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ACE CD, Inc. (EL SALVADOR PARK IMPROVEMENTS)
Recording Requested By, And When Recorded Mail To: Clerk of the Council, City of Santa Ana 20 Civic Center Plaza, P.O. Box 1988 Santa Ana, CA 92702 Recorded in Official Records, Orange County Hugh Nguyen, Clerk -Recorder IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII NO FEE * 8 R 0 0 0 8 2 0 8 0 4 4$ 2016000099266 2:33 pm 03109116 227 417 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS SFHI:r, (9 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 construction of EL SALVADOR PARK IMPROVEMENTS under contract entered into on 0 7/7/2015 with ACE CD INC. on which contract CONTRACTORS BONDING AND e INSURANCE COMPANY is surety. The property on which such work improvement was u o placed is in the City of Santa Ana, County of Orange, State of California, and described as ;o u Project No. 14-7540 located at: EL SALVADOR PARK. The work improvement on said ow property was accepted as completed on 3/4/2016. a o ? CITY OF SAN A, A MUNICIPAL CORPORATION x w0 3�c�—I6 w F Dated: Principal Civil neineer- Tyrone Chesanek qTITLE a___________________________________________________________________________________________ O U VERIFICATION a I, the undersigned, say: I am the City Engineer - Edwin "William" Galves 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; anyI declare under penalty of perjury that the facts therein stated are true. Executed on / at Santa Ana, California (Signature of individual 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 CITY COUNCIL MEETING DATE: JULY 7, 2015 TITLE: AWARD CONTRACT FOR CONSTRUCTION OF EL SALVADOR PARK IMPROVEMENTS (PROJECT 14-7540) {STRATEGIC PLAN NO. 6, 1B, 1G} CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED JUL 0 i 2015 51/As Recommended ❑ As Amended ❑ Ordinance on 15' Reading ❑ Ordinance on 2nd Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER Award a contract to ACE CD, Inc., the lowest responsible bidder, in accordance with the unit bid prices, totaling $318,344.98, for construction of EI Salvador Park Improvements. 2. Approve the Project Cost Analysis for a total estimated project delivery cost of $410,172. DISCUSSION This action will allow for the construction of park improvements in EI Salvador Park. The project will include a new community garden and security lighting. The new community garden will be enclosed with a chain link fence and will include a tool shed, new landscaping, irrigation, new benches, new picnic tables, and new security lighting. In addition, the existing outdated and inadequate lighting will be replaced to improve security and visibility. EI Salvador Park is an 8.5 -acre community park that includes a community center, swimming pool, lighted ball fields, picnic facilities, and basketball, volleyball, and handball courts. The community will have access to the new garden beds and tool shed. Once completed, these improvements will enhance the appearance of the park and the neighborhoods. A Notice Inviting Bids was advertised on May 5 and 6, 2015, and bids were opened on May 26, 2015. The following tables summarize the bid invitations made and the bids received: Contract Award For EI Salvador Park Improvements July 7, 2015 Page 2 Contractor Participation Data Santa Ana contractors receiving notices 15 Contractors requesting bidding documents 26 Bids received 3 Bids received from Santa Ana contractors 0 Bid Results Summary Rank BIDDER'S NAME CITY BID AMOUNT 1 ACE CD, Inc. Glendora $318,344.98 2 HYM Engineering, Inc. Buena Park $460,570.00 3 Faris Construction Company Oceanside $471,000.00 A total of three bids were received and all were deemed responsive. ACE CD, Inc. submitted the lowest responsive bid in the amount of $318,345 which is consistent with the engineer's estimate of $300,000. Therefore, staff recommends award of this contract to ACE CD, Inc. STRATEGIC PLAN ALIGNMENT Approval of this item supports the City's efforts to meet Goal #6 Community Facilities & Infrastructure, Objective #1 (establish and maintain a Community Investment Plan for all City assets), Strategy B (equitably maintain existing streets and associated assets in a state of good repair so they are clean, safe, and aesthetically pleasing for all users), and Strategy G (develop and implement the City's Capital Improvement Program in coordination with the Community Investment Plan). ENVIRONMENTAL IMPACT In accordance with the California Environmental Quality Act, the recommended actions are exempt from further review. Categorical Exemption Environmental Review No. ER 2015-58 has been filed for this project. FISCAL IMPACT The Project Cost Analysis estimates project expenditures of $410,172, which include the construction contract, construction administration and inspection, as well as contingencies Contract Award For EI Salvador Park Improvements July 7, 2015 Page 3 (Exhibit 2). The budget for Community Development Block Grant funds will be carried forward from Fiscal Year 2014/15 to Fiscal Year 2015/16 for Project 14-7540 in Account No. 13518783- 66220 for expenditure in Fiscal Year 2015/16. Public Works Agency L� Gerardo Mouet Executive Director Parks, Recreation & Community Services Agency uu)�4-�Ak Kelly Reende Executive Di for Community Development Agency FM/EW G/ET Exhibits: 1. Location Map 2. Cost Analysis 3. Construction Contract APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez Executive Director Finance & Management Services Agency PROJECT NO. 14-754( EXHIBIT 1 SANTA ANA �[ crrY COUNCIL EL SALVADOR PARK IMPROVEMENTS A JULY QA7E= (PROJECT N0. 14-7540) JULY 7, 2015 euei tc voans as xc. PAGE 1 OF 1 COST ANALYSIS PROJECT NO. 14-7540: EL SALVADOR PARK IMPROVEMENTS Construction Contract $318,344.98 .. .... - Contract Administration .................... $15,548.22 .......... Inspection and Testing ........... ........... ......... .......... ........ ........ ........................ $30,199.60 ......... ...... .1...1... Survey $3,995.04 Contingencies $42,084.16 TOTAL ESTIMATED CONSTRUCTION $410,172.00 COSTS Exhibit 2 THE REGISTER 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796.7000 1 Fax (714) 796-6059 (2nt5.5 c.C.p') State of California ) County of ORANGE ) ss Notice Type: BID -NOTICE INVITING BIDS Ad Description; EI Salvador Park Improvements I am a OWzen of the United States and a resident of the State of California; i am over the age of eighteen years, and not a pally to or interested in the above entitled mailer. I am the principal, Clerk of the printer and publisher of the THE REGISTER, a newspaper published in the English language to the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general circulation as defined by the laws of the Slate of California by the Superior Court of the County of ORANGE, State of California, under date 1111911905, Case No. A21046. That the notice, of which the annexed is a. printed copy, has boon published in each regular and entire Issue Of said newspaper and not in any supplement thereof on the following dates, to -wit:. 0510512015,0510612015 Executed on: 0510612015 At SANTA ANA, California t certify (or declare) under penalty of perjury that the foregoing Is Wk and correct, Signature In., sr—"kv Ming ., nv0 e'A' NOTICE To OOMTMOTORS PROJECT NO, 14,7540: EL SALVADOR PARK IMPROVEMENTS Instruction on bid aulonr- Won we Included m the con - read Cocnmanla,- 'Tho coneam documents and the combine eteolu n c, eat of the Plans and spoda� oationa are "Wrabie at the Publlc Woft Aggancy Mum. ler, First Floor, ! ONIp Con. ter Phzs, Roes Amex, Sante Ana, rietdomta92701. `In accordanea With the pro- visions of the California La. bor Code, p,wWr h; wage rates eepp ty, 51s, 585 CME.17a 11# THE REOMITER ,Se045ate w 11111111I1111111111111Illl1111111111111111111111111111131111111I CITY OF SANTA ANA CONSTRUCTION CONTRACT PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS This CONSTRUCTION CONTRACT is made and entered into this 7"' day of July, 2015 by and between the CITY OF SANTA ANA, CALIFORNIA, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California, hereinafter referred to as "CITY" and ACE CD, INC, hereinafter referred to as "CONTRACTOR". WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: 1. CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost and expense necessary to construct and complete in a good and workmanlike manner and to the satisfaction of the City Engineer of the CITY, the Project No. 14-7540, El Salvador Park Improvements identified in and in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. 2. The complete Construction Contract consists of the "Contract Documents," as defined by the Standard Specifications for Public Works Construction and which include the following: ..Notice Inviting Bids ...Instructions to Bidders ...Bid Proposal ...Bid Bond ... Contract Forms ...Contract Bonds ...General Provisions ... Special Provisions ...Technical Provisions ... Project Plans • ...Appendices In case of conflict between the Contract Documents, the precedence of documents shall be as established in the Standard Specifications for Public Works Construction. 3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete Project No. 14-7540, El Salvador Park Improvements the sum total amount not to exceed $318,344.98 as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A". 'fhe BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not Page] of3 CITY OF SANTA ANA CONSTRUCTION CONTRACT PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. 4. CONTRACTOR agrees to complete the Project No. 14-7540, El Salvador Park Improvements within the time specified in the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A") including commencing construction within the timeframe therein specified after issuance of a Notice to Proceed. 5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on the Project No. 14-7540, El Salvador Park Improvements a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law. 6. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work (Performance Bond), and one in the amount of One Hundred Percent (100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention payment, furnish a warranty performance and payment bond equal to at least ten (10%) percent of the final Contract price or $1,000, whichever is greater (Warranty Bond). 7. CONTRACTOR shall, upon project completion as a condition of project acceptance, furnish a Warranty Payment and Performance bond to be approved by the CITY, in the amount of Twenty -Five Percent (25%) of the Contract price, to warrant the work done under said Contract Agreement against material or quality defects for a period of one year after acceptance by the AGENCY. s. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the CITY. u H Page 2 of 3 CITY OF SANTA ANA CONSTRUCTION CONTRACT PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City AUeTney---z I Sandoval \ f Assistant City Attorney CITY OF SANTA ANA DAVID CAVAZ S City Manager RECOMMENDED FOR APPROVAL: VFrdsavipour, P.E. Executive Director, Public Works Agency CONTRACTOR: ACE CD, INC. Page 3 of 3 MAYOR Miguel A, Pulldo MAYOR PRO TEM Vincent F. Sarmiento COUNCILMEMBERS Angelica Amezoua P. David Bonavldes Michele Martinez Raman Royna Sal Tina)wo May 21, 2015 ADDENDUM No, ONE PUBLIC WORKS AGENCY 20 civlo Center Plaza M,38 o P,0, Box 19m M�36 Santa Ana, California 82702 www.s •` n� RYq SUBJECT: PROJECT NtO$,14.7540: EI Salvador park Improvements The following change has been made to Specifications for the subject. project: Specifications CITY MANACBR David Cavazos CITY ATTORNEY gonia R. Carvalho CLERK oF'rm COUNCIL Maria D, I+Uizar 1, Appendix G- Federal Wage Rate: Federal wage rates were updated on 5/8/15; therefore, replace entire Appendix G with the attached. The latest Federal Wage Rate determination can also be obtalned at the following location, upon entering Davis -Bacon Act Wage Decision (DBA WD) #GA35 www.wdo I , qo v/d b a ,asp x All other terms and conditions remain the same. CITY OF SANTA ANA ev u T7 Eduvin" Ghalve gineerC 'c\ �V-, V w v Exhibit A ')AN'rA ANA Cn'Y COQN01L MlgudA-i HO,� I am'nna ero 1 Al"Wir811vifmto ! Ntd'W'M.h.'u Angdm Am«ond P90*1 QvmvidW I rwwnNeyne Muyof I Moyor P1, Toch, W¢M113 1 Wdrd I i 1Ndtd r^.I Wold U WeM a War? 5 MNtidrt?4�gnLw-.LL�r� '�Iiatlgrs o�n6L,>uun�ar, I Y9n �LWiuJ]lceala:.ku°aua I MAhLirl'r?suGpimdaWrSwAWe *)A�neaatila@i �n1r-aoA�s>fv esvo ado .raplaa..og r+I �1��gw�ynamuuaadus CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: Acg Ga IvtC- REQUIREMENT: The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the following schedule: Item Description Quantity Unit _Unit Price Amount 1 Mobilization 1 LS $ $.. d'43 66 2 Unclassified Excavation* 23 CY _ $`J,M135 $ 116IT50 3 Construct PCC Pavement* 7 CY $. �;O°v $ 2-1516"1'11 4 Construct Stabilized 3" Autumn Gold Decomposed Granite with weed control fabric* 280 SF$ °"t„ t35 $ I , 0 5 Construct PCC Slab Including wire mesh 600 SF $ 7 6 Construct PCCSidewalk 300 SF $ "?°'7v 7 Construct PCC Curb Ramp 200 SF $ Ix3r20 S Construct PCC Driveway (T=6") 10o SF $315'140 3t5 10 9 Construct RCC Curb (B-1) 125 LF �0,,4.r, 10 Construct Parkway Culvert per C.S.A. Std. Plan No. 318, Type "ll" 1 EA $1, s'etri° tha r¢+Cr 11 Construct PCC Mow Strip 364 LF $ 13,20 $ ii -f 0 F ° ilGt 12 Raised Garden Bed (Complete In Place) 1 LS $%2,00o, r $ '12, 000 13 CMU Storage Shed Include Stan ding Seam Roof (Complete in Place) 1 LS $)-4,ov' $.)Lt,A00 14 CMU Block Wall (H=4') 65 LF $1.2 e, 50 15 Furnish& Install Picnic Table by Quickcrete (Madel #3 Q-LBT-96PT) 5 EA $a186t?' BP -1 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO, 14-7540 EL SALVADOR PARK IMPROVEMENTS Item Description Quantity Unit Unit Price Amount 16 Furnish& Install Picnic Table byQuickcrete 1 EA $,Q�r((S�' $,�,�'(� •'' (Model# Q-LBT-102PTADA) 17 Furnish& Install Concrete Bench by 4 EA $I1agq°°�° $ tl'1:.3"1U Quickcrete (Modelo # 02 -CAL -72B) 18 Furnish & Install INV Double Rolling Gate 1 EA $31535 $ 5 '7 S* • r Vinyl -Coated (Including all accessories for r chain lock) 19 Furnish & Install 1"x P' Chain Link Fence 346 LF $ -7V 6 50 $Pi 73 q, ✓- Black Vinyl -Coated (Included fabric, posts, and footing, 1-14') 20 Furnish & Install P'x1" Chain Link Fence 1 EA $ 21 tp GS • l $ ,Z` r! 45 - Black Vinyl- Coated Pedestrian Gate (6 wide) 21 Construct Rock Swale 1 LS $ 7153 5 $ 771 535 ^ 22 Furnish and Install Redwood 160 LF $8,61) $ 11 r.(. n Header(2"x4") 23 Furnish and Install Phoenix Dactylifera: 8 EA $3rJ 2fJ `' $1611 ( bo ' Date Palm Tree (25' BTM) 24 Landscaping 1 LS $2715110- $)-71,00_,- 25 Irrigation 1 LS $4,75a"$2 1I'050- 26 Landscape and Irrigation Maintenance 1 LS $g1,�;0-'"-$ 12,50-✓ 27 Furnish and Install Organic Soil* 73 CY $ 6tt"50 $ 71e)6'51) 28 Security Lighting 1 LS $ WeC)Cdr • 15dyo �,••'" TOTAL BID 3 r Ti irk( The lowest BIDDER shall be selected on based on the lowest responsible total bid. The City reserves the right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any). * 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. TIME FOR COMPLETION OF IMPROVEMENTS AND LIQUIDATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within seventy 70 working ...days- after the commencement date stated in the Notice to Proceed. The bidder also proposes to commence construction of the Work within ten BP -2 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS 110 days after issuance of a Notice to Proceed, and to continue in a diligent and workman -like manner without interruption, and to complete the construction thereof within the time specified above. The liquidated damages amount in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $1,000 per calendar day. Name of Firm A cf� Cb ) h c Signature of BIDDER Title t%M('eA (if an individual, so state) BP -3 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS BIDDER'S STATEMENT BIDDER understands and agrees that this Bid Proposal, Contract Documents and subsequent Construction Contract Agreement 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) business days 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. BIDDER understands that a bid is required for the entire work, that the estimated quantities set forth in the bid schedule are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. The BIDDER also certifies that the bid is a balanced bid. In accordance with Section 7028.15 of the California Business and Professions Code, the undersigned certifies under penalty of perjury that the foregoing is true and correct. Name of Firm A C5 C/) 'vac Signature of BIDD Title a)5 f (if an individual, so state) (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.) BP -4 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS joll CONTRACTOR'S LICENSING and REGISTRATION STATEMENT The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she and all his/her subcontractors are registered with the State of California Department of Industrial Relations (DIR), and that the following is true and correct. Contractor's Name: C® I �}C • _ ____ Business Address:_ 4), Aog e 6.46'41Al^Cf, rl4cJu 0 Business E -Mail / Address: Cl CP_ (v( (co Cts Wn Telephone: State Contractor's License No. and Class: g q7 qo % A , -s, C,27 License Expiration Date: State Dept. of Industrial Relations (DIR) Registration No.:wo 01 T �t�_,_,-......,_._.. State Dept. of Industrial Relations (DIR) Registration Expiration Date: of, p 15 Signed: `a Title: () C9& BP -5 of 17 CITY OF SANTA ANA ox PROPOSAL 04 PROJECT NO, 1.4-7540 EL SALVADOR PARK IMPROVEMENTS )ON PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well as California Code of Regulations, Title 8, Section 16,000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Since the services are being performed as part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Agreement. Contractor shall make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The undersigned certifies that the foregoing is true and correct. Name of Firm &C9 C0 I V\e I Signature of BI Title 0rfiCOA (if an individual, so state) BP -6 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO, 14-7540 EL SALVADOR PARK IMPROVEMENTS OWNERSHIP AFFIDAVIT a STATE OF CALIF� COUNTYOF ORNIA LLS CITY OP5ANT-A-"A XrL.;,&,I� ) _, A k/ Q�: L Y" ._ , being duly sworn, deposes and says: ❑INDIVIDUAL That he/she is the party making the foregoing proposal: ❑ PARTNERSHIP That he/she is a member of the co -partnership firm designated as: and who has been and Is duly vested with the authority to make and execute instruments for the copartnership by: who constitute the other members of the co -partnership. CORPORATION That he is of: A cl� C1) 'fir — a corporation which Is making the foregoing proposal: ©JOINT VENTURE That he is of: one of the parties making the foregoing proposal as a Joint venture, and the he/she has been and Is duly vested with the authority to execute instruments for an on behalf of the parties making said bid who are; that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion to secure any advantage against the City of Santa Ana or any person interested in the proposed cont for himself or any other person. Signature of BIDDER Subscribed and sworn to before me this +fi?day of 20 Signature of office Administering Oath (Notary Public) BP -7 of 17 11 -1V t � „� � `�� '� � � 9• r °C'ir 11 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS KNOW ALL MEN BY THESE PRESENTS that, D D Systems Inc DBA Ace CD Inc , as BIDDER, and Contractors Bonding and Insurance Company , as SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sum of Ten Percent of Total Amount Bid---- Dollars ($10% of Bid ), which is ten percent (10%) of the total amount bid by BIDDER to AGENCY for the above -stated project, for the payment of which sum, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is accepted and a contract is awarded and entered into by BIDDER in the manner and time specified, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 22nd day of May . 2015. BIDDER* D D Systems Inc DBA Ace CD Inc - 1199 Englewild Drive, Glendora, CA 91741 Phone: (626) 523-1141 SURETY* Contractors Bonding and Insurance Company- 111 Pacifica, Suite 350, Irvine, CA 92618 Julie Durkin (949) 341-9110. Subscribed and sworn to before me ,20—. Signature: Notary Public in and for the County of *"Please See Attached" , State of this _ day of *Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. BP -8 of 17 CALIFORNIA ALL-PURPOSE ACKNOWLEDOMENT CIVIL CODE89 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Orange On 05/22/2015 before me, R, Paramo, Notary Public Date Here Insert Name and Title of the Officer personally appeared Rebecca Haas -Bates NerneKof SignerN who proved to me on the basis of satisfactory evidence to be the person* whose name4 is/axe subscribed to the within instrument and acknowledged to me that Wshe/they executed the same in His/herltlKair authorized capacity(ies), and that by hWher/thair signature4on the instrument the persont(a}„ or the entity upon behalf of which the person(s) acted, executed the instrument. R. PARAMO AMO commission 0 2035890 Notary Public - California z Orange County v My Comm. Expires Au 6, 201 7 Place Notary Seat Above I certify under PENALTY OF PERJURY under the laws of the State of A lifornia that the foregoing paragraph Is true-aad correct. my I'radA and Signature of Notary 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: Bid Bond Document Date: 05/22/2015 Number of Pages:.One1 Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: Rebecca Haas -Bates ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General D Individual [RAttorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Contractors Bonding and Insurance Company Signer's Name: D Corporate Officer — Title(s): ❑ Partner — Cl Limited D General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator n Other: Signer Is Representing: 02014 National Notary Association - www.NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907 RLIO y ekle cople POWER OF ATTORNEY nn R11 Company RLI Insurance Company No (800) 45-2ortib 02.1 ax: (309)69-2 Contractors Bonding and Insurance Company Y6one:(800)645-2407.�Fax: (309)689-2036 � p y Know All Men by These Presents That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That this Power of Attorney may be effective and given to either or both of RLI Insurance Company and Contractors Bonding and Insurance Company, required for the applicable bond. That RSI Insurance Company and/or Contractors Bonding and Insurance Company, each Illinois corporations (as applicable), each authorized and licensed to do business in all states and the District of Columbia do hereby make, constitute and appoint; William Sorkin, Sergio D. Bechara Rebecca Haas -Bates, Richard Adair, jointly or severally contorted upon him/her to sign, execute, acknow undertakings, and recognizances in an amount not to ( $10,000,000.00 ) for any single obligation. , as Attorney in Pact, with tent power and authc on its behalf as Surety, in general, any and bonds, Dollars The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company, RLI Insurance Company and Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of the Resolution adopted by the Board of Directors of each such corporation, and now in force, to -wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations or the Corporation shall be executed in the corporate name of the Corporation by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Corporation. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers. of Attorney or other obligations of the Corporation. The signature of any such officer and the corporate seal may be printed by facsimile or other electronic image," IN WITNESS WHEREOF, RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have paused these presents to be executed by its respective Vice President with its corporate seal affixed this 22nd day of Janiutrv, 2015, PNCE RLI Insurance Company `•,.a}�Op ANOlryg�.. ao"7.eO .i.. 2o ,•• a a'�`a, •.A,q•, Contractors Bonding and Insurance Company 1?py♦. OOPPOggTe.R&�:' j¢ � OOP40R,4T� •q{•- _4 :g _ •Z- L-. SEAL II SEAL s, °u •. r•rs Roy C. Die Vice President State of Illinois • •s SS �c�inos �<LtNbt. County of Peoria CERTIFICATE On this 22nd day of January 1 2015 before me, a Notary Public, personally appeared Ray C. Dip , who being by me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of the RLI Insurance Company and/or Contractors Bonding and Insurance Company, and acknowledged said instrument to be the voluntary act and deed of said corporation. I, the undersigned officer of RLI Insurance Company, and/or Contractors Bonding and Insurance Company, each Illinois corporations, do hereby certify that the attached Power of Attorney is in Rill force and effect and is irrevocable; and Ruthennore, that the Resolution of the Company as set forth in the Power of Attorney, is now in force. In testimony whereof, i have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding and Insurance Company this ZZ2 CAday of, Igy. Qom' Ij—, RLI Insurance Company M.Bockler Notary Public Contractors Bonding and Insurance Company cosrsrrrrracraz r T L C i?1 "OFFICIA711A Roy G. Dio Vica President JACQUELINE COMMISSION EXP 0475709020212 A0059115 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540,t,Z EL SALVADOR PARK IMPROVEMENTS LIST OF SUIS -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: o Streets, highways including bridge projects: Y2% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: Y2% of the bid Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State Department of Industrial Relations (DIR). BIDDER proposes to subcontract certain portions of the work to the firms listed below: Name ACk LVt'�jO z �eG>�r,`t License #/Exp. p 1 'UA DIR Reg. #/Exp. 104200 Al 1 UZ d $a t5 Location �-eA br, Phone �vpr{Br� Type OfWork CC%lZit Amount $ 90 , gpo Name VlnA"!j Lin.Ivtt�r'A (ff-r License #/Exp. 0,4751 P110015 DIR Reg. #/Exp. 10000 U767 G i1rf5 License # Location Phone Type Of Work Gmt•Crt. fe. Amount$ A k nor Name License #/Exp. DIR Reg. #/Exp. License # Location Phone _ Type Of Work Amount $ _e --_..T _ Signature o idder Name License #/Exp. DIR Reg. #/Exp. Location Phone Type Of Work Amount $ INST14 License #/Exp. DIR Reg.#/Exp. License # _ Location Phone _ Type Of Work Amount $ 010115 License #/Exp. DIR Reg.#/Exp. License # _ Location Phone _ Type Of Work Amount $ BP -4 of 17 CITY OR SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS REFERENCES The following are the names, addresses, and telephone numbers for THREE public agencies for which BIDDER has performed similar work within the past three years. 1. Address of Owner. Name and Telephone Number of person familiar with projfte�ct. Contract Amount Type of Work Date Completed 2. las AiA4tkog e4'� 116-,ii6(1A Le, �f To4rits we3L lit &�, &v,;k-,o-gso bA rI4gonas Name ad Address of owner. Name and Telephone Number of person familiar with project. *"-1— �"0[7 Nvy' zmmvnwte-v �f lt%iAojup Contract Amount Type of Work Date Completed 3. Z907;tek i'8lav%P/ So vii k( �a At's gat _ �_ .� psjAlit-; w�icti°tiy4L Name and Addre s 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. __e"V1tt� S53o �✓alvtncc0 Ro(. Zlvrve> C,� `26dr1 BP -10 of 17 CITY OF SANTA ANA PROPOSAL 01 A PROJECT NO. 14-7540 OA ELSALVADORPARK IMPROVEMENTS ,. ADDITIONAL REFERENCES The following are the names, addresses, and telephone numbers for THREE public agencies for which the BIDDER or Subcontractor has performed Park Improvement projects in the past 5 years. 1. 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. BP -11 of 17 CITY OF SANTA ANA PROPOSAL PROJECT N0, 14-7540 OA EL SALVADOR PARK IMPROVEMENTS NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) 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, 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 making a false certification may subject the certifier to criminal prosecution. Signed State of California /� County of l.r�._�U�r Subscribed and sworn to (or affirmed) before me on this NIA day of 4" 20 f by qHi 111 Lel fP_ proved to me on the basis of satisfactory evidence to be the personO�who appeared before me Notary Public Sinature Notary Public Seal AnRmnNDO HEGpAHt Commisslon 0 1954908 a Notary Public - California Loa Angeles County M1R Camm. 9a Sires Dct 29, 2016 r BP -12 of 17 CITY OF SANTA ANA ° f PROPOSAI. PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS 10. NON-DISCRIMINATION CERTIFICATE 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. S. 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 BP -13 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. 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: _ Title: 'f tl ce '- Firm: I n ( Date:,, �( BP -14 of 17 CITY OF SANTA ANA PROPOSAL PROJECT N0. 14-7540 EL SALVADOR PARK IMPROVEMENTS 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 20 working days shall: 1. Apply to the joint apprenticeship committee administering the apprenticeship standards of the craft or trade in the area of the site of the public work for a certificate approving the contractor under the apprenticeship standards for the employment and training of apprentices in the area or industry affected. 2. Employ the number of apprentices or the ratio of apprentices to journeymen stipulated in the apprenticeship standards. 3. Contribute to the fund or funds in each craft or trade in which he/she employs journeymen or apprentices on the public work, in the same amount or upon the same basis and in the same manner as the other contractors, except contractors not signatory to the trust agreement shall pay a like amount to the California Apprenticeship Council. Signed:{........_ Title: d % ce Y' Firm: ACPS Cb NIC, Date: ZU /15 BP -15 of 17 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 up any part of the compensation to which he/she is otherwise entitled. Signed: Title: p i°Ce c" Firm: A.r-r— ri'1 tyr-, Date: 5 /zd/ 15 SP -16 of 17 CITY OF SANTA ANA PROPOSAL PROJECT NO. 14-7540 EL SALVADOR PARK IMPROVEMENTS PUBLIC CONTRACT CODE SECTION 10162 QUESTIONAIRE In conformance with Public Contract Code Section 10162, the BIDDER shall complete, under penalty of perjury, the following questionnaire: Has the BIDDER, any officer of the BIDDER, or any employee of the BIDDER who has a proprietary interest in the BIDDER, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes No e-� If the answer is yes, explain the circumstances in the following space. BP -17 of 17 } \ \ \ & w � a } \ A� o® CERTIFICATE OF LIABILITY INSURANCE 7/1 TE(MMI DNYYY) 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 Brown & Brown Insurance Brokers of Sacramento, Inc P. s Box 61904356 -9043 38004 Roseville CA 95661-9043 CONTACT NAME:PHONE egl. 916-630-8643 F"c . 800-783-0083 EMAIL INSURERS AFFORDING COVERAGE NAIC N 1/30/2015 INSURERA:Starr Surplus Lines Ins. Co. 13604 DAMAGETORE RIrD PREMISES Ea occurrence $100,000 INSURED DDSYS-1 INSURER B D D Systems Inc. dba: Ace CD Inc. INSURER C: GENERAL AGGREGATE $2,000,000 PRODUCTS- COMP/OP AGG $2,000,000 $ 1199 Englewild Dr INSURER D: LIABILITY ANY AUTO AU OS SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS NSURER E: Glendora CA 91741 NSURER F: EM$a COVERAGES CERTIFICATE NUMBER: 964626688 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 rypE OF INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYYJ LIMITS A 1,C70MMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR Y Y SLPGGL0313500 1/30/2015 1/30/2016EACH OCCURRENCE $1,000,000 DAMAGETORE RIrD PREMISES Ea occurrence $100,000 GEN'L X MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: PNOLICY E JECT I� PRO- ILOC OTHER', GENERAL AGGREGATE $2,000,000 PRODUCTS- COMP/OP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO AU OS SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS EM$a BODILY INJURY (Per person) $ BOD LY INJURY Per accltlent $ ( ) PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB EXCESS LIAB H OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFIC ERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E, L. EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE $ EL. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additions Remarks Schedule, may be attached if more space is required) Certificate holder is included as an Additional Insured under Commercial General Liability policy per endorsements CG 20 10 10 01 & CG 20 37 1001, Re: Project No: 14-7540- EI Salvador Park Improvements CERTIFICATE HOLDER CANCELLATION © 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza PO Box 1988 M-22 Santa Ana CA 92702 AUTHOOZED REPRESENTATIVE © 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART of Person or Blanket as required by virtue of written contract. Operations: remium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included In the "products -completed operatlons hazard". CG 20 37 10 01 Sample COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR MileMtMEel J, This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Blanket as required by written contract on a primary & non-contributory basis (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed. or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 Sample A� ®� CERTIFICATE OF LIABILITY INSURANCE ATE 7/13/2015 v) 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(los) 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 CNAME:ONTACT Justine Bustillos Southern California Insurance Brokerage IPHONE ,(909)592-2215 rax -Mol.(909)305-0391 10670 Civic Center Drive #210 EMAIL ADDRESS:0uatine@socalinsurance.com License #0177159 INSURERS AFFORDING COVERAGE NAIC# INSURERA:State Compensation Ins. Fund 35076 Rancho Cucamonga CA 91730 INSURED INSURER B PRODUCTS - COMP/OP AGS $ INSURERC: DD Systems, Inc., DBA: ACE CD, inc. INSURER D: 1199 Englewild Dr. INSURER E INSURER F: BODILY INJURY (Per person) $ Glendora CA 91741 COVERAGES CERTIFICATE NUMBER:15/16 WC RENEWAL 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 OF ADDLSUBR POLICY NUMBER POLICY EFF MMIDDNWY) POLICY EXP (MMIDDIYYYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITYDAMAGE CLAIMS -MADE ❑ OCCUR ROSE ANNEX (M-22) SANTA ANA, CA 92701 Diana Kubo, CISR/CMR EACH OCCURRENCE $ Toft TED PREMISES E.occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JPCT 71 LOC PRODUCTS - COMP/OP AGS $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea..,dent BODILY INJURY (Per person) $ BODILY INJURY (Per accldenry $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAROCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS be. NIA 9098335-15 3/1/2015 3/1/2016 WC STATU- OTH- X V E.L. EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 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 required) RE: ALL CA. OPERATIONS CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INR025 (vnlnme m ©1988.2010 ACORD CORPORATION. All rights reserved. Th. ArVn!Pn ......A Innn ar. r.ni.t.rcrl mar4. of Af r)Pn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SANTA ANA 20 CIVIC CENTER PLAZA - AUTHORIZED REPRESENTATIVE ROSE ANNEX (M-22) SANTA ANA, CA 92701 Diana Kubo, CISR/CMR ACORD 25 (2010/05) INR025 (vnlnme m ©1988.2010 ACORD CORPORATION. All rights reserved. Th. ArVn!Pn ......A Innn ar. r.ni.t.rcrl mar4. of Af r)Pn