verne Producer Number: 909- 593 -7776 WC 99 03 15 (01/07) OP ID: CC EVIDENCE OF PROPERTY INSURANCE DATE(MMIDD/YYYY) DEDUCTIBLE ov16r2o1z THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY - PHONE 909 - 593 -7776 AIC No Ext COMPANY' : United Agencies, Inc. (H) -- Continental Insurance Co. CA License #0252636 P.O. Box 10238 2911 Bonita Ave., Ste. A Van Nuys, CA La Verne, CA 91750 Kevin W. Hardy FAX No :909 -593 -5477 ADDRIESS: CODE: 240048027 suB CODE: SUB AGENCY CU M RID #; - INSURED LOAN NUMBER POLICY NUMBER CITY OF ROHNERT 4025670826 Paso Robles Tank, Inc. EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL PO Box 3229 11/15/91 11/15/12 TERMINATED IF CHECKED Paso Robles, CA 93447 -3229 THIS REPLACES PRIOR EVIDENCE DATED: LOCATIONMESCRIPTION JOB: City of Rohnert Park - Ladders Replacement for Tank's #1 and #2 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 EVIDENCE OF PROPERTY INSURANCE 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. GUVtKAUtc INf OKMATiON _ COVERAGE 1 PERILS I FORMS AMOUNT OF INSURANCE DEDUCTIBLE Builders Risk including Installation- Special Form $6,000,000 $2,60 (Maximum Limit per Jobsite /Location) Public Works & Community Svrc Sub- Limits: Earthquake & Flood 600 Enterprise Drive Rohnert Park, CA 94928 - Earthquake Limit $1,000000 -Flood Limit $1,000,000 "'6% Ded of Limits /subject to $60,000 Min Ded Scheduled Contractors Equipment $1,625,960 $2,50 rw na,,uu nt J C41pi VVIIWUVIIS City of Rohnert Park is named as Loss Payee regarding Project: Ladders Repplacement for Tank's #1 & #2 -Pro !'ect No. PWCS 2010-14. "'3D days oUce of cancelaation applies per policy provisions except 10 days or non payment of premium UANULLLA I ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AnnrrinmA1 HdTFRF7RT NAME AND ADDRESS X MORTGAGEE LOSS PAYEE ADDITIONAL INSURED LOAN # City of Rohnert Park, Dept of Public Works & Community Svrc AUTHORIZED REPRESENTATIVE 600 Enterprise Drive Rohnert Park, CA 94928 AGUKLI 6! IXUVy /9Z) ©1993.2009 ACORD CORPORATION -. All rights reserved. The ACORD name and logo are registered marks of ACORD