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HomeMy WebLinkAboutG&F CONCRETE CUTTING INC.-2014INSURANCE ON FILE. WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK O couNcl . °' DATE Agreement No. Evel y f) Lev, Z ON- THE -JOB TRAINING AGREEMENT UNDER THE WORKFORCE INVESTMENT ACT N- 2014 -026 THIS AGREEMENT is made and entered into this 25 day of February, 2014 between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California (hereinafter "CITY ") and G &F Concrete Cutting, Inc (hereinafter "EMPLOYER "). WITNESSETH Recitals: A. CITY has been designated a Local Workforce Investment Area ( "LWIA ") pursuant to Section 116 of the Workforce Investment Act ( "WIA "), P.L. 105 -220, 29 USC Section 2801, to receive federal funds to promote effective delivery of job training services to local area residents. B. The State of California has created the California Workforce Investment Board pursuant to Section 111 of the Workforce Investment Act, P.L. 105 -220, 29 USC 2821 to administer the WIA programs operated by the State of California. C. As a LWIA, CITY is entitled to receive federal funds to establish programs to prepare eligible unskilled youth, adults and dislocated workers for entry into the labor market, and to provide job training to those individuals who face serious barriers in obtaining productive employment ( "said Program "). D. EMPLOYER is able and willing to train eligible unskilled applicants for entry into the labor market and is willing to operate said program pursuant to the WIA and applicable federal, state and local laws. WHEREFORE, for and in consideration of the respective and mutual covenants and promises hereinafter contained and made, and subject to all the terms and conditions hereof, the parties hereto do hereby agree as follows: 1. Term. The effective term of this Agreement is for the period beginning March 3, 2014, and ending August 29, 2014. The term of this Agreement may be extended upon agreement of all parties and execution of an amendment of the term. 2. Scope of Work. The EMPLOYER shalt employ and train one employee (hereinafter "Trainee ") in the occupation and in accordance with the OJT Training Outline set forth in Exhibit A, attached hereto and incorporated herein by this reference. Said Trainee shall be referred by the City of Santa Ana W /O /R/K Center. Training must significantly raise the Trainee from his /her prior position in both level of skill and salary by the end of the training period. 3. Funding. CITY shall reimburse the EMPLOYER an amount not to exceed $4,851.00 in accordance with the Cost Computation included in Exhibit A. EMPLOYER shall bill the CITY monthly on an invoice provided by CITY for actual and reasonable cost for providing the services described in this Agreement. Reimbursement of EMPLOYER under this Agreement shall be limited to the costs incurred during the basic work week, excluding overtime and any paid holidays or sick leave. 4. Subcontracting Prohibited. The EMPLOYER shall not subcontract or assign the OJT Training. Any attempt by the EMPLOYER to delegate or assign OJT training duties under this Agreement shall void, and permit CITY to immediately terminate, this Agreement. 5. Employer Obligations. During the training, the EMPLOYER shall ensure that the Trainee: a. is on the EMPLOYER's payroll, not paid as a contracted employee /independent contractor; and, b, receives the same benefits as EMPLOYER's other employees performing similar work; and, C. is paid the salary as indicated in Exhibit A with appropriate payroll taxes withheld and reported; and, d. is provided Worker's Compensation Insurance coverage, pursuant to state law; and, e. is provided by EMPLOYER with safety instructions and equipment necessary for reasonable protection against injury and damage. CONTRACTOR shall maintain appropriate standards for health and safety in work and training situations. Where special clothing or equipment is provided to the EMPLOYER's regular employees, EMPLOYER shall provide the same type of clothing or equipment to the Trainee performing similar work. 6. Employment of Trainee. The EMPLOYER shall employ the Trainee as a regular member of EMPLOYER's work force. If EMPLOYER wants to continue to employ the Trainee upon the successful completion of the training period under this Agreement, said employment shall be subject to the same conditions of employment applied to EMPLOYER's other regular employees, including termination for unsatisfactory performance. E 7. Patent, Copyrights and Rights in Data. The EMPLOYER will disclose to the CITY any invention, written product, computer program developed or data assembled as a result of performance of work under this Agreement within seventy four (74) days of invention, development or assembly. The CITY, State of California, and U.S. Department of Labor will have the right to patent any invention and copyright any written product or computer program or data generated by EMPLOYER. Upon written request, EMPLOYER will transfer all pertinent information, specifications and right, title and interest to the designated agency. 8. INVENTIONS, PATENTS AND COPYRIGHTS. A. Reporting Procedure. If any project produces patentable items, patent rights, processes, or inventions in the course of work under a U.S. Department of Labor (DOL) grant or agreement, the CONTRACTOR shall report the fact promptly and frilly to the CITY. The CITY shall report the fact to the Grant Officer, at the DOL. Unless there is a prior agreement between the CITY and the DOL and its representative on these matters, the DOL shall determine whether to seek protection on the invention or discovery. The DOL and its representative shall determine how the rights in the invention or discovery, including rights under any patent issued thereon, will be allocated and administered in order to protect the public interest consistent with the "Governmental Patent Policy" (President's Memorandum for Heads of Executive Departments and Agencies, August 23, 1971, . and Statement of Government Patent Policy). B. Copyright Policy. 1. Unless otherwise provided in the terms of the grant or agreement, when copyright -able material is developed in the course of or under a DOL Grant or agreement, the author and the CITY which developed the work is free to copyright material or to permit others to do so. The EMPLOYER and the Workforce Investment Board (WIB) shall have a royalty - free, nonexclusive and irrevocable license to reproduce, publish, use and to authorize others to use all copyrighted material. 2. The DOL reserves a royalty -free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for Federal Government purposes: (a) The copyright in any work developed under any grant, sub -grant, or contract under a grant or subgrant; (b) Any right of copyright to which a grantee, subgrantee or a EMPLOYER purchases ownership with grant support; and (c) EMPLOYER shall comply with the requirements of 29 CFR Part 97.34. C. Rights to Data. The DOL and the CITY shall have unlimited rights to any data first procured or delivered under this Agreement. 9. Hold Harmless. The EMPLOYER shall indemnify, defend and hold harmless CITY, and its officers, agents and employees, from and against any and all damages to property or injuries to or death of any person or persons, including property and employees or agents of CITY, and shall indemnify, defend and hold harmless CITY, and its officers, agents and employees, from any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not limited to, workers' compensation claims, resulting 3 from or arising out of the negligent acts, errors or omissions of EMPLOYER, its employees, agents or subcontractors. 10. Insurance. The EMPLOYER shall obtain at its sole cost and file with the City of Santa Ana — Santa Ana W /O /R/K Center, upon execution of this Agreement, and maintain for the period covered by this Agreement, a policy or policies of commercial general liability insurance or a certificate of such insurance, satisfactory to the City Attorney of CITY, naming CITY, and its officers, agents and employees, as insured or additional insured (see attached Additional Insured Endorsement, Exhibit C), which provides coverage not less than that provided in the form of a comprehensive general liability insurance policy against liability for any and all claims and suits for damages or injuries to persons or property resulting from or arising out of operations of EMPLOYER, and its officers, agents, or employees. Said policy or policies of insurance shall provide coverage for both bodily injury and property damage in no less than One Million Dollars ($1,000,000). Said policy of comprehensive public liability insurance shall be endorsed to provide to CITY and to the State of California, Employment Development Department, at least thirty (30) days written notice prior to cancellation; name CITY, its officers, agents, employees, and volunteers, and the State of California, its officers, employees, and volunteers as additional insured; and state that such coverage is primary to any other coverage or self - insurance of the State of California and CITY. Governmental entities may substitute a certificate of self - insurance. 11. Record Keening. CITY, the State of California and the United States government and /or their representatives shall have access for purposes of monitoring, auditing and examining of EMPLOYER'S activities, performance, books, documents, papers, and records of EMPLOYER'S subcontractors, bookl=pers and accountants, and employees and participants related to this Agreement. Such agencies or representatives shall also schedule on -site monitoring in their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants and entering any premises or onto any site in which any of the services or activities funded hereunder are conducted or in which any of the records of EMPLOYER are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. In the event EMPLOYER does not make the above - referenced documents available within the City of Santa Ana, California, EMPLOYER agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. All accounting records and evidence pertaining to all costs of EMPLOYER and all documents related to this Agreement shall be kept available at the location where EMPLOYER conducted the program, as well as in the County of Orange, for the duration of this Agreement and thereafter for three (3) years after completion of an audit. Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which CITY, the State of California or the United States Government take exception, N shall be retained beyond the three (3) years until resolution of disposition of such appeals, litigation, claims, or exceptions. 12. Government Funding. This Agreement is valid and enforceable only if sufficient funds are made available to the State by the United States Government for the same Fiscal Year as for this Program. In addition, this Agreement is subject to any additional restrictions, limitations, or conditions enacted by Congress or any statute enacted by Congress which may affect the provision, terms or funding of this Agreement in any manner. 13. Payment Cap. City's OJT payments to EMPLOYER shall not exceed a maximum of fifty percent (50 %) of the wages paid by EMPLOYER during the training period specified in Exhibit A. 14. Amendment of Agreement. No alteration or variation of the terms of this Agreement shall be valid and /or binding unless made in writing and signed by both parties. There are no oral understandings or agreements between the parties. 15. Breach/Sanctions. If, through any cause, EMPLOYER violates any of the terms and conditions of this Agreement, or if EMPLOYER reports inaccurately or if any Audit Report makes disallowances, EMPLOYER shall promptly remedy its acts or omissions and /or repay CITY all amounts due CITY as a result of EMPLOYER's violation. For any such failures or violations, CITY shall also have the right at its sole discretion to either: (1) discontinue program support until such time as EMPLOYER fulfills its obligations or remedies all violations of this agreement or prior agreements; and/or (2) collect outstanding amounts as determined by CITY due CITY by offsetting or debiting from current claims or invoices, if after thirty (30) days' written notice EMPLOYER has failed to repay same or a repayment schedule has not been made; and /or (3) terminate this Agreement by giving written notice to EMPLOYER of such termination in accordance the notice provision in Paragraph XVIII herein below. 16. Termination. Either party may terminate this Agreement upon thirty (30) days prior written notice to the other party. However, the CITY may immediately terminate this Agreement at such time as funds are not made available to CITY through the United States Department of Labor or the State of California Employment Development Department for the purpose of carrying out this Agreement. 17. Independent Contractor. The EMPLOYER, and any agents and employees of the EMPLOYER, in the performance of this Agreement, shall act in an independent capacity as independent contractors and not as officers, employees, or agents of the CITY. This Agreement is not intended nor shall it be construed to create an employer - employee relationship between EMPLOYER and CITY, nor a joint venture relationship. The EMPLOYER shall not subcontract in the name of the CITY. 18. Equal Employment Opportunities. The EMPLOYER warrants that it will comply with Title VI of the Civil Rights Act of 1964, and the requirements relating to equal employment opportunities set forth in Executive Order No. 11246, as amended by E.O. 5 11375 and supplemented by the requirements of 41 CFR Part 60. EMPLOYER will also comply with all applicable federal and state laws and regulations, and particularly those assurances and certifications set forth in Exhibit B attached hereto and by this reference incorporated herein. 19. Prohibitions. The EMPLOYER shall not use any of the training funds provided under this Agreement for political or sectarian activities. 20. Grievance Procedure. The EMPLOYER shall continue to operate, or shall establish and maintain a grievance or complaint handling procedure relevant to the terms and conditions of employment and the EMPLOYER's activities and programs, which shall meet at a minimum the requirements set forth in Section 101(31) of the Act and 663.700- 710 and regulations promulgated by the State or Federal Government. Employers that do not have a grievance or complaint handling procedure shall use the procedures prescribed by the CITY. 21. Guidelines. The CITY shall make the WIA applicable federal regulations and policy guidelines available to EMPLOYER at CITY — W /O /R/K Center, 1000 E. Santa Ana Blvd., Suite 200, Santa Ana, California 92701. The CITY shall also inform the EMPLOYER of changes in the WIA regulations or policy guidelines if such changes affect the operation of this Agreement. 22. Drug Free Workplace. The EMPLOYER agrees to provide a drug -free work place and to execute a certification as set forth in Exhibit D attached hereto and incorporated herein by this reference. 23. Notices. All notices, reports and correspondence between the parties hereto respecting this Agreement shall be in writing and deposited in the United States mail, postage prepaid, addressed as follows: CITY: City of Santa Ana — Santa Ana WORK Center 1000 E. Santa Ana Blvd., Suite 200 Santa Ana, CA 92701 Attention: WORK Center Director EMPLOYER: G &F Concrete Cutting, Inc P.O. Box 10215 (1006 E. Chestnut, 92701) Santa Ana, CA 92711 -0215 ATT: Dan Farias 9 24. Debarment. To protect the public interest and ensure the integrity of Federal programs, CITY may only conduct business with responsible persons and may not make any award or permit any award to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension ". See also 29 CRF Parts 97.35 and 98.510. EMPLOYER must review and sign Exhibit E "Debarment ", which is attached hereto and incorporated herein by this reference. 24. Merger. This Agreement, together with the attachments hereto, expresses the total understanding of the parties. There are no oral understandings of the parties or terms and conditions other than as stated herein. 25. Validity. The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. 26. Miscellaneous Provisions. a. Each undersigned represents and warrants that its signature hereinbelow 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: Q Marie D. Huizar 01 Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney (By Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: CITY OF SANTA ANA 1 David Cavazos City Manager EMPLOYER: General Manager Tax ID #: 33- 014173 State ID #: 296 - 1261 -1 TRAINING PLAN I. GENERAL Exhibit A 1. Name of OJT Employer: G &F Concrete Cutting, Inc. 2. Address of OJT Work -site: 1006 E. Chestnut Ave, Santa Ana, CA 92701 3. Phone Number: 4. Training Supervisor: Dan Farias 5. Name of OJT Trainee: David Rivera 6. Application Number of Trainee: 1023635 7. Grant/Program: WIA - 201 8. Proportion of trainees /employees: (at time Agreement entered into) a. Total number of employer's regular employees C. Cumulative number of trainees currently in OJT II. OCCUPATION AND ON -TI3E -JOB TRAINING OUTLINE: 1. Occupation: Shop Assistant/Grounds Maintenance 2. Length of Time in Business: 34yrs 3. ONET Code: 49- 9042.00 SVP Level: (6.0 to < 7.0) 4. Hourly Starting Wage: $14.00 Start Date: 3/3/14 End Date: 8/29/14 Hours 693 5. State and Federal Tax I.D.: State: 296- 1261 -1 Federal 33- 014173 6. Basic Work Week Hours: 7. Outline of On -the -Job Training Plan and Method of Assessment: 1 ELEMENTS OF TRAINING HOURS OF TRAINING 1. Shop Safety - Knowledge of relevant equipment, policies, 40 procedures, and strategies to ensure protection of people, and institutions doing concrete business. Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate of proficiency within trst Month and a half o training, 2. Bobcat Operation — Familiarization with the parts of a bobcat; 200 levers to control direction, pedals to control the bucket and safety mechanisms. Check maintenance of bobcats such as lift anns, bobtaeh, rims, tires, axles, cylinders, tracks and mainframe. Learn to safely operate different type of bobcats as appropriate for job at hand. Measurement Method. Q & A, task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. 3. Tool and Equipment Operation — Proper usage of hammers, hoists, saws, drills and wrenches. Adjust parts of devices for 233 proper usage. Maintenance and inventory control. Measurement Method. Q & A task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. 4. Tool and Equipment Repair — Servicing, repairing, adjusting, 220 and testing machines, devices, moving parts, and equipment that operate primarily on the basis of mechanical principles, Detennining cause of operations errors and deciding what to do about it. Identify the strength and weaknesses of alternatives solutions. Perform maintenance under supervision. Repair or replace defective equipment. Measurement Method; Q & A task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. FIMMMCIII DWAX&`I Measurement method: how will it be determined if OJT participant acquired the skill? Q &A, observation, product review /inspection, etc. PROFICIENT MODERATE MARGINAL It. COST COMPUTATION Hourly Reimbursement: $7.00 (50% of $14.00) Training Hours: 693 Cost Per Trainee (Hourly Reimbursement X Training Hours) = $4851.00 III. Person(s) authorized to sign payment invoices for EMPLOYER: Dan Farias r. Print Name c--Signaturt< Title Print Name Signature Title Date Date ASSURANCES A. The EMPLOYER assures that: 1. It will comply with the requirements of the Workforce Investment Act (WIA), the California Unemployment Insurance Code, as amended, and the regulations and policies promulgated thereunder. 2. No OJT participant displaces a regular employee nor shall an OJT participant fill a position of a person who has been laid off from the same or similar position. 3. No current employees are receiving unemployment insurance benefits as a result of layoffs or work reductions. No person in the United States shall on the grounds of race, color, sex, religion, national origin, age, disability, sexual orientation, or marital status be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives federal financial assistance and will immediately take any measure necessary to effectuate this Agreement. It will comply with provisions of the Hatch Act, if applicable, which limits the political activities of employees. Individuals receiving training on the job shall be compensated by the EMPLOYER at such rate, including periodic increases, as may be deemed reasonable under regulations prescribed by the Secretary of Labor, but in no event at a rate less than that specified in Section 6 (a) (1) of the Fair Labor Standards Act of 1938 or, if higher, under the applicable State or local minimum wage law. Services and activities provided under this Agreement will be administered by or under the supervision of the EMPLOYER. No relative by blood, adoption or marriage of the EMPLOYER may be trained under this Agreement. Appropriate standards for health and safety in work and training situations will be maintained. 10. Conditions of employment or training are appropriate and reasonable with regard to the type of work, the geographical region, and the proficiency of the trainee. 11. Training will not be for any occupation which requires less than six weeks of training according to the Specific Vocational Preparation Table (SVP Code). 12. Training will, to the maximum extent practicable, be consistent with every individual's fullest capabilities and lead to employment possibilities. 13. The program will, to the maximum extent feasible, contribute to the occupational development or upward mobility of individual participants. 14. Training will be in accordance with the training plan, which plan incorporates documentation that must be completed by EMPLOYER before end of contract. EXHIBIT B 15. *Dot and * *SVP code books will be used to determine length of OJT period. The training time may not be longer than the SVP Code allows; however, contractors are encouraged to negotiate shorter training periods whenever applicable. 16. OJT trainees shall not number more than 40% of the EMPLOYERS work force. 17. All EMPLOYER training payments (reimbursements) must be exclusive of any and all EMPLOYER fringe benefits, paid holidays, paid sick days and overtime compensation. 18. The participating EMPLOYER must keep an accurate and up -to -date time sheet for the OJT trainee. 19. Payroll records, time and attendance records and job duties retained on file by the participating EMPLOYER for each OJT trainee are subject to review. 2/25/2014 Employer Signature Date EXHIBIT B 36 (vrc A "® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 o2iaaizoia THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT HAVE Willis OP Arizona, Inc. C/o 26 Century Blvd. P.O. Box 305191 Nashville, IN 37230 PHONE , 877 -945 -7378 1 FAgiCX,.Nah 888- 467 -2378 i A�°MAII r•1Eicatee(dwillie.com S` INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: National Fire Ins. Co. of Hartford 20478 -001 2078177299 INSURED tl @F concrete Cutting, Inc. INSURERS: Nationwide Mutual Insurance Company - 23787 -001 INSURERC; D �1 CAFE EJiEN TED P aoccurence P.O. Box 10215 Santa Ana, CA 92713. ' -" INSURER 0; X INSURER E: INSURER R COVERAGES CERTIFICATE NUMBER: 21172079 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I NSR TYPE OF INSURANCE OD' SUB POLICY NUMBER POLICY SEE POLICY eXP LIMITS A GENERAL LIABILITY y 2078177299 7/18/2013 7/18/2014 EACH OCCURRENCE $ 1 000 D �1 CAFE EJiEN TED P aoccurence $ 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS- MADEEXIOCCUR MEO EXP An' /one poregn) $ 15,000 PERSONAL dADV INJURY $ 1 000 000 _� GENERAL AGGREGATE $ 2 00 000 GENTAGGRCGATE LIMITAPPLIES PER; PRODUCTS- COMPIOP AGG _ $ 2 00 00 _ § POLICY X PRO- LOC B AUTOMOBILE LIABILITY Y ACP HA 7244085907 7/18/2013 7/18/2014 (rE MBJc N ED SINGLE LIMIT $ 1,000,000 X BODILY INJURY(Perpemcn) $ ANYAUTO ALLOVINED SCHEDULED AUT08 AUTOS MIRED AUTOS NON OWNED AUTOS'%)'�'� "t Y INJURY PLarancidenl BODI ( ) $ kPAUE eoawlGenl $ UMBRBLLALIAa OCCUR ,.. EACH OCCURRENCE $ AGGREGATE _ $ EXCESS LIAB OLAIMS -MADE x' ,� ° 4� DED RETENTION$ $ -- WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVFI—I OFFICER /MEMBER EXCLUDED? LJ N/A y P,5` -+('� : C,(ty CSTAT - O - EL. EACH ACCIDENT $ IManda/ory,In NH) Yee,doacnba under DEBCRIP7ION OF OPERATIONS below C.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach Aeon! 101, Addlloqul Remarks Schedule, If more space Is required) Project: Job Hiring Program The City of Santa Ana, it's officers, employees, agents, and representative are included as Additional Insureds as respects to GanOYal Liability and Auto Liability per written contract. CERTIFICATE HOLDER CANCELLATION Coll:4345056 Tp1;1760214 Cert:2117V79 © 1989- 2010AQ,QIff1(j2P,Q 6ION. All rights reserved. ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD k�',.xx JJ--jj JYj$ II II (1�, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, City of Santa Ana AUTHORIZED REPRESENTATIVE Attn: Purchasing Department 20 Civic CenL-er Plaza M -16 Santa Ana, CA 92702 Coll:4345056 Tp1;1760214 Cert:2117V79 © 1989- 2010AQ,QIff1(j2P,Q 6ION. All rights reserved. ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD k�',.xx JJ--jj JYj$ II II (1�, G- 140331 -C (Ed 10/10) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -WITH PRODUCTS - COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below,) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract' to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional Insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf in the performance of your ongoing operations specified in the "written contract; or c. "Your work" that is specified in the "written contract' but only for "bodily Injury' or "property damage" included in the "products- completed operations hazard," and only If: (1) The "written contract' requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. We will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. Required by the "written contract'; b. Described In B.1. above; or c. Afforded to you under this policy. 3. This insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the "written contract," this insurance will be primary and non- contributory relative to insurance on which the additional insured is a Named Insured. 4. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, Inspection, architectural or engineering activities; or G- 140331 -C Includes copyrighted material of Insurance Services Office, Inc., with Its permission (Ed, 10/10) c=vurorr C Page 1 of 2 2 b. Any premises or work for which the additional Insured Is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional Insured under this endorsement will as soon as practicable: (1) Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit' that does result; D. (2) Except as provided in Paragraph B.3 of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit' to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But If the "written contract requires this insurance to be primary and non- contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. G- 140331 -C (Ed. 10/10) We have no duty to defend or Indemnify an additional Insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." 2. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph 4,a, of the Other Insurance Condition is deleted and replaced with the following: 34. Other Insurance a. Primary Insurance This insurance is primary and non- contributory except when rendered excess by endorsement G- 140331 -C, or when Paragraph b. below applies. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition; "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury" or "property damage "; or b The offense that caused the "personal and advertising injury" for which the additional insured seeks coverage under this Coverage Part. G- 140331 -C Includes copyrighted material of Insurance Sewicas Offlce, Inc., with Its permission Page 2 of 2 (Ed. 10/10) EXHIBIT C 2 130INE:ISS AUTO AC 01 02 03 08 THIS ENC ORSEMENTCHANCi!ES THE POLVUY, PLEASE REACT IT CAREFULLY, This endorsement i dtfies lnsum% provided under the foplowIng: BUSINESS ALTO COVERAGE FORM A. CHANGES FOR TRAILERS AND FARM or organization quallflas, as an "Insured" un- EOUIPMEN'T der itte Who Is An Insured provision con - l. VnderSECTION I, COVERED AUTOS, the lamed In Sectlon I1- UABILITY COVERAGE of the Coverege Form fo!IlawIng are added be Paragda!ph C. Carlaln 'trailer&, Moklle Equipment and Ternparaa'y Ci. 'FCEpLAOElO EXCLUSIONS Substitute Aube: The EApooted or Intended Injury Exclusion 4. 7mila!rs " dealgoad to be lowed by a priµ IN SECTION 11 - LIA011.1IY'COV"ERAGE Is. veto passenger type 'IaLxW or a pickup, !replaced iby the ihlllowlinq panel truck or van if not used for !weir EKlaa¢'ted or Intended Injury riass pu!paoWs, other than favming or "Bodily , dory or " "property dnmago" which is ranc'hing. expected or intended by the 'Insured ". This B. - Farm wagons or farm !hmplerrrents while excluslon appllles even if the !resol(Ing " "bad, being towed h y a covered " auto ", lrly I'd a ry"' or "properly dour pp e ": B. Cl FOR ADDITIONAL NEWLY a. !Is of, a different kind., quality or degree A.COLfll VEHICLES than frMailyexpe'cted or inntended; or 2. Paragraph B2 of SO OTION I - COVERED b. !s susiainad by a dlfferc nt peeson, eathy, AUTOSI's replaced by the followIng: real prpparty; or poreo l property than 2. It Syi lest 7 is entered !nsxl to a'mye!n that ilsitlally expeotod or Irdan!dod. age In Ilsrn T! rhos of the Declarations, an iE. ADDITIONAL EXCLUSIONS 'auto' you acqulrs will be a coveeed The foil exclusions are added to ".4aule" far that ooveraga only if: SECTION it — LIABiLrrYCOVERAGE; A. We allmadycover at least one "ar try" Damage to Named Insured's Property you own for that covarogo or It r planes an "ado "' you previously Anyola ln ar "wit fo " "proparlydampge "'!by yawned that had that rxlverago; and 1"pu or on your' behelf agalnet any other per - b. You tall us wlltiiat IlO days &€tai" you y y ,sort or entry that Is also a (Named Insured under this policy. acgulra d that you want !us to oover' Itfor that coverage, Abuse or Moo*tnt ov The most we wIl poet ter Phyeioal Damage "Badly iajury+' nor "property darnaga" arising Coverage for "lass° under tht%Coveraga Ex- out of. tonolort Is $100,000 per 'lauty , subjed to a. The actual or threatened abuse or me. he !largest deduotible applicable to any Iestaton by anyone or any person wh "le "auto'" for that Cove.rege. in the care, custody or tontno�l of any'lin- C, !RLANKCTADDITIONALINSURrIS su!rod",or Any !,person or organization wwintoh you have b. The nagl'lgentt agreed toname .asanaddlt'lonal!lnsuredIna l) Ennplpyment; wrtitan contract, executed prior to an aQok 2) Invoatlgatlon; dent, other than a contract for the lease or 3) Superulslon; rental of a vehicle Is an "Insured" for Uability Coverage, bout only to tie extent that poraon 4y Cteporting to the proper authorities, or folio o to so report) or AC 01 02 03 08 Includes copyrighted moterlal of inswanoe Servicas Office, Inc., page 9 of 3 withSCSpairnd alien. EXHIBIT C ti AC 0102 03 G a 5) Rata Lion; of a pereon for whom any `Inearod'iat or ever was ilegally responsiible and whose conduct would be ewoludad by Pars• graph a, above, Abuse means an so which 'Is oommil ed with the intent to cause harm:. r „;xirtaslwas CR. "Bodll,y Irtury” or "property damage" eavosd by the exploston of exploelves you make, aelltp.r trorrsprv:"f. ROIling Mores If a covered "auto" Is a irgiling!starer'bodily injury " or "property damage" resul&V fram the handling, use or condition of any Item the "Insured "makes, sells' or dlstd>sufes it the 101tity or damrxge occurs after the "in- sumd" has given up possession of the Item. Wrong Delivery of' Llglulel Products "Bodly iju:ry" or "property damage" reault Ir1g Pom the doIN" of any liquid Into the wrong receptads or to the wrong add'ross, at, from the doilvery of one Liquid for smother, If the "bawdily Injury" or "proparty damage "' occurs ai'ter the delivery Ihas been cow- plated. f�ellirorery �bs cualsldered ca'mptetad ovon if fur. flier earvloo ormatlmLon•anco work, or oorroa, tio�rn, repair or replaoarnenk Is required'. ''.be, cause of wrong delivery, Profess lonal "Services "Bodily'lnjury "'° a. Resulting from the prov',Iding or the fail- ure to provide any medical or other Ipro� fe��lcrral servloes. b, Resulting from food or drink rurnished with these services, "Bodily injury" or "'prcporty -data" result Ing from the.handln,g of corpses. F, MOTOR ROME CONTENTS COVERAGE 1. For a covered "auto "' 'that is a motor, home the followwlryg exclusions are added TO SLO71 1N III— PHYSICAL DAMAGE! Motor Home Contents This Insurance (foes notepplytw a. "Loss' to the covered "autdo" contents, except equipment usual to trucks or pri- vate pass- ,ongar"arut+as" K b, "Loss" to TV antenmas, awnings or ca� belles. a, "Loss" to equlprnant des19nod to create added IIving facilities. However, these oxoluslona do oust rapply If Misoeianeous Porsanal Prolparty Coverage Is provided by endorsement to this policy. ACODENTAL AIIRSAG DISCHARGIS. COVERAGE Under Paragraph !13,1a, of „ Earlolm III PHYSICAL, DAMAGE, the follbw'Ing Its rwdds& Machartoal breakdown does ¢wt Irrolude the ao- oldental discharge of an alt ag. PHYSICAL DA14ACE WWT OF INSURANCE Paragraph C. Limlt of Insurance of SBCTi£1N III - ,PHYSICAL DAMAGE INSURANCE 1s repllaeed by the follo wlrkg,: C. L:ImIt Of Insuiranoe I. The most we will pay for "loss" In any one "accident Is flee Iessar of: a. The actual ossih value of the damaged or stolen property as of the tm of the "Joss"; or b.. The cost of repairing or raplar� ,Q the damaged or stolen prop, arty. 2. An adjuratrment for deprealatlon and physical condition Will be made In dotennrning actual Cash value In tlae event. of total ",loss" 3. 'nhe cast of repairing or replacing rattrlr: a. Be haeed o n aii pest hate which Irdclud'as parts furnished by the odgirtal equipment manufacturer or other sources Including nan- or9glnall equipment rnanufactur- ers and b. Includes a deduction for 'boftor- ment for a .part or parks the '€ are �normally subject tie fapal'r or re- placement during the useful Life of the "auto'", such as, but lust lim tad to tires aaiid hatted as. Betterment means the difference batwoen 9Aa actual cash value of a part immediately before the '"loss "' and the costto replace that.part wllh a new part. Page 2 of23 Includes copyrighted material of Insurance Services Office, Inc., with ICS parmission. EXHIBIT C AC 10102 03 03 .s- 1. GLASS REPAIR -WAIVER OFDEDUCTIBLE Under Pisrag'sph t?, Doduotiible of SECTION III - PHY81CAL DAMAGE COVERAGE, the follovw drug, Is ad'dad:. No deductble applies to glass damage If the giass Is repaired farther then rep[aeod. JI, AMENDED DUTIES IN EVENT OF ACCIMT, CLAIM, SUIT, OR LOSS The requirement In Loss Condition 2,a. Dutfas In The Even Of Auu'I!dant, Clatmi, Stilt Or Loss - of SECTION IV - B'USINESS AUTO CONDITIONS lhal you must notify us of all "ami de'nif" "s%SiM",, "suit°, or "Ivies" applies only when the °aooldenf, clslm "', "sulN , o r loas° Is known'to: 1. Ypum, if you are an daadavldhwl 2. A,partnor, If you are a pa'tttriairshipl 1 An executive officer or the employee dosig� hated by you to give sutler n gee if yew are a ool+porablon; or 4. A member, If you are a Ilmited liability oonro Pear", K. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SE.CTON iV- BUSINESS AU'T'O CONDITIONS - B,Z is amondad by the addition or Toe follom Ing: if you unintentionally faill to:distdose'any hazard's OxIstiirlp at the Incept:len date of your polley, we Will not eleny coverage under IN& Cov!arage Form :because of such fallure. However, this provision does notaffectour right to oollect ad'd1- f orna'I promium or exeroise our dght of eencella bore Car nonmriewal. L. AUTOS HIRED OR RENTED BY EMPLOYEES Ir Ihgred or ranted "autos" are euvered "aut ° on this pol'lgl the following provisions apply: A. Changes In Llabillty Coverage The fallowing is added to the Who is An In> cured Provision in SECTION It-- LIAMLIt"Y ITQVERAGEs AC 0102 03 08 An "arnpll'oy ' of yours Is or) "insured" wrhile operating an ' "auto" hired or' ranted under a contract or pp,rean Vont In that "sumpJ'tyya6 °a," name, with your pe mnlsslon, while pof onnirng. dutlas related to the oonducl of your bu'al- ness. 1 ChanaOs In funeral Conditions Paragraph S.h. of the Other insurance Oprdiltion 'Ira the Business Auto Cowrrage Form is replaced by the folfowing: For Hired Auto Physical Damage Coverage, the following are deemed to ba oovared! ' "autos" Y13 own: 1. Any txowerad "auto" yyou lease, hire, rent or barrow, and 2. Any toverod "autee" hired or rented by your "employee" under as oontraCt In that ilndivldival "ernployea°a! name, w1th your pa"'ladlon, while performing, duties re- lated to the w nduct of your burl oess. However, any "auto" Chet ;Is leased, hired, rented or borrowed with a driver Is net a rxJVarad "aulo ". M. EMERGENCY LOCKOUT - PRIVATE PASSENGER VEHICLES We will reimburse you: up to $50 for reasonabla expense linaurred for lie ',servlcssof'a litulismith io gain entry Into your covered °auto " of the pd, vate passen,gertype subject to these provi'siransr 1,. Your door key or key entry pad Ives boon lost, stolen or looked In your oevamd "auto^ and you are unsbta to enter such "autcr, , or 2. Your Roy, or'kay entry pad has been lost or stolen and you have olhoRgetI the Ipok to prevent an unauthorized entry; and S, Or.gginal copies of reaelpts for 'services of a lookamlth must be provided before raim- bursorriontg's payat le, All terms anti conditions of thas policy apply unless modified by this andoraernont AC 01 02 03 08 Include$ copyrighted irnatana} lot tn'wiranue Servuloes Office, Inc:„ Page 3 of with Its pemritlsf:on. EXHIBIT C G Client #:1387115 305GFCON ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIPD YYYY) 0212412014 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 SY 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 polioy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the polley, certain policies may require an endorsement. A statement on this certificate does not confer rlghts to the certificate holder In lieu of such endorsement(s). PRODUCER BB &T Insurance Services of Orange County 680 Langsdorf Drive Suite 100 Fullerton, CA 92831 N Leslie Lessley D E 714 578.7252 . .4�cl�le Ext: ac No)! 877-297-9259 AeDRIESS; liessley @bbandt.com INSURER a APPORDINOCOVERAGE NAIC# INSURER A: California Insurance Company 38865 INSURED 0 & F Concrete Cutting Inc PO Box 10215 INSURERS: $ INSURER C: $ PERSONAL &ADV INJURY $ Santa Ana, CA 92711 INSURER O; GENERAL AGGREGATE INSURERS: GEML AGGREGATE POLICY N$VRERPI LIMIT APPLIES PER: jEOT LOD PRODVCTS•COMP /OPAGG COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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, ILTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/OID/YYYY MMI�DMYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ PREMISES E occuErrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE POLICY LIMIT APPLIES PER: jEOT LOD PRODVCTS•COMP /OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUf09 HIRED AUTOS AUTOSWNEO CO�Idep SINGL9719 T BODILY INJURY(Perperson) $ BODILY INJURY(Poreccldent) $ Nor ewd1sy2 GE $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A _ WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNERIEXECUTIVE Y/N OFFICENMEMPEREXCL UU DED? (Mandatory In NH) II yes, describe under DESCRIPTION OF OPERATIONS below NIA 468828630101 mm 110112014 01/01/2015 X WC STAN- FORT' E.L. EACH ACCIDENT $1,000000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sehodul0, If more apace Is requlred) RE; Purchasing Dept Certificate Holder includes: The City of Santa Ana, its officers, employees, agents, and representatives City of Santa Ana Attn Purchasing Dept 20 Civic Center Plaza M -16 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE n laan.Dnan erxnnn CnaonlxannM Au rinN«e .e�,,.,,e,l ACORD 25 (2010105) 1 of 1 The ACORD name and to ells(ernd, marks of ACORD #S118958651M11 838144 l�rl I4 I 4.� SLSEL a Certification Regarding Drug -Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Housing and Urban Development in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug -Free Workplace Act, the U.S. Department of Housing and Urban Development, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug -Free Workplace Act, CERTIFICATION A. The contractor certifies that it will provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug -free awareness program to inform employees about — (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph -(a) that, as a condition of employment under the contract, the employee will - -. . (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. 1 *14:11Mk9C (e) Notifying the U.S. Department of Housing and Urban Development within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - ( 1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). B. The contractor shall insert in the space provided on the attached "Place of Performance" form the site(s) for the performance of work to be carried out with the grant funds (including street address, city, county, state, and zip code) .the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U.S. Department of Housing and Urban Development immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. Dated: 2/25/2014 Employer Signature EXHIBIT D DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS Name: G &F Concrete Cutting, Inc. Name of Contractor: Contractor Number: Date: 2/25/2014 The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract covered by the certification: Place of Performance (include street address, city, county, state, zip code for each site): G &F Concrete Cutting, Inc. 1006 E. Chestnut Ave. Santa Ana, CA 92701 EXHIBIT D Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26,1988 Federal Re ig ster (pages 19160 - 19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION - Attached) (1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (2) Where the prospective recipient of federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Dan Farias — General Manager Name and Title of Authorized Representative 2/25/2014 Signature Date EXHIBIT E INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective recipient of federal assistance funds is providing the certification as set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. 3. The prospective recipient of federal assistance fluids shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms 'covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. 6. The prospective recipient of federal assistance funds further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. T A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it deterinines the eligibility of its principals. Each participant may, but is not required to check the List of Parties Excluded from Procurement or Non - Procurement Programs. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOL may pursue available remedies, including suspension and /or debarment. EXHIBIT E