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HomeMy WebLinkAboutALL AMERICAN ASPHALT (LOCAL STREET SLURRY SEAL 2013-14)Recorded in Official Records, Orange County Recording Requested By,Hu111 '1111 uyen, Clerk -Recorder And When Recorded Mail To: IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIII NO FEE Clerk of the Council, City of Santa Ana 20 Civic Center Plaza, P.O. Box 1988 *$ R 0 0 0 7 1 3 1 8 0 8$ Santa Ana, CA 92702 201400051753710:16 am 12102114 424`16N12 1 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 THIS SPACE FOR COUNTY RECORDERS USE ONLY NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana, California, 92701, is the owner of the property hereinafter described, that said owner has caused a construction of LOCAL STREET SLURRY SEAL 2013-2014 under contract entered into on o June 17. 2014, with ALL AMERICAN ASPHALT, on which contract FIDELITY AND a� x w DEPOSIT COMPANY OF MARYLAND is surety. The property on which such work wimprovement was placed is in the City of Santa Ana, County of Orange, State of California, and PQ H z described as Project Nos. 14-6812 located at: VARIOUS LOCATIONS. The work improvement Qw on said property was accepted as completed on November 14, 2014. haw UCITY OF SAXAN A UNICIPAL CORPORATION w by c7 � Dated: '`/ � City Engineer —Edwin "William" Galvez q N TITLE O VERIFICATION I, the undersigned, say: I am the City Engineer - Edwin "William" Galvez of the City of Santa Ana, California; I executed the foregoing Notice of Completion acting on behalf of the owner of the property therein described; I make this verification on behalf of said corporation by authorization of the City Council of the City of Santa Ana; I have read said notice and know the contents thereof; and I declare under penalty of perjury that the facts therein stated are true.�/ Executed on �� 2 2� /� , at Santa Ana, California (Signature of in vidual swearing that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN (10) DAYS AFTER COMPLETION REQUEST FOR COUNCIL ACTION JUNE 17, 2014 TITLE: CONTRACT AWARD •R LOCAL EMULSIONSTREETS RESURFACING USING RUBBERIZED AGGREGATE SLURRY (PROJECT 146812) CLERK OF COUNCIL USE ONLY: APPROVED JUN 1 7 2014 --As d) OTC ❑ As Amended ❑ Ordinance on I" Reading ❑ Ordinance on 2ntl Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO f:1141R1IiTdi7 Award a contract to the lowest responsible bidder, All American Asphalt, in accordance with the Base Bid, totaling $1,091,344, for the construction of the Local Streets Resurfacing using Rubberized Emulsion Aggregate Slurry, 2. Approve the Cost Analysis for a total estimated project delivery cost of $1,300,000 (Exhibit 1). The City has made a significant investment to rehabilitate local streets over the last ten years, and therefore a top priority is to maintain and protect that investment. The City's Pavement Management Program effectively strategizes short and long-term maintenance schedules to maximize performance of the entire street pavement network, including identifying preventative maintenance improvements (Exhibit 2). The application of a surface slurry seal to streets every seven to ten years will ensure a continued high level of service. Historically, a conventional slurry seal has been used. Rubberized slurry seals offer superior performance over conventional slurry by providing a more flexible surface that resists cracking while also benefiting the environment by repurposing recycled tires. There are several rubberized slurry products available, including Tire Rubber Modified Slurry Seal (TRUSS) and Rubberized Emulsion Aggregate Slurry (REAS). Both provide similar wear and aesthetic characteristics. In an effort to compare the performance of each of these products, two projects are recommended for award on June 17, 2014, Both products are industry proven applications for street maintenance. Based on the bids received, staff recommends award of REAS for this contract. Contract Award for Local Streets Resurfacing Using Rubberized Emulsion Aggregate Slurry June 17, 2014 Page 2 Bid procedures have been followed as established by the City's Municipal Code and in adherence to the Public Contracts Code. The Notice Inviting Bids was advertised on April 29 and 30, 2014, and bids were opened on May 20, 2014. The following is a summary of the bid invitations mailed and received, and the bid results: Contractor Participation Data Santa Ana contractors receiving notices 6 Contractors requesting bidding documents 12 Bids received 2 Bids received from Santa Ana contractors 0 Bid Results Summary RANK BIDDERS NAME LOCATION BID 1 All American Asphalt Corona $1,091,344 2 atin s Co Pavement Com any Juru a Valley $1,356,071 Two bids were received and deemed responsive, with All American Asphalt submitting the lowest responsive bid. Their bid amount of $1,091,344 compares favorably to the Engineer's Estimate of $1,100,000. ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the recommended actions are exempt from further review. Categorical Exemption Environmental Review No. 2014-51 was filed for this project. FISCAL IMPACT The estimated total delivery cost of this project is $1,300,000, which includes construction administration, inspection, testing, survey and contingencies (Exhibit 1). Funding is available to cover costs in the Gas Tax Residential Street Improvement Fund (Account 05817661-66220). Edwin "William" Galvaz, P.E. Interim Executive Director Public Works Agency EW G/ET APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez Executive Director Finance & Management Services Agency Exhibit 1: Cost Analysis 2: Local Streets REAS Location Map & List Contract Award for Local Streets Resurfacing Using Rubberized Emulsion Aggregate Slurry June 17, 2014 Exhibit 1 COST ANALYSIS PROJECT 14-6812 LOCAL STREETS REAS SLURRY Construction Contract $1,091,344 Contract Administration $44,522 Inspection and Testing $55,000 Contingencies $109,134 TOTAL ESTIMATED DELIVERY COST $1,300,000 EXHIBIT 2A (N]S) p' SANTA ANA TnLE My COLD CONTRACT AWARD FOR PWAi RUBBERIZED MULSION ETS AGGREGATESLURRY wa a .mss waxer (PROJECT NO, 146812) Name From To ALPINE AV RAMONA DR OLIVE ST ALPINE AV WOODLAND PL ROSS ST ALPINE AV BIRCH ST E/0 BIRCH ST BAKER ST GARRY AV CARRIAGE DR BELL AV GARNSEY ST ROSS ST BERKELEY ST BAKER ST SHELTON ST BERKELEY ST LOWELLST FLOWER ST BIRCH ST STEVENS AV KELLER AV BIRCH ST MACARTHUR BLVD ALTON AV BIRCH ST HIGHLAND ST BISHOP ST BIRCH S'F PINE ST WALNUT ST BROADWAY BROADWAY PL S/0 BROADWAY PL CAROL AV W/O BIRCH ST BIRCH ST CENTRAL AV BAKER ST ROSEWOOD AV COLUMBINE AV WOODLAND PL MAIN S"F CUBBON ST FLOWER ST BROADWAY CUBBON ST BROADWAY MAIN ST CURIE AV GARNSEY ST ROSS ST GARNSEY ST ALPINE AV COLUMBINE AV GARNSEY ST ANAHURST PL EDINGER (FRONTAGE) AV GLENWOOD PL BRISTOL ST LOWELLST HARVEY AV W/O BIRCH ST BIRCH ST HARVEY AV TIMBER ST E/O TIM BER ST HEMLOCK WY BAKER ST SHELTON ST KELLER AV WOODLAND PL BIRCH ST LOWELL ST WARN ER AV ANAHURST PL LOWELL ST BERKELEY ST EDINGER (FRONTAGE) AV OLIVE ST WARNERAV ANAHURST PL ORION AV BIRCH ST E/0 BIRCH ST PARTON ST MACARTHUR BLVD ALPINE AV POMONAST W/O SHELTON ST SHELTON ST POMONA ST LOWELL ST E/O LOWELL ST POMONA ST FLOWER ST GARNSEY ST POMONA ST SYCAMORE ST MAIN ST RAMONA DR COLUMBINE AV N/0 COLUMBINE AV RICHLAND ST VAN NESS AV BROADWAY RICHLAND ST BROADWAY SYCAMORE ST ROSS ST ALPINE AV COLUMBINE AV ROSS ST S/O ANAHURST PL SAINT ANDREW PL ROSS Si" MCFADDEN AV CHESTNUT AV RUSSELL AV W/O MAGNOLIA AV MAGNOLIAAV SAINT ANDREW PL FLOWER ST PARTON ST EXHIBIT 2B CONTRACT AWARD FOR LOCAL STREETS RESURFACING USING RUBBERIZED EMULSION AGGREGATE SLURRY (PROJECT NO.: 146812) Page 1 of 2 Name From To SAINT GERTRUDEPl. BRISTOL ST BAKERST SAINT GERTRUDE PL FLOWER ST BROADWAY SAINT GERTRUDE PL BROADWAY MAIN ST SHELTON ST OCCIDENTALST EDINGER (FRONTAGE) AV SHELTON ST BROOK ST WALNUT ST SIERRA DR W/O BIRCH ST BIRCH ST SIERRA DR TIMBER ST SYCAMORE ST STANFORD ST W/O SHELTON ST SHELTON ST STAN FO RD ST LOW ELL ST E/O LO W E LL ST SYCAMORE ST COLUMBINE AV ALTON AV SYCAMORE ST POMONAST EDINGER AV SYCAMORE ST CUBBON ST RICHLAND ST TIMBER ST S/0 COLUMBINE AV COLUMBINE AV TIMBER ST S/0 SIERRA DR ALTON AV TOWNER ST WARNER AV ANAHURST PL WOODLAND PL KELLERAV JUNIPER AV WOODLAND PL ALPINE AV COLUMBINE AV WOODLAND PL IANAHURST PL IEDINGER (FRONTAGE) AV EXHIBIT 2B CONTRACT AWARD FOR LOCAL STREETS RESURFACING USING RUBBERIZED EMULSION AGGREGATE SLURRY (PROJECT NO,: 146812) Page 2 of 2 THE REGISTER 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 790-7000 / Fax (714) I'M .0059 PROOF OF PUBLICATION (2015,5 C.C.p') Stale of California ) County of ORANGE ) ss Notice Type: BID- NOTICE INVITING BIDS Ad Description; Local Street Slurry Seal FY 13/14 I am a citizen of the United States and a resident of the State of California; I am over the age of eighteen years, slid not a party to or interested in the above entitled matter. I am the principal clerk of the printer and publisher of the THE REGISTER, a newspaper published In the English language In the ally or SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the State of California by the Superior Court of the County of ORANGE, State of California, under date 11/19/1906, Case No. A21040. That the notice, of which the annexed is a printed copy, has been published in each regular and entire Issue of said newspaper and not In. any supplement thereof on the following dates, to -wit: 04/29/2014,04/30/2014 Executed on: 04/30/2014 At SANTAANA, California I certify (or declare) under penalty of penury that the foregoing Is true and correct. Signa re This space For Filing stamp only CNS#; 2615732 III I II II III II IIIII II III III II I I I II * A 0 0 0 0 0 3 4 0 5 9 8 9 MAYOR Miguel A. Polido MAYOR PRO TEM "rinajerr S,,v sal COUNCIL MEMBERS Angelica Amezoua P. David Banavides Michele Martinez Roman A. Reyna Vincent P. Sarmiento CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza (M-20) P.O. BOX 1988 • Santa Ana, California 92702 (714) 667-2700 • Fax (714) 979.1461 wmv,santa-ana.org NOTICE OF EXEMPTION CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D. Huizar FILED MAY 16 2014 GRANGE COUNTY CLERK -RECORDER DEPARTMENT 6Y: DEPUTY From the Requirements of the California Environmental Quality Act (CEQA) Fee Exemption per California Government Code Section 6103 To: COUNTY CLERK From: City of Santa Ana County of Orange Planning & Building Agency P.O. Box 238 20 Civic Center Plaza M-20 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title: Local Slurry 13114 ProjectNumber(s): PWA-2014.590-CIP Project Location: SEE /}-n-ncNr_� Data of Approval: 06/17/2014 City: Santa Ana County: Orange ER Number: Project Description: Work Includes applying slurry seal material to surface of roadway Applicant Name: Kenny Nguyen , City of Santa Ana Applicant Address: Ross Annex, 20 Civic Center Piaza, 3rd Floor M-36 SANTA ANA, CA 92702 Name of Public Agency Approving Project: City Council Name of Person or Agency Carrying Out Project: Nguyen, Kenny Exempt Status: ❑ Ministerial (Sec, 15268) ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec, 16269 (b through a)) ❑ General Rule (Sec, 15061(b)(3)/(5)) ❑ Statutory Exemption: * Categorical Exemption: 15301(c) Reasons) Why Project Is Exempt From CEQA: 15301(c) -existing roadway City Contact: Seen Thomas Signature: Title: ER -2014-51 POSTED MAY 16 2014 ORANGE COUNTY CLERK-REqPRDtR DEPARTMENT BY: DEPUTY Recorded in Official Records, Orange Co4dty HceDClerk-Recorder I NO FEE * R 0 0 0 6 7 0 1 7 4 2 20148500043511:26 am 05/16/14 214 304 Z01 0.00 60.00 0.00 0,00 0.00 0,00 o.00 o.00 Telephone: (714) 647-5665 Assistant Engineer Date: SANTA ANA CITY COUNCIL 5/15/2014 Miguel A. Pulido Sal Tinalero - Vincent F. Sarmianlo Michele Martinez Annalica Annucua P, David aenavides Roman Rayne Mayor Mayor Pro Tern Ward 6: Ward Ward2 Ward Ward Ward MpulolQQsanlaenaora'STlnaler san naarabSarmiento2dsa[rte-ana.orgl MMartlnezaaante.anaoraAAmpzcr a(�6A01�.6Ga:.Qr6,,DDanav tl@ sanfaane om RRovna sante-@no.ora FILED Project 14-6812 MAY 16 2014 Local Street Slurry Seal 2013-14 ER DEPART148NI' DEPUTY Page 1 of 5 MAY 16 2014 ORANGE COUNTY CLE RE RIDER DEPARTMENT DY.�. DEPUTY Name From To By, 2ND ST TOWNSEND ST DAISY AV tz 2ND ST DAISY AV RAITT ST 10TH ST TOWNSEND ST ENGLISH ST 11TH ST PACIFIC AV RAITT ST 12TH ST RAITT ST PACIFIC AV ADAMS ST CHANNEL SALTA ST ADAMS ST RENE DR CHANNEL ADAMS ST RITA WY RENE DR ADAMS ST SPRUCE ST RITA WY ADAMS ST PACIFIC AT SORUCE ST ALPINE AV RAMONA DR OLIVE ST ALPINE AV WOODLAND PL GARNSEY ST ALPINE AV GARNSEYST PARTON ST ALPINE AV PARTON ST ROSS ST ALPINE AV BIRCH ST END BAKER ST GARRY AV CARRIAGE DR BELL AV ROSS ST GARNSEY ST BERKELEY ST BAKER ST SHELTON ST BERKELEY ST FLOWER ST LOWELLST BIRCH ST STEVENS AV KELLER AV BIRCH ST MACARTHUR BLVD ALPINE AV BIRCH ST ALPINE AV COLUMBINE AV BIRCH ST COLUMBINEAV COLUMBINEAV BIRCH ST COLUMBINE AV SIERRA DR BIRCH ST SIERRA DR CAROL AV BIRCH ST CAROL AV HARVEY AV BIRCH ST HARVEY AV ALTON AV BIRCH ST HIGHLAND ST RICHLAND ST BIRCH ST RICHLAND ST BISHOP ST BIRCH ST PINE ST WALNUTST BREWER AV LINDA WY END BROADWAY BROADWAY PL END BROOK ST SULLIVAN ST BAMDAL ST CAROL AV BIRCH ST END CENTRALAV LINDA WY DOUGLAS ST CENTRALAV END LINDA WY CENTRALAV PACIFIC AV POPLAR ST CENTRAL AV POPLAR ST BRISTOL ST CENTRALAV BAKER ST ROSEWOOD AV COLUMBINE AV GARNSEY ST WOODLAND PL COLUMBINE AV ROSSST GARNSEY ST COLUMBINE AV BIRCH ST ROSS ST COLUMBINE AV BIRCH S7 TIMBER ST COLUMBINEAV TIMBER ST SYCAMORE ST I ER DEPART148NI' DEPUTY Page 1 of 5 MAY 16 2014 ORANGE COUNTY CLE RE RIDER DEPARTMENT DY.�. DEPUTY Project 14-8612 Local Street Slurry Seal 2013-14 FILED MAY 16 2014 ORANGE COUNTY CLMR ECOROERDEPARTMENT Name From To COLUMBINE AV SYCAMORE ST MAIN ST CUBBON ST FLOWER ST GARNSEY ST CUBBON ST GARNSEY ST PARTON ST CUBBON ST PARTON ST VAN NESS AV CUBBON ST VAN NESS AV ROSS ST CUBSON ST ROSS ST BIRCH ST CUBBON ST BIRCH ST BROADWAY CUBBON ST BROADWAY SYCAMORE ST CUBBON ST SYCAMORE ST MAIN ST CURIE AV GARNSEY ST ROSS ST DANBURY WY GREENWICH AV END DIAMOND ST OCCIDENTALST POMONAST DIAMOND ST POMONA ST STANFORD ST DIAMOND ST STANFORD ST EDINGER AV ENGLISH ST 5TH ST CIVIC CENTER DR ENGLISH ST 12TH ST 11TH ST EVERGLADE ST HALL AV KNOX AV FLORAST LINDA WY LINDA WY FLORA ST SALTA ST LINDA WY FLORA ST SALTA ST END FLORA ST RENE DR RITA WY FLORA ST RITA WY PACIFIC AV GARNSEY ST ALPINE AV BELL AV GARNSEY ST BELL AV CURIE AV GARNSEY ST CURIE AV COLUMBI NE AV GARNSEYST SAINT GERTRUDEPL ANAHURSTPL GARNSEY ST SAINT ANDREW PL SAINT GERTRUDE PL GARNSEY ST POMONAST SAINT ANDREW PL GARNSEY5T EDINGER (FRONTAGE) AV POMONAST GLENWOOD PL BRISTOL ST BAKER ST GLENWOOD PL BAKER ST TOWNER ST GLENWOOD PL TOWNER ST LOWELL ST GREENVILLE ST GARRYAV SEGERSTROM AV GREENVILLE ST HALL AV NORTHWOOD GREENVILLE ST NORTHWOOD WARNER AV GREENWICH AV GRISET PL DANBURY WY GREENWICH AV GRISET PL END GRISET PL SEGERSTROM AV GREENWICH AV HALL AV RAITT ST WOOD ST HALL. AV LINDA WY END HALL AV LINDA WY JOAN WY HALL AV JOAN E WY SALTA ST HALL AV PACIFIC AV SPRUCE ST HALL AV POPLAR ST PACIFIC AV Page 2 of 5 DEPUTY MAY 16 2014 ORANGE COUNTY CLE R ORDEROEPARTMENT DY: "^'^ DEPUTY FILED Project 14-6812 MAY 1 6 2014 Local Street Slurry Seal 2013-14 Name From To HARVEY AV BIRCH ST END By:_ HARVEY AV TIMBER ST END HEMLOCK WY DOUGLAS ST RAITT ST HEMLOCK WY ROSEWOOD AV BAKER ST HEMLOCK WY SHELTON ST ROSEWOOD AV JOAN WY HALLAV END KELLER AV WOODLAND PL PASTEUR ST KELLER AV PASTEUR ST ROSS ST KELLER AV ROSS ST BIRCH ST KING ST WASHINGTON AV JUDITH LN KING ST JUDITH LN 14TH ST KING ST 14TH ST 15TH ST KING ST 15TH ST 17TH ST KNOX AV EVERGLADE ST GLENARBOR ST LINDAWY ADAMS ST END LINDAWY BREWER AV CENTRALAV LINDAWY HALL AV BREWER AV LINDAWY FLORA ST HALLAV LINDAWY FLORA ST WARNER AV LOWELL ST ANAHURST PL WARNER AV LOWELL ST POMONA ST BERKELEY ST LOWELL ST STANFORD ST POMONA ST LOWELL ST EDINGER (FRONTAGE) AV STANFORD ST OLIVE ST WARNER AV ANAHURSTPL ORION AV BIRCH ST END PACIFIC AV HEMLOCK WY ADAMS ST PACIFIC AV ADAMS ST CENTRALAV PACIFIC AV FLORA ST HALLAV PACIFIC AV WARNER AV FLORA ST PARTON ST MACARTHUR BLVD ALPINE AV POMONA ST GREENVILLE ST TOWNSEND ST POMONA ST SHELTON ST END POMONA ST LOWELL ST END POMONA ST FLOWER ST WOODLAND PL POMONA ST WOODLAND PL GARNSEY ST POMONA ST SYCAMORE ST MAIN ST POPLAR ST HEMLOCK WY CENTRALAV POPLAR ST CENTRALAV CENTRALAV POPL4 ST CENTRALAV HALLAV POPLAR ST HALLAV END POPLAR ST GLENWOOD PL CAMDEN PL POPLAR ST CARLTON PL GLENWOOD PL POPLAR ST SAINT ANDREW PL CARLTON PL RAMONA DR ICOLUMBINE AV JEND Nk Page 3 of 5 MAY 16 2014 )EPARTMENT DEPUTY ORANGE COUNTY CLER -RE; RDER DEPARTMENT DY' DEPUTY Project 14-6812 Local Street Slurry Seal 2013.14 FILED MAY 16 2014 ORANGE COUNTY CLERK-RECOft M DEPARTMEri Name , From TO RAY CI RAITTST END RENE DR OCCIDENTALST SAINT ANDREW PL RICHLA D ST VAN NESS AV ROSSST RICHLA D ST ROSSST BIRCH ST RICHLA D ST BIRCH ST BROADWAY RICHLAND ST BROADWAY SYCAMORE ST RITA WY ADAMS ST FLORA ST ROSS ST ALPINE AV BELL AV ROSSST BELL AV CURIE AV ROSSST CURIE AV COLUMBINE AV ROSS SiEND ANAHURST PL ROSS St ANAH U RST PL SAINT GERTRUDE PL ROSS 51 SAINT GERTRUDE PL AC -PCC TRANSITION ROSSST AC -PCC TRANSITION SAINT ANDREW PL ROSS S7 MCFADDEN AV CUBBON ST Rbsssf CU BBON ST HIGHLAND ST ROSSSI HIGHLAND ST RICHLAND ST ROSSSI RICHLAND ST BISHOP ST ROSS S BISHOP ST CAMILE ST ROSS 5 CAM ILE ST CH ESTNUT AV RUSSELL AV END MAGNOUAAV SAINTANDREW PL END RENE DR SAINT 'NDREW PL RENE DR PACIFIC AV SAINT NDREW PL PACIFICAV POPLAR ST SAINT NDREW PL POPLAR ST BRISTOLST SAINTINDREWPL FLOWER ST WOODLAND PL SAINT NDREW PL WOODLAND PL GARNSEYST SAINT NDREW PL GARNSEY ST PARTON ST SAINT GERTRUDE PL BRISTOL ST MAGNOLIA AV SAINT ERTRUDE PL MAGNOLIA AV BAKER ST SAINT ERTRUDE PL WOODLAND PL FLOWER ST SAINT qERTRUDE PL GARNSEYST WOODLAND PL SAINT qERTRUD,E, PL PARTON ST GARNSEY ST SAINT ERTRUDE PL VAN NESS AV PARTON ST SAINT ERTRUDEPL ROSSST VAN NESS AV SAINT ERTRUDE PL BIRCH ST ROSS ST SAINT ERTRUDE PL BROADWAY BIRCH ST SAINT ERTRUDE PL SYCAMORE ST BROADWAY SAINT ERTRUDE PL MAIN ST SYCAMORE ST 5ALTA T ADAMS ST HALL AV SALTA T HALL AV FLORA ST SAN LO ENZO AV DOUGLAS ST END SHEI-Ti NST IBERKELEY ST OCCIDENTAL ST SHELT N ST IBERKELEY ST Page 4 of S DEPUTY ED MAY 16 2014 ORANGE COUNTY CLERK.R ORDERCEPARTMEI BY: „__OEPUT Project 14-6812 Local Street Slurry Seal 2013.14 FILED MAY 16 2014 ORANGE COUNTY CLERK•RECOXER DEPARTMENT Name From To SHELT04 ST STANFORDST POMONAST SHELT04 ST EDINGER (FRONTAGE) AV STANFORDST SHELT04 ST HIGHLAND ST BROOKST SHELT04 ST RICH LAND AV HIGHLAND ST SHELTONI ST BISHOP ST RICHLANDAV SHELTO 4 ST CAM ILE ST BISHOP ST SHELTO 4 ST MYRTLE ST CAMILE ST SHELTO I ST CHESTNUTAV MYRTLE ST SHELTO q ST PINE ST CHESTNUTAV SHEL70 q ST WALNUTST PINE ST SIERRA R BIRCH ST END SIERRA R TIMBER ST SYCAMORE ST SPRUCE ST HALL AV ADAMS ST SPRUC ST HALLAV END STAN PC RD ST END SHELTONST STAN PC RD ST LOWELLST END SYCAMORE ST COLUMBINE AV SIERRA DR SYCAMORE ST SIERRA OR ALTON AV SYCAMORE ST POMONAST EDINGER AV SYCAMORE ST HIGHLAND ST CUBBON ST SYCAMORE ST RICHLAND ST HIGHLAND ST TIMBER ST COLUMBINEAV END TIMBER ST SIERRA DR END TIMBER ST HARVEY AV SIERRA DR TIMBER ST ALTONAV HARVEY AV TOWNER ST WARNER AV ANAHURSTPL TOWN ENDST OCCIDENTALST POMONAST TOWN ENDST 2ND ST IST ST TOWN ENDST 10TH ST WASHINGTON AV WOOD ND PL AURORA AV KELLER AV WOOD AND PL MURPHYAV AURORAAV WOOD ND PL ORION AV MURPHY AV WOOD ND PL JUNIPER AV ORION AV WOOD AND PL COLUMBINE AV ALPINE AV WOOD AND PL ANAHURST PL SAINT GERTRUDE PL WOOD AND PL SAINT GERTRUDE PL SAINT ANDREW PL WOOD AND PL SAINT ANDREW PL OCCIDENTALST WOOD ANDPL JOCCIDENTAL ST POMONAST WOOD NDPL 1POMONAST EDINGER(FRONTAGE)AV —DEPUTY POSTED ED Page 5 of 5 MAY 16 2014 ORANGE COUNTY CLEkW,R RDERDEPARTMENT DEPUTY .,. .j State of California - Deparim. rit of Fish and Wildlife 2014 ENVIRONMENTAL, FILING FEE CASH RECEIPT t DFW 753.5a (Rev. 09/13) RECEIPTIt a 5 0 9 1. 1 '- 6--r +-- _—�A Local Public Agency ❑ School District ❑ Other Special District ❑ State Agency ❑_ Private Entity CHECK APPLICABLE FEES:- _ _ ❑ Environmental Impact Report(EIR) $3,029.75 $ ❑ Mltigmed/Negative Dedication(MND)(ND) $2,181.25 $ ❑ Application Fee Water Diversion (State Water Resources Controt Board only) $850.00 $ ❑ Projects Subject to Certifled Regulatory Programs (CRP) $1,030.25 $ ❑ County Adminislrativo Fee $50.00 $ Project that is exempt from fees Notice of Exemption (attach) CDFW No Effect Determination (attach) ❑ Other $ PAYMENT METHOD: ❑ Cash ❑ Credit ❑ Check ❑ Other TOTALRECEIVED $ / ) � APPLICANT YELLOW-COMWASE PINK.LLADAGENCY GOLDEN ROD -COUNTY CLERK MAYOR Miguel A. Pulido MAYOR PRO TEM Sal Tinajero COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Vincent F. Sarmiento May 6, 2014 ADDENDUM No, ONE CITY OF SANTA ANA PUBLIC WORKS AGENCY P.O. Box 1988 M-36 Santa Ana, California 92702 www.aanta-ana.ora CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria 0. Huizar SUBJECT: PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 The following change has been made to the Specifications for the subject project: Specifications I. Page BP 3 of 14: Replace with the attached page BP 3 of 14. All other terms and conditions remain the same. FOR THE 99Y OF SANTA ANA Taig Higgins, P.E. Acting City Engineer SANTA ANA CIT)' COUNCIL MlguelA POW. Sal I Vnda�t F. Sarmlanto MRhole Manlnez Aatgal. gmazwa PDavid B.rwdes Roman Re, e Mayor Mayor Pro Tam,Ward6 ( Wardt i Ward Ward Ward Ward MPulitlo septa-ana ora STinaiaroepsanla-ana oro VSarmler`lo(ols 1 - MMarli s (01 ! gAroaEjid�rJ,Santa9na orq DBer Av,da anlaana.om RRe na Santa -a ti a.aro MAYOR Miguel A. Pulldo MAYOR PRO TEM Sal Tinajero COUNCILMEMBERS Angellca Amazcua P. David Benevides Michele Martinez Roman Reyna Vincent F. Sarmiento May 16, 2014 ADDENDUM No. TWO [41ijklil[S]I&I t ♦1 1 PUBLIC WORKS AGENCY P.O. Box 1988 M-36 Santa Ana, California 92702 www.santa-ana.ora CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar SUBJECT: PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 The following changes have been made to the Specifications for the subject project: Specifications 1. Pages BP 1 of 14 through BP 3 of 14: Replace with the attached pages BP 1 of 14 through BP 3 of 14. 2. Pages 14 and 15: Replace with the attached pages 14 and 15. 3. Appendix E: Replace with the attached Appendix E. All other terms and conditions remain the same. FORT ECI O SANTA ANA Taig Higgins, P.E. Acting City Engineer SANTA ANA CITY COUNCIL Miguel A. Pulldo Sal Tinajero Vincent E Sarmlenlo Michela MerIDxez Angelica Ameze. AOedd oenavldas Roman Reyna Mayor Mayor Pro Tem, Ward e Ward Word I Word Wai4 Words MPtItlo1<Tsanla-ana.om STSaargSt.amta.anaorg VSarmientotavanta ane ora MMart'noz&Asanla-ane org AArnezcua(As2 ria-: enro gBenavldeuace"la-ana on Roym.Fusantaana.orn CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL, 2013-14 PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA 1101011 REQUIREMENT: MAY 16, 2014 ADDENDUM NO. TWO The undersigned declares that he/she has carefully examined the location of the proposed work, that he/she has examined the Plans and Specifications and read the accompanying instruction to BIDDERS, and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans, specifications and special provisions, for the unit price(s) or lump sum(s) set forth in the following schedule: Item # Bid Item Unit Quantity Unit Price Amount 1. Mobilization LS 1 $k(— $ �?(00 - 2. Traffic Control LS l $ 45"7o - $ 45-700- 5-700p3. 3. Unclassified Excavation* CY 700 $ ik"A $ lo -100- 4. AC Pavement* IN 1,400 $ CV_ $ 1309-00- 3C79-00_5. 5. Crack Sealing* GAL 400 $ T, $ MOO- OO-6. 6. Install White Turn Lane Line per LF 100 $ 053 $ 53' COSA STD. Plan No, 112513-1, Detail "2"pp 7. Install Double Yellow Line per COSA LF 1,400 $ $ 2,557 `" STD. Plan No. 112513-1, Detail "4" 8. Install Yellow Center Line per COSA LF 4,300 $ .561 s2,53 -7 - 2,53-7STD. STD. Plan No. 112513-1, Detail "6" 9. Install 12" Wide Line LF 3,400 $ $� - 10. Remove Striping LF 9,200 $ $- 11. Install Legend EA 210 $ $ 12. Remove Legend EA 210 $ $ l u l��' 13. Furnish and Install Traffic Loop EA 60 $ )-00- $ 12000 TO BE INCLUDED IN BID PACKAGE BPI of 14 MAY 16, 2014 CITY OF SANTA ANA ADDENDUM NO. TWO PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL, continued Item # Bid Item Unit Quantity Unit Price Amount 14. Temporary Construction Sign EA 5 15. Protection of Surface Utility Frames LS l $$ 500 y and Covers 16, Rubberized Emulsion Aggregate TN 1,400 $ 524— $ —133W10 Slurry (REAS) Seal Type 2* TOTALBID ------------------------------------------------------------------------------ The lowest responsible bidder will be selected based on the low Total Bid. * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the "25%" limit as stated in Section 3-2 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. TO BE INCLUDED IN BID PACKAGE BP2of14 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL & CONTRACT AGREEMENT BID PROPOSAL, continued MAY 16, 2014 ADDENDUM NO. TWO PROJECT NO. 14-6812: BIDDER LOCAL STREET SLURRY SEAL 2013-14 Firm Address Phone 957-731e-706 Fax 9, / r 739 - q&7 Email �ub�iCW®1ILS(W laate�ieCcnQr�(�/Pe,� BIDDER Signature TO BE INCLUDED IN BID PACKAGE BP 3 of 14 (772 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT LIST OF SUB -CONTRACTORS Section 4100 et. seq, of the Public Contract Code requires listing of all subcontractors with the bid for all subcontract work exceeding the following amount: - Streets, highways including bridge projects; %2% of the bid or $10,000, whichever is greater - Buildings, parks, or other projects: %2% of the bid BIDDER proposes to subcontract certain portions of the work to the firms listed below: NAME,; 5(` \ Pec;y`l Inc, LOCATION ()c'aMp, Cj _ PHONE "j I q - ct lawl— 5(p TYPE OF WORK Sof X25 $ l% 00 NAME 00VICQ12 QkA4 A LOCATION () rWgk, PHONE�1'{ U q •- 9�j�y TYPE OF WORK 51wPw%1 J $ C lAAAOJD NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION — PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK F NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK NAME LOCATION _ PHONE TYPE OF WORK BP4of14 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL & CONTRACT AGREEMENT BIDDER'S STATEMENT BIDDER understands and agrees that this written proposal (or any part thereof specifically designated and accepted by the City of Santa Ana, hereinafter AGENCY) shall constitute the entire agreement between BIDDER and the AGENCY only after it has been accepted by the City Council, endorsed by the Clerk of the Council with her signature and official seal noting hereon the action of approval of the Council, signed by the Public Works Agency Executive Director or his duly authorized agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to BIDDER or deposited with the United States Postal Service properly addressed to the BIDDER with the correct postage affixed thereto. BIDDER further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish AGENCY all required bonds and certificate of liability insurance within ten (10) days (excluding Saturdays, Sundays and AGENCY'S legal holidays), or the funds, check, draft, or BIDDERS bond substituted in lieu thereof accompanying this proposal shall become the property of the AGENCY and shall be considered as payment of damages due to the delay and other causes suffered by AGENCY because of the failure to furnish the necessary bonds and because it is distinctly agreed that the proof of damages actually suffered is difficult to ascertain; otherwise said funds, check, drafts, or BIDDER'S bond substituted in lieu thereof shall be returned to the undersigned. AP BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the bid schedule are solei for the purpose of comparing bids and that final compensation under the `�. Y PrP p g , contract will be based upon the actual quantities of work satisfactorily completed. All terms contained in the Specifications, the Certification of Non -Discrimination by Contractors, and the Workers' Compensation Insurance Certificate are to be incorporated by reference into this Agreement and are made specifically as part of this bid. Name of Firm h 96mican. AwLH Signature of BIDDER Title'r pi `U �11 LL" 1 (if an individual, so state�— TO BE INCLUDED IN BID PACKAGE BP5of14 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT continued (If a firm or co -partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) AWarded toad ( /imOiT.O.P&YJ TION OF COUNCIL: on the basis of lowest responsible and responsive bidder in the amount of 4Q /.34y ATTEST: CLERK OF THE COUNCIL , APPROVED AS TO FORM: Date _ _ (Limper /% 20 ACCEPTED FOR THE CITY OF SANTA ANA: EXECUTIVE DIRE TOR PUBLIC WORKS AGENCY TO BE INCLUDED IN DID PACKAGE BP6of14 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR The undersigned contractor or corporate officer, during the performance of this contract, certifies as follows: 1. 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. TO BE INCLUDED 1N BID PACKAGE BP7of14 CITY OF SANTA ANA PROJECT NO, 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT CERTIFICATION OF NONDISCRIMINATION BY CONTRACTOR (continued) 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 is subject to all the penalties imposed for a violation of the Chapter. Signed �-A i Title Date TO BE INCLUDED IN BID PACKAGE BP8oft4 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT WORKERS' COMPENSATION INSURANCE CERTIFICATION As required by California Labor Code Section 1860 and 1861, the Contractor certifies as follows: I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of the Code, and I will comply with such provisions before commencing the performance of the work of this contract. If I, as the Contractor, now or at any time during the course of this agreement, qualify as an employer under California Labor Code Section 3300, unless the hired employee(s) is (are) persons excluded by said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate from my workers' compensation insurance carrier certifying that I carry such insurance and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior written notice to the City of Santa Ana Date TO BE INCLUDED IN BID PACKAGE BP9of14 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT REFERENCES The following are the names, addresses, and telephone numbers for three public agencies for which BIDDER has performed similar work within the past two years. 1. * S'W- Name and Address of Owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 2. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed 3. Name and Address of owner. Name and Telephone Number of person familiar with project. Contract Amount Type of Work Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from whom BIDDER intends to procure insurance and bonds. s"v� 3p,. ., I[ uT ., [fi k ALhens HCl .1kutoe i ._1,1, > _E �l .r� i � 'at t f /'I l r '91761 ON) 937-V70 TO BE INCLUDED IN BID PACKAGE BP 10 of 14 PAST WORK REFERENCES City of Westminster Citywide Slurry Seal Project 8200 Westminster Blvd Contract Amount: $357,270 Westminster, CA 92683 Completed: 7/2011 Contract: Tuan Pham, (714) 548-3456 City of Torrance 3031 Torrance Blvd Torrance, CA 90509 Contact: Sue Herbers, (310) 618-2870 City of Palos Verdes Estates 340 Palos Verdes Drive West Palos Verdes Estates, CA 90274 Contact: (310) 378-0383 City of Buena Park 6650 Beach Blvd Buena Park, CA 90622 Contact: Wood Nousome, (714) 562-3678 City of Carson 701 E Carson St Carson, CA 90745 Contact: Rick Boutros, (310) 952-1700 City of Rancho Santa Margarita 22112 El Pasco Rancho Santa Margarita, CA 92688 Contact: Joe Parco, (949) 635-1813 City of Rancho Cucamonga 10500 Civic Center Dr Rancho Cucamonga, CA 91730 Contact: Shelley Hayes, (909) 477-2700 City of Santa Clarita 23920 Valencia Blvd Santa Clarita CA 91355 Contact: Bill Whitlatch, (661) 259-2489 Slurry Seal of City Parking Lot Facility Contract Amount: $38,730 Completed: 2/2012 Slurry Seal — Various Locations Contract Amount: $457,370 Completed: 6/2012 2011-12 Slurry Sealing Contract Amount: $203,000 Completed: 7/2012 Citywide Rubberized Slurry Contract Amount: $342,640 Completed: 10/2012 Annual Residential Sherry Seal Contract Amount: $180,000 Completed: 6/2013 FY 2012/2013 Slurry Seal Contract Amount: $328,000 Completed: 8/2013 2011/12 Overlay & Slurry Seal Program Contract Amount: $5,995,000 Completed: 9/2013 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S STATEMENT REGARDING APPRENTICESHIP REQUIREMENTS The undersigned BIDDER 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 150 -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 C Sign Title Finn Date SIIN114 TO BE INCLUDED IN BID PACKAGE BP 11 of 14 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly 'induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, 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 bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid 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, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. j Note: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that malting a false certification may subject the certifier to criminal prosecution. �,Z f Signed� State of California County ofRwAkAe Subscribed and sworn to (or affirmed) before me on this J-\ day of Mp9y_ 20V�, by 2!\}a\p proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.' REBECCA ANGELA PARRA Commission Ar 2024944 Notery Public • California Riverside County My Comm. Ea ires May 17, 2g17 Nota4ryPu—1icgnature Notary Public Seal TO BE INCLUDED IN BID PACKAGE BP 12 of 14 CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT BIDDER'S 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, to give 9p any part of the compensation to which he/she is otherwise entitled. Signedr/�r Title Firm Date 5�14�1k BP 13 of 14 TO BE INCLUDED IN BID PACKAGE CITY OF SANTA ANA PROJECT NO. 14-6812: LOCAL STREET SLURRY SEAL 2013-14 PROPOSAL AND CONTRACT AGREEMENT CONTRACTOR'S LICENSING STATEMENT The undersigned contractor, or corporate officer, declares under penalty of perjury that the following is true and correct. Contractor's Name: Business Address: Telephone: 9CI— State Contractor's License No. and Class: itc&o707Y C^la Expiratic Date: Signed: Title: TO BE INCLUDED IN BID PACKAGE BP 14 of 14 That we, ALL AMERICAN ASPHALT BOND NO. 085 97 423 , as Principal, (hereinafter called the "Principal"), and FIDELITY AND DEPOSIT COMPANY OF MARYLAND , P.O. Box 1227, Baltimore, Maryland 21203, a corporation duly organized under the laws of the State of Maryland, as Surety, (hereinafter called the "Surety"), are held and firmly bound unto City of Santa Ana as Obligee, (hereinafter called the "Obligee"), in the sum of TEN PERCENT OF THE TOTAL BID PRICE IN -------- Dollars ($ 10% OF TOTAL BID PRICE ),for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Local Street Slurry Seal 2013-14 (Project No 14-6812) Bid Date: May 20, 2014 NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 13th day of May 2014 A.D., Q. M- R. Paramo, Notary Public Witness ALL AMERICAN ASPHALT (SEAL) P'tPcip� Robw+lu1 T k 1ra.Pr�cteG L f FIDELITY AND DEPOS T�PANY OF MARYLAND Surety By �'p+aa V (SEAL) Rebecca Haas -Bates , Atiorney-in-Fact Printed in cooperation with the American Institute of Architects (AIA) by Fidelity and Deposit Company of Maryland . Fidelity and Deposit Compmty of Maryland vouches that the language in the document conforms exactly to the language used in A]A Document A-310, February 1470 Edition BID70000ZZ0701f Fidelity and Deposit Company of Maryland ��p��®� S?4w Home Office: P.O. Box 1227. Baltimore. MD 21203-1227 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, ALL AMERICAN ASPHALT BOND NO. 085 97 423 , as Principal, (hereinafter called the "Principal"), and FIDELITY AND DEPOSIT COMPANY OF MARYLAND , P.O. Box 1227, Baltimore, Maryland 21203, a corporation duly organized under the laws of the State of Maryland, as Surety, (hereinafter called the "Surety"), are held and firmly bound unto City of Santa Ana as Obligee, (hereinafter called the "Obligee"), in the sum of TEN PERCENT OF THE TOTAL BID PRICE IN -------- Dollars ($ 10% OF TOTAL BID PRICE ),for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Local Street Slurry Seal 2013-14 (Project No 14-6812) Bid Date: May 20, 2014 NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 13th day of May 2014 A.D., Q. M- R. Paramo, Notary Public Witness ALL AMERICAN ASPHALT (SEAL) P'tPcip� Robw+lu1 T k 1ra.Pr�cteG L f FIDELITY AND DEPOS T�PANY OF MARYLAND Surety By �'p+aa V (SEAL) Rebecca Haas -Bates , Atiorney-in-Fact Printed in cooperation with the American Institute of Architects (AIA) by Fidelity and Deposit Company of Maryland . Fidelity and Deposit Compmty of Maryland vouches that the language in the document conforms exactly to the language used in A]A Document A-310, February 1470 Edition BID70000ZZ0701f CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT Jill I 11m;llialaiggg 1;1; State of California County of Riverside On May 14, 2014 before me, Rebecca Angela Parra, Notary Public Date Here Insert name and Title of the Officer personally appeared Robert Bradley Name(s) of Signer(s) f who proved to me on the basis of satisfactory evidence to be the person(s) whose name(r) is/are subscribed to the within instrument ]+�►w+►r�.�r� and acknowledged to me that he/she/theyexecuted the same in REBECCA ASNGGELA PARA r his/herkFieir authorized capacity(ies), and that by his/herJtkeir Commission a 2024944 [ signature(&) on the instrument the person(s), or the entity upon behalf ` = of which theperson(s) ?s Notary Public • California z acted, executed the instrument. Riverside County n M Comm. Ex ire& Ma 17, 2017 1 certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing paragraph is true and correct. WITNESS my hhvd and official seal Signature Place Notary Seal Above i lura of No Wry Public OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document Bid Bond Document Date 5/13/2014 Number of Pages: One (1) Signer(s) Other Than Named Above: Fidelity and Deposit Company of Maryland Capacity(les) Claimed by Signer(s) Signer's Name: Robert Bradley o Individual X Corporate Officer—Title(s): Vice -President o Partner ❑ to Limited c General Li Attorney in Fact Li Trustee o Other: Signer's Name: o Individual o Corporate Officer—Title(s): _ Li Partner 0 o Limited o General Top of thumb here o Attorney in Fact ❑ Trustee to Other: Signer is Representing: All Amcrirnn Acnhorr I Signer is Top of thumb here CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE < .v� .w d- � xe«v:_ :o<.� sem- �<.., <-�<,-.•.. State of California County of Orange _ ____.__ — On 5/13/2014 before me, R. Paramo, Notary Public Date Here Insert Name and Title of the Officer personally appeared Rebecca Haas -Bates Name(s) ofSigneris) R. PARAMO Commission # 2035890 i®. Notary Public - California z �' Orange County My Comm. Expires . 5, 2017 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(s) whose name(46) is/at-e subscribed to the within instrument and acknowledged to me that #e/she/tirer executed the same in 1:4/her/*ek authorized capacity(fes), and that by frizz/her/tksir signaturet on the instrument the person(*,, or the entity upon behalf of which the perscn(e) acted, executed the instrument. PERJURY under the laws t -the foregoing paragraph Signature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form town unintended document, Description of Attached Document Title or Type of Document: Bid Bond Document Date: 5/13/2014 Number of Pages: One (1) Signer(s) Other Than Named Above: All American Asphalt Capacity(les) Claimed bySigner(s) Signer's Name:- Rebecca Haas -Bates 0Corporate Officer —Title(s): I-1 Partner W-- ❑ Urn ited U General 1.1 Individual OAttomey in Fact 0 Trustee ❑ Guardian or Conservator C-1 Other: Signer Is Representing: _ hidelity and Deposit Company of Maryland Signer's Name: O Corporate Officer -- Title(s): ......... 11 Partner — Cl Limited n General © Individual 17 Attorney in Fact E7 Trustee C7 Guardian or Conservator U Other: Signer Is Representing: 0 2013 National Notary Association* www.Nat[onaiNotary.org ® 1 -800 -US NOTARY (1-800-876-6827) Item #5907 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attomevs-in-Pact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument render the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any fime." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attomey and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed, IN T,FSTIMO Y EREOF, I have he�r�e'%nto subscribed my name and affixed the corporate seals of the said Companies, thisj, day of �, 20 1. ��.11 S lase l�' EAL 440� az�� Geoffrey Delisio, Vice President 306%. 7640763 Premium is included in the performance bond, Executed in, 1 Counterpart Attachment A CONTRACTOR'S PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS, THAT: WHEREAS, the City of Santa Ana, State of California, and All American (hereinafter designated as "Principal„) have entered into an agreement whereby Principal agrees to install and complete certain designated public improvements, which said agreement, dated June 17, 2014 ____, entitled "Project No. 14-6812 - Local Street Slurry Seal 2013-2014 is hereby referred to and made a part hereof; and WHEREAS, under the terms of said agreement, Principal is required before entering upon the performance of the work, to file a good and sufficient Contractor's Payment Bond with the City of Santa Ana to secure the claims to which reference is made in Title 3, (commencing with Section. 9000) of Part 6 of Division 4 of the Civil Code of the State of California. NOW THEREFORE, said Principal and the undersigned as corporate Surety, are held firmly bound unto the CITY OF SANTA ANA, and all contractors, subcontractors, laborers, naaterialmen. and other persons employed in the performance of the aforesaid agreement and referred to in the aforesaid Civil Code, in the sum of One Million Nines One Thousand, Three Hundred* DOLLARS ($ 1,091,344.00 _ for materials famished or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to such work or labor or for any amounts required to be deducted, withheld and paid over to the Franchise Tax Board from the wages of employees of the Principal and his subcontractors pursuant to Section 18806 of the Revenue and Taxation Code, with respect to such work and labor; that said Surety will pay the same in an amount not exceeding the amount hereinabove set forth, and also in case suit is brought upon this Bond, will pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by the City in successfully enforcing such obligation, to be awarded and fixed by the court, and to be taxed as costs and to be included in thejudgment therein rendered. IT IS HEREBY EXPRESSLY STIPULATED AND AGREED that this Bond shall inure to the benefit of any and all persons, companies and corporations entitled to file claims Title 3, (commencing with Section 9000) of Part 6 of Division 4 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this Bond. Should the condition of this bond be fidly performed, then this obligation shall become null and void, otherwise it shall be and remain in full force and effect. *Forty Four and 00/100 1 A . . The Surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of said agreement or the specifications accompanying the same shall in any manner affect its obligations on this Bond, and it does hereby waive notice of any such change, extension, alteration or addition. IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and Surety above named, on June 19 2014 PRINCIPAL: All American Asphalt (Type Company Name) M to Title: M40AJ rpY6St'%-( Y'c�" (Attach Acknowledgements of both Principal and Surety signatures) APPROVED AS TO FORM: aty Attorney Payment Bond - P.W. (except subdivisions) 02/13 2 SURETY: Fidelity and Deposit Company of Maryland ('type Company Name) By: Au�ge Title: Rebecca Haas -Bates, Attorney -in -Fact us Title: CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT State of California County of Riverside on June 20, 2014 before me, Rebecca Angela Parra Notary Public Date Here Insert name and Title of the Officer personally appeared Robert Bradley and Michael Farkas REBECCA ANGELA PAR RA Commission # 2024944 Z gel Notary Public - California z z �`'`' Riverside County D My Comm. Expires May 17, 2017 who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that he/she/they executed the same in 4W44er/their authorized capacity(ies), and that by NsAier/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing paragraph is true and correct. WITNESS my � an official seal. Signature o ,� ,2 Place Notary Seal Above 51gnmure& Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document Payment Bond No. 7610763 Document Date: _6/19/2014 Number of Pages: Two (2) Signers) Other Than Named Above: Fidelity and Deposit Companyof Maryland Capacity(les) Claimed by Signer(s) Signer's Name: Robert Bradley Signer's Name: Michael Farkas ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): Vice President ❑ Partner ❑ ❑ Limited o General ❑ Attorney in Fact ❑ Trustee ❑ Other: Top of thumb here ❑ Corporate Officer—Title(s): Secretary ❑ Partner 0 ❑ Limited o General ❑ Attorney in Fact ' ❑ Trustee ❑ Other: Signer is Representing: Signer is Top of thumb here CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE <... .a•. �... •c.•ra<,'. <.� .t.a<.a<.c: .a .a ,a< :.•.: !<.S. ,a .aesa.c t. Y.e.e: r :•.'<.. ar-..,e.v �.y.0 �e�ae State of California County of Orange On 6/19/2014 before me, R. Paramo, Notary Public Date Here Insert Name and Title of the Officer personally appeared Rebecca Haas -Bates R. PARAMO commission M 2035890 a "=s Notary Public - California ZZ Z orange County M Comm. E ires Au 5, 2017 J Place Notary Seal Above Names) of who proved to me on the basis of satisfactory evidence to be the persons) whose name(&) is/ere subscribed to the within instrument and acknowledged to me that 4+e/sheAfrer executed the same in his/her/tt+eir authorized capaclty(iea), and that by fifs/her:/tgslr signatureft on the instrument the person(*, or the entity upon behalf of which the person(e) acted, executed the instrument. cerlty<u NAL ERJURY under the laws of t tate of Cal nia that t foregoing paragraph ssand correct 1NITNFSS my hand, a d official e 1• OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Payment Bond No. 7640763 Document Date: 6/19/2014 Number of Pages: Two 2) Signer(s) Other Than Named Above: All American Asphalt Capacity(lbs) Claimed by Signer(s) Signer's Name: Rebecca Haas -Bates ❑ Corporate Officer — Title(s): Ell Partner — 0Limited ❑General ❑ Individual Attorney in Fact ❑ Trustee ❑ Guardian or Conservator .7 Other. Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited '❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑Guardian or Conservator ❑ Other: Signer Is Representing: Signer Is Representing: Fidelity and Deposit Company of Maryland 2013 National Notary Association • www.NationalNotary.org a 1 -800 -US NOTARY (1-800-876-6827) Item #5907 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attornevs-in-Pact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizanees, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney -hr -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time. CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in fall force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the Presideht or aVice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and die following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. TESTIMONIf� WHEREOF, I have her unto subscribed my name and affixed the corporate seals of the said Companies, this lday oP_, 20. ^Q o[ros� dGPN 1N3�°k roe BBAL p %, ttw • � »., teas ; ��a"' =a•., y�a q � •`Sti j....... "t�.`P Geoffrey Delisio, Vice President ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by THOMAS O. MCCLELLAN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint William SYRKIN, Rebecca HAAS -BATES, Sergio D. BECHARA and Richard ADAIR, all of Irvine, California, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 15th day of January, A.D. 2013. ATTEST: W. ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND $$AL ea•l —• n? pat +4a ~ low •'/\ydb+j ry e... ... v..� Assistant Secretary Vice President Eric D. Barnes Thomas O. McClellan State of Maryland City of Baltimore On this 15th day of January, A.D. 2013, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, THOMAS O. MCCLELLAN, Vice President, and ERIC D. BARNES, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Duna, Notary Public My Commission Expires: July 14, 2015 POA -F 012-0033D %, ndrl 7640763 Premium: $4,311.00 Premium is for contract term and is subject To adjustment based on final contract price. Executed in: 1 Counterpart KNOW ALL'MEN BY THESE PRESENTS THAT: WHEREAS, The City of Santa Ana; State of California, and All American Asphalt complete certain designated public improvetaents, which said agreement, dated June 17, 2014 Attachment B entitled `° Project No. 14-6812 - Local Street Slurry Seal 2013-2014 is hereby referred to and made a part hereof, and WHEREAS, said Principal is required under the terms of said agreement to furnish a Bond for Faithful Performance of said agreement, NOW, THEREFORE, we, the Principal and Fidelity and Deposit Company of Maryland as Surety, are held and Brady head unto the City of Santa Ana (hereinafter called "City") in the pound soar of One Million Ninety One Thousand, Three Hundred* DOLLARS ($ 1,091,344.00 ) lawful money of the United States, for the payment of which sum well, and truly to bee, we bind ourselves, our heirs, successors, executors and a nlstrators, jointly and severally, firmly by these , presents. The condition of this obligation is such that if the above bounded Principal, his or its heirs; executors, administrators, successors or assiM shalt in all things stand to and abide by, and well and truly keep and perforin the covenants, conditions and provisions in the said agreement acid any alteration thereof made as therein provided, on Ills or their part, to be Impt and performed at the tune and in the manner therein specified, and in all respects according to their true talent and meaning, and shag indemnify and save harmless City, its officers, agents and employees, as therein stipulated, then this obligation shall become null and void; other rise it shall be and remain in full force and e As part of the obligation secured hereby and in addition to the face amount specified therefor, there shall be included costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by City in successftdly enforcing such obligation, all to be taxed as costs and included in any judgment rendered.;. *Forty Four and 00/100 0 The Surety hereby stipulates and agrees that no thartge., extension of time, alteration or addition to the terms of the agreement or to the work to be performed thereunder or the specifications accompanying the same shall int anywise affect its obligations on this Bond, anis it does hereby waive notice of any such change, extension of time; alteration or addition to the terms of the agreemeatt or to the work or to the specifications. IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and Surety above named, on June 19 2914 PRINCIPAL: All American Asphalt (Type Company Name) ST : Fidelity and Deposit Company of Maryland (Type Company Name) (Attach acknotvledgements ofhoth Principal and Surety signatures) ity Attorney 6102 ki Ey_.. TRIC Rebecca Haas -Bates, Attorney -in -Fact By Title: CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT State of California County of Riverside on June 20. 2014 before me, Rebecca Angela Parra Notary Public Dale Here Insert name and Title of the Officer personally appeared Robert Bradley and Michael Farkas REBECCA ANGELA PARRA / v'Al Commisslon # 2024944 NotaryPublic - California z Rverside County n My Comm. Expires May 17. 2017 who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by kHs/kter/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing paragraph is true and correct. WITNESSzt* official seal Signature Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document Performance Bond No. 7610763 Document Date: 6/19/2014 Number of Pages: Two (2) Signer(s) Other Than Named Above: Fidelity and Deposit Company of Marland Capacity(ies) Claimed by Signer(s) Signer's Name: Robert Bradley Signer's Name: Michael Farkas ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): Vice President ❑ Partner ❑ o Limited ❑General ❑ Attorney in Fact ❑ Trustee • Other: Signer is Representing: Top of thumb here ❑ Corporate Officer—Title(s): Secretary ❑ Partner 11 o Limited o General ❑ Attorney in Fact ❑ Trustee Top of thumb here ❑ Other: Signer is Representing: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE l<:r .ca Y'.Y".<qC <� a .a .¢ .1 ,ca¢.iit.c, w Uu •sCr st - .as "M XInt/ I ¢CsaG:it/- State of California County of Orange On 6/19/2014 Date personally appeared before me, R. Paramo, Notary Public Here Insert Name and Title of the OffIcer Rebecca Haas -Bates rsr R. PARAMO Commission # 2085890 z qz a ti Notary Public - California z Orange County " MyCommm. Expires Aug 5, 2017 Place Notary Seal Above Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the persons) whose names) is/are subscribed to the within instrument and acknowledged to me that 44e/sheltfra executed the same in kris/her/tlneit- authorized capacity(iee), and that by his/her/t4ae r signature(s) on the Instrument the person*,, or the entity upon behalf of which the person(e) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the St a' ornia t a foregoing paragraph struecorrect•WITNy hand an official se of Notary Public OPTIONAL Though this section is optional, completing this information can dater alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Performance Bond No. 7640763 Document Date: 6/19/2014 Number of Pages: Two (2) Signer(s) Other Than Named Above: All American Asphalt Capacity(ies) Claimed by Signer(s) Signer's Name: Rebecca Haas -Bates ❑ Corporate Officer—Titles) FJ Partner— ❑ Limited ❑ General ❑ Individual 7Attorney in Fact Trustee ❑ Guardian or Conservator ❑ Other. Signer's Name; ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer Is Representing: Fidelity and Deposit Company of Maryland © 2013 National Notary Association o www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876.6827) Item #5907 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attorneys -in -Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate sea], appoint attomeys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in fill force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is stili in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the 'facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I�''6T6,,,E,STIMO Y WHEREOF, I have her unto subscribed my name and affixed the corporate seals of the said Companies, this i`t�tt'lday of .Q.UW� 0 , 20�. ^� OVOS' afu`��tN56q-aµAS aa.� un, A8 Geoffrey Delisio, Vice President ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies") by THOMAS O. MCCLELLAN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint William SYRKLN, Rebecca HAAS -BATES, Sergio D. BECIIARA and Richard ADAIR, all of Irvine, California, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as filly and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a tme copy of Article V, Section 8, of the By -Laws of said Companies, and is now in 'force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 15th day of January. A.D. 2013. ATTEST: W. Assistant Secretary Eric D. Barnes ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND �ynkry ........... Fr'� eGpy.' G�....... v� 6 1989 r� s5 ANi • m u,w a eJ"a• --ff/'e", ll ( Vice President Thomas O. McClellan State of Maryland City of Baltimore On this 15th day of January, A.D. 2013, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, THOMAS O. MCCLELLAN, Vice President, and ERIC D. BARNES, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saah, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. /1 / c '+ Constance A. Dunn, Notary Public My Commission Expires: July 14, 2015 POA -F 012-0033D •' 4 A ' CERTIFICATE OF LIABILITY INSURANCE -DATE 06/19/201414 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 LIC #0829370 1-925-244-7700 CONTACTNAMCertificate Department Edgewood Partners Insurance Centers (EPIC) PHONEFAX [Irvine Branch] wC,Ap,�„(925) 244 7700 _...�Lc No1:.(925) 901-0671 _ P.O. Box 5003 E-MAADDRESS: EPICcertsBEdgewoodlns.com Sen Ramon, CA 94583 INSURERS AFFORDING COVERAGE NAIC# _ INSURER A: ARCH SPECIALTY INS CO 21199 INSURED INSURER B: ZURICH AMER INS CO116535 All American Asphalt INSURERC: NATIONAL UNION FIRE INS CO OF PITTS 119445 P.O. BOX 2229 _ INSURER D: INSURER E: Corona, CA 92578-2229 INSURER F ! $ COVERAGES CERTIFICATE NUMBER: 40276401 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OFINSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDDIYYW POLICY -E —XP MMIODNYVY LIMITS A GENERAL LIABILITY GPP002265805 08/01/1 08/01/14 EACH OCCURRENCE $ 1,000,000 X.. COMMERCIAL GENERAL LIABILITY DAMAOETO RENTED ......100, PREMISES Ee ocom.11ce $ 000 CLAIMS -MADE ❑X OCCUR MED EXP (Any ono person) $ PERSONAL &ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS CONFIDE AGO $2,000,000 $ POLICYM PRO LOC JPCT B AUTOMOBILE LIABILITY _ BAP557108801 08 Ol 1 08/01/14 COMBINEDSINGLE LIMIT Ea accident 2,_000,000 BODILY INJURY (Per parson) _ $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILYINJURY(Peraoddenl) $ PROPERTY ede $X HIRED AUTOS X ON -OWNED $ C UMBRELLA LIAB X OCCUR BE11665540 08/01/1 08/01/14 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 X EXCESS ILIAD CLAIMS -MADE DEC X RETENTION $10, 000 F0110W1 -Form $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMSER EXCLUDED? NIA WC593205700 OB O1 1 / / 08/01/14 X WC STATU- OTH- TO V LIMIT E E.L EACH ACCIDENT ------- $ 11000,000 " --'—"—'-- (Mandatory inNH) El DISEASE - EA EMPLOYE $1,000,000 Ifyas',descrlbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is race red) RE: City of Santa Ana - Project #14-68121 Local Street Slurry Seal 2013-2014 [2] Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) AHilgen-IRV 40276401 © 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1988 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 USA ACORD 25 (2010105) AHilgen-IRV 40276401 © 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM SECTION II — WHO IS INSURED is amended to include as an additional insured those persons or organizations who are required under a written contract with you to be named as an additional insured, but only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of your subcontractors: A. In the performance of your ongoing operations or "your work', including "your work" that has been completed; or B. In connection with premises owned by or rented to you. As used in this endorsement, the words "you" and "your" refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Schedule Project The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, RE; City of Santa Ana - Project #14-6812; Local California 92702; its officers, employees agents and volunteers Street Slurry Seal 2013-2014 Endorsement Number This endorsement Is effective on the inception date of this policy unless otherwise stated herein (The Information below is required only when this endorsement is issued subsequent to the preparation of the policy,) Policy Number: GPP002265805 Named Insured: All American Asphalt Endorsement Effective Date'. 811113 00 CGL0006 00 05 07 3584 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE — BROAD FORM, CGL POLICY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, the following paragraph is added to Condition 4. Other Insurance: Where the Named Insured is required by a written contract to provide insurance that is primary and non-contributory, and the written contract so requiring is executed by the Named Insured before any ,occurrence" or offense, this insurance will be primary, but only if and to the extent required by that written contract. All other terms and conditions of this Policy remain unchanged. Schedule Project The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, RE; City of Santa Ana - Project #14-6812; Local California 92702; its officers, employees agents and volunteers Street Slurry Seal 2013-2014 Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Policy Number: GPP002265805 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/13 00 CGL0130 00 09 06 Page 1 of 1 3584 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM Schedule Project The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, RE: City of Santa Ana - Project #14-6812; Local California 92702; its officers, employees agents and volunteers Street Slurry Seal 2013-2014 Under SECTION IV —COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 8. Transfer Of Rights of Recovery Against Others to Us is amended by the addition of the following provision: We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payments we make for injury or damage arising out of your operations or "your work" done under a written contract with that person or organization. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: GPP002265805 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/13 00 CGL0121 00 09 06 Includes Copyright Material from Insurance Services Office, Inc. Page 1 of 1 3564 POLICY NUMBER; BAP 5571088.01 COt IJEFICIAL AUTO CA 20 48 02 99 THIS ENDORSEME14T CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED This endorsement modules insurance provided undarthefo9owing: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERCOVERAGE FORM' TRUCKERS COVERAGE FOAM WRh respect to coverage provided by this endorsement„ the provislons of the Coverage Form, apply unless modified by this endorsement. This endorsement IdentffIse parson(s) or organizations) who are 'Ins under the Who Is An Insured Pravislon of the Coverage Form. This endorsement does not agar coverage provided in the Coverege Form. This endorsement changes the poficy effective on the Inception date of the poky unless another elate Is indicated below. Endorsement Eff active: 08/0 1/2013 SCHEDULE Namur of Person(s) or Organizatlain(s): ANY PERSON OR ORGANIZATION TO WHOtd OR WHICH YOU ARE REQUIRED TO PROtrIDE ADDITIONAL INSURER STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY., NON—CONTRIBUTORY BASIS, INA WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Schedule Project The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, RE: City of Santa Ana - Project #14-6812; Local California 92702; its officers, employees agents and Street Slurry Seal 2013-2014 volunteers jlf no entry appears above, Information required to complete this endorsement will be shown in the Declaratlons as fppllcabta to th a endorsement.) Each person or organization shown In the Sctioduleis an insured"far LoNfIty Coverage, but only to the tent that person or organization qualifies as an "Ensured under the Who Is An Insured Provision contalned in Section II of the Coverage Form, GA 2p 4802 90 Copyright, Insurance Serves Office, Enc., ISM Page f of 1 I3 3684 Waiver C11"'11wid'er Of Rights Of Reemety Against Oil ieiis'ro Us Pdtcy Wu: 11flaurevr Pot. I H.s,P.Dat® at Pot. Off. Dasa or Trod. RUS5710seol 00/01./7013 08%01(2018 0&/01/2014 This endorsenioutis issued Lf Elie company named in the Deelduation5.,11. changes the Imlicy onthe effective date listed above at die hour stated in the Declaratimis, TIRSENDOIV ff14iENT CitANCESTHEPOIdCY. PLEASE Riw) r1' wa'i.1aLL `. This end'.orsenient modifies insurance providedunder the: 1luwdrtess,iWaCoverage Farm Tmckens Caw nyk, Fenn Garage Cowwwnugm Fenn It'.IutorCuniercovenu+„e libnn. SCHP D U LE Name at Renxm or Orpunianlicas ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH I EETHE INSURED, EXECUTED PRIOR rTO THE ACCIDENT OR LOSS, THAT fStAhleduleOF SUBROGATION BE PRO�ID ct UNDER THIS rolPOLICY The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, RE: City of Santa Ana - Project #14-6812; Local California 92702; its officers, employees agents and volunteers Street Slurry Seal 2013-2014 we Waive any rigi'3t of reaoeerywe may have agonist tire &si.pnated person or organization show,'nin the schedule because of paymeno we make for injury or damage caused by an iecideu@' or"#css" resulting f€ in tine ownership, rnainte ouric,a, or use of a emend "autia" for which a Waiver of SubDOgntton is required In conjunction with work performed by you for 11> desiguated. pexsai or organization,. The waiver applies only to die Iles gna.ted laerson w organization drown in the schedule, U -CA -320. B CIV (41 94) P'aSe T of i 3584 3s°m O�Cl WORKERS' COMPENSATION AND EMPLOYEW LIASTUTY INSURANCE: POLICY CALIFORNIA lids endorsement oharsgea the polloy to which it Is attachled offective on the ioception date of the policy uniaos a di.:. rent date is indicated belowr,. lT araga r adauss"neod be WnplslodcragYkMeedse' >ddsina d mbsaqu rd io pyep&sfion etd9,a .l Thda ondomment, effective ori 08101(2013 at t2;01 A;M, standard time, farrns a part of policy No. WC503205M0 of the Zuft American Insurance Company WME of INSUPA04CE COMPANY) Issued to Adi American Asphat We have the right to recover our payments from anyone liable err an Injury hovered by this policy, We will not en&rrce our right against the porson or organizagan named in Che Schedule. (This agreement applies any to the extent that you podarm work under a written contract thatrayuiras you to obtain this agreement from us) you must maintain payroll records oQLurately segregating the renwmeration of your o mptloyeos while engaged in the werk descried in the Schadulo. The addil anal pra dura for this ondors4imvrit shall be miumothrerwisedue onsuch nOfatiart. Person or Organization The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees agents and volunteers W<125214-84) We 49 03 06r£ed, 4.&1;) Schedule % of the California workaxV oomposavon pfo- Job Descrfpt on RE: City of Santa Ana - Project #14-6812; Local Street Slurry Seal 2013-2014 ALLPfRS AND/OR OWANIZATONSTRAT Arts ReIUIRED0Y WRITTEN CONTRACT09AGREEMENTirIPTFUTHEhNSURED,EXEOUT J PRIOR T4 T4ht ACCID ENT OR LOSS, THAT WAIVE R 0 F So BROGATION BE PROVIDED U WER THIS POUCY FOR WORK .€tRF0RMEUEly YOU fM THAT PERSONAND/OR OROANUATI ON., Page 9 of Y 3584