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HomeMy WebLinkAboutPALP DBA EXCEL PAVING19"i,%i.8UAANCE NOT ON FILE A-2020-245-04 91 NORK MAY NOT PROCEED CLERK OF COUNCIL. DATE: AGREEMENT TO PROVIDE ON -CALL CONSTRUCTION REPAIR SERVICES (Flo W Su ih )THIS AGREEMENT is made and entered into this 1st day of December, 2020 by and between Palp hie. dba Excel Paving Company ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. On September 22, 2020, the City issued Request for Proposal No. 20-106, by which it sought qualified contractors to provide on -call asphalt pavement, concrete pavement, and stormdrain repair services for the City's Public Works Agency. B. Contractor submitted a responsive proposal that was among those selected by the City. Contractor represents that it is able and willing to provide the services described in the scope of work that was included in RFP 20-106 and addenda thereto. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional contracting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES On an on -call basis, and at the City's sole discretion, Contractor shall perform the services described in the scope of work that was included in RFP No. 20-106 and addenda thereto, which is attached as Exhibit A and incorporated in full. 2. COMPENSATION a. City neither warrants nor guarantees any minimum or maximum compensation to Contractor under this Agreement. Contractor shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit B. Contractor is one of four contractors selected to provide services on an on -call basis under RIP No. 20-106 and addenda thereto. The total compensation for any services provided by the contractors selected under RFP No. 20-106 shall not exceed the shared aggregate amount of $900,000 during the term of this agreement, including any extension periods. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of Page 1 of 8 performance set forth in the Recitals and Scope of Work, which may reasonably be expected by City. E7§000_V*1i I This Agreement shall commence on the date first written above and terminate on November 30, 2023, unless terminated earlier in accordance with Section 17, below. The term of this Agreement may be extended for one 2-year period upon a writing executed by the City Manager and City Attorney. 4. PREVAILING WAGES Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. 5. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Page 2 of 8 Documents & Data which were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 7. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Contractor's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. C. Worker's Compensation Insurance. In accordance with the California Labor Code, Contractor, if Contractor has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. If Contractor is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved by the City. (iii) Certificates and policies shall state that the policies shall not be cancelled Page 3 of 8 or reduced in coverage or changed in any other material aspect, by contractor, without thirty (30) days prior written notice to the City. (iv) Contractor shall supply City with a fully executed additional insured endorsement. f. If Contractor fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 8. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 9. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor shall defend, indemnify and hold harmless the City, its officers, agents, representatives, and employees against any and all liability, including costs, and attorney's fees, for infringement of any United States' letters patent, trademark, or copyright contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 10. RECORDS Page 4 of 8 Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 11. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interest and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 13. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) Page 5 of 8 P.O. Box 1988 Santa Ana, CA 92702-1988 Fax 714- 647-6956 Executive Director Public Works Agency City of Santa Ana 20 Civic Center Plaza (M-21) P.O. Box 1988 Santa Ana, CA 92702 To Contractor: Palp Inc. dba Excel Paving Company 2220 Lemon Avenue Long Beach, CA 90806 Attn: Curtis P. Brown III, President A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these timeframes, weekends, federal, state, County or City holidays shall be excluded. 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered mill and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other contractors retained by City. Page 6 of 8 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 18. NON-DISCRIMINATION Contractor shall not discriminate because of race, color, creed, relation, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities or in connection with any activities under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 19. JURISDICTION -VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 20. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, Page 7 of 8 A-2020-245-04 permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 21. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: i� Daisy Gomez Clerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: ` Jd9n M. Funk Assistant City Attorney FOR APPROVAL Nabil Saba, PE Executive Director Public Works Agency CITY OF SANTA ANA —�>1_JA, Kristine Ridge City Manager CONTRACTOR N e: Curtis P. Brown, III itle: President, PALP Inc. DBA Excel Paving Company Page 8 of 8 EXHIBIT A Appendix ATTACHMENT 1 SCOPE OF WORK CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR ON -CALL EMERGENCY ASPHALT CONCRETE, CONCRETE AND STORMDRAIN REPAIR SERVICES RFP NO.: 20-106 The City of Santa Ana (City) desires to enter into an agreement with a qualified construction company for the repair of roadway asphalt concrete and concrete, underground, storm drain, and/or other infrastructure within the public right of way (with the exception of water and sanitation systems) that may experience failures within the term of the agreement on an on -call and emergency work for general improvements, on an as needed, Task Order basis. Ancillary related work includes, but is not limited to, occasional replacement traffic pavement markings and sign replacements and related support services and paid for as described in Section I.A. "Nature of Work." The purpose of this request for proposals is to obtain qualified construction firms to augment the City's capacity to perform emergency roadway and storm drain repair water service in the event of system failures. DESCRIPTION OF WORK The scope of work will vary per Task Order within the public right-of-way. It may include, but not be limited to, the procurement and/or removal of materials, excavation, installation, backfill, compaction, grading, sidewalk and paving, curb and gutter, fencing, guardrail, barrier, catch basins, removing and/or replacing pipe and related appurtenances, conduits, wiring, and pavement markings, signs, sign posts and miscellaneous other street furniture, and repairing various items within the public right-of-way, traffic control, mobilization, compliance with this agreement and all other work necessary to complete on -call emergency Task Orders specified per incident. The work completed shall be in compliance with the City's Standard Plans, Caltrans Standard Plans and the "Greenbook" and Caltrans' Standard Specifications and as specified in this agreement. Work shall also be in compliance with the City's Standard Plan No. 1160, "Street Work and Utility Permit General Provisions." City of Santa Ana RFP 20-106 Page Al-1 QUANTITIES FOR FEE SCHEDULE (UNDER SEPARATE COVER) For the purposes of providing a Fee Schedule based on the below Sample Task Orders, the following work items and quantities are provided. The Fee Schedule in Attachment 5: Each Fee Schedule shall include a schedule of the hourly billing rates for ALL contractor and subcontractor staff and labor personnel. Additionally, for each discipline that a company seeks to be considered, the below table(s) shall be completed. For example, if a General Contractor is submitting for Asphalt Concrete and Concrete Work, Sample Task Orders A and B would both be required to be completed as part of the Fee Schedule. Each table shall include the filling in of the last two columns for the relevant sample task orders for whichever category(ies) are being submitted for consideration. However, actual work will be paid for as described in Section I.A. "Nature of Work." Sample Task Orders for Asphalt Concrete and Concrete roadway and sidewalk and Stormdrain public right-of-way related work are, respectively: Sample Task Order A - Asphalt Concrete Item Description Qty Unit Unit Price Total I Unclassified Excavation 550 CI' 2 AC Pavement 130 TN 3 Furnish and Install #6 Pullbox 4 EA 4 Adjust Manhole to Finished Grade 5 EA 5 PCC Curb and Gutter (Type A-2-8 100 LF 6 Signing and Striping 1 LS 7 Traffic Control Work 1 LS Sample Task Order B - Concrete Paving Item Description Qty Unit Unit Price Total I Unclassified Excavation 550 Cy 2 PCC Sidewalk Tom" 2,500 SF 3 PCC Curb Ramp 3,000 SF 4 PCC Curb and Gutter (Type A-2-8) 100 LF 5 Furnish and Install #6 Pullbox 4 EA 6 Adjust Manhole to Finished Grade 5 EA 7 Catch Basin (Type `B," W=10' I EA 8 Remove and Replace 30" Reinforced Concrete Pie 75 LF 9 Guard Rail Replacement (Caltrans RSP A77N4) 50 LF 10 Guard Rail Replacement Termination Caltrans) I EA 11 Remove and Replace Chain Link R/W Fence 50 LF 12 Concrete Barrier Type 836 Caltrans 50 LF 13 Traffic Control Work 1 LS City of Santa Ana RFP 20-106 Page Al-2 Sample Task Order C - Stormdrain Item Description Qty Unit Unit Price Total 1 Unclassified Excavation 550 Cy 2 AC Pavement 130 TN 3 Remove and Replace 18" Corrugated Metal Pipe (CAV) 75 LF 4 Remove and Replace 18" Reinforced Concrete Pipe (RCP) 75 LF 5 Remove and Replace 30" Reinforced Concrete Pipe (RCP) 75 LF 6 Catch Basin (Type "B," W=10') 1 EA 7 Traffic Control Work 1 LS For each Task Order Issued by Public Works Agency, the City may or may not require the Contractor to provide cash deposit or surety "Payment" and "Performance" bond. Depending upon the size, nature and risk of the work, the City may use the amounts specified by the "Greenbook," surface drainage or street improvement plan measurements, or the approved itemized cost for each On -call or Emergency Task Order to calculate bond amounts, if any. Task Order work shall be per the City's Standard Plans, As -Built Plans, or other direction from the Public Works Agency. If required for a Task Order, the cash deposit or the surety bonds shall guarantee the construction of all necessary improvements for the Task Order, however, Bid Bonds shall not be reauired at the time of the submittal of RFP Proposal. For Task Orders, the City also reserves the right to retain 10% of progress pay amounts for the one-year warranty work. If so, the cash deposit shall be released approximately 135 days after all related permits and/or other approvals required are signed off by the City's Constriction Inspector, and the passage of any lien periods. In the event the work is not completed within one year of the date that a street work permit or Task Order is signed, applicant agrees that the City may apply the cash deposit to the cost of completing the work and such work may be completed at the sole convenience of the City of Santa Ana. CONTRACTOR RESPONSIBLITIES Contractor must be able to respond to City's request for emergency repair work on a timely and urgent manner. The contractor shall be available on an on -call basis, 24/7, and ready to respond in the event of an emergency. Service calls shall be responded within one hour. Contractor's repair crews must be able to arrive at job site within 8 hours of approval from City to commence work. Regular business hours are considered from 7:00 am to 5:00 pm (Monday through Friday). Anytime outside of business hours of operation may be considered after hours/weekends. The Contractor shall, prior to award of contract and without additional expense to the City, possess all licenses and permits (unless waived by the City) required for the performance of the work required by this contract, including but not limited to a California Class (A, C-8 or C34) Contractor's license and a City of Santa Ana Business License. City of Santa Ana RFP 20-106 Page Al-3 1. Street work shall be required to be performed by a licensed contractor for any and all the work in the public right of way. The contractor must provide the following prior to initiating Task Order work. a. A City of Santa Ana business license. b. A Certificate of Insurance of general liability containing requirements as set forth by the City Attorney and per the Standard Agreement. c. A Contractors license (with appropriate classification). d. Proof of Worker's Compensation Insurance. 2. Provide BMPs and/or erosion control plans for planned Task Order work unless directed otherwise by the City: 3. If required, the Contractor shall submit, for review and approval, a surface drainage/grading/erosion control plan, prepared by a registered civil engineer, showing the direction and means of flow within the street. Any Subcontractors intended to be used, shall be listed in the proposal. Any additional subcontractors that may become necessary, shall require approval by the City prior to start of any assigned work. When a Subcontractor performs all or any part of the work, a markup shall be applied to the Subcontractor's actual cost of such work. The Contractor may add a markup of 10 percent on the first $5,000 of the subcontracted portion of the extra work and a markup of 5 percent on work added in excess of $5,000 of the subcontracted portion of the work may be added by the Contractor. PAYMENT AND INVOICING: Selected Contractor shall invoice the City based on time and material according to the City's standard invoice template. Tasks and hours shall be clearly identified and all rates must match those included in the approved agreement. City shall retain ten percent (10%) of the invoice amount from each payment until the completed Project has been accepted by the City. The City will provide information in its possession relevant to the preparation of the required information in the RFP. The City will provide only the staff assistance and the documentation specifically in referred to herein. • Furnish scope of work and provide general direction as needed for any assigned Task Orders • All plan check coordination within the City • Construction administration • Electronic files (sample plans & specifications, City of Santa Ana's CADD Standards), if needed City of Santa Ana RFP 20-106 Page Al-4 • Electronic files for title sheets and sheet borders, if needed DEFINITION OF ITEMS (SAMPLE TASK ORDERS A. B & Cl: The unit prices paid for the items listed in the Contractor's Proposal as defined herein include full compensation for furnishing all labor, materials, tools, and equipment, and doing all work involved in furnishing and installing the materials complete and in place, in accordance with the details shown in the Task Order, Standard Plans, Sketch, Other Plans, as directed by the Engineer. All incidental work which is not otherwise specified, and which is necessary to complete the improvements shall bef urnished and installed as though such work was specified, and no additional compensation would be allowed therefore. If not stated otherwise, work shall be in conformance to APWA's 2012 Greenbook specifications. Each Sample Task Order's work items include, but are not limited to, the following listed below for the Fee Schedule Submittal. Actual Task Order work, if granted, will generally be on a Time and Materials basis in accordance with labor rates for the type of work and material required per Task Order granted and according to the schedule of rates provided as part of this proposal. The Sample Task Order information provided will primarily be used to compare various proposals. Sample Task Order A Items of Work Item No. 1- Unclassified Excavation Payment for Unclassified Excavation shall be at the contract unit price per Cubic Yard listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Payment for unclassified fill, if any, is considered as included in the unit price paid for unclassified excavation. Payment for over -excavation shall be paid for at the unit price for unclassified excavation Item No. 2 - Asphalt Concrete (AC) Pavement Payment for Asphalt Concrete (AC) Pavement shall be at the contract unit price bid per Ton as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Payment for asphalt concrete pavement used in areas of over -excavation to mitigate unsuitable subgrade materials shall be paid for at the contract unit price bid per ton. City of Santa Ana RFP 20-106 Page Al-5 Item No. 3- Furnish and Install New #6 Pull Box The work under this item for Furnish and Install New #6 Pull Box shall be in accordance with the latest CA MUTCD, Caltrans and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents to be provided for each Task Order Work. The assumed material for placement shall be concrete and any removal of an existing pull box shall be included in the price paid to furnish and install a new pull box and no additional payment will be allowed therefore. Payment for Furnish and Install New #6 Pull Box shall be at the contract unit price paid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 4 - Adjust Manhole to Finished Grade Payment for Adjust Manhole to Finished Grade shall be at the contract unit price bid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 5 - PCC Curb & Gutter (A-2-8) The work under this item consists of grading, compacting subgrade, and constructing PCC Curb & Gutter and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-5, "Concrete Curbs, Walks, Gutters, Cross Gutters, Alley Intersections, Access Ramps, and Driveways" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for PCC Curb & Gutter (A-2-8) shall be at the contract unit price bid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 6 - Signing & Striping The work under this item for Signing and Striping shall be in accordance with the latest CA MUTCD, Caltrans and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents to be provided for each Task Order Work. Payment for Signing & Striping shall be at the contract Lump Sum listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, disposal of all removed materials and incidentals as required and no additional compensation will be allowed therefore. City of Santa Ana RFP 20-106 Page Al-6 Item No. 7 — Traffic Control The work under this item for Signing and Striping shall be in accordance with the latest Watch Manual, CA MUTCD, Caltrans and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents to be provided for each Task Order Work. Payment for Traffic Control shall be at the contract unit price per Lump Sum (LS) as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Sample Task Order B Items of Work Item No. 1 - Unclassified Excavation Payment for Unclassified Excavation shall be at the contract unit price per Cubic Yard listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Payment for unclassified fill, if any, is considered as included in the unit price paid for unclassified excavation. Payment for over -excavation shall be paid for at the unit price for unclassified excavation. Item No. 2 - PCC Sidewalk (T=4") The work under this item consists of grading, compacting subgrade, and constructing 4-inch thick PCC Sidewalk shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-5, "Concrete Curbs, Walks, Gutters, Cross Gutters, Alley Intersections, Access Ramps, and Driveways," of the Standard Specifications, plans, and contract document specifications. Payment for PCC Sidewalk (T=4") shall be at the contract unit price bid per Square Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including famishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Payment for thickness (T=6") shall be paid 1.5 times the unit price. Item No. 3 - PCC Curb Ramp The work under this item consists of grading, compacting subgrade, and constructing PCC Curb & Gutter and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-5, "Concrete Curbs, Walks, Gutters, Cross Gutters, Alley Intersections, Access Ramps, and Driveways" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for PCC Curb Ramp shall be at the contract unit price bid per Linear Foot as listed in the Fee City of Santa Ana RFP 20-106 Page Al-7 Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 4 - PCC Curb & Gutter (A-2-8) The work under this item consists of grading, compacting subgrade, and constructing PCC Curb & Gutter and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-5, "Concrete Curbs, Walks, Gutters, Cross Gutters, Alley Intersections, Access Ramps, and Driveways" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for PCC Curb & Gutter (A-2-8) shall be at the contract unit price bid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 5- Furnish and Install New #6 Pull Box The work under this item for Furnish and Install New #6 Pull Box shall be in accordance with the latest CA NMTCD, Caltrans and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents to be provided for each Task Order Work. The assumed material for placement shall be concrete and any removal of an existing pull box shall be included in the price paid to furnish and install a new pull box and no additional payment will be allowed therefore. Payment for Furnish and Install New #6 Pull Box shall be at the contract unit price paid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 6 - Adjust Manhole to Finished Grade Payment for Adjust Manhole to Finished Grade shall be at the contract unit price bid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 7- Catch Basin (Type `B," W=101) The work under this item consists of grading, compacting subgrade, and constructing Catch Basin and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-1, "Concrete Structures" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Catch Basin (Type `B," W=10') shall be at the contract unit price paid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing catch basins and/or other appurtenances, including fuuishing all materials, labor, equipment, tools, and incidentals as required to construct a new catch basin, soil preparation and compaction, and no additional compensation will be allowed therefore. City of Santa Ana RFP 20-106 Page Al-8 Item No. 8 — Remove and Replace 30" Reinforced Concrete Pipe The work under this item consists of grading, compacting subgrade, and constructing Remove and Replace 30" Reinforced Concrete Pipe and shall be in accordance with the provisions of Section 306, "Underground Conduit Construction" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Remove and Replace 30" Reinforced Concrete Pipe shall be at the contract unit price paid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing pipe, furnishing all materials, labor, equipment, tools, and incidentals as required to install new pipe, bedding preparation, and no additional compensation will be allowed therefore. Item No. 9 — Guard Rail Replacement (Caltrans RSP A77N4) The work under this item consists of grading, compacting subgrade, and constructing Guard Rail Replacement (Caltrans RSP A77N4) and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," with the provisions of Section 204, "Lumber and Treatment with Preservatives," Section 304-2.2 "Flexible Metal Guard Rail," any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Guard Rail Replacement (Caltrans RSP A77N4) shall be at the contract unit price paid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing guard rail, furnishing all materials, labor, equipment, tools, and incidentals as required to install new guardrail, foundation preparation, and no additional compensation will be allowed therefore. Item No. 10 - Guard Rail Replacement Termination (Caltrans) The work under this item consists of grading, compacting subgrade, and constructing Guard Rail Replacement Termination (Caltrans) and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," with the provisions of Section 204, "Lumber and Treatment with Preservatives," Section 304-2.2 "Flexible Metal Guard Rail," any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Guard Rail Replacement Termination (Caltrans) shall be at the contract unit price paid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing guard rail termination, furnishing all materials, labor, equipment, tools, and incidentals as required to install new guardrail termination, foundation preparation, and no additional compensation will be allowed therefore. Item No. 11— Remove and Replace Chain Link R/W Fence The work under this item consists of grading, compacting subgrade, and construction of foundations to support the posts for Remove and Replace Chain Link Fence and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-5, "Concrete Curb, Walks, Gutters, Cross Gutters, Alley Intersections, Access Ramps, and Driveways" and Section 304-3 "Chain Link Fence" of the Standard Specifications any City Standard Specifications, plans, and/or any City's Special Provisions/Contract City of Santa Ana RFP 20-106 Page Al-9 Documents provided by the City for each Task Order. Payment for Remove and Replace Chain Link R/W Fence shall be at the contract unit price bid per Square Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing chain link fence (and posts/foundations), furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 12 —Concrete Barrier Type 836 (Caltrans) The work under this item consists of grading, compacting subgrade, and removing and/or construction Concrete Barrier Type 836 (Caltrans) and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," Caltrans Standard Specifications, any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Concrete Barrier Type 836 (Caltrans) shall be at the contract unit price bid per Lineal Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing concrete barrier or other appurtenances, furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Item No. 13 — Traffic Control The work under this item for Signing and Striping shall be in accordance with the latest Watch Manual, CA MUTCD, Caltrans and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents to be provided for each Task Order Work. Payment for Traffic Control shall be at the contract unit price per Lump Sum (LS) as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Sample Task Order C Items of Work Item No. 1- Unclassified Excavation Payment for Unclassified Excavation shall be at the contract unit price per Cubic Yard listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Payment for unclassified fill, if any, is considered as included in the unit price paid for unclassified excavation. Payment for over -excavation shall be paid for at the unit price for unclassified excavation City of Santa Ana RFP 20-106 Page Al-10 Item No. 2 - Asphalt Concrete (AC) Pavement Payment for Asphalt Concrete (AC) Pavement shall be at the contract unit price bid per Ton as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. Payment for asphalt concrete pavement used in areas of over -excavation to mitigate unsuitable subgrade materials shall be paid for at the contract unit price bid per ton. Item No. 3 — Remove and Replace 18" Corrugated Metal Pipe (CMP) The work under this item consists of grading, compacting subgrade, and constructing Remove and Replace 18" Corrugated Metal Pipe (CMP) and shall be in accordance with the provisions of Section 306, "Underground Conduit Construction" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Remove and Replace 18" Corrugated Metal Pipe (CMP) shall be at the contract unit price paid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing pipe, furnishing all materials, labor, equipment, tools, and incidentals as required to install new pipe, bedding preparation, and no additional compensation will be allowed therefore. Item No. 4 — Remove and Replace 18" Reinforced Concrete Pipe The work under this item consists of grading, compacting subgrade, and constructing Remove and Replace 18" Reinforced Concrete Pipe and shall be in accordance with the provisions of Section 306, "Underground Conduit Construction" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Remove and Replace 18" Reinforced Concrete Pipe shall be at the contract unit price paid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing pipe, furnishing all materials, labor, equipment, tools, and incidentals as required to install new pipe, bedding preparation, and no additional compensation will be allowed therefore. Item No. 5 — Remove and Replace 30" Reinforced Concrete Pipe The work under this item consists of grading, compacting subgrade, and constructing Remove and Replace 30" Reinforced Concrete Pipe and shall be in accordance with the provisions of Section 306, "Underground Conduit Construction" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Remove and Replace 30" Reinforced Concrete Pipe shall be at the contract unit price paid per Linear Foot as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing pipe, furnishing all materials, labor, equipment, tools, and incidentals as required to install new pipe, bedding preparation, and no additional compensation will be allowed therefore. City of Santa Ana RFP 20-106 Page Al-11 Item No. 6- Catch Basin (Type °B," W=10') The work under this item consists of grading, compacting subgrade, and constructing Catch Basin and shall be in accordance with the provisions of Section 301-1, "Subgrade Preparation," and Section 303-1, "Concrete Structures" and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents provided by the City for each Task Order. Payment for Catch Basin (Type `B," W=10') shall be at the contract unit price paid per Each as listed in the Fee Proposal, and shall include full compensation for doing all work, including removal or replacement of existing catch basins and/or other appurtenances, including furnishing all materials, labor, equipment, tools, and incidentals as required to construct a new catch basin, soil preparation and compaction, and no additional compensation will be allowed therefore. Item No. 7 — Traffic Control The work under this item for Signing and Striping shall be in accordance with the latest Watch Manual, CA MUTCD, Caltrans and any City Standard Specifications, plans, and/or any City's Special Provisions/Contract Documents to be provided for each Task Order Work. Payment for Traffic Control shall be at the contract unit price per Lump Sum (LS) as listed in the Fee Proposal, and shall include full compensation for doing all work, including furnishing all materials, labor, equipment, tools, and incidentals as required and no additional compensation will be allowed therefore. City of Santa Ana RFP 20-106 Page Al-12 EXHIBIT B PALP INC. DBA EXCEL PAVING COMPANY QUANTITIES FOR FEE SCHEDULE (UNDER SEPARATE COVER) For the purposes of providing a Fee Schedule based on the below Sample Task Orders, the following work items and quantities are provided. The Fee Schedule in Attachment 5: Each Fee Schedule shall include a schedule of the hourly billing rates for ALL contractor and subcontractor staff and labor personnel. Additionally, for each discipline that a company seeks to be considered, the below table(s) shall be completed. For example, if a General Contractor is submitting for Asphalt Concrete and Concrete Work, Sample Task Orders A and B would both be required to be completed as part of the Fee Schedule. Each table shall include the filling in of the last two columns for the relevant sample task orders for whichever category(ies) are being submitted for consideration. However, actual work will be paid for as described in Section I.A. "Nature of Work." Sample Task Orders for Asphalt Concrete and Concrete roadway and sidewalk and Stormdrain public right-of-way related work are, respectively: Sample Task Order A - Asphalt Concrete Item Description Qty Unit Unit Price Total 1 Unclassified Excavation 550 Cy $195 $107,250 2 AC Pavement 130 TN $150 $19,500 3 Funish and Install #6 Pullbox 4 EA $800 $3,200 4 Ad -just Manhole to Finished Grade 5 EA $900 $4,500 5 PCC Curb and Gutter (Type A-2-8) 100 LF $120 $12,000 6 Si pin =and StripingStfiping $7,000 7 Traffic Control Work 1 LS $34,000 $34,000 Sample Task Order B - Concrete Paving Item Description Qty Unit Unit Price Total 1 Unclassified Excavation 550 Cy $195 $107250 2 PCC Sidewalk (T=4" _ 2,500 SF $16 $40,000 3 PCC Curb Ranip 3,000 SF $42 $126 000 4 PCC Curb and Gutter T ne A-2-8) 100 LF $120 $12,000 5 Furnish and Install #6 Pullbox 4 EA $800 $3 200 6 Adjust Manhole to Finished Grade 5 EA $900 $4,500 7 Catch Basin (Type `13," W=10') I EA $12,000 $12 000 8 Remove and Replace 30" Reinforced Concrete Pipe 75 LF $340 $25,500 9 Guard Rail Replacement Caltrans RSP A77N4 50 LF $123 $6,150 10 Guard Rail Replacement Termination Caltrans) 1 EA $8,200 $8,200 11 Remove and Replace Chain Link R/W Fence 50 LP $100 $5,000 12 Concrete Barrier Type 836 Caltrans) 50 LF $500 13 Traffic Control Work 1 LS $43,000 L$25,000 $43,000 City of Santa Ana RFP 20-106 Page Al-2 Addendum No. 2 Page 4 of 6 PALP INC. DBA EXCEL PAVING COMPANY Sample Task Order C - Stormdrain Item Description Qty Unit Unit Price Total 1 Unclassified Excavation 550 Cy $195 $107,250 2 AC Pavement 130 TN $150 $19,500 3 Remove and Replace 18" Cormgated Metal Pie (CMP) 75 LF $310 $23,250 4 Remove and Replace 18" Reinforced Concrete Pie RCP 75 LF $320 $24.000 5 Remove and Replace 30" Reinforced Concrete Pipe (RCP) 75 LF $340 $25,500 0 Catch Basin (Type "13", W=10' 1 EA 1 $12,000 $12,000 7 Traffic Control Work 1 LS $35,000 $35,000 SURETY BOND For each Task Order Issued by Public Works Agency, the City may or may not require the Contractor to provide cash deposit or surety "Payment" and "Performance" bond. Depending upon the size, nature and risk of the work, the City may use the amounts specified by the "Greenbook," surface drainage or street improvement plan measurements, or the approved itemized cost for each On -call or Emergency Task Order to calculate bond amounts, if any. Task Order work shall be per the City's Standard Plans, As -Built Plans, or other direction from the Public Works Agency. If required for a Task Order, the cash deposit or the surety bonds shall guarantee the. construction of all necessary improvements for the Task Order, however. Bid Bonds shall not be required at the time of the submittal of RFP Proposal. For Task Orders, the City also reserves the right to retain 10% of progress pay amounts for the one-year warranty work. If so, the cash deposit shall be released approximately 135 days after all related permits and/or other approvals required are signed off by the City's Construction Inspector, and the passage of any lien periods. In the event the work is not completed within one year of the date that a street work permit or Task Order is signed, applicant agrees that the City may apply the cash deposit to the cost of completing the work and such work may be completed at the sole convenience of the City of Santa Ana. Contractor must be able to respond to City's request for emergency repair work on a timely and urgent manner. The contractor shall be available on an on -call basis, 24/7, and ready to respond in the event of an emergency. Service calls shall be responded within one hour. Contractor's repair crews must be able to arrive at job site within 8 hours of approval from City to commence work. Regular business hours are considered from 7:00 am to 5:00 pm (Monday through Friday). Anytime outside of business hours of operation may be considered after hours/weekends. The Contractor shall, prior to award of contract and without additional expense to the City, possess all licenses and permits (unless waived by the City) required for the performance of the work required by this contract, including but not limited to a California Class (A, C-8 or C34) Contractor's license and a City of Santa Ana Business License. City of Santa Ana RFP 20-106 Page Al-3 NAM u A O y 0 i, o (fl 0 69 0 H3 0 FA 0 fA 0 b) 0 69 .MNw g �W �y o'j O as O 'i.��A �I ��o Vy.� F v O U� F3 E3 � G pw° AuU. ,n 3.3 .o�p wF°O U69 o 0 0 0 Efl 0 0 69 0 0 69 0 0 Cfi 0 0 cA 0 0 69 0 0 69 0 0 69 0 0 69 0 0 b) 0 0 604 0 0 r{� o 0 fA 0 0 5q o 0 to b O 7 O QQ H v N lo o pp pp qF w 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O 0 O La V H3 FH G9 EA V) (A 64 ER Cq H) fA H9 EA Gl9 F C � V't tl' M •� �' H dUA W °did da'.� �.$ �� � hqb .�•47 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 a 0 o 0 0 0 0 0 0 0 0 0� arnrroorv,�r�nm�000�n0000v ('i fV d' o w O O 0 O O O (� 64 69 69 b9 W3 £f3 69 fR s-) G,i s4 zv &4 sv FA W a' S N � ❑❑ '� � � r3i� ,,qO O V] V O �N 0 x 0 0 0 0 0 0 0 i w U o 0 �f���rn U voi W CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and all his/her subcontractors are registered with the State of California Department of Industrial Relations (DIR), and that the following is true and correct. Contractor's Name: PALP, INC DBA EXCEL PAVING Business Address: LONG BEACH CA 90806 Business E-Mail Address: Q ter-011g&A O°n",rfolgt Telephone: 5621599-F841 STATE LIC# 688659 State Contractor's License No. and Class; License Expiration Date:��'L �r State Dept. of Industrial Relations (DIR) Registration No,: \00000 State Dept. of Industrial Relations (DIR) Registration Expir 'on Date: 1 Signed: �y L'1-__�. _ � Title: Curtis P. Brown III President City of Santa Ana RFP 20-106 Page Al-23 PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT Contractor is aware of the requirements of California Labor Code Section 1720, et seq„ as well as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Since the services are being performed as part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Agreement, Contractor shall make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The undersimed certifies that the foreaoine is true and correct. PALP, IN!C DBA NameofFirm cxrr-i pgtnnir(-,') Signature of CONTRACTOR Title (if an individual, so City of Santa Ana RFP 20-106 Page Al-24 OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS: CITY OF SANTA ANA ) Curtis P. Brown III being duly sworn, deposes and says: ❑ INDIVIDUAL That he/she is the party making the foregoing proposal: [] PARTNERSHIP That he/sire is a member of the co -partnership firm designated as: and who has been and is duly vested with the authority to make and execute instruments for the co- partnership by: who constitute the other members of the co -partnership. f u CORPORATION That he is of: pnesq)ENT PALP, WC DBA EXCEL P0U 1r, GGAiPP WY — a corporation which is making the foregoing proposal: 17 JOINT VENTURE That he is of one of the parties making the foregoing proposal as a joint venture, and the he/she has been and is duly vested with the authority to execute instruments for an on behalf of the parties making said bid who are: that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any advantage against the City of Santa Ana or any person interested in the proposed contract, for himself or, ny other person. �X Curtis P. Brown III - President Sir attire of CONTRACTOR Subscribed ai d sw o to before me tbis day of CCL- yt19A9l1?A 20 1 Signature of officer tministering Oath (Notary Public) CPNILLCOMM.$21tary Do';No� Public-CLOS ANOELESCmm. apiresoot 29, 2o2oI _._....... ..._._...._......_..... ......_..-._... ... .-........ . City of Santa Ana RFP 20-106 Page Al-26 LIST OF SUB -CONTRACTORS Section 4100 et. seq. of the Public Contract Code requires listing of all subcontractors with the proposal/bid for all subcontract work exceeding the following amount: o Streets, highways including bridge projects: 'r/x% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: '/2% of the bid Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State Department of Industrial Relations (DIR). CONTRACTOR proposes to subcontract certain portions of the work to the firms listed below: Name A M License #/Exp. DIR Reg.#/Exp. Location Phone M-3 Type Of Work Amount $ Name _Q PrL License #/Exp. DIR Reg.#/Exp. License # Location Phone Aa! 1pi Type Of Work Amount $ Name License # DIR Reg. #/Exp. Name qqAQj _ License #/Exp. �400DOZVi fe �b DIR Reg. #/Exp. tk �5 Location 3oo L ° � - Phone tI'D (9011b Type Of Work r� _ Amount $ 'VA Name (yt35381 t License #/Exp. 16fl0U01I t7D _. DIR Reg. #/Exp. License # J Locution Phone — Type Of Worki ltytD,alq 7" Amount $ N _ _ Name License # ej V- ) Location l p Phone Type Of Work, Amount $ License #/Exp. DIR Reg.#/Exp. License # Location _ Phone Type Of Work Amount $ Curtis P. Brown tlt --'resident SAnature of CONTRACTOR City of Santa Ana RFP 20-106 Page Al-26 L endum Noe 5 of 6 The following are the names, addresses, and telephone numbers for THREE public agencies for which the CONTRACTOR has performed similar work within the past three years. 1. `A 3. Name and Address of Owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Name and Address of owner. Type of Work Name and Telephone Number of person familiar with project. Date Completed Contract Amount Type of Work Date Completed The following are the names, addresses, email addresses, and telephone numbers of all brokers and sureties from whom CONTRACTOR intends to procure insurance and bonds from for Task Orders. Aso V 1 City of Santa Ana RFP 20-106 Page Al-27 12 Piz y H N NiNM N,N�q MIN Ell NN 1 H�H�H H.N �?1. NjN q! y NHNNN P1 E y x:: NN N NMNNN 9 N NON H N N N RE H V 11 H I IPP2111011 Ell pi 1 181 55 IR 14 mt Hill '! I�Ilog NA I INEw - H I Fm fit' N;T jE AR -F5 SIa Ail Fu IL 12 I All A JIB al L9 iN Ld w 261W uj 1,61 5; -11V i w 3 6; V UF L�: s m V v uj td Ld,Iii Z9 L? Ij L F4 fill LW 01 9A Ing Rim 9 F; 911'" 11 Atli Cow 1'1 w REFERENCES_CONTINUEDI The following are the names, addresses, and telephone numbers for THREE public agencies for which the SUBCONTRACTOR has performed similar work in the past five years. 1 City of Redondo Beach, 415 Diamond St, Redondo Beach, CA 90277 (310)372-1171. Name and Address of Owner. Name and Telephone Number of person familiar with project, $920,749.25 curb. gutter sidewallc, age ess ram1L on going Contract Amount Type of Work Date Completed 2 City of Santa Monica, 1437 4th St Suite 300, Santa Monica, CA 90401 (310)458-8411 Name and Address of owner. Name and Telephone Number of person familiar with project. 4/17/2020 _869 878.45 _ curb Witter x gutter sidewalk, driveway Contract Amount Type of Work Date Completed 3. City of San Clemente, 910 Calle Negocioi St 100, San Clemente, CA 92673 (949)361-8200 Name and Address of owner. - Name and Telephone Number of person familiar with project. $65,739.00 _ curb, gutter, sidewalk curb ramp 7/30/2019 Contract Amount u Type of Work Date Completed The following are the names, addresses, email addresses, and telephone numbers of all brokers and sureties from whom CONTRACTOR intends to procure insurance and bonds from for Task Orders, Alliant Insurance ,Services, Inc. 333 S. Hope St Suite 3750, Los Angeles, CA 90071, Michelle Stevens (1131--)443-2461 ------ - - — — . --" Venbrook,11512 El Camino Real, Suite 120, San Diego, CA 92130, Brooke LaFrenz (858)764-7447 City of Santa Ana RFP 20-106 Page Al-28 REFERENCES,TMED I1 The following are the names, addresses, and telephone numbers for THREE public agencies for which the SUBCONTRACTOR has performed similar work in the past five years. 1. Metro - 1 Gate Plaza Los Angeles Ca. Name and Address of Owner. Helario Rommel - 231-922-4654 - Helario@metro.net _ _ Name and Telephone Number of person familiar with project. 3Mllliom Plus an Call - Fencing, servloes & Malmenance 2016-2018 - extended 2020 Contract Amount Type of Work Date Completed 2. City of Name ana Aaaress or owner. Frank Neely - 562-570-5419 - frank.neely@longbeach.gov Name and Telephone Number of person familiar with project. On Call - Fencing, Services & Maintenance 2018-2020 Contract Amount Type of Work Date Completed 3. Caltrans Dist, 12 Name and Address of owner. _Heath Palczewski - 714-716-5536 heath.palczewsks e(a7dot.ca•gov Name and Telephone Number of person familiar with project. 5Million Plus Contract Amount On Call - Metal Beam Guardrail Maintenance 2018-2020 Type of Work ._ Date Completed The following are the names, addresses, email addresses, and telephone numbers of all brokers and sureties from whom CONTRACTOR intends to procure insurance and bonds from for Task Orders. Atlantic Specialty Insurance Company- 77 Water Street 17th Floor New York 952-852-2431 HUB International Insurance Services Inc. 4695 MacArthur Court Suite 600 949-623-1036 :axr=�aeaa City of Santa Ana RFP 20-106 Page Al-28 RHFERENCLS, (C,ONTINTJt;D) The following are the names, addresses, and telephone numbers for THREE public agencies for which the SUBC/ONTRACTlOO has performed similar work in the past fiveF years.] t 1. �F� _h _��8 (cay uapill� 112. �tr riatw C%C 1j% aj y,{vi dray .) Name and Address of Owner, _ .Name and Telephone Number ofperson familiar with project Contract Amount Type of Work Date Completed Name and Address of owner. C C-ik Name and a/nd Telejf nouphone Number of 16 —yrson fact. familiar. with proje Contract 1ittt — Type of Work � YI?ate Completed — Name and Telephone Number of person familiar with project. SA 2 Contract Amount Type of Work Bate Completed The following are the names, addresses, email addresses, and telephone numbers of all brokers and sureties from whom CONTRACTOR intends to procure 'insurance and bonds from for Task Orders. 61c, , c'"7 r l ti City of Santa Ana: RpP 20-100 Page At-28 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the CONTRACTOR declares that the this Proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the Proposal is genuine and not collusive or sham; that the CONTRACTOR has not directly or indirectly induced or solicited any other CONTRACTOR to put in a false or sham Proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any CONTRACTOR or anyone else to put in a sham Proposal, or that anyone shall refrain from submitting a Proposal; that the CONTRACTOR has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the Fee Proposal costs of the CONTRACTOR or any other CONTRACTOR, or to fix any overhead, profit, or cost element of the Fee Proposal, or of that of any other CONTRACTOR, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the Proposal are true; and, further, that the CONTRACTOR has not, directly or indirectly, submitted his or her Proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, Proposal depository, or to any member or agent thereof to effectuate a collusive or sham Proposal. Note: The above Non -collusion Affidavit is part of the Proposal. CONTRACTORS are cauti red that making a false certification may subject the certifier to criminal prosecution. Curtis P. Brown III Signed 4.r `, iEiFttt State of California County of i pg AngdBg �lp`1�1 Subscribe �n d st�prn to (or affirmed) before me on this (1L� day of � 20_, by Curtis . tifl)wfl ll.l. proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me — -- Notary Puf is Signature Notary Public Seal :',, C. PNILL'pl' -r,` 5 COMM. #2170177 ro #Cy*,5,1 a Nota Publto-Calitornla a -� LOS ANGELES COUNTY a \\\ v�,r. My Comm. Expires Oct29,2020 : City of Santa Ana RFP 20-166 Page Al-29 NON -LOBBYING CERTIFICATION The prospective participant certifies, by signing and submitting this Proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her Proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subreci ents shall certify and disclose accordingly. Signed: Gull 4 ur is raven ill —fireside Title: PALP, INC DSA Firm: EXCEL PAVING COb1PA (Y Date: OCT ,, j. na City of Santa Ana RFP 20-106 T Page Al-30 NON-DISCRIMINATION CERTIFICATE The undersigned contractor or corporate officer, during the performance of this contract, certifies as follows: The Contractor shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The Contractor shall take affirmative action to ensure that applicants are employed, and that employees are treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or 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, notices to be provided setting forth the provisions of this nondiscrimination clause. 2. The Contractor shall, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 3. The Contractor shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Contractor shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. City of Santa Ana RFP 2t)-106 Page Al-31 7. The Contractor shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor may request that the United States enter into such litigation to protect the interests of the United States. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any contractor of public works violating this Section '.9 subject to all the penalties imposed for a violation of the Chapter, Signed: f �1—--• �______ urns P. Title: Brown III President Firm: EXC%.L PAVING COMPANY Date: City of Santa Ana RFP 20-101i Page Al-32 STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS The undersigned CONTRACTOR is familiar with the requirements of Section 1777.5 of the State Labor Code regarding employment of apprentices, and understands that contractors on contracts exceeding $30,000 or 20 working days shall: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 3. Contribute to the fund or funds in each craft or trade in which he/she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the California Apprenticeship Council. Signed: rLr __. ,k _ Title: Cu is P. Brown III President PAI-P, !hC DBA Finn: t=Xc e. PAVING QQMRP NY Date: City of Santa Ana RFP 20-106 Page Al-33 STATEMENT REGARDING "ANTI -KICKBACK" REQUIREMENTS The undersigned is submitting this proposal for performing by contract the work required by these bid documents, agrees to comply with the Copeland "Anti -Kickback" Act (18 USC 74) as supplemented in the Department of Labor regulations (29 CFR, Part 3). This act provides that each contractor or subcontractor shall be prohibited from inducing, by any means, any person employed in the construction or repair of public work, t ) give up any part of the compensation to which he/she is otherwise entitled. Signed: e Title: urtis P. Brown III President PALL, IN— DEA Firm: I -=Pi- pAUINC CChdRMY Date: City of Santa Ana RFP 20-106 Page Al-34 PUBLIC CONTRACT CODES CTION 10162 OUESTIONNAIU In conformance with Public Contract Code Section 10162, the CONTRACTOR shall complete, under penalty of perjury, the following questionnaire: Has the CONTRACTOR, any officer of the CONTRACTOR's organization, or any employee of the CONTRACTOR's Company who has a proprietary interest in the CONTRACTOR, ever been disqualified, removed, or otherwise prevented from proposing/bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No ✓/ If the answer is yes, explain the circumstances in the following space. 0* _------- -- - ... _ -. ----- -- ---- __- Cfty of Santa Ana RFP 20-106 _ Page Al-35 STATEMENT REGARDING COMMUNITY WORKFORCE AGREEMENT (CWA) REOUMBMENTS This is to certify that the undersigned CONTRACTOR, and subcontractors, have read and understood the CWA entered into by and between the City of Santa Ana, the Los Angeles/Orange Counties Building and Construction Trades Council, and the signatory Craft Councils and Local Unions, effective as of September 1, 2017. The CWA is available at: http://www.Santa-ana.or pwa/documents/CWA The undersigned CONTRACTOR hereby agrees to comply with all terms and conditions of the CWA, and is capable of completing construction of the project continuously, and without interruptions or delays. If awarded any work covered by the CWA, CONTRACTOR will also be required to sign the Letter of Assent that appears as Attachment A to the CWA. Public Works Construction Permit: The Contractor may be required to obtain a Public Works Construction Permit if the CWA thresholds for a Task Order are met or exceeded as described in this RFP's Section III.E "Licenses & Permits." The undersigned has reviewed and understands that a Public Works Construction Permit for CWA administration fees and deposit that may be required as described in this RFP's Section III.E "Licenses & Permits." Signed: Title: urtis P. Brown III President ,U MA Firm: EXCEL PAMI NG COMRA- N Date: OCT -1 101E City of Santa Ana RFP 20-106 Page Al-36 MAYOR Miguel A. Pulldo MAYOR PRO TEM Juan Vllleges COUNCILMEMBERS Phil Bacerra Nelida Mendoza David Peneloza Vicente Sarmlento Jose Solodo CITY OF SANTA ANA 20 Civic Center Plaza • P.O. Box 1988 M-22 Santa Ana, California 92702 www Santa-ana ono October 6, 2020 ADDENDUM ONE CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez SUBJECT: RFP NO. 20-106: ON -CALL EMERGENCY ASPHALT CONCRETE, CONCRETE AND STORMDRAIN REPAIR SERVICES The following changes/clarifications have been made to the above Request for Proposal: 1. QUESTIONS/ANSWERS QUESTION #1: This question is in regards to license requirements. PlanetBids description states... "Class (A, C- 8 or C34)." RFP page 2 of 55 states in bold "Class (A or 034 & C-10). Which would be the correct requirement? ANSWER: Class (A, C-8 or C34). See attached Addendum #1 where Page 2 of the RFP is replaced with the attached with the only update to clarify the licenses required. All other terms and conditions of the RFP remain unchanged. If you have any further questions, please post on Planetbids. Monica M. Suter Senior Civil Engineer Attachment: Addendum No. 1 SANTA ANA CITY COUNCIL Miguel & PNldo Juan V@egae Vicente Sarmlento David Ponaloza Jose aolodo Phil sate" Nelida Mendoza Mayor Mayor Pro Tem. Ward 5 WBM1 Ward Ward Ward Wards piay5da0jjata_gaayCg IvipeaastIDeenta-ann ore =a,�,_lzse9;dedj-ana nra daaaalua&AId8Za0.Cra leolodo(A=ana-ana nm ban carrarlysaota-ana or nmxndn>g(�aantumna MAYOR Miguel A. Pulido MAYOR PRO TEM Juan Villages COUNCILMEMBERS Phil Became Nellda Mendoza David Peneloza Vicente Sanniento Jose Solorio CITY OF SANTA ANA 20 Civic Center Plaza • P.O. Box 1988 M-22 Santa Ana, California 92702 v Msenta•ana.grg October 12, 2020 ADDENDUM TWO CITY MANAGER Kristine Ridge CITY ATTORNEY $onto R. Carvalho CLERK OF THE COUNCIL Daisy Gomez SUBJECT: RFP NO. 20-106. ON -CALL EMERGENCY ASPHALT CONCRETE, CONCRETE AND STORMDRAIN REPAIR SERVICES The following changes/clarifications have been made to the above Request for Proposal: 1. The new Bid Closing Date is: Tuesday, October 20, at 11:00 am (both electronic and hard copy); 2. The new deadline for questions and clarifications is: Thursday, October 15, 2020. 3. Six Pages of the RFP have been replaced: The Cover Page, Notice Inviting Proposals, Page 14 and Page A1-3, Al-27 and Al-28, see attached. 4. Clarifications: a. There is NO BID BOND REQUIRED FOR THIS SUBMITTAL --see updated RFP No. 20-106 (Including replaced pages). b. This project is unique as an RFP for On -call Construction/Repair Services for the City on an As -needed, On -call and Emergency basis. c. The Separate FEE PROPOSAL information is mainly for comparison/evaluation purposes along with the schedule of rates per firm as required in the RFP. d. For work required, companies will be asked for a specific quote from each of the qualified firms with agreements per category. Following a comparison of each on -call or emergency service repair quote received, the City will issue a Notice to Proceed on a Task Order basis, as required. All other terms and conditions of the RFP remain unchanged. Any additional y Monica M. Suter Senior Civil Engineer Attachment: Addendum No. 2 SANTA ANA CITY COUNCIL Miguel A. Pulido Juan Villages Vicente Sarmienlo David Penaloza Jose aniodo Phil Become Nellda Mandou Mayor Mayor Pm Tom, Word 6 Wahl1 Word Ward Wood Ward Ildo® nl INll.migoonlaaneoro rser_gr lenlo(h5¢anig_ana.are yieanelozaidaenta-ane.ota I3� 1- ploo.ougAinenlenao nmendozat,�santa=ana org Appendix ATTACHMENT 3 CERTIFICATIONS • Contractor's Licensing and Registration Statement • Prevailing Wage Compliance and Monitoring Statement • Ownership Affidavit + List of Sub -contractors (If included) • References + Non -Collusion Affidavit • Non -Lobbying Certification Non -Discrimination Certification • Statement Regarding Apprenticeship Requirements • Statement Regarding "ANTI -KICKBACK" Requirements • Public Contract Code Section 10162 Questionnaire + Statement Regarding Community Workforce Agreement (CWA) Requirements City of Santa Ana RFP 20-106 Page Al-22 Digitally signed by Francine R. Francine R. Villareal Villareal PALP, INC. Date: 2021.06.2309:0�tAWA ,d►coRO CERTIFICATE OF LIABILITY INSURANCE DAT/1612D/Y 616/2021 1 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: (A/CC,Nro, Ext): (949) 553-9800 FAX No):(949) 553-0670 The Wooditch Company Insurance Services, Inc. 1 Park Plaza, Suite 400 Irvine, CA 92614 A DD E-MAIL INSURERS AFFORDING COVERAGE NAIC # INSURERA: Executive Risk Indemnity,Inc. 35181 INSURED INSURER B : Federal Insurance Company 20281 INSURER 7 Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC INSURER D7 2230 Lemon Avenue Long Beach, CA 90806 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X X 54310180 6/1/2021 6/1/2022 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 71 PEA LOC PRODUCTS - COMP/OPAGG $ 2,000,000 EMPLOYEE BENEFI $ 1,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Perperson) $ ANY AUTO X X 54310182 6/1/2021 6/1/2022 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/ R/EXECUTIVE X 54310181 6/1/2021 6/1 /2022 X PER STATUTE EERR E.L. EACH ACCIDENT 1,000,000 $ OF EXCLUDED? EXCLUDED? ❑ (Mandatory in NH) N/A A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Excel Job #5770; Agreement #A-2020-245-04; RFP# 20-106, RFCA 12/1/2020, Item #09; On -Call Emergency Asphalt Concrete, Concrete and Storm Drain Repair Services. glaipwv/auaiwv/wcwv City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insureds as respects General Liability and Auto Liability per attached endorsements. This insurance shall apply as Primary and Non -Contributory per attached endorsement. Waiver of Subrogation for General Liability, Auto Liability and Workers' Compensation: See Attached Endorsements. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE � oRaN iaia a& � APPROPVE REVIEWED &APPROVED BY.- EWEI z a v� ACORD 25 (2016/03) © 1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Risk Management Analyst AFRO AGENCY CUSTOMER ID: PALP, INC. LOC #: 1 ADDITIONAL REMARKS SCHEDULE JEANA Page 1 of 1 AGENCY NAMED INSURED Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC 2230 Lemon Avenue Long Beach, CA 90806 POLICY NUMBER EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Cancellation: *Except 10 days notice of Cancellation for non-payment of premium. *Should this policy be cancelled before the expiration date, The Wooditch Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* ACORD 101 (2008/01) © 2008 ACORD CO The ACORD name and logo are registered marks of ACORD HORaN RiskMwagementDMsian REVIEWED & APPROVED BY. - Risk Management Analyst POLICY NUMBER: 54310180 COMMERCIAL GENERAL LIABILITY CG20371219 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY WHEN THE CONTRACT SPECIFIES COVERAGE FOR COMPLETED OPERATIONS ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 12 19 © Insurance Services Office, Inc., 2012 �oRaN } z RiskMmWmedDMsfan REVIEWED & APPROVED SY.- f R. V;&wd Risk Management Analyst POLICY NUMBER: 54310180 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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, 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) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 �oRaN } z RiskMmaganadDMsfan REVIEWED & APPROVED SY.- f R. V;&wd Risk Management Analyst Policy Number: 54310180 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 �oRaN } z RAMmVmedDMsiun REVIEWED & APPROVED BY.- f R. V;&'Vd Risk Management Analyst POLICY NUMBER: 54310180 COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE FOR SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Additional Insured: Location Of Covered Operations: WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at the Location Of Covered Operations shown in the Schedule, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under this policy provided that: (1) The Additional Insured is a named insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. 10-02-2461 (Ed. 7-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. �oRaN r RiskMmWmentDMsian REVIEWED & APPROVED BY.- p L" R. W&Wd Risk Management Analyst POLICY NUMER: 54310180 b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Or Waiver Of Rights Of Recovery Against Others To Us We will waive the right of recovery we would otherwise have had against another person or organization, for loss to which this insurance applies, provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured's rights to recover all or part of any payment made under this Coverage Part have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Coverage C. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means an electronic, oral, written or other notice, about goods, products or services, designed for the specific purpose of attracting the general public or a specific market segment to use such goods, products or services. "Advertisement" does not include any e-mail address, Internet domain name or other electronic address or metalanguage. 2. "Advertising injury" means injury, other than "bodily injury", "property damage" or "personal injury", sustained by a person or organization and caused by an offense of infringing, in that particular part of your "advertisement" about your goods, products or services, upon their: a. Copyrighted "advertisement"; or b. Registered collective mark, registered service mark or other registered trademarked name, slogan, symbol or title. 3. "Asbestos" means asbestos in any form, including its presence or use in any alloy, by-product, compound or other material or waste. Waste includes materials to be recycled, reconditioned or reclaimed. 4. "Auto" means: a. A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 5."Bodily injury" means physical: a. I nj u ry; b. Sickness; or c. Disease; sustained by a person, including resulting death, humiliation, mental anguish, mental injury or shock at any time. All such loss shall be deemed to occur at the time of the physical injury, sickness or disease that caused it. 6. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above; or c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in Paragraph a. above; (2) The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a short time on your business; or (3) "Advertising injury" or "personal injury" offenses that take place through the Internet or similar electronic means of communication Form 10-02-1800 (Rev. 09- Includes copyrighted material of ISO Properties, Inc., witl 17) its permission �oRaN � z RiskMmaganadDMsfan REVIEWED & APPROVED BY.- f R. V;&wd Risk Management Analyst Policy Number: 54310182 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement modifies the Business Auto Coverage Form. 1. EXTENDED CANCELLATION CONDITION Paragraph A.2.b. — CANCELLATION - of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. 2. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is an "insured" under any other automobile policy- (b) That has exhausted its Limit of Insurance under any other policy; or (c) 180 days or more after its acquisition or formation by you, unless you have given us written notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A.1. — WHO IS AN INSURED — of SECTION II — LIABILITY COVERAGE is amended to add the following: d. Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Lessors as Insureds Paragraph A.1. — WHO IS AN INSURED — of SECTION II — LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if: (1) The agreement requires you to provide direct primary insurance for the lessor; and (2) The "auto" is leased without a driver. Such leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You; 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee" or agent of the lessor, operating an "auto" with the permission of any of 1. and/or 2. above. D. Persons And Organizations As Insureds Under A Written Insured Contract Paragraph A.1 — WHO IS AN INSURED — of SECTION II — LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed under an express provision in a written "insured contract", written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an "insured". However, such person or organization is an "insured" only: Form: 16-02-0292 (Rev. 11-16) Page Rlsk MwwgmadDmsbt "Includes copyrighted material of Insurance Services Office, Inc. with its per �� RmAEWED & APPROVED BY: ` if1 1 L FU4.6;.He Z MA44d Ris k Management Analyst Policy Number: 54310182 (1) with respect to the operation, maintenance or use of a covered "auto'; and (2) for "bodily injury" or "property damage" caused by an "accident' which takes place after: (a) You executed the "insured contract' or written agreement; or (b) The permit has been issued to you. FELLOW EMPLOYEE COVERAGE EXCLUSION B.S. - FELLOW EMPLOYEE — of SECTION II — LIABILITY COVERAGE does not apply. PHYSICAL DAMAGE — ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. —TRANSPORTATION EXPENSES — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day for temporary transportation expense, subject to a maximum limit of $1,000. AUTO LOAN/LEASE GAP COVERAGE Paragraph A. 4. — COVERAGE EXTENSIONS - of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: c. Unpaid Loan or Lease Amounts In the event of a total "loss" to a covered "auto', we will pay any unpaid amount due on the loan or lease for a covered "auto' minus: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue loan/lease payments at the time of the "loss"; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor: d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. We will pay for any unpaid amount due on the loan or lease if caused by: 1. Other than Collision Coverage only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto'; 2. Specified Causes of Loss Coverage only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto'; or 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any covered "auto. 6. RENTAL AGENCY EXPENSE Paragraph A. 4. — COVERAGE EXTENSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: d. Rental Expense We will pay the following expenses that you or any of your "employees" are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business: MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT: 1. $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or "loss" of, that vehicle, including income lost due to absence of that vehicle for use as a replacement; 2. $2,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered "loss"; and 3. $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement. 4. $7,500 maximum total amount for paragraphs 1., 2. and 3. combined. 7. EXTRA EXPENSE — BROADENED COVERAGE Paragraph A.4. — COVERAGE EXTENSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: e. Recovery Expense We will pay for the expense of returning a stolen covered "auto' to you. 8. AIRBAG COVERAGE Paragraph B.3.a. - EXCLUSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage. 9. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - BROADENED COVERAGE Paragraph C.1.b. — LIMIT OF INSURANCE - of SECTION III - PHYSICAL DAMAGE is deleted and replaced with the following: b. $2,000 is the most we will pay for "loss" in any one "accident' to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is: (1) Permanently installed in or upon the covered "auto' in a housing, opening or other location that is not normally used by the "auto' manufacturer for the installation of such equipment; (2) Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or (3) An integral part of such equipment. 10. GLASS REPAIR — WAIVER OF DEDUCTIBLE Form: 16-02-0292 (Rev. 11-16) Pag MwwgmentDmsbt 'Includes copyrighted material of Insurance Services Office, Inc. with its per REviexrED&APPROVED BY: aRisk Management Analyst Policy Number: 54310182 Under Paragraph D. - DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Paragraph D.- DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: If this Coverage Form and any other Coverage Form or policy issued to you by us that is not an automobile policy or Coverage Form applies to the same "accident", the following applies: 1. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Paragraph A.2.a. - DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV - BUSINESS AUTO CONDITIONS is deleted and replaced with the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when the "accident" is known to: (1) You or your authorized representative, if you are an individual; (2) A partner, or any authorized representative, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company. Knowledge of an "accident", claim, "suit" or "loss" by other persons does not imply that the persons listed above have such knowledge. Notice to us should include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons or witnesses. 13. WAIVER OF SUBROGATION Paragraph A.S. - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced with the following: 5. We will waive the right of recovery we would otherwise have against another person or organization for "loss" to which this insurance applies, provided the "insured" has waived their rights of recovery against such person or organization under a contract or agreement that is entered into before such "loss". To the extent that the "insured's" rights to recover damages for all or part of any payment made under this insurance has not been waived, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. — CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV — BUSINESS AUTO CONDITIONS - is deleted and replaced with the following: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Form because of such failure. 15. AUTOS RENTED BY EMPLOYEES Paragraph B.S. - OTHER INSURANCE of SECTION IV — BUSINESS AUTO CONDITIONS - is amended to add the following: e. Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. If an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this insurance will be primary to the "employee's" personal insurance. 16. HIRED AUTO — COVERAGE TERRITORY Paragraph B.7.b.(5). - POLICY PERIOD, COVERAGE TERRITORY of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced with the following: (5) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and 17. RESULTANT MENTAL ANGUISH COVERAGE Paragraph C. of - SECTION V — DEFINITIONS is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death as a result of the "bodily injury" sustained by that person. Form: 16-02-0292 (Rev. 11-16) Pag MwwgmentDmsbt "Includes copyrighted material of Insurance Services Office, Inc. with its per RmAEWED & APPROVED BY: '0® Ris k Management Analyst Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Palp Inc. DBA Excel Paving Company Policy Number Symbol: WCF Number:54310181 Policy Period Effective Date of Endorsement 6/1 /2021 TO6/1 /2022 6/1 /2021 Issued By (Name of Insurance Company) FEDERAL INSURANCE Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 WC 90 03 75 (05/18) Authorized Representative a r N RAManWmadDivisian 3 REVIEWED & APPROVED BY: —E� Risk Management Analyst